Moral distress has been identified as an occupational hazard for clinicians caring for vulnerable populations. The aim of this systematic review was (i) to summarize the literature reporting on prevalence of, and factors related to, moral distress among nurses within acute mental health settings, and (ii) to examine the efficacy of interventions designed to address moral distress among nurses within this clinical setting. A comprehensive literature search was conducted in October 2022 utilizing Nursing & Allied Health, Embase, CINAHL, PsychInfo, and (...) PubMed databases to identify eligible studies published in English from January 2000 to October 2022. Ten studies met inclusion criteria. Four quantitative studies assessed moral distress among nurses in acute mental health settings and examined relationships between moral distress and other psychological and work-related variables. Six qualitative studies explored the phenomenon of moral distress as experienced by nurses working in acute mental health settings. The quantitative studies assessed moral distress using the Moral Distress Scale for Psychiatric Nurses (MDS-P) or the Work-Related Moral Stress Questionnaire. These studies identified relationships between moral distress and emotional exhaustion, depersonalization, cynicism, poorer job satisfaction, less sense of coherence, poorer moral climate, and less experience of moral support. Qualitative studies revealed factors associated with moral distress, including lack of action, poor conduct by colleagues, time pressures, professional, policy and legal implications, aggression, and patient safety. No interventions targeting moral distress among nurses in acute mental health settings were identified. Overall, this review identified that moral distress is prevalent among nurses working in acute mental health settings and is associated with poorer outcomes for nurses, patients, and organizations. Research is urgently needed to develop and test evidence-based interventions to address moral distress among mental health nurses and to evaluate individual and system-level intervention effects on nurses, clinical care, and patient outcomes. (shrink)

This article outlines current safe harbors in the law for healthcare practitioners who work in a disaster setting. It reviews available legal protection in crisis situations with respect to the Emergency Medical Treatment and Labor Act (EMTALA), criminal liability, and licensure.

Background: Scholarly work is needed to develop the conceptual and theoretical understanding of trust to nursing practice. The transition from hospital care to complex pediatric homecare involves nurses in myriad roles, including management and care provision. Complex pediatric homecare transforms children, families, professionals, and communities, but its exact implications are unclear. Research objectives: To conduct an ethical inquiry into the role and responsibilities of nurses in the qualitative experience of adults involved in the hospital-to-home transition of young, ventilator-dependent children. Research (...) design: We followed methods described by Franco Carnevale. We used a sociologically grounded theoretical orientation—trust—to re-interpret qualitative data for an ethical inquiry into a specific facet of that data. Participants and study context: The participants included 26 adults, including 14 nurses, involved in the hospital-to-home transition in a Canadian province. Participants represented family, hospital, home, and government. Ethical considerations: The Conjoint Health Research Ethics Board at the University of Calgary approved this study. Findings: First, the concept and practice of trust was salient to the experience of transition. For example, responsibilities’ allocation between hospital-based professionals to mothers, home-based nurses, and non-professionals necessitated reliance and vulnerability. Second, the consequences of distrust connected to recognized challenges. For example, tensions along rural–urban, medical-family, and professional–personal divide each revealed suspicion and uncertainty that led to isolation and anxiety for all involved. Third, recommendations to improve the experience and mitigate the challenges of transition can be grounded in trust promotion. For example, transition-specific education programs and codes of ethics would promote openness, recognize mutual vulnerability, and advance trust in transition. Conclusions: The challenges to transition evidenced distrust, while trust represents a powerful tool to counter these challenges and their implications. A climate of trust could bridge divides between mothers and professionals; rural and urban professionals; and professionals with differing relationships with the family. (shrink)

Faced with the liability of newness, a scarcity of resources, and concerns of survival, new firms frequently encounter difficult ethical decisions and might be pressured to make choices that run counter to the tenets of more developed ethical and moral reasoning. This study explores the impact of newness and entrepreneurial orientation on the ethical climate of firms. Data collected from 304 individuals across 37 firms indicated that firm newness was more strongly related to ethical climate than was an entrepreneurial orientation. (...) Results also revealed that firm newness may be usefully conceptualized in both continuous and categorical terms, with each operationalization holding a somewhat different relationship with climate. Finally, results revealed that firm size was related to several types of ethical climates. (shrink)

Typical emotions share important features with paradigmatic intentional states, and therefore might admit of distinctions made in theory of intentionality. One such distinction is between attitude and content, where we can specify the content of an intentional state separately from its attitude, and therefore the same content can be taken up by different intentional attitudes. According to some philosophers, emotions do not admit of this distinction, although there has been no sustained argument for this claim. In this article, I argue (...) that the way values figure in emotional experience qualifies the content of emotional experience such that the attitude-content distinction cannot be applied. (shrink)

The huge amounts spent on store security and crime prevention worldwide, not only costs international businesses, but also amounts to a hidden tax on those law-binding consumers who bear higher prices. Most previous research has focused on shoplifting and ignored many other ways in which consumers cheat businesses. Using a hybrid of both qualitative research and survey approaches in four countries, an index of 37 activities was developed to examine consumers’ unethical activities across UK, US, France, and Austria. The findings (...) indicate that around three quarters of consumers in all four countries can be classified as heavy offenders for these minor cheats. The paper argues that government agencies, marketers, and retailers should adopt more pro-active preventative approaches, rather than reactive loss limitation measures to combat unethical behavior. (shrink)

Can we be realists about a general category but pluralists about concepts relating to that category? I argue that paleobiological methods of delineating species are not affected by differing species concepts, and that this underwrites an argument that species concept pluralists should be species category realists. First, the criteria by which paleobiologists delineate species are ‘indifferent’ to the species category. That is, their method for identifying species applies equally to any species concept. To identify a new species, paleobiologists show that (...) interspecies processes, such as phenotypic plasticity, sexual dimorphism, or ontogenetic diversity, are a worse explanation of the variance between specimens than intraspecies processes. As opposed to operating under a single or plurality of species concepts, then, paleobiologists use abductive inferences, which would be required regardless of any particular species concept. Second, paleobiologists are frequently interested in large-scale, long-term morphological patterns in the fossil record, and resolving the fine-grained differences which result from different species concepts is irrelevant at those scales. I argue that this claim about paleobiological practice supports what I call ‘indifference realism’ about the species category. The indifference realist argues that when legitimate investigation is indifferent to a plurality of concepts, we should be realists about the category those concepts pertain to. (shrink)

In this short paper, we introduce our Special Section in Feminist Theory titled ‘Feminist human-computer interaction: Struggles for past, contemporary and futuristic feminist theories in digital innovation’. Over the last years, we worked with the authors of the articles presented herein to bring together feminist theories with their practical application in the design, development, use and exploration of digital technologies. Our section follows three aspects: an overview of past feminist histories and discourse; the development of actionable, contemporary theory; and speculative (...) futures of what a feminist human-computer interaction could be. Together with the contributing authors, we are excited to explore these areas of post-disciplinary connection at the intersection of theory, practice and activism. (shrink)

This book is a collection of essays exploring adaptive systems from many perspectives, ranging from computational applications to models of adaptation in living and social systems. The essays on computation discuss history, theory, applications, and possible threats of adaptive and evolving computations systems. The modeling chapters cover topics such as evolution in microbial populations, the evolution of cooperation, and how ideas about evolution relate to economics. The title Perspectives on Adaptation in Natural and Artificial Systems honors John Holland, whose 1975 (...) Book, Adaptation in Natural and Artificial Systems has become a classic text for many disciplines in which adaptation play a central role. The essays brought together here were originally written to honor John Holland, and span most of the different areas touched by his wide-ranging and influential research career. The authors include some of the most prominent scientists in the fields of artificial intelligence evolutionary computation, and complex adaptive systems. Taken together, these essays present a broad modern picture of current research on adaptation as it relates to computers, living systems, society, and their complex interactions. (shrink)

This study investigates the performance of psychopathic individuals on tasks believed to be sensitive to dorsolateral prefrontal and orbitofrontal cortex (OFC) functioning. Psychopathic and non-psychopathic individuals, as defined by the Hare psychopathy checklist revised (PCL-R) [Hare, The Hare psychopathy checklist revised, Toronto, Ontario: Multi-Health Systems, 1991] completed a gambling task [Cognition 50 (1994) 7] and the intradimensional/extradimensional (ID/ED) shift task [Nature 380 (1996) 69]. On the gambling task, psychopathic participants showed a global tendency to choose disadvantageously. Specifically, they showed an (...) impaired ability to show learning over the course of the task. On the ID/ED task, the performance of psychopathic individuals was not significantly different from incarcerated controls on attentional set-shifting, but significant impairments were found on response reversal. These results are interpreted with reference to an OFC and amygdala dysfunction explanation of psychopathy. (shrink)

Cells live in dynamic environments that necessitate perpetual adaptation. Since cells have limited resources to monitor external inputs, they are required to maximize the information content of perceived signals. This challenge is not unique to microscopic life: Animals use senses to perceive inputs and adequately respond. Research showed that sensory‐perception is actively shaped by learning and expectation allowing internal cognitive models to “fill in the blanks” in face of limited information. We propose that cells employ analogous strategies and use internal (...) models shaped through the long process of evolutionary adaptation. Given this perspective, we postulate that cells are prone to “misperceptions,” analogous to visual illusions, leading them to incorrectly decode patterns of inputs that lie outside of their evolutionary experience. Mapping cellular misperception can serve as a fundamental approach for dissecting regulatory networks and could be harnessed to modulate cell behavior, a potentially new avenue for therapy. (shrink)

Alexithymia is associated with emotion processing deficits, particularly for negative emotional information. However, also common are a high prevalence of somatic symptoms and the perception of somatic sensations as distressing. Although little research has yet been conducted on memory in alexithymia, we hypothesized a paradoxical effect of alexithymia on memory. Specifically, recall of negative emotional words was expected to be reduced in alexithymia, while memory for illness words was expected to be enhanced in alexithymia.Eighty-five high or low alexithymia participants viewed (...) and rated arousing illness-related , emotionally positive , negative , and neutral words . Recall was assessed 45 min later.High alexithymia participants recalled significantly fewer negative emotion words but also more illness-related words than low alexithymia participants. The results suggest that personal relevance can shape cognitive processing of stimuli, even to enhance retention of a subclass of stimuli whose retention is generally impaired in alexithymia. (shrink)

The importance of the spiritual dimension in the lives of people living in conditions of poverty and social exclusion and the often-critical role of faith-based organisations has gained increasing relevance in development research and practice. A growing line of research focuses on how to integrate the faith dimension into the evaluation of social programmes and on quantifying the effects of faith. The objective of this article is to propose a framework for integrating a spiritual dimension into the design and practice (...) of impact evaluation by using the concept of integral human development. Integral human development emerged within the Catholic social tradition, but is not specific to it. It is a perspective on human development that integrates the material and spiritual, recognises the interdependence between humans and their environment or territory and demands change at both the individual and collective levels. This framework is then applied to the design of an impact evaluation of a faith-based programme that accompanies people with drug and alcohol addictions in Argentina. The article highlights the following characteristics of an integral impact evaluation: the interaction between multiple well-being dimensions; the use of knowledge and methods of analysis from multiple disciplines; the importance of understanding the diverse pathways to improvements in well-being; the assessment of the spiritual dimension through changes in one's relationships with oneself, others and the environment; and the importance of assessing personal change within the context of social and community transformation. (shrink)

This book examines the theory and practice of argument in primary, secondary and tertiary education. Several of its chapters offer theoretical discussion of the forms and functions of argument within social, philosophical, historical and rhetorical contexts.

Following the recent condemnation of the National Health Service charging regulations by medical colleges and the UK Faculty of Public Health, we demonstrate that through enactment of this policy, the medical profession is betraying its core ethical principles. Through dissection of the policy using Beauchamp and Childress’ framework, a disrespect for autonomy becomes evident in the operationalisation of the charging regulations, just as a disregard for confidentiality was apparent in the data sharing Memorandum of Understanding. Negative consequences of the regulations (...) are documented to highlight their importance for clinical decision makers under the principles of beneficence and non-maleficence. Exploration of the principle of justice illuminates the core differentiation between the border-bound duties of the State and borderless duties of the clinician, exposing a fundamental tension. (shrink)

Van Fraassen's constructive empiricism is presently the most influential and well-developed alternative to scientific realism. In this paper I argue that a reasonable condition on the distinction between belief and agnosticism prevents van Fraassen from claiming that we can be agnostic about what a theory says about unobservable entities while simultaneously accepting that theory. The upshot is that we must find some other way to do justice both to the argument for constructive empiricism and to van Fraassen's cogent criticisms of (...) scientific realism. I suggest that a highly attractive alternative is founded upon semantic anti-realism, and that empiricists should develop this alternative. (shrink)

In a critical discussion, interlocutors can strategically maneuver by shading their expressed degree of standpoint commitment for rhetorical effect. When is such strategic shading reasonable, and when does it cross the line and risk fallacious derailment of the discussion? Analysis of President George W. Bush’s 2002–2003 prewar commentary on Iraq provides an occasion to explore this question and revisit Douglas Ehninger’s distinction between argumentation as coercive correction and argumentation as a person-risking enterprise. Points of overlap between Ehninger’s account and pragma-dialectical (...) argumentation theory suggest avenues for harmonization of rhetorical and dialectical perspectives on argumentation. Out of this conceptual convergence comes theoretical resources for understanding strategic maneuvering, by accounting for ways that discussants exploit gaps between their externalized and actual discussion attitude. As such higher-order strategic maneuvering played a major role in the 2003 Iraq prewar discourse failure, perspicacious understanding of this particular argumentative maneuver carries practical, as well as theoretical import. (shrink)

The use of doll therapy for people with dementia has been emerging in recent years. Providing a doll to someone with dementia has been associated with a number of benefits which include a reduction in episodes of distress, an increase in general well-being, improved dietary intake and higher levels of engagement with others. It could be argued that doll therapy fulfils the concepts of beneficence (facilitates the promotion of well-being) and respect for autonomy (the person with dementia can exercise their (...) right to engage with dolls if they wish). However, some may believe that doll therapy is inappropriate when applied to the concepts of dignity (people with dementia are encouraged to interact with dolls) and non-maleficence (potential distress this therapy could cause for family members). The absence of rigorous empirical evidence and legislative guidelines render this a therapy that must be approached cautiously owing to the varied subjective interpretations of Kitwood’s ‘malignant social psychology’ and bioethics. This article suggests that by applying a ‘rights-based approach’, healthcare professionals might be better empowered to resolve any ethical tensions they may have when using doll therapy for people with dementia. In this perspective, the internationally agreed upon principles of the United Nations Convention on the Rights of Persons with Disabilities provide a legal framework that considers the person with dementia as a ‘rights holder’ and places them at the centre of any ethical dilemma. In addition, those with responsibility towards caring for people with dementia have their capacity built to respect, protect and fulfil dementia patient’s rights and needs. (shrink)

Managers in ethnic businesses are confronted with ethical dilemmas when taking action based on ethnic ties; and often as a result, they increase the already vulnerable positions of these businesses and their stakeholders. Many of these dilemmas concern the capital that is generated through variations in the use of ethnic stakeholder social ties. The purpose of this paper is to suggest a stakeholder-based model of social capital formation, mediated by various forms of ethnic ties, to explore the duality of ethnicity: (...) it can aid and hinder an ethnic business. Drawing upon the social capital/economic development, stakeholder salience, ethnic businesses literatures, and on social identity theory, we develop a cyclical model of relationships among ethnic business stakeholder attributes and social capital, as mediated by three-way Simmelian bonding and bridging ties, which then, in turn, affects the ethnic stakeholder attributes. We argue that the development of bridging yet strong ties through this cyclical process is relevant for the improvement of the positions of ethnic businesses in terms of both economic success and social responsibility. Specifically, we suggest that, given the duality of ethnicity in business, managers can prioritize stakeholder relationships based upon how these stakeholder ties affect social capital. (shrink)

A key claim of classical phenomenology is that intentional experiences involve a distinctive kind of implicit intentionality, which accompanies the relevant explicit intentionality. This implicit intentionality is purportedly co-constitutive of the object-presenting phenomenology of those intentional experiences. This implicit intentionality is often framed by Husserl and other classical phenomenologists in terms of horizonal intentionality or intentional horizons. Its most interesting form is labelled the 'inner horizon'. My aim in this paper is to consider whether a case can be made for (...) thinking that affective-evaluative experiences, predominately conscious emotions, exhibit a form of implicit intentionality in terms of an inner horizon. I suggest that one plausible way of motivating this idea is by reference to the normative phenomenology of the relevant experiences, in which particular objects' values are presented as either an ideal 'ought to be' or an ideal 'ought not to be'. (shrink)

The criterion of "arguability" has tended to steer Critical Inquiry away from the kind of pluralism which defines itself as neutral, tolerant eclecticism toward a position which I would call "dialectical pluralism." This sort of pluralism is not content with mere diversity but insists on pushing divergent theories and practices toward confrontation and dialogue. Its aim is not the mere preservation or proliferation of variety but the weeding out of error, the elimination of trivial or marginal contentions, and the clarification (...) of fundamental and irreducible differences. The goal of dialectical pluralism is not liberal toleration of opposing views from a neutral ground but transformation, conversion, or, at least, the kind of communication which clarifies exactly what is at stake in any critical conflict. A good dramatization of Critical Inquiry's editorial ideal would be the dialogue of the devil and angel in Blake's Marriage of Heaven and Hell, an exchange in which each contestant enters into and criticizes the metaphysics of his contrary and which ends happily with the angel transformed into a devil. (shrink)

Because Hobbes is understood to be a proto-liberal thinker, a great deal hinges on how we understand his writings. Does he contribute to the development of a purely secular political self-understanding, as many liberals today claim? And, by extension, does that mean that liberal thought today best stands on a purely secular foundation? What, then, should we make of the extensive theological speculation throughout his Leviathan ? Here, I argue that to reconcile the seemingly purely secular claims in Leviathan with (...) the obviously religious claims found there we must move beyond reading him in terms of what I here call 'the fable of liberalism', and comprehend Leviathan as a whole in terms of Reformation era debates between Protestants and Roman Catholics about the limits and purview of reason. Understood in that way we see his claims about 'reason' in a new and important light. Rather than being an inevitable development that comes to supercede honour and glory, as the fable of liberalism suggests, 'reason' is seen to have an historically contingent character, whose parameters are established by wagers about the meaning of religious experience. (shrink)

Cases of 'convergence' could play an important role in the construction and corroboration of adaptive hypotheses. In particular, they could inform us about the evolutionary histories of novel traits. However, there is a problem of causal depth in the use of analogies. Natural Selection's affect on phenotype is constrained by phylogenetic history to a degree that we are unfounded in projecting adaptive stories from one lineage to another. I will argue for two approaches to resolve this issue. First, by constraining (...) our catchment area to closely related lineages we can control for developmental noise. Second, by integrating analogies into explanations which incorporate other streams of evidence or bootstrapping an analogous model across many instantiations, we can overcome the problem of causal depth. (shrink)

When individuals learn from what others tell them, the information is subject to transmission error that does not arise in learning from direct experience. Yet evidence shows that humans consistently prefer this apparently more unreliable source of information. We examine the effect this preference has in cases where the information concerns a judgment on others’ behaviour and is used to establish cooperation in a society. We present a spatial model confirming that cooperation can be sustained by gossip containing a high (...) degree of uncertainty. Accuracy alone does not predict the value of information in evolutionary terms; relevance, the impact of information on behavioural outcomes, must also be considered. We then show that once relevance is incorporated as a criterion, second-hand information can no longer be discounted on the basis of its poor fidelity alone. Finally we show that the relative importance of accuracy and relevance depends on factors of life history and demography. (shrink)

In 2000, US Secretary of Health and Human Services Secretary Tommy Thompson mobilized the US public health infrastructure to deal with escalating trends of excess body weight. A cornerstone of this effort was a report entitled The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. The report stimulated a great deal of public discussion by utilizing the distinctive public health terminology of an epidemic to describe the growing prevalence of obesity in the US population. We suggest (...) that the ensuing controversy was fueled in part by the report's ambiguous usage of the evocative term “epidemic.” In some passages, the report seems to use “epidemic” in a literal sense, suggesting that rising prevalence of excess body weight should be defined technically as a disease outbreak. Other passages of the report present the same key term metaphorically, leaving readers with the impression that the epidemic language is invoked primarily for rhetorical effect. Here, we explore dynamics and implications of both interpretations. This analysis sheds light on the ongoing public argument about the appropriate societal response to steadily increasing body sizes in the US population; likewise, it capitalizes on the accumulated knowledge that the field of public health has garnered from combating diverse historic epidemics. Our interdisciplinary approach deploys critical tools from the fields of rhetoric, sociology and epidemiology. In particular, we draw from metaphor theory and public address scholarship to elucidate how the Call to Action frames public deliberation on obesity. We turn to the applied public health literature to develop a reading of the report that suggests a novel approach to the problem—application of the Epidemic Investigation protocol to streamline the public health response and reframe the public argument about obesity. (shrink)

It is commonly recognized that the modern capacity for mass online communication carries various dangers: fake news, rampant conspiracy theories, trolling, and so forth. It is less commonly realized that moral problems remain when the contents of online communications are completely innocuous. This article discusses one of the noteworthy features of modern digital technology, the fact that it is possible to precisely target specific audiences, and argues that this can make mass communications such as advertising and political campaigns morally problematic. (...) What is more, this holds even if the communicator is using only rational persuasion. In being selective about who sees which arguments, one becomes liable to mislead the audience despite sticking to honest, evidence-based, rational argumentation. (shrink)