The text focuses on the status of sciences, starting from the psychiatric discipline, related to the crisis that from the 60s to today has threatened his epistemological presuppositions. Not otherwise, the other sciences, on the the wave of progress and technological development, end up reaching increasingly important results, paying the price of losing the condition and the aim of research and knowledge.

Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs’ perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants’ moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and (...) explored participants’ perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses. (shrink)

Campbell, Ulrich, and Grady (2016) should be commended for attempting to contribute to the discussion of what many believe is currently a messy concept. They propose that a broader definition of mo...

The target article by Grady and colleagues (2008) is a valuable and exciting contribution to the debate about the importance of ethics education for nurses. The findings indicated that ethics educa...

Volume 24, Issue 12, December 2024, Page 51-53.

In their article “Moral Stress and Moral Distress: Confronting Challenges to Healthcare Systems Under Pressure” Buchbinder et al. (2024) provide a thoughtful conceptual distinction between moral di...

A recent Carnegie Report on Nursing Education – Educating Nurses: A Call for Radical Transformation challenges the nursing profession to embrace an education model that integrates knowledge, skilled know how and ethical comportment. Placing ethics in such a prominent position in nursing education is a radical transformation. Teaching ethics must be intentional and it is integral to the development of individual nurses and the profession as a whole. The development of moral imagination has a prominent place in this new education (...) model. The moral imagination is the ability to ponder and wonder about the inherent rightness or wrongness of decisions, choices and behaviors. This paper will review some key issues relevant to teaching ethics and then explore what nurturing the moral imagination could do for nurses as they learn to apply abstract ethics concepts to their clinical practice. (shrink)

The article “Moral distress: What are we measuring?” by Kolbe and de Melo-Martin (2023) is an important contribution both to the literature and research agenda for the complicated construct of mora...

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society (...) for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

The primary objective was to review pediatric ethics consultations at a large academic health center over a nine year period, assessing demographics, ethical issues, and consultant intervention. The secondary objective was to describe the evolution of PECs at our institution. This was a retrospective review of Consultation Summary Sheets compiled for PECs at our Academic Health Center between January 2008 and April 2017. There were 165 PECs reviewed during the study period. Most consult requests came from the inpatient setting, with (...) the Pediatric and Neonatal Intensive Care Units being the highest utilizers. Consultation utilization increased over the study period. The most common patient age was less than one year. Physicians were most likely to request consultation. Patient Best Interest, Withholding/Withdrawing of Life Sustaining Therapy, and Provider Moral Distress were ethical issues most commonly identified by the consultants. Making recommendations was the most common consultant intervention. The ethics consultation process evolved over time from informal provider discussions, to a hospital infant care review committee, to a pediatric only consultation service, to a combined adult/pediatric consultation service, with variable levels of salary support for consultants. Ethics consultation requests are growing at our institution. Similarities in identified ethical issues exist between our findings and existing literature, however meaningful comparisons remains elusive secondary to variability in approaches to investigation and reporting. A combined paid/volunteer/trainee ethics consultation service model appears sustainable and real time ethics consultation is feasible using this approach. (shrink)

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective (...) ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (shrink)

Conscientious objections (CO) can be disruptive in a variety of ways and may disadvantage patients and colleagues who must step-in to assume care. Nevertheless, nurses have a right and responsibility to object to participation in interventions that would seriously harm their sense of integrity. This is an ethical problem of balancing risks and responsibilities related to patient care. Here we explore the problem and propose a nonlinear framework for exploring the authenticity of a claim of CO from the perspective of (...) the nurse and of those who must evaluate such claims. We synthesized the framework using Rest’s Four Component Model of moral reasoning along with tenets of the International Council of Nursing’s (ICN) Code of Ethics for Nurses and insights from relevant ethics and nursing ethics literature. The resulting framework facilitates evaluating potential consequences of a given CO for all involved. We propose that the framework can also serve as an aid for nurse educators as they prepare students for practice. Gaining clarity about the sense in which the concept of conscience provides a defensible foundation for objecting to legally, or otherwise ethically, permissible actions, in any given case is critical to arriving at an ethical and reasonable plan of action. (shrink)

In this paper we propose to trace the historical and epistemological causes of the social construction of the image of nursing in pandemics by COVID-19, where the heroic and vocational attributes of its praxis hide the scientific and technological ones. To do so, we will begin by showing how "empirical" knowledge was historically contrasted with biomedical theoretical knowledge, medical technological praxis with the "art of caring", under a hierarchization of the professions on traditional gender roles. We will then demonstrate the (...) ways in which the romanticized image of nursing manifested itself so far during the pandemic, not only consolidating the status quo of the profession but also deepening it, by emphasizing a heroic attitude of those "on the front line of battle" as opposed to the physicians who made the decisions. Finally, we will analyze epistemologically what nursing theorists understand by "nursing praxis" in order to elucidate what is and is not visible in the constituted image of the profession. (shrink)

The idea of a role in nursing that includes expertise in ethics has been around for more than 30 years. Whether or not one subscribes to the idea that nursing ethics is separate and distinct from bioethics, nursing practice has much to contribute to the ethical practice of healthcare, and with the strong grounding in ethics and aspiration for social justice considerations in nursing, there is no wonder that the specific role of the nurse ethicist has emerged. Nurse ethicists, expert (...) in nursing practice and the application of ethical theories and concepts, are well positioned to guide nurses through complex ethical challenges. However, there is limited discussion within the field regarding the specific job responsibilities that the nurse ethicist ought to have. The recent appearance of job postings with the title “nurse ethicist” suggest that some healthcare institutions have identified the value of a nurse in the practice of ethics and are actively recruiting. Discomfort about the possibility of others defining the role of the nurse ethicist inspired this paper (and special issue). If the nurse ethicist is to be seen as an integral part of addressing ethical dilemmas and ethical conflicts that arise in healthcare, then nurse ethicists ought to be at the forefront of defining this role. In this paper, we draw upon our own experiences as nurse ethicists in large academic healthcare systems to describe the essential elements that ought to be addressed in a job description for a nurse ethicist practicing in a clinical setting linked to academic programs. Drawing upon our experience and the literature, we describe how we perceive the nurse ethicist adds value to healthcare organizations and teams of professional ethicists. (shrink)

AimsThis study evaluates a protocol for early, routine ethics consultation for patients on extracorporeal membrane oxygenation to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019. Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of (...) treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages. (shrink)

IntroductionIn this study we compared the effects of a mindfulness-based intervention with a story reading intervention on the executive functions and psychological profile of children in two different public schools in São Paulo, Brazil.MethodsIn this controlled clinical trial, 207 children aged 8 to 9 years old responded to the Five-Digit Test, stress levels, depression, anxiety, positive and negative affect, at baseline and 8 weeks later. From T0 to T1, school 1 participated in MBI classes and school 2 in IS classes.ResultsIn (...) school 1, children improved their scores on all tests except reading and counting compared with school 2. No differences were observed between groups in terms of emotional health.ConclusionIt is feasible to implement MBI or SI in Brazilian public schools. Students in the MBI group presented broader effects in executive functions, while students in the SI group showed a trend toward reduced negative affect and depression symptoms. (shrink)

euroscience of Rule-Guided Behavior brings together, for the first time, the experiments and theories that have created the new science of rules. Rules are central to human behavior, but until now the field of neuroscience lacked a synthetic approach to understanding them. How are rules learned, retrieved from memory, maintained in consciousness and implemented? How are they used to solve problems and select among actions and activities? How are the various levels of rules represented in the brain, ranging from simple (...) conditional ones if a traffic light turns red, then stop to rules and strategies of such sophistication that they defy description? And how do brain regions interact to produce rule-guided behavior? These are among the most fundamental questions facing neuroscience, but until recently there was relatively little progress in answering them. It was difficult to probe brain mechanisms in humans, and expert opinion held that animals lacked the capacity for such high-level behavior. However, rapid progress in neuroimaging technology has allowed investigators to explore brain mechanisms in humans, while increasingly sophisticated behavioral methods have revealed that animals can and do use high-level rules to control their behavior. The resulting explosion of information has led to a new science of rules, but it has also produced a plethora of overlapping ideas and terminology and a field sorely in need of synthesis. In this book, Silvia Bunge and Jonathan Wallis bring together the worlds leading cognitive and systems neuroscientists to explain the most recent research on rule-guided behavior. Their work covers a wide range of disciplines and methods, including neuropsychology, functional magnetic resonance imaging, neurophysiology, electroencephalography, neuropharmacology, near-infrared spectroscopy, and transcranial magnetic stimulation. This unprecedented synthesis is a must-read for anyone interested in how complex behavior is controlled and organized by the brain. (shrink)

Given a space in an elementary submodel M of H, define XM to be X∩M with the topology generated by . It is established, using anti-large-cardinals assumptions, that if XM is compact and its regular open algebra is isomorphic to that of a continuous image of some power of the two-point discrete space, then X=XM. Assuming in addition, the result holds for any compact XM satisfying the countable chain condition.

Si c’est avec le bouddhisme que l’Inde entre véritablement dans l’histoire, tant dans l’histoire de la philosophie que dans celle des événements et lieux mémorables, pour la première fois gravée sur la pierre et le rocher – une donnée à la fois remarquable et problématique –, la perception d’une Inde compacte et quelque peu isolée dans l’ensemble du monde a longtemps encouragé une vision incomplète de la civilisation indienne et de son passé. On constate que les grands changements s’accompagn...

Parmi les 'but de l'homme' (puruṣārtha) qui orientent la vie humaine dans le monde indien, le dharma occupe une position très élevée, au-dessus de 'l'intérêt' (artha) et du 'désir' (kāma), respectivement la sphère du pouvoir (politique, économique, social) et celle de l'amour (y compris les passions et les plaisirs de la vie). Enfin, le dharma englobe le quatrième et ultime but de l'homme, la 'délivrance' (moksa). Le caractère normatif du dharma fixe la place de chacun dans la société, par l'exercice (...) de son devoir spécifique. Mais il ne se décline pas moins selon les dispositions individuelles de chacun, et l'action de l'homme en est la véritable mesure. Par-delà la littérature du dharma, le volume réunit des enquêtes sur cette notion 'en contexte,' de la poésie védique à la grammaire, de l'épopée au théâtre, des traditions religieuses et philosophiques--les premières Écoles bouddhiques, la Mīmāmsā, le tantrisme--à la médecine classique (Āyurveda) et jusqu'à la jurisprudence indienne moderne (du XVIIe au XIXe siècle) avec deux éclairages inédits sur le dharma des femmes. Une telle approche tend à restituer la complexité de quelques visages du dharma ainsi recomposés, non pas 'tel ou tel' aspect mais pour chaque cas le 'tout' d'un système à plusieurs facettes, à l'appui d'une histoire singulière dont les auteurs s'attachent à montrer points forts et limites, situations ambiguës, paradoxes et contradictions."--Page 4 of cover. (shrink)

A distinguishing characteristic of the biomedical model is its compartmentalized view of man. This way of seeing human beings has its origin in Greek thought; it was stated by Descartes and to this day it still considers humans as beings composed of distinct entities combined into a certain form. Because of this observation, one began to believe that the focus of a health treatment could be exclusively on the affected area of the body, without the need to pay attention to (...) patient’s subjectivity. By seeing pain as a merely sensory response, this model was not capable of encompassing chronic pain, since the latter is a complex process that can occur independently of tissue damage. As of the second half of the twentieth century, when it became impossible to deny the relationship between psyche and soma, the current understanding of chronic pain emerges: that of chronic pain as an individual experience, the result of a sum of physical, psychological, and social factors that, for this reason, cannot be approached separately from the individual who expresses pain. This understanding has allowed a significant improvement in perspective, emphasizing the characteristic of pain as an individual experience. However, the understanding of chronic pain as a sum of factors corresponds to the current way of seeing the process of falling ill, for its conception holds a Cartesian duality and the positivist premise of a single reality. For phenomenology, on the other hand, the individual in his/her unity is more than a simple sum of parts. Phenomenology sees a human being as an intending entity, in which body, mind, and the world are intertwined and constitute each other mutually, thus establishing the human being’s integral functioning. Therefore, a real understanding of the chronic pain process would only be possible from a phenomenological point of view at the experience lived by the individual who expresses and communicates pain. (shrink)

In The Oxford Handbook of Philosophy in Music Education, editors Wayne D. Bowman and Ana Lucia Frega have drawn together a variety of philosophical perspectives from the profession's most exciting scholars from all over the world. Rather than relegating philosophical inquiry to moot questions and abstract situations, the contributors to this volume address everyday concerns faced by music educators everywhere. Emphasizing clarity, fairness, rigour, and utility above all, The Oxford Handbook of Philosophy in Music Education will challenge music educators (...) all over the world to make their own decisions and ultimately contribute to the conversation themselves. (shrink)

There is empirical evidence suggesting a positive link between direct experiences in nature and people’s environmental attitudes (EA) and behaviors (EB). This has led researchers to encourage more frequent contact with nature, especially during childhood, as a way of increasing pro-environmentalism (i.e., pro-EA and pro-EB). However, the association between experiences in nature and EA/EB is complex, and specific guidelines for people’s everyday contact with nature cannot be provided. This article offers an overview of the research conducted until know about the (...) relation between experiences in nature and pro-environmentalism, and opens up new inquiries for future research. We begin with an introduction to people’s current tendency toward an alienation from the natural world and set out the objectives of the article. It is followed by three main sections. The first one reports on what experiences in nature refer to, how and where they occur. The second section describes the different approaches used to investigate and interpret the experiences in nature-EA and EB relation. The last section provides suggestions for future research. We close by making some final remarks about the importance of (re)stablishing a greater interaction with nature for people’s pro-EA and EB. (shrink)

The structure as well as the themes of theSymposiumsuggest that Eryximachus’ speech plays a fundamental role in the dialogue. The problem is that what he says in praise of love is far from clear and continues to be a subject of debate. The aim of our article is to re-examine this speech to clarify its meaning and determine its contribution to Plato’s theory of love. First, we will analyse thetextof theSymposium, then we will investigate itsmedicalback-ground, and finally we will evaluate (...) itsphilosophicalimpact. We will argue that Eryximachus’ speech, which draws inspiration from the Hippocratic Collection and the Pre-Socratic thought, is based on the concept of ‘harmony’: a balanced and organised unity of opposites. According to Eryximachus, love – conceived of as harmony – is the key to thehealthand thevirtueof human beings, as well as to the cosmic order and justice. Thereby the specificity of Eryximachus’ speech will become clear: Plato tries to combinescienceandmoralityby proposing, among other things, some considerations onbioethics. (shrink)

This paper aims to explore the cartographical method as a political option able to destroy the linguistic and semiotic empire of sense. Starting from the difference between map and tracing, Deleuze and Guattari understood the power of a rhizomatic expression, commonly represented by the obsessive and compulsive gesture of autistics, or their impossibility of speaking correctly. This phenomenon has been deeply analysed by Fernand Deligny through his experience in the Cévennes, where he inaugurated his personal anti-psychoanalytic and anti-linguistic method. During (...) this collective living, the wanderings of the autistic children, called Lignes d’erre, were traced and gathered in a cartography in which action overtakes word and speech, and human gestures are reterritorialized. Characterized by movement without finality, life in Cévennes becomes a “life raft”, where the raft is no more the shipwreck of humanity, but the shelter for no- speakers. Therefore, a new spatial configuration is given, where the bonds between people and with objects exist exactly as the pieces of wood in the raft: namely slacken, rhizomatic. (shrink)

Un certain nombre de sources arabes font état d'une polémique entre Alexandre et Galien. Une tendance marquée de la recherche a été de lire nos sources grecques, relativement peu nombreuses, à la lumière de cette tradition. L'objectif de cet article est de contester le bien-fondé d'une telle orientation, et de dégager en même temps le statut spécifique de ce genre de récit biographique.

This study examined linguistic patterns in mothers’ reports about their toddlers’ involvement in everyday household work, as a way to understand the parental ethnotheories that may guide children’s prosocial helping and development. Mothers from two cultural groups – US Mexican-heritage families with backgrounds in indigenous American communities and middle-class European American families – were interviewed regarding how their 2- to 3-year-old toddler gets involved in help with everyday household work. The study’s analytic focus was mothers’ responses to interview questions asking (...) about the child’s efforts to help with a variety of everyday household work tasks. Results showed that mothers responded with linguistic patterns that were indicative of ethnotheoretical assumptions regarding children’s agency and children’s prosocial intentions, with notable contrasts between the two cultural groups. Nearly all US Mexican-heritage mothers reported children’s contributions and participation using linguistic forms that centered children’s agency and prosocial initiative, which corresponds with extensive evidence suggesting the centrality of both children’s autonomy and supportive prosocial expectations in how children’s helpfulness is supported in this and similar cultural communities. By contrast, middle-class European American mothers frequently responded to questions about their child’s efforts to help with linguistic forms that “pivoted” to either the mother as the focal agent in the child’s prosocial engagement or to reframing the child’s involvement to emphasize non-help activities. Correspondence between cultural differences in the linguistic findings and existing literature on socialization of children’s prosocial helping is discussed. Also discussed is the analytic approach of the study, uncommon in developmental psychology research, and the significance of the linguistic findings for understanding parental ethnotheories in each community. (shrink)

This important new book provides a multidisciplinary overview on different discourses and practices, exploring cutting-edge questions from the burgeoning field of artistic research.

Estudos indicam que o estresse altera o sistema imune e pode influir na etiologia, progressão e severidade de doenças. A resiliência pode ser definida como a capacidade que algumas pessoas desenvolvem e as ajudam a passar por situações adversas na vida, a superá-las, e ainda a saírem fortalecidas ou..