Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research Design In this qualitative (...) study, we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. Participants and Research Context A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. Ethical Considerations This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. Results The main causes of moral distress related to goals of care, communication, teamwork, respect for patient’s preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Conclusions Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions. (shrink)

Intensive Science and Virtual Philosophy cuts to the heart of the philosophy of Gilles Deleuze and of today's science wars.At the start of the 21st Century, ...

This encyclopedia entry describes intensions and extensions as aspects of the meanings of pieces of language.

In this article, we report findings from a qualitative study that explored how the relatives of intensive care unit patients experienced the nurses’ role and relationship with them in the end-of-life decision-making processes. In all, 27 relatives of 21 deceased patients were interviewed about their experiences in this challenging ethical issue. The findings reveal that despite bedside experiences of care, compassion and comfort, the nurses were perceived as vague and evasive in their communication, and the relatives missed a long-term (...) perspective in the dialogue. Few experienced that nurses participated in meetings with doctors and relatives. The ethical consequences imply increased loneliness and uncertainty, and the experience that the relatives themselves have the responsibility of obtaining information and understanding their role in the decision-making process. The relatives therefore felt that the nurses could have been more involved in the process. (shrink)

I think recent discussions of content and reference have not paid enough attention to the role of language as a convention-governed system of communication. With this as a background theme, I explain the role of A-intensions in elucidating one important notion of content and correlative notions of reference.

Suffering repeated experiences of moral distress in intensive care units due to applications of futility reflects on nurses’ patient care negatively, increases their burnout, and reduces their job satisfaction. This study was carried out to investigate the levels of job satisfaction and exhaustion suffered by intensive care nurses and the relationship between them through the futility dimension of the issue. The study included 138 intensive care nurses. The data were obtained with the futility questionnaire developed by the (...) researchers, Maslach Burnout Inventory and Minnesota Satisfaction Questionnaire. It was determined that nurses who agreed to the proposition that the application of futility demoralizes health-care professionals had low levels of job satisfaction but high levels of depersonalization. It was determined that nurses had moderate levels of job satisfaction, emotional exhaustion, and personal achievements but high levels of sensitivity. Nurses’ job satisfaction and sensitivities are positively affected when they consider that futility does not contradict the purposes of medicine. (shrink)

Researchers have identified the phenomena of moral distress through many studies in Western countries. This research reports the first study of moral distress in Iran. Because of the differences in cultural values and nursing education, nurses working in intensive care units may experience moral distress differently than reported in previous studies. This research used a qualitative method involving semistructured and in-depth interviews of a purposive sample of 31 (28 clinical nurses and 3 nurse educators) individuals to identify the types (...) of moral distress among clinical nurses and nurse educators working in 12 cities in Iran. A content analysis of the data produced four themes to describe the nurses’ moral distress. The four themes were as follows: (a) institutional barriers and constraints; (b) communication problems; (c) futile actions, malpractice, and medical/care errors; (d) inappropriate responsibilities, resources, and competencies. The results demonstrate that moral distress for intensive care unit nurses is different and that the nursing leaders must reduce moral distress among nursing in intensive care. (shrink)

Previous work suggests that moral intensity and the perceived importance of an ethical issue can influence individual ethical decision making. However, prior research has not explored how the various dimensions of moral intensity might differentially affect PIE, or how moral intensity might function together with (or in the presence of) PIE to influence ethical decision making. In addition, prior work has also not adequately investigated how the operational context of an organization, which may embody conditions or practices that create barriers (...) to ethical decision making, may differ from other functional areas of an organization. Consequently, this study investigated the relationships among moral intensity, perceived ethical issue importance, and three stages of the ethical reasoning process: recognition of an ethical issue, ethical judgment, and ethical intention. Using an internet-based, self-report survey containing two operations management scenarios and various ethics measures, information was collected from business professionals working for a Midwestern financial services organization. The hierarchical regression results indicated that some dimensions of moral intensity were positively related to PIE, ethical issue recognition, and ethical judgment, and that PIE was associated with increased ethical issue recognition and ethical judgment. The steps of ethical reasoning were also positively interrelated. (shrink)

By 2050, global livestock production is expected to double—growing faster than any other agricultural sub-sector—with most of this increase taking place in the developing world. As the United Nation’s four-hundred-page report, Livestock’s Long Shadow: Environmental Issues and Options , documents, livestock production is now one of three most significant contributors to environmental problems, leading to increased greenhouse gas emissions, land degradation, water pollution, and increased health problems. The paper draws on the UN report as well as a flurry of other (...) recently published studies in order to demonstrate the effect of intensive livestock production on global warming and on people’s health. The paper’s goal is to outline the problems caused by intensive livestock farming and analyze a number of possible solutions, including legislative changes and stricter regulations, community mobilizing, and consumers choosing to decrease their demand for animal products. (shrink)

Deleuze's interpretation of Spinozan philosophy is intrinsically related to the concept of intensity. Attributes are defined as intensive qualities, modal essences as intensive quantities or degrees of power; the life of affects corresponds to continuous variations in intensity. This essay will show why Deleuze needs the concept of intensity for his reading of Spinozan philosophy as a philosophy of expressive immanence. It will also discuss the problems that spring from this reading: in what way, if any, are modal (...) essences modified by the intensive variations of affects? How can the Spinozan conception of eternal modal essences be reconciled with the idea of affections of essence? What is the ethical import of the life of existing modes, when modal essences are considered as eternal? While these questions, in particular the last two, confront each commentator on Spinoza and demand a solution in one way or another, the essay will conclude with a question which is posed from an exclusively Deleuzian perspective: why is the concept of the virtual, which takes centre stage in Deleuze's own philosophy of immanence, missing in his account of Spinoza? (shrink)

Background Patient dignity is sometimes neglected in intensive care unit (ICU) settings, which may potentially cause psychological harm to critically ill patients. However, no instrument has been specifically developed to evaluate the behaviors of dignified care among critical care nurses. Aim This study aimed to develop and evaluate ICU Dignified Care Questionnaire (IDCQ) for measurement of self-assessed dignity-conserving behaviors of critical care nurses during care. Methods The instrument was developed in 3 phases. Phase 1: item generation; phase 2: a (...) two-round Delphi survey and a readability pilot study; phase 3: cross-sectional survey with model estimation. The questionnaire was evaluated by item analysis, exploratory and confirmatory factor analysis, assessment of internal consistency reliability, and test-retest reliability. The investigation was conducted using a convenience sample of 392 critical care nurses from 6 cities in Zhejiang Province, China, of which 30 participated in the test-retest reliability survey 2 weeks later. Ethical considerations The study was approved by ethics committee. All participants provided written informed consent before the survey. The questionnaire survey was anonymous. Results The results showed acceptable reliability and validity of the IDCQ. The 17-item final version questionnaire was divided into 2 dimensions: absolute dignity and relative dignity. These two factors accounted for 62.804% of the total variance, and model fitting results were acceptable. The Cronbach’s alpha coefficient of the questionnaire was 0.94, and the test-retest intraclass correlation coefficient (ICC) was 0.88 after 2 weeks. Conclusions This study developed a brief and reliable instrument (IDCQ) to assess dignified care in ICU nursing. It can help critical care nurses identify their behaviors in maintaining patient dignity and discover their deficiencies. It may also serve as a clinical nursing management tool to help reduce patient disrespect experience in ICU. (shrink)

This paper argues that the difference between contemporary software intensive scientific practice and more traditional non-software intensive varieties results from the characteristically high conditionality of software. We explain why the path complexity of programs with high conditionality imposes limits on standard error correction techniques and why this matters. While it is possible, in general, to characterize the error distribution in inquiry that does not involve high conditionality, we cannot characterize the error distribution in inquiry that depends on software. (...) Software intensive science presents distinctive error and uncertainty modalities that pose new challenges for the epistemology of science. (shrink)

Significant scientific and technological advances in intensive care have been made. However, patients in the intensive care unit may experience discomfort, loss of control, and surreal experiences. This has generated relevant debates about how to humanize the intensive care units and whether humanization is necessary at all. This paper aimed to explore how humanizing intensive care is described in the literature. A scoping review was performed. Studies published between 01.01.1999 and 02.03.2020 were identified in the CINAHL, (...) Embase, PubMed, and Scopus databases. After removing 185 duplicates, 363 papers were screened by title and abstract. Full-text screening of 116 papers led to the inclusion of 68 papers in the review based on the inclusion criteria; these papers mentioned humanizing or dehumanizing intensive care in the title or abstract. Humanizing care was defined as holistic care, as a general attitude of professionals toward patients and relatives and an organizational ideal encompassing all subjects of the healthcare system. Technology was considered an integral component of intensive care that must be balanced with caring for the patient as a whole and autonomous person. This holistic view of patients and relatives could ameliorate the negative effects of technology. There were geographical differences and the large number of studies from Spain and Brazil reflect the growing interest in humanizing intensive care in these particular countries. In conclusion, a more holistic approach with a greater emphasis on the individual patient, relatives, and social context is the foundation for humanizing intensive care, as reflected in the attitudes of nurses and other healthcare professionals. Demands for mastering technology may dominate nurses’ attention toward patients and relatives; therefore, humanized intensive care requires a holistic attitude from health professionals and organizations toward patients and relatives. Healthcare organizations, society, and regulatory frameworks demanding humanized intensive care may enforce humanized intensive care. (shrink)

Faster R-CNN architecture is used to solve the problems of moving path uncertainty, changeable coverage, and high complexity in cold-air induced large-scale intensive temperature-reduction detection and classification, since those problems usually lead to path identification biases as well as low accuracy and generalization ability of recognition algorithm. In this paper, an improved recognition method of national ITR path in China based on faster R-CNN in complicated meteorological systems is proposed. Firstly, quality control of the original dataset of strong cooling (...) processes is carried out by means of data filtering. Then, according to the NITR standard and the characteristics of NITR, the NITR dataset in China is established by the intensive temperature-reduction areas located through spatial transformation. Meanwhile, considering that the selection of regularization parameters of Softmax classification method will cause the problem of probability calculation, support vector machine is used for path classification to enhance the confidence of classification. Finally, the improved faster R-CNN model is used to identify, classify, and locate the path of NITR events. The experimental results show that, compared to other models, the improved faster R-CNN algorithm greatly improves the performance of NITR’s path recognition, especially for the mixed NITR paths and single NITR paths. Therefore, the improved faster R-CNN model has fast calculation speed, high recognition accuracy, good robustness, and generalization ability of NITR path recognition. (shrink)

Decades of research conducted in Western, Educated, Industrialized, Rich, & Democratic (WEIRD) societies have led many scholars to conclude that the use of mental states in moral judgment is a human cognitive universal, perhaps an adaptive strategy for selecting optimal social partners from a large pool of candidates. However, recent work from a more diverse array of societies suggests there may be important variation in how much people rely on mental states, with people in some societies judging accidental harms just (...) as harshly as intentional ones. To explain this variation, we develop and test a novel cultural evolutionary theory proposing that the intensity of kin-based institutions will favor less attention to mental states when judging moral violations. First, to better illuminate the historical distribution of the use of intentions in moral judgment, we code and analyze anthropological observations from the Human Area Relations Files. This analysis shows that notions of strict liability—wherein the role for mental states is reduced—were common across diverse societies around the globe. Then, by expanding an existing vignette-based experimental dataset containing observations from 321 people in a diverse sample of 10 societies, we show that the intensity of a society's kin-based institutions can explain a substantial portion of the population-level variation in people's reliance on intentions in three different kinds of moral judgments. Together, these lines of evidence suggest that people's use of mental states has coevolved culturally to fit their local kin-based institutions. We suggest that although reliance on mental states has likely been a feature of moral judgment in human communities over historical and evolutionary time, the relational fluidity and weak kin ties of today's WEIRD societies position these populations' psychology at the extreme end of the global and historical spectrum. (shrink)

Intensive care units are not always able to admit all patients who would benefit from intensive care. Pressure on ICU beds is likely to be particularly high during times of epidemics such as might arise in the case of swine influenza. In making choices as to which patients to admit, the key US guidelines state that significant priority should be given to the interests of patients who are already in the ICU over the interests of patients who would (...) benefit from intensive care but who have not been admitted. We examine four reasons that in principle might justify such a prioritization rule and conclude that none is convincing. We argue that the current location of patients should not, in principle, affect their priority for intensive care. We show, however, that under some but not all circumstances, maximizing lives saved by intensive care might require continuing to treat in the ICU a patient already admitted rather than transferring that patient out of the unit in order to admit a sicker patient who would also benefit more from intensive care. We conclude that further modelling is required in order to clarify what practical policies would maximize lives saved by intensive care. (shrink)

This study investigated the differences in morphometry and functional plasticity characteristics of the brain after long-term training of different intensities. Results showed that an aerobic group demonstrated higher gray matter volume in the cerebellum and temporal lobe, while an anaerobic group demonstrated higher gray matter volume in the region of basal ganglia. In addition, the aerobic group also showed significantly higher fractional amplitude of low-frequency fluctuation and degree centrality in the motor area of the frontal lobe and parietal lobe, and (...) the frontal gyrus, respectively. At the same time, the anaerobic group demonstrated higher fALFF and DC in the cerebellum posterior lobe. These findings may further prove that different brain activation modes respond to different intensities of physical activity and may help to reveal the neural mechanisms that can classify athletes from different intensity sports. (shrink)

Caring for a child in a pediatric intensive care unit is emotionally and physically challenging and often leads to conflict. Skilled mediators may not always be available to aid in conflict resolution. Careproviders at all levels of training are responsible for managing difficult conversations with families and can often prevent escalation of conflict. Bioethics mediators have acknowledged the important contribution of mediation training in improving clinicians’ skills in conflict management. Familiarizing careproviders with basic mediation techniques is an important step (...) towards preventing escalation of conflict. While training in effective communication is crucial, a sense of fairness and justice that may only come with the introduction of a skilled, neutral third party is equally important. For intense conflict, we advocate for early recognition, comfort, and preparedness through training of clinicians in de-escalation and optimal communication, along with the use of more formally trained third-party mediators, as required. (shrink)

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is (...) essential. We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)

An experimental survey was undertakento explore the links between thecharacteristics of a moral issue, the degree ofmoral intensity/moral imperative associatedwith the issue, and people'sstated willingness to pay for policy toaddress the issue. Two farm animal welfareissues were chosen for comparison and thecontingent valuation method was used to elicitpeople's wtp. The findings of the surveysuggest that increases in moral characteristicsdo appear to result in an increase in moralintensity and the degree of moral imperativeassociated with an issue. Moreover, there was apositive link (...) between moral intensity/moralimperative associated with an issue andpeople's stated wtp for policy to address theissue. The paper discusses the relevance of thefindings of the survey in the context of thedebate concerning the relationship betweenmoral and economic values and the use of thecontingent valuation method to estimatepeople's wtp of policy options with moraldimensions. (shrink)

Intensive motherhood (IM) has become an established social norm in many countries, especially Western ones. Centred upon the mother providing lengthy full-time, intensive care focused on the child’s needs, these social norms can be seen in the actions of mothers in diverse social locations. However, recent research has demonstrated that women’s ability to engage in IM is affected by factors like education, race, ethnicity, religion or socioeconomic status as well as by cultural and structural conditions. The goal of (...) this paper is to analyse IM in the Czech context by focusing on factors that most affect a mother’s ability to engage in IM. Biographical interviews were held with 17 mothers, and the following three areas were discussed most in their narratives: (a) use of information on childrearing, (b) attitude to paid employment and juggling family and work, and (c) the financial, mental and emotional costs of motherhood. (shrink)

The present study uses cross‐cultural samples of marketing practitioners from two European Union (EU) nations (the United Kingdom and Spain) and China to examine the relationships between moral intensity, personal moral philosophies and ethical decision making. Additionally, cross‐cultural comparisons were made regarding intentions, personal moral philosophies and moral intensity. Results indicate that both samples tend to use the perceived harm construct (e.g. magnitude of consequences, probability of effect, temporal immediacy and concentration of effect) to determine intentions in situations involving ethical (...) issues. However, social consensus tends to be situation‐specific for both groups and proximity seems not to be used at all when making decisions in situations involving ethics. As for personal moral philosophies, idealism is only used by the EU sample; however, for both samples, the use of relativism depends upon the specific situation. (shrink)

Abstract This paper reports the results obtained in an aid project designed to improve transport in the municipal area of Jocotán (Guatemala). The rural road network of an area occupied by indigenous people was analysed and a road chosen for repair using the labour-intensive method–something never done before in this area. The manpower required for the project was provided by the population that would benefit from the project; the involvement of outside contractors and businesses was avoided. All payment for (...) labour went into the pockets of the local people. The small earth movements made and the use of local materials guaranteed the project’s environmental sustainability, while the on-site training of the local community prepared its members for the continued maintenance of the road, thus investing the project with social sustainability. Content Type Journal Article Pages 1-24 DOI 10.1007/s11948-011-9290-2 Authors Rodrigo Ares, BIPREE Research Group, Universidad Politécnica de Madrid, Madrid, Spain José-María Fuentes, BIPREE Research Group, Universidad Politécnica de Madrid, Madrid, Spain Eutiquio Gallego, BIPREE Research Group, Universidad Politécnica de Madrid, Madrid, Spain Francisco Ayuga, BIPREE Research Group, Universidad Politécnica de Madrid, Madrid, Spain Ana-Isabel García, BIPREE Research Group, Universidad Politécnica de Madrid, Madrid, Spain Journal Science and Engineering Ethics Online ISSN 1471-5546 Print ISSN 1353-3452. (shrink)

Positing that education is a movement from one way of being to another more desirable one, An Intense Calling argues that ethics should be the prime focus for the field of education. The book locates ethics, education, and justice in human subjectivity and describes education as a necessary practice for ethical reflexivity, change, and becoming (ethically) different. It also situates ethics as something that exceeds subjectivity thereby engaging ethics as a material phenomenon through topics such as aesthetics and solidarity with (...) non-humans. Jesse Bazzul explores various concepts in the book including power, biopolitics, the commons, subjectivity, and materiality and draws from over twenty years of experience teaching in different countries including Canada, Ireland, the United States, China, and Ukraine. Taking a wide-ranging philosophical approach, the book entangles ethics, urgent political issues, and pressing educational contexts of the twenty-first century. In doing so, An Intense Calling maintains that ethics is the core of education because education involves finding better ways of living and being in the world. (shrink)

A full understanding of emotions and emotion characteristics can only be reached when their dynamic nature is taken into account. As such, a primary objective of the present study is to describe and account for variability in temporal profiles of experienced emotional intensity. Participants were asked to make detailed drawings of intensity profiles of recently experienced episodes of anger, sadness, joy and affection. Functional data analysis revealed three features that together accounted for 84% of the total variability: (i) steepness at (...) onset; (ii) skewness; and (iii) the number of peaks. Emotions differed with regard to the first two features, with the rise at onset being steeper for sadness and joy and affection being the most negatively skewed emotion under study. Individual differences regarding each of the three features were found, however, they did not strongly generalise across emotions. (shrink)

This study was conducted to gain opinions about euthanasia from nurses who work in intensive care units. The research was planned as a descriptive study and conducted with 186 nurses who worked in intensive care units in a university hospital, a public hospital, and a private not-for-profit hospital in Adana, Turkey, and who agreed to complete a questionnaire. Euthanasia is not legal in Turkey. One third (33.9%) of the nurses supported the legalization of euthanasia, whereas 39.8% did not. (...) In some specific circumstances, 44.1% of the nurses thought that euthanasia was being practiced in our country. The most significant finding was that these Turkish intensive care unit nurses did not overwhelmingly support the legalization of euthanasia. Those who did support it were inclined to agree with passive rather than active euthanasia (P = 0.011). (shrink)

Since the days of classical Montague Grammar, formal semantics is frequently characterised as intensional, type-logical and model-theoretic. This paper takes a closer look of some less obvious changes these three key concepts have undergone since the appearance of English as a Formal Language. While intensions used to be crucial for resolving substitution puzzles, they are now giving way to more general constructions of index-dependant denotations. Types, on the other hand, were promoted from handy taxonomic devices to driving forces in meaning (...) composition. Finally, the rôle of models was overestimated in the early days of formal semantics, but appears to have lost its importance. (shrink)

This paper investigates a limitation of the model of belief and knowledge prevailing in mainstream economics, namely the state-space model. Because of its set-theoretic nature, this model has difficulties in capturing the difference between expressions that designate the same object but have different meanings, i.e., expressions with the same extension but different intensions. This limitation generates puzzling results concerning what individuals believe or know about the world as well as what individuals believe or know about what other individuals believe or (...) know about the world. The paper connects these puzzling results to two issues that are relevant for economic theory beyond the state-space model, namely, framing effects and the distinction between the model-maker and agents that appear in the model. Finally, the paper discusses three possible solutions to the limitations of the state-space model, and concludes that the two alternatives that appear practicable also have significant drawbacks. (shrink)

The measurement of sensory intensity has had a long history, attracting the attention of investigators from many disciplines including physiology, psychology, physics, mathematics, philosophy, and even chemistry. While there has been a continuing doubt by some that sensation has the properties necessary for measurement, experiments designed to obtain estimates of sensory intensity have found that a general rule applies: Equal stimulus ratios produce equal sensory ratios. Theories concerning the basis for this simple psychophysical rule are discussed, with emphasis given to (...) the physical correlate theory, which considers judgments of subjective magnitudes to be based upon estimates of physical dimensions that vary regularly with changes in degree of stimulation. For the most thoroughly investigated sensory scales, brightness and loudness, the physical correlate is considered to be distance. Our “tacit knowledge” of the sensory effects of changing distance plays an essential role in matching motor activities to environmental conditions and in ensuring accurate perceptual evaluations through brightness and loudness constancies. In psychophysical experiments, subjects apparently use this same tacit knowledge when required to estimate relative subjective magnitudes. The evidence related to the physical correlate theory is summarized, and it is concluded that, while under appropriate conditions we demonstrate considerable skill in evaluating environmental relationships, we are quite unable to estimate the neurophysiological nature or quantity of sensory response. A psychophysics devoted to studying conditions required for accuracy and conditions producing errors in the perception of environmental relationships would seem to be more valuable than one devoted to subjective magnitudes. (shrink)

In his 'Why We Need A-Intensions', Frank Jackson argues that "representational content [is] how things are represented to be by a sentence in the communicative role it possesses in virtue of what it means," a type of content Jackson takes to be broadly descriptive. I think Jackson overstates his case. Even if we agree that such representational properties play a crucial reference-fixing role, it is much harder to argue the case for a crucial communicative role. I articulate my doubts about (...) Jackson's views on this point by contrasting them with the views of John Stuart Mill, usually regarded as an early believer in something like a direct reference account of content for names, but someone who, on my reading, teaches us a salutary lesson about the importance of separating the question of how reference is determined from the question of how we succeed in communicating. (shrink)

_the a priori role_ (for word T). For instance, perhaps anyone who understands the word _water_ is able to know, without appeal to any further a posteriori information, that _water_ refers to the clear, drinkable natural kind whose instances are predominant in our oceans and lakes (if _water_ refers at all.

Background: Maintaining patient’s dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units. Objectives: The aim of this study was to uncover the cultural factors that impeded maintaining patients’ dignity in the cardiac surgery intensive care unit. Research Design: The study was conducted using a critical ethnographic method proposed by Carspecken. Participants and research context: Participants included all physicians, nurses and staffs working in the study setting (two (...) cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace. Ethical Consideration: Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained. Findings: The findings of the study fell into the following main themes: “Presence: the guarantee for giving enough attention to patients’ self-esteem”, “Instrumental and objectified attitudes”, “Adherence to the human equality principle: value-action gap”, “Paternalistic conduct”, “Improper language”, and “Non-interactive communication”. The final assertion was “Reductionism as a major barrier to the maintaining of patient’s dignity”. Discussion: The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches. Conclusion: Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships. (shrink)

Background: Neonatal nurses report a great deal of ethical challenges in their everyday work. Seemingly trivial everyday choices nurses make are no more value-neutral than life-and-death choices. Everyday ethical challenges should also be recognized as ethical dilemmas in clinical practice. Research objective: The purpose of this study is to investigate which types of ethical challenges neonatal nurses experience in their day-to-day care for critically ill newborns. Research design: Data were collected through semi-structured qualitative in-depth interviews. Phenomenological-hermeneutic analysis was applied to (...) interpret the data. Participants and research context: Six nurses from neonatal intensive care units at two Norwegian hospitals were interviewed on-site. Ethical considerations: The study is designed to comply with Ethical Guidelines for Nursing Research in the Nordic Countries and the Helsinki declaration. Findings: Findings suggest that nurses experience a diverse range of everyday ethical challenges related to challenging interactions with parents and colleagues, emotional strain, protecting the vulnerable infant, finding the balance between sensitivity and authority, ensuring continuity of treatment, and miscommunication and professional disagreement. Discussion: A major finding in this study is how different agents involved in caring for the newborn experience their realities differently. When these realities collide, ethical challenges arise. Findings suggest that acting in the best interests of the child becomes more difficult in situations involving many agents with different perceptions of reality. Conclusion: The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care. (shrink)