Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

'Philosophy arises through misconceptions of grammar', said Wittgenstein. Few people have believed him, and probably none, therefore, working in the area of the philosophy of mathematics. Yet his assertion is most evidently the case in the philosophy of Set Theory, as this paper demonstrates (see also Rodych 2000). The motivation for twentieth century Set Theory has rested on the belief that everything in Mathematics can be defined in terms of sets [Maddy 1994: 4]. But not only are there notable items (...) which cannot be so defined, including numbers and mereological sums, the very notion of a set, as formalized within this tradition, is based on a series of grammatical confusions. (shrink)

P.M.S. Hacker, recounting some of Wittgenstein's views, says : [T]he pervasive conception of behaviour that has informed philosophical psychology for the last three centuries has misrepresented human behaviour as 'bare bodily movement', from which it is supposed we infer, by analogy or inference to best explanation, the inner state and so on from which the behaviour might be thought to arise … But we see the pain in a person's face hear the glee in his chortles, perceive the affection in (...) the looks and gestures of lovers. In this paperIexplain how this can be, before meeting several objections. (shrink)

Concepts of stability and symmetry in irreversible thermodynamics are developed through the analysis of system energy flows. The excess power function, derived from a local energy conservation equation, is shown to yield necessary and sufficient stability criteria for linear and nonlinear irreversible processes. In the absence of symmetry-destroying external forces, the linear range may be characterized by a set of phenomenological coefficient symmetries relating coupled forces and displacements, velocities, and accelerations, whereas rotational phenomena in nonlinear processes may be characterized by (...) skew-symmetric components of the phenomenological coefficients. A physical interpretation of the nature of the skew-symmetric parts is given and the variational principle of minimum dissipation of energy is related to a stability criterion. (shrink)

The scope of the thermodynamic theory of nonlinear irreversible processes is widened to include the nonlinear stability analysis of system motion. The emphasis is shifted from the analysis of instantaneous energy flows to that of the average work performed by periodic nonlinear processes. The principle of virtual work separates dissipative and conservative forces. The vanishing of the work of conservative forces determines the natural period of oscillation. Stability is then determined by the variations of the dissipative forces with amplitude of (...) oscillation. If the work is a minimum, under certain conditions, the motion is stable. Reduction to linear analysis shows the coincidence with the impedance analysis of electrical circuit theory. The theory is applied to the analysis of temporal interactions of nonlinear irreversible processes in the particular cases of synchronization and hysteresis. Characteristic nonequilibrium phenomena of directional energy transfers, self-excitation, system passivity, wave modulation, and “beat” phenomena are observed. Possible relationships with biological processes are discussed. (shrink)

In list-method directed forgetting, reexposure to forgotten List 1 items has been shown to reduce directed forgetting. proposed that reexposure to a few List 1 items only during a direct test of memory reinstates the entire List 1 episode. In the present experiments, part-list reexposure in the context of indirect as well as direct memory tests reduced directed forgetting. Directed forgetting was reduced when 50% or more of the items were reexposed, and was intact when only 25% were reexposed. Furthermore, (...) part-list reexposure appeared to reinstate only reexposed items-not the entire List 1 episode. (shrink)

Jean-Paul Sartre, in describing the realization of his freedom, was often inclined to say mysterious things like ‘I am what I am not’, ‘I am not what I am’ (‘as I am already what I will be …, I am the self which I will be, in the mode of not being it’, ‘I make myself not to be the past … which I am’.) He was therefore plainly contradicting himself, but was this merely a playful literary figure (paradox), or (...) was he really being incoherent? By the latter judgment I do not mean to reject his statements entirely (like many of his Anglo-Saxon contemporaries); for I believe there is an intimate link between contradiction and freedom, as I shall explain in this paper. But a minor thing we must first have out of the way is the suggestion that Sartre's language was just a rhetorical trope, designed merely to express some banal platitude in a bemusing way: ‘I am not yet what I will be’, ‘I am no longer what I was’ are sane and sensible, for instance, but cannot be the meant content of Sartre's sayings, since, while they would indeed describe the reform of some character, they would be appropriate only before or after some metamorphosis, not, as Sartre clearly intended, in the midst of some process of riddance and conversion, whether radical or otherwise. Yet, in the turmoil of such a change, ‘I am not what I am’ (or the everyday ‘I am not myself’) still, surely, cannot be true, and if that is the case, Sartre must be being inocherent, and therefore, obfuscating and deliberately obscure, and hence, it seems, must properly be rejected by all right and clear thinking men. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

The paper presents and applies Hilbert's Epsilon Calculus, first describing its standard proof theory, and giving it an intensional semantics. These are contrasted with the proof theory of Fregean Predicate Logic, and the traditional (extensional) choice function semantics for the calculus. The semantics provided show that epsilon terms are referring terms in Donnellan's sense, enabling the symbolisation and validation of argument forms involving E-type pronouns, both in extensional and intensional contexts. By providing for transparency in intensional constructions they support a (...) Model Conceptualism to contrast with traditional intensional logic's Modal Realism. But epsilon-terms also symbolise fictions, and through their difference from iota terms enable the solution of a number of outstanding puzzles about Direct Reference and de re beliefs. (shrink)