The abolition of the political institutions of the Belgian provinces, as provided in the government declaration of 7 June 1977, puts a question into the usefulness of the provincial institutions.This contribution intends to throw more light on the policy at the provincial level - now and in the near past - by means of a brief functional and financial analysis. Beforehand, it has to be mentioned that juridical and institutional limitations do exercise a restraining influence on the functioning of the (...) provinces.A task-analysis shows that they are mainly concerned with «traditional» tasks, but they recently take into consideration «modern» tasks in the domain of social welfare.However, the means of the Belgian provinces are very limited ; as a result, the current expenditures of the provinces do not exceed 3 % of all public current expenditures. It shows the relative small importance of the provinces in the total government structure. (shrink)

An attempt is made to confront Foucault and Bourdieu. First of all by answering the question: Why did Foucault never discuss Bourdieu, while Bourdieu increasingly discusses Foucault, more and more in the sense of a sharp rejection of some of Foucaults main positions? In a second move, the similarities and differences between their positions in the field and their intellectual life histories are outlined. In a third part, Bourdieu's critique of Foucault is presented extensively, up to some pages of Ein (...) soziologischer Selbstversuch. (shrink)

Since the French Revolution the relationship between the Catholic church and modernity has always been very troublesome. First I will describe how the church saw its own position with regard to modernity and how its stance evolved. In a second stage, I will then focus on how modernity `framed' Catholicism: this I will refer to as the modernity and modernization of Catholicism. The insights obtained will be used in a third part in order to get a better understanding of the (...) present and future situation of the church. I will round off with some conclusions concerning Catholic intellectuals and Catholic intellectual traditions from 1800 onwards. (shrink)

A survey conducted in 1985 at the party conferences of the Belgian ecology parties Agalev and Ecolo, allows to brush an empirically based picture of the militants and the internal functioning of these parties. The "new middle class" background of the militants, the stratarchic order in the cadre party, the manifest links with the socalled "new social movements" and the specific brand of a new left-libertarian ideology all point to the new and different character of these parties, in comparison tothe (...) established Belgian parties. (shrink)

Severe staffing shortages have emerged as a prominent threat to maintaining usual standards of care during the COVID-2019 pandemic. In dire settings of crisis capacity, healthcare systems assume the ethical duty to maximise aggregate population-level benefit of existing resources. To this end, existing plans for rationing mechanical ventilators and intensive care unit beds in crisis capacity focus on selecting individual patients who are most likely to survive and prioritising these patients to receive scarce resources. However, staffing capacity is conceptually different (...) from availability of these types of discrete resources, and the existing strategy of identifying and prioritising patients with the best prognosis cannot be readily adapted to fit this real-world scenario. We propose that two alternative approaches to staffing resource allocation offer a better conceptual fit: (1)prioritise the worst off: restrict access to acute care services and hospital admission for patients at relatively low clinical risk and (2)prioritise staff interventions with high near-term value: universally restrict selected interventions and treatments that require substantial staff time and/or energy but offer minimal near-term patient benefit. These strategies—while potentially resulting in care that deviates from usual standards–support the goal of maximising the aggregate benefit of scarce resources in crisis capacity settings triggered by staffing shortages. This ethical framework offers a foundation to support institutional leaders in developing operationalisable crisis capacity policies that promote fairness and support healthcare workers. (shrink)

Multinational corporations' international staffing policies have been evaluated in terms of cost and efficiency arguments. Research has not addressed, however, the ethical impact of these policies on diverse stakeholder groups. This paper presents a conceptual framework by which ethnocentric, polycentric and geocentric staffing policies are theoretically linked to underlying decision-making modes of instrumentality, bounded rationality and economic rationality, respectively. It goes on to describe the ethical rationales associated with each policy type, namely, distributive justice, moral rights of man, and utilitarianism. (...) An investigation of resulting ethical dilemmas affecting relevant MNC stakeholder groups is incorporated and offered as a tool for analyzing the true and full costs of trade-offs when choosing one policy over another. The paper concludes with a discussion of the implications of the conceptual framework for theory and practice and directions for future research. (shrink)

On January 22, 2002, California Governor Gray Davis released the state's long-anticipated, proposed regulations establishing hospital nurse-to-patient ratio requirements. The Safe Staffing Law mandating minimum ratios was enacted in October 1999 in response to legislators concerns that [q]uality of patient care is jeopardized because of staffing changes implemented in response to managed care. While the law was scheduled to take effect by January 1, 2002, conflict within the medical community regarding appropriate ratios slowed down the rulemaking process. Lawmakers now anticipate (...) that the rule will be implemented by January 2003. Approximately 5,000 new nurses will need to be hired for California's hospitals to come into compliance with the proposed regulation. (shrink)

This manuscript explores the argument for lower student-to-school counselor ratios in U.S. public education. Drawing upon a comprehensive historical review and existing research, we establish the integral role of school counselors and the notable benefits of reduced student-to-counselor ratios. Our analysis of national data exposes marked disparities across states and districts, with the most underfunded often serving higher percentages of low-income students and students of color. This situation raises significant ethical concerns, prompting a call for conscientious policy reform and targeted (...) investment. Informed by emerging best practices, we propose recommendations for enhancing counselor staffing and ultimately student outcomes. This ethical argument underscores the need for proactive actions and provides a basis for future research to further delineate the impact of school counselor ratios on educational equity and student success. (shrink)

Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified (...) four strategies associated with NPM which add to workload after‐hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care. (shrink)

In this paper, we examine the practicalities of nurse managers’ work. We expose how managers’ commitments to transformational leadership are undermined by the rationing practices and informatics of hospital reform underpinned by the ideas of new public management. Using institutional ethnography, we gathered data in a Canadian hospital. We began by interviewing and observing frontline leaders, nurse managers, and expanded our inquiry to include interviews with other nurses, staffing clerks, and administrators whose work intersected with that of nurse managers. We (...) learned how nurse managers’ responsibility for staffing is accomplished within tightening budgets and a burgeoning suite of technologies that direct decisions about whether or not there are enough nurses. Our inquiry explicates how technologies organize nurse managers to put aside their professional knowledge. We describe professionally committed nurse leaders attempting to activate transformational leadership and show how their intentions are subsumed within information systems. Seen in light of our analysis, transformational leadership is an idealized concept within which managers’ responsibilities are shaped to conform to institutional purposes. (shrink)

Healthcare is increasingly impacted by chronic short staffing of nurses, which causes and is caused by increased nurse burnout and decreased retention. Nurses’ unions seek to address these problems by proposing safer nurse-to-patient ratios, retention bonuses for working through the COVID-19 pandemic, Personal Protective Equipment (PPE) stockpiles, sabbatical leaves, measures aimed at reducing workplace violence, and maintaining or increasing wages and benefits to keep nurses at the bedside. Chronic short staffing and burnout directly affect the quality and availability of patient (...) care—as the International Council of Nurses has pointed out, there is no healthcare without healthcare workers. This article draws on Neiman’s argument that the US healthcare system is best understood as a system of competing interests aimed at fulfilling the community’s obligation to provide access to quality healthcare. Nurses’ unions use contract negotiations, legislative advocacy, and strikes to pressure other members of the healthcare community to address chronic short staffing, burnout, and retention. Nurses’ unions in the US thus play a unique role in the system of competing interest as an organized group whose primary interest aligns with the community’s obligation to provide access to quality healthcare. This article argues that nurses’ professional duty to care for patients includes a duty to support nurses’ unions as an important way to address the factors outside of nurses’ direct practice that impacts the quality and accessibility of the care that nurses provide to patients. This duty to support unions applies to unionized and non-unionized nurses in the US, and includes duties to participate in union activities, to not cross picket lines, and to avoid work for strikebreaking nurse agencies. (shrink)

To deal with the upcoming challenges and complexity of the nursing profession, it is deemed important to reflect on our current organization of care. However, before starting to rethink the organization of nursing care, an overview of important elements concerning nursing care organization, more specifically nursing models, is necessary. The aim of this study was to conduct a mapping review, accompanied by an evidence map to map the existing literature, to map the field of knowledge on a meta‐level and to (...) identify current research gaps concerning nursing models in a hospital setting. Next to nursing models, two other organizational correlates seem to be of importance when looking at the organization of nursing care: nurse staffing and skill mix. Although it seems that in recent research, the theoretical focus on the organization of nursing care has been left behind, the increasingly complex healthcare environment might gain from the use of nursing theory, or in this case, care delivery models. As almost no fundamental studies have been done toward the combination of care delivery models, nurse staffing, and skill mix, those elements should be taken into account to fully capture the organization of nursing care in future research. (shrink)

In the article the subject of the theme and purpose of the work is the conceptualization of the formation and development of a new type of society – the smart- society developing in the modern era of the information revolution. The article uses the system methodology for the analysis of complex problems of development of project-oriented business from information to smart-business and analysed category vehicle concept of the development of project-oriented business. Defined the essence of the project-oriented organization and its (...) purpose in terms of the transition from the information entity to smart organizations in terms of digital transformation. Shown is an example of the application of smart technologies-staffìng organizations, indicating difficulties finding staff to work in the smart organìzcaìâh in the conditions of the digital transformation of society in the age of the Internet. (shrink)

By means of data from the most comprehensive source of teacher data in the nation, Schools and Public School Teacher Staffing Survey (SASS), we designeda follow-up quantitative study to test the effects of two decades of national policy mandates on instructional time allotments for core academic subjects. We used data from the SASS data from National Center for Educational Statistics (NCES) (1993/1994, 1999/2000, 2003/2004, 2007/2008) to examine national trends of continued marginalization of social studies by exploring the influence of recent (...) educational policy on defining elementary curricula in the 21st Century. With the reauthorization of NCLB in 2007 and newly mandated science testing in grades 3 through 5, we sought to understand statistically how this policy change has affected instructional decisions regarding time allocated to core academic subjects (ELA, mathematics, science and social studies) in elementary schools. Findings provide evidence of the national trend of the declining role of social studies in an era in which testing is associated with importance. Moreover, grade level disparities unique to social studies intensified the effects of 2007 NCLB policy mandates of science testing for 3rd through 5th grade students. Results provide a broader and nationally generalizable understanding of the declining role of social studies in elementary schools and the reduction of time practitioners spend teaching social studies. Thus, the growing imbalance in instructional time distributions for social studies and the tipping of the time distribution scales in favor of science document teacher responses to the expansion of testing mandates and the continued absence of studies from the national testing landscape. (shrink)

As the COVID-19 pandemic impacts on health service delivery, health providers are modifying care pathways and staffing models in ways that require health professionals to be reallocated to work in critical care settings. Many of the roles that staff are being allocated to in the intensive care unit and emergency department pose additional risks to themselves, and new policies for staff reallocation are causing distress and uncertainty to the professionals concerned. In this paper, we analyse a range of ethical issues (...) associated with changes to staff allocation processes in the face of COVID-19. In line with a dominant view in the medical ethics literature, we claim, first, that no individual health professional has a specific, positive obligation to treat a patient when doing so places that professional at risk of harm, and so there is a clear ethical tension in any reallocation process in this context. Next, we argue that the changing asymmetries of health needs in hospitals means that careful consideration needs to be given to a stepwise process for deallocating staff from their usual duties. We conclude by considering how a justifiable process of reallocating professionals to high-risk clinical roles should be configured once those who are ‘fit for reallocation’ have been identified. We claim that this process needs to attend to three questions that we consider in detail: (1) how the choice to make reallocation decisions is made, (2) what justifiable models for reallocation might look like and (3) what is owed to those who are reallocated. (shrink)

Registered nurses (RNs) employed in an urban medical center in the USA identified moral distress as a practice concern. This study describes RNs' moral distress and the frequency of morally distressing events. Data were collected using the Moral Distress Scale and an open-ended questionnaire. The instruments were distributed to direct-care-providing RNs; 100 responses were returned. Morally distressing events included: working with staffing levels perceived as `unsafe', following families' wishes for patient care even though the nurse disagreed with the plan, and (...) continuing life support for patients owing to family wishes despite patients' poor prognoses. One high frequency distressing event was carrying out orders for unnecessary tests and treatments. Qualitative data analysis revealed that the nurses sought support and information from nurse managers, chaplaincy services and colleagues. The RNs requested further information on biomedical ethics, suggested ethics rounds, and requested a non-punitive environment surrounding the initiation of ethics committee consultations. (shrink)

Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers (HCWs) refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients. I argue that it is morally permissible for HCWs (...) to abstain from work when their duty to treat is outweighed by the combined risks and burdens of that work. For HCWs who live with their families, the obligation to protect one’s family from infection contributes significantly to those burdens. There are, however, a range of complicating factors including the strength of duty to treat which varies according to the HCW’s role, the vulnerability of family members to the disease, the willingness of family members to risk infection and the resources available to the HCW to protect their family. In many cases, HCWs in ‘frontline’ roles with a weak duty to treat and families at home will be morally permitted to abstain from work given the risks posed by COVID-19; therefore, society should provide additional incentives to maintain sufficient staff in these roles. (shrink)

Objectives: To characterise UK undergraduate medical ethics curricula and to identify opportunities and threats to teaching and learning.Design: Postal questionnaire survey of UK medical schools enquiring about teaching and assessment, including future perspectives.Participants: The lead for teaching and learning at each medical school was invited to complete a questionnaire.Results: Completed responses were received from 22/28 schools . Seventeen respondents deemed their aims for ethics teaching to be successful. Twenty felt ethics should be learnt throughout the course and 13 said ethics (...) teaching and learning should be fully integrated horizontally. Twenty felt variety in assessment was important and three tools was the preferred number. A shortfall in ethics core competencies did not preclude graduation in 15 schools. The most successful aspects of courses were perceived to be their integrated nature and the small group teaching; weaknesses were described as a need for still greater integration and the heavily theoretical aspects of ethics. The major concerns about how ethics would be taught in the future related to staffing and staff development.Conclusions: This study describes how ethics was taught and assessed in 2004. The findings show that, although ethics now has an accepted place in the curriculum, more can be done to ensure that the recommended content is taught and assessed optimally. (shrink)

This study aimed to: (1) develop and evaluate the Moral Distress Scale for Psychiatric nurses (MDS-P); (2) use the MDS-P to examine the moral distress experienced by Japanese psychiatric nurses; and (3) explore the correlation between moral distress and burnout. A questionnaire on the intensity and frequency of moral distress items (the MDS-P: 15 items grouped into three factors), a burnout scale (Maslach Burnout Inventory — General Survey) and demographic questions were administered to 391 Japanese psychiatric nurses in 2007—2008. These (...) nurses experienced relatively low levels of moral distress despite the fact that they were commonly confronted by morally distressing situations. All the circumstances in which the participants experienced moral distress were included in the ‘low staffing’ factor, which reflects the characteristics of Japanese psychiatric care. The frequency score of the low staffing factor was a significant predictor of burnout. (shrink)

The authors work in a variety of clinical ethics consultation services (CECSs) that employ a range of methods and approaches. This article discusses the approach to ethics consultation at the Center for Medical Ethics and Health Policy at Baylor College of Medicine and describes the development and transformation of the authors’ CECSs. It discusses how one CECS shifted from a nascent program with only fifty consultations a year to a vibrant, heavily staffed service with five hundred ethics consultations a year.

The annual volume of ethics consultations (ECs) has been a topic of interest in the bioethics literature, in part because of its presumed relationship to quality. To better understand factors associated with EC volume, we used multiple linear regression to model the number of case consultations performed in the last year based on a national survey. We found that hospital bed size, academic affiliation, and urban/rural location were all associated with EC volume, but were not the primary drivers. Instead, these (...) variables affected EC volume through three other variables, all of which relate to ethics staffing: the percentage of case consultations performed by a single individual; whether the survey respondent’s main role at the hospital contained the word “ethics”; and especially, the number of full-time ethics program staff. We conclude that EC is an example of supply-sensitive care, and further research is needed to determine the optimal level of EC activity. (shrink)

Background: There is controversy concerning the use of physical restraint. Despite this controversy, some nurses still consider the application of physical restraint unavoidable for some of their clients. Aim: Identify the perceptions and practice of physical restraint in China. Research design: This was a descriptive study that combined qualitative interviews with a quantitative cross-sectional survey. Participants: A total of 18 nurses were interviewed and 330 nurses were surveyed. Ethical considerations: Approval of the study was obtained from the hospital ethics committee. (...) Permission to conduct the study was obtained from the director of nursing. Participants were assured that their participation is voluntary. Results: Physical restraint was commonly used to protect patients’ safety. Naturally, intensive care unit nurses used physical restraint much more frequently than general medical/surgical ward nurses ( p < 0.01). In addition, night shift nurses tended to use physical restraint more frequently. Conclusion: Nursing managers should be aware of the role nurses play in the use of physical restraint. In-service training regarding the proper use of physical restraint should be strengthened and nurse staffing levels should be improved in order to minimize the use of physical restraint in China. (shrink)

Background: Acting ethically, in accordance with professional and personal moral values, lies at the heart of nursing practice. However, contextual factors, or obstacles within the work environment, can constrain nurses in their ethical practice – hence the importance of the workplace ethical climate. Interest in nurse workplace ethical climates has snowballed in recent years because the ethical climate has emerged as a key variable in the experience of nurse moral distress. Significantly, this study appears to be the first of its (...) kind carried out in New Zealand. Aim/objective: The purpose of this study was to explore and describe how registered nurses working on a medical ward in a New Zealand hospital perceive their workplace ethical climate. Research design/participants/context: This was a small, qualitative descriptive study. Seven registered nurses were interviewed in two focus group meetings. An inductive method of thematic data analysis was used for this research. Ethical considerations: Ethics approval for this study was granted by the New Zealand Ministry of Health’s Central Regional Health and Disability Ethics Committee on 14 June 2012. Findings: The themes identified in the data centred on three dominant elements that – together – shaped the prevailing ethical climate: staffing levels, patient throughput and the attitude of some managers towards nursing staff. Discussion: While findings from this study regarding staffing levels and the power dynamics between nurses and managers support those from other ethical climate studies, of note is the impact of patient throughput on local nurses’ ethical practice. This issue has not been singled out as having a detrimental influence on ethical climates elsewhere. Conclusion: Moral distress is inevitable in an ethical climate where the organisation’s main priorities are perceived by nursing staff to be budget and patient throughput, rather than patient safety and care. (shrink)

Background: Providing oncological care to children is demanding and ethical issues concerning what is best for the child can contribute to moral distress. Objectives: To explore healthcare professionals’ experiences of situations that generate moral distress in Swedish paediatric oncology. Research design: In this national study, data collection was conducted using the Swedish Moral Distress Scale-Revised. The data analysis included descriptive statistics and non-parametric analysis of differences between groups. Participants and research context: Healthcare professionals at all paediatric oncology centres in Sweden (...) were invited to participate. A total of 278 healthcare professionals participated. The response rate was 89%. Ethical considerations: In its advisory statement, the Regional Ethical Review Board decided that the study was of such a nature that the legislation concerning ethical reviews was not applicable. All participants received written information about the aim of the study and confidentiality. Participants demonstrated their consent by returning the survey. Findings: The two situations with the highest moral distress scores concerned lack of competence and continuity of personnel. All professional groups reported high levels of disturbance. Nurses rated significantly higher frequencies and higher total Moral Distress Scale scores compared to medical doctors and nursing assistants. Discussion: Lack of competence and continuity, as the two most morally distressing situations, confirms the findings of studies from other countries, where inadequate staffing was reported as being among the top five morally distressing situations. The levels of total Moral Distress Scale scores were more similar to those reported in intensive care units than in other paediatric care settings. Conclusion: The two most morally distressing situations, lack of competence and continuity, are both organisational in nature. Thus, clinical ethics support services need to be combined with organisational improvements in order to reduce moral distress, thereby maintaining job satisfaction, preventing a high turnover of staff and ensuring the quality of care. (shrink)

Background: Collaboration between physicians and nurses is key to improving patient care. We know very little about collaboration and interdisciplinary practice in African healthcare settings. Research question/aim: The purpose of this study was to explore the ethical challenges of interdisciplinary collaboration in clinical practice and education in Botswana Participants and research context: This qualitative descriptive study was conducted with 39 participants (20 physicians and 19 nurses) who participated in semi-structured interviews at public hospitals purposely selected to represent the three levels (...) of hospitals in Botswana (referral, district, and primary). Ethical considerations: Following Institutional Review Board Approval at the University of Pennsylvania and the Ministry of Health in Botswana, participants’ written informed consent was obtained. Findings: Respondents’ ages ranged from 23 to 60 years, and their duration of work experience ranged from 0.5 to 32 years. Major qualitative themes that emerged from the data centered on the nature of the work environment, values regarding nurse–doctor collaboration, the nature of such collaboration, resources available for supporting collaboration and the smooth flow of work, and participants’ views about how their work experiences could be improved. Discussion: Participants expressed concerns that their work environment compromised their ability to provide high-quality and safe care to their patients. The physician staffing structure was described as consisting of a few specialists at the top, a vacuum in the middle that should be occupied by senior doctors, and junior doctors at the bottom—and not a sufficient number of nursing staff. Conclusion: Collaboration between physicians and nurses is critical to optimizing patients’ health outcomes. This is true not only in the United States but also in developing countries, such as Botswana, where health care professionals reported that their ethical challenges arose from resource shortages, differing professional attitudes, and a stressful work environment. (shrink)

Background The high public demand for healthcare services during the COVID-19 pandemic and strict infection control measures, coupled with threat of severe illness and death, and limited resources, led to many healthcare workers (HCWs) experiencing ethically challenging situations (ECSs). Objective To systematically explore first-hand accounts of ECS-evoking moral distress among HCWs during this public health emergency. Research design This was an open cohort study. All participants were asked whether they had been in ECS-evoking moral distress during the pandemic. Those who (...) had were asked to describe these situations. Answers were systematically analyzed according to three levels of root causes for ECSs, using thematic analysis. Participants and research context In January 2022, 977 HCWs from four Norwegian university hospitals participated. Ethical considerations The study received ethical approval from the Norwegian Ethical Review Authority (No. 130944). Results In total, 508 participants (52%) reported that they had experienced ECS-evoking moral distress during the pandemic, whereof 323 provided a qualitative description. We found that while a few reported ECSs caused at the patient level, and some described situations at the unit/team level, the vast majority reported situations caused at the system level, predominantly related to resource scarcity, particularly poor staffing. Conclusion Our findings strongly indicate that efforts to mitigate moral distress among HCWs should be targeted at the system level. More specifically, the study findings highlight resource limitations, particularly poor staffing, as a major cause of moral distress during the pandemic. (shrink)

It is frequently claimed that nursing is vital to the safe, humane provision of health care and health service to our populations. It is also recognized however, that nursing is a costly health care resource that must be used effectively and efficiently. There is a growing recognition, from within the nursing profession, health care policy makers and society, of the need to analyse the contribution of nursing to health care and its costs. This becomes increasingly pertinent and urgent in a (...) situation, such as that existing in Ireland, where the current financial crisis has lead to public sector employment moratoria, staff cuts and staffing deficits, combined with increased patient expectation, escalating health care costs, and a health care system restructuring and reform agenda. Such factors, increasingly common internationally, make the identification and effective use of the nursing contribution to health care an issue of international importance. This paper seeks to explore the nature of nursing and the function of the nurse within a 21st century health care system, with a focus on the Irish context. However, this analysis fits into and is relevant to the international context and discussion regarding the nursing workforce. This paper uses recent empirical studies exploring the domains of activity and focus of nursing, together with nurses perceptions of their role and work environment, in order to connect those findings with core conceptual questions about the nature and function of nursing. (shrink)

This study examined the association of nurses’ ethical conflict with hospitals with organizational commitment, stress, turnover intention, absence and turnover. Participants were 410 nurses working at four different Canadian hospitals. A longitudinal design was used where nurses completed a questionnaire to capture ethical conflict, stress and organizational commitment, and one year later, measures of turnover intention, absence and actual turnover were obtained for the same sample. We found three aspects of nurses’ ethical conflict with hospitals: patient care values, value of (...) nurses, and staffing policy values. Our findings showed that all three aspects of nurses’ ethical conflict are associated with stress and patient care values is associated with actual turnover. We also found that staffing policy values is predictive of turnover intention, and that patient care values is predictive of absenteeism. Thus, our findings show the multidimensionality of nurses’ ethical conflict with hospitals. Further implications of our findings for practice and theory are discussed. (shrink)

Background: The concept of dignity can be divided into two main attributes: absolute dignity that calls for recognition of an inner worth of persons and social dignity that can be changeable and can be lost as a result of different social factors and moral behaviours. In this light, the nursing profession has a professional dignity that is to be continually constructed and re-constructed and involves both main attributes of dignity. Objectives: The purpose of this study was to determine how nurses (...) described nursing’s professional dignity in internal medicine and surgery departments in hospital settings. Research design: The research design was qualitative. Ethical considerations: This study was approved by the ethics committees of the healthcare organizations involved. All the participants were provided with information about the purpose and the nature of the study. Participants: A total of 124 nurses participated in this study. Method: The data were collected using 20 focus group sessions in different parts of Italy. The data were analysed by means of a conventional inductive content analysis starting from the information retrieved in order to extract meaning units and sorting the arising phenomena into conceptually meaningful categories and themes. Results: Nursing’s professional dignity was deeply embedded in the innermost part of individuals. Regarding the social part of dignity, a great importance was put on the values that compose nursing’s professional identity, the socio-historical background and the evolution of nursing in the area considered. The social part of dignity was also linked to collaboration with physicians and with healthcare assistants who were thought to have a central role in easing work strain. Equally important, though, was the relationship with peers and senior nurses. Conclusion: The organizational environments under scrutiny with their low staffing levels, overload of work and hierarchical interactions did not promote respect for the dignity of nurses. To understand these professional values, it is pivotal to comprehend the role of different health professions in their cultural milieu and the evolution of the nursing profession in diverse countries. (shrink)

What did science make possible for colonial rule? How was science in turn marked by the knowledge and practices of those under colonial rule? Here I approach these questions via the social history of Madras Observatory. Constructed in 1791 by the East India Company, the observatory was to provide local time to mariners and served as a clearinghouse for the company’s survey and revenue administration. The astronomical work of Madras’ Brahmin assistants relied upon their knowledge of jyotiśāstra [Sanskrit astronomy/astrology], and (...) can be seen as a specialized form of the kind of South Indian scribal labor and knowledge that also staffed the company’s tax offices. If at Greenwich the division of labor meant observatory work bore resemblances to the factory and the accounts office, in Madras, astronomy and accounting drew on similar labor forms because they were part of the same enterprise. But the company did not just adapt preexisting forms of labor, it also attempted to produce its own at a school built near the observatory to train “half-caste” orphans as apprentice surveyors and assistant computers. The school, staffed by the Brahmins, drew upon knowledge and pedagogical practice associated with the tinnai, the schools in which upper-caste children learned to read, write, and calculate. For a time, the observatory’s social order was literally “half-caste.” The paper also considers how the relationship between caste, status, and instrument was reflected in the visual and material culture of the observatory, such as in Indian-language inscriptions on its central pillar. For company astronomers, the measurement of time meant reworking the relationships among the Indian past, the colonial present, and an imperial posterity. Science under colonial rule spanned multiple temporal and social registers because it was the result of negotiations between the demands of political economy and the knowledge and practices of colonized others. (shrink)

In their target article, Fox & Duke provide evidence that consult volumes vary based on ethics staffing, leading to their conclusion that ethics consultation is an example of supply-sensitiv...

Background: Since moral distress affects psychological aspects of psychiatric nurses, it is an important theme. Previous studies showed relationships between moral distress and job satisfaction; however, there are few studies which investigate relationships between moral distress and other effective variables and then we highlighted relationships among these variables. Objective: This study aimed to (1) examine relationships among moral distress, sense of coherence, mental health, and job satisfaction and (2) clarify the most predictive variable to job satisfaction. Research design: This study (...) is a cross-sectional study. Participants were 130 psychiatric nurses in a hospital in Japan. They completed the Moral Distress Scale for Psychiatric nurses (Unethical conduct, Low staffing, and Acquiescence to patients’ rights violations), the sense of coherence scale (Comprehensibility, Manageability, and Meaning), the General Health Questionnaire, and the Job Satisfaction scale. Ethical consideration: This study was approved by the ethical board of St Mary’s College. Nurses participated voluntarily and were anonymous. Results: Results showed that subscales of the Moral Distress Scale for Psychiatric nurses negatively correlated to the sense of coherence and the Job Satisfaction. A multiple regression analysis showed that “Acquiescence to patients’ rights violations” of the Moral Distress Scale for Psychiatric nurses and “Meaning” of the sense of coherence influenced the Job Satisfaction much more than other variables. These two variables were correlated to job satisfaction scale, and other variables without them did not significantly correlate to job satisfaction scale. Discussion: These results suggest that moral distress negatively related to sense of coherence and job satisfaction, a subscale of the Moral Distress Scale for Psychiatric nurses and that of the sense of coherence affected the job satisfaction the most. Conclusion: Decreasing of acquiescence to patients’ rights violations and finding meaning in nursing may improve job satisfaction. (shrink)