BackgroundKnowledge about the psychosocial experiences of sick-listed workers in the first months of sick leave is sparse even though early interventions are recommended. The aim of this study was to explore psychosocial experiences of being on sick leave and thoughts about returning to work after 8–12 weeks of sickness absence.MethodsSixteen individuals at 9–13 weeks of sick leave participated in semi-structured individual interviews. Data was analyzed through Giorgi’s descriptive phenomenological method.ResultsThree themes emerged: energy depleted, losing normal life, searching for a (...) solution. A combination of health, work, and family challenges contributed to being drained of energy, which affected both work- and non-work roles. Being on sick leave led to a loss of social arenas and their identity as a contributing member of society. Participants required assistance to find solutions toward returning to work.ConclusionEven in this early stage of long-term sick leave, sick listed workers faced complex challenges in multiple domains. Continuing sick leave was experienced as necessary but may challenge personal identity and social life. Those not finding solutions may benefit from additional early follow-up that examine work-related, social and personal factors that influence return to work. (shrink)

Priya’s situation highlights several important ethical issues in the field of global health work. These can be categorized as issues relevant to her predeparture motivations and preparation, her role as a Western professional working in the Democratic Republic of the Congo , and her responsibilities once she returns home, having engaged in a project “in the field.”To consider the ethical issues inherent in global health work, individuals must ask themselves several critical questions . These include questions (...) of motivation: “Why am I doing this work? What do I hope to gain? What are my personal objectives?” . Answering these questions may be an uncomfortable exercise as one realizes that his or her motivations are not as purely altruistic as originally imagined . In Priya’s case, her interests and training suggest a longstanding commitment, but she must be honest with herself in her use of this internship to “build he .. (shrink)

Examining the ethics of long-term, career involvement by physicians in global health work is vital, given growing professional interest and potential health implications for communities abroad. However, current literature remains heavily focused on ethical considerations of short-term global health training experiences. A literature review informed our development of an ethics framework centered on two perspectives: the practitioner perspective, further subdivided into extrinsic and intrinsic factors, and community perspectives, specifically that of the host community and the physician’s (...) home community. Some physician factors included cultural/linguistic differences, power imbalances, and sustainable skills/competencies. Receiving community factors included resource limitations, standard of care disparities, and community autonomy. Home community factors focused on the opportunity cost of an unavailable physician who was trained and supported by the local community. Descriptive review permitted comparison with existing short-term literature, noting similarities and differences. Our framework provides a basis for further research and critical analysis of ethical implications of career-long physician global health work. (shrink)

Examining the ethics of long-term, career involvement by physicians in global health work is vital, given growing professional interest and potential health implications for communities abroad. However, current literature remains heavily focused on ethical considerations of short-term global health training experiences. A literature review informed our development of an ethics framework centered on two perspectives: the practitioner perspective, further subdivided into extrinsic and intrinsic factors, and community perspectives, specifically that of the host community and the physician’s (...) home community. Some physician factors included cultural/linguistic differences, power imbalances, and sustainable skills/competencies. Receiving community factors included resource limitations, standard of care disparities, and community autonomy. Home community factors focused on the opportunity cost of an unavailable physician who was trained and supported by the local community. Descriptive review permitted comparison with existing short-term literature, noting similarities and differences. Our framework provides a basis for further research and critical analysis of ethical implications of career-long physician global health work. (shrink)

Health-related quality of life is the ultimate general goal for medicine, health care and public health, including health promotion and health education. The other important general goal is health-related welfare. The aim of the paper is to explain what this means and what the consequences of these assumptions are for health work. This involves defining the central terms “health”, “quality of life” and “welfare” and showing what their conceptual relations are. (...) class='Hi'>Health-related quality of life has two central meanings: health-related well-being, which constitutes quality of life, and health as ability, which contributes causally to quality of life. Four meanings of health-related welfare are put forward: general well-being, health as ability, other inner properties of the individual, and external factors. States and processes covered by these categories contribute causally to health-related quality of life. Finally, using these distinctions, some more specific goals for medicine and health care, on the one hand, and for public health and health promotion, on the other, are outlined. In the former fields work is primarily directed towards changing the health-related quality of life of the individual through direct measures, “manipulating” the individual, whereas public health work and health promotion primarily use indirect measures and further health through various sorts of health-related welfare changes, e.g. through changing the environment. (shrink)

In order to maximize human performance, defence forces continue to explore, develop, and apply human performance enhancement (HPE) methods, ranging from pharmaceuticals to (bio)technological enhancement. This raises ethical, legal, and societal concerns and requires organizing a careful reflection and deliberation process, with relevant stakeholders. We discuss a range of ethical, legal, and societal aspects (ELSA), which people involved in the development and deployment of HPE can use for such reflection and deliberation. A realistic military scenario with proposed HPE application can (...) serve as a starting point for such an iterative and participatory process. Stakeholders can discuss this application, modify its features, and design appropriate processes around it – for instance, procedures for informed consent. We propose that organizing aspects into these three categories – ethical, legal, and societal – can help involve appropriate interlocutors at different moments: legal aspects with people in strategy or management roles, from the start of a project; ethical aspects with people in operations and medical roles, during development; and societal aspects with people in communication and personnel roles, during deployment. Notably, we developed and discussed this framework and the three aspects in close collaboration with personnel from the military. (shrink)

It is well-known that a sense of belonging is crucial in relation to gaining and maintaining sound mental health. Work is also known to be an essential aspect of recovery from mental health problems. However, there is scant knowledge of what a sense of belonging in the workplace represents. This study explores the nature and meaning of a sense of belonging in the workplace as experienced by persons struggling with mental health issues.Using a descriptive phenomenological methodology, (...) sixteen descriptions of the lived experience of belonging in the workplace were analyzed. The analysis reveals that the experience of belonging in the workplace is restricted and fragile until the moment one becomes accepted, but grows stronger and more resilient as one chooses how one wants to participate. Nonetheless, the sense of belonging is haunted by mixed emotions and ambivalence between the wish to be taken care of and the longing for professional appreciation. (shrink)

Humanitarian healthcare work presents a range of ethical challenges for expatriate healthcare professionals, including tragic choices requiring the selection of a least-worst option. In this paper we examine a particular set of tragic choices related to the prioritization of care and allocation of scarce resources between individuals in situations of widespread and urgent health needs. Drawing on qualitative interviews with clinicians, we examine the nature of these choices. We offer recommendations to clinical teams and aid organizations for preparing (...) and supporting frontline clinicians in their efforts to determine the least-worst option, and in their responsibility for making such choices. (shrink)

The article analyses European regulations concerning the health protection at work with nanomaterials in the context of the Christian vision of human work. The increasingly widespread presence of nanotechnology in workplaces requires serious reflection on the adequacy of employers’ measures to protect workers’ health from the risks in the workplace. The lack of clear guidance in European legislation directly concerning work with nanoparticles is problematic. Moreover, the health consequences for workers using nanomaterials in the (...) work process are not fully explored in science. It is therefore essential to consider what values should accompany employers in shaping working conditions and what values should be legislated when creating occupational health and safety law. First of all, how should the employers deal with the unknown? Should they abandon nanomaterials for which they do not have adequate information at all until the consequences for workers’ health have been established? Should such action be limited to situations where studies indicate the toxicity of the nanomaterials present in the working environment? In this context, the article analyses values and objectives indicated by the teaching of the Catholic Church. The publication presents a Christian vision on the protection of workers’ health and their place in the work process. Europe has been under the influence of Christianity for many centuries now. The Catholic Church’s view of human labour continues to be present in public debates in Europe. The Christian view of human labour is focused on the working man and his dignity. Irrespective of other concepts of labour, Christianity assumes the priority of a human being over capital. The Catholic Church analyses the working man as going beyond the Earthly context, which is not typical for such doctrines as liberalism or Marxism. The author’s article is an attempt in answering the question about how up to date the Catholic Church’s views on human labour are in the light of nanotechnology development in the workplace. (shrink)

The position concerning the mental health of black and minority ethnic women in Britain is closely linked to that of their respective communities in general. Issues concerning inappropriate care and treatment; lack of access to services; and service delivery based on assumptions and stereotypes govern the way in which black women and men experience mental health care and treatment. This article discusses the specific nature of black women's position, within the wider context of black communities’ experience as a (...) whole. While the term ‘black and minority ethnic communities’ covers a range of differing communities, the focus here is on the experiences of women from African, African-Caribbean and Asian communities. In relation to women in these communities, reference is made to issues concerning: (1) older women; (2) women of mixed heritage; (3) women's roles as care-givers; and (4) the position of refugees and asylum seekers. The article also explores and outlines the importance of self-help strategies including, e.g. befriending and counselling and the role of religion and spirituality in enabling many black people to manage their mental distress. (shrink)

Health and health care are vitally important to all of us, and academic interest in the law regulating health has, over the last 50 years, become an important field of academic study. An analysis of the development of, changes in, and scope of Health Law and Ethics to date, is both timely and of interest to students and scholars alike, along with an exploration of its likely future development. This work brings together contributions from leading (...) and emerging scholars in the field. Each contributor has been invited to select and analyse a 'leading work', which has for them shed light on the way that Health Law and Ethics has developed. The chapters are both autobiographical, reflecting upon the works that have proved significant to contributors, and also critical analyses of the current state of the field. This collection also includes a specially written Introduction and Conclusion, which critically reflect upon the development of Health Law and Ethics and its likely future developments in the light of the reflections by contributors on their chosen leading works. The book will be of interest to students, teachers and researchers in Health Law and Ethics, as it provides critical discussions and assessments of some of the leading scholarship in the field. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Working on the Clinton Administration's Health Care Reform Task ForceNancy Neveloff Dubler (bio)This narrative is based on my understanding of the elements of the Health Security Act that may have ethical implications. I have reconstructed these elements from my experience on the Health Care Reform Task Force and they are part of the health care plan that the President presented to Congress. (At the time (...) this article went to press, the actual legislation, which should answer my remaining specific questions more clearly, had not yet been released.) I perceive the most important features of the plan to be:• The legislation will create a "right" to health care for all citizens—access to care will be universal;• The plan will involve some form of managed competition in which groups of providers (called Approved or Accredited Health Plans (AHPs)) will offer comparable benefit packages at slightly (or widely) different costs;• The AHPs will negotiate with the Health Alliance (HA) to determine the price that they will charge their consumer-patients;• There will be open enrollment with no barriers to coverage, such as exclusions for pre-existing conditions;• Community rating will be in effect in different localities and enrolled persons in any AHP will pay the same premium;• The coverage for any enrolled person will be portable;• The overall structure will be a cooperative federal/state enterprise in which the states will have quite extensive abilities to fashion variations of the basic plan to meet their particular needs;• Primary care will be encouraged and incentives for physicians to train in primary care specialties provided;• Non-physician providers will be central to the functioning of the health care plans;• Efforts will be made to develop a "person power" pool so that people with an abstract "right" to health care will have real access to providers, in their localities, who can fulfill the promise that the right creates; [End Page 421]• The goal of cost containment will be central to the organization and regulation of the system;• Administrative simplicity and quality protections will be central.Co-chairing the Bioethics Working Group (BWG) of the White House Task Force on Health Care Reform was a unique experience. Approximately 40 Task Force working groups were established by Hillary Rodham Clinton, the President, and the senior Task Force staff. Various members of the President's office and other knowledgeable members of the Executive Branch selected the participants. In our group, appointments were made largely on the recommendations of the co-chairs. The BWG, among the last of the groups formed, carried the official name "The Working Group on the Ethical Foundations of the New System" and was jointly led by me and Marion Gray Secundy, a Professor of Bioethics at Howard University. The fact that the leadership of the Task Force saw fit to establish such a group, thereby confirming that bioethics is a player in the arena of health care policy, was in itself significant and was made no less so by the lack of clarity regarding the group's aims and goals.The working groups of the Task Force were organized into clusters, determined by the relatedness of the somewhat distinct, but always overlapping, content of their investigations. Separate clusters and working groups, for example, looked at mental health, long term care, and the benefit package and coverage for low-income and non-working families. On this last issue there was also a working group that explored health policy initiatives for underserved populations. This multiple focus on related issues proved to be an excellent method for ensuring that the complexity of these topics was sufficiently explored. There was a published schedule for when these groups met together, and members of other groups who had similar or overlapping concerns were invited to attend and to participate.Every week or so, all of the working groups reported to the Task Force leadership, under the direction of Ira Magaziner, in a process called a "tollgate." Prior to the tollgate, the working groups were required to submit formal written analyses of the problems they had most recently been considering. Copies of these documents were placed in a special room so that those who were interested could review... (shrink)

This book provides a comprehensive insight into the ways in which psychoanalysts think and work. Mary Brownescombe Heller and Sheena Pollet bring together internationally known contributors trained at the Institute of Psychoanalysis to explore the broad range of clinical work, thinking, and teaching undertaken with children, families, adults and staff by psychoanalysts in the UK public health sector. Divided into four sections, _The Work of Psychoanalysts in the Public Health Sector_ covers: clinical work with (...) parents and young children clinical work with adults and their families analytic thinking in health service practice analytic support for health service staff. Experienced psychoanalysts discuss work with various client groups including parents with babies, children, adolescents who self harm, and adults with serious mental health conditions and psychosis. The book also explores how psychoanalytically-informed work can be used alongside other treatment methods, and how health service staff can best be trained and supported. _The Work of Psychoanalysts in the Public Health Sector_ offers the reader a broad perspective and a clear understanding of the various analytical concepts used in clinical practice. It will be invaluable reading for anyone interested in, or already using psychoanalytic ideas and techniques in the health sector, as well as students in training. (shrink)

The popularity and availability of global health experiences has increased, with organizations helping groups plan service trips and companies specializing in “voluntourism,” health care professionals volunteering their services through different organizations, and medical students participating in global health electives. Much has been written about global health experiences in resource poor settings, but the literature focuses primarily on the work of health care professionals and medical students. This paper focuses on undergraduate student involvement in short (...) term medical volunteer work in resource poor countries, a practice that has become popular among pre-health professions students. We argue that the participation of undergraduate students in global health experiences raises many of the ethical concerns associated with voluntourism and global health experiences for medical students. Some of these may be exacerbated by or emerge in unique ways when undergraduates volunteer. Guidelines and curricula for medical student engagement in global health experiences have been developed. Guidelines specific to undergraduate involvement in such trips and pre-departure curricula to prepare students should be developed and such training should be required of volunteers. We propose a framework for such guidelines and curricula, argue that universities should be the primary point of delivery even when universities are not organizing the trips, and recommend that curricula should be developed in light of additional data. (shrink)

Since the revolutionary mood of the 1960s, patient-centered mental health care and a research emphasis on service users as experts by experience have emerged hand in hand with a view of service users as consumers. What happens to knowledge derived from firsthand experience when mental health users become experts and actively choose care? What kind of perspective do service users pursue on psychological distress? These are important questions in a field where psychiatric expertise on mental illness is socially (...) structured and constrained as an intra-personal disturbance of the mind. We argue that experience experts have lost a coherent perspective on care and health. We illustrate this by rationally reconstructing how the interpersonal view of mental health first gained and then lost coherence between the conception of mental health, the practice of mental health care, and the user experience. Harry Stack Sullivan’s interpersonal theory was a paradigm case for such coherence. The inclusion of mental health consumers as ‘experts by experience’ in the mental health field took place at the cost of Sullivan’s coherent interpersonal theory. Service users who interact side by side with medical experts as experience experts are constrained by the evidence-based imperative and consumerism. Service users are caught up in a race among experts to gain knowledge about mental problems from a third-person perspective instead of from first-person experience. To make a contribution service users have more to gain from a research approach that appreciates that they are persons among persons rather than experts among experts. (shrink)

Public health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors. The current study aimed to examine: [1] risk (...) factors associated with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic. We employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic. About half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30–2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0–10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress. Our findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs’ work environment. (shrink)

Using mixed methods, we explored new music students’ concepts of wellbeing and success and their current state of wellbeing at a university music department in Switzerland. Music performance is a competitive and achievement-oriented career. Research suggests musicians face vocation-specific challenges to physical health and mental wellbeing but has yet to investigate music students’ beliefs about wellbeing and success. With a self-report questionnaire we investigated new music students’ quality of life and self-efficacy. Through qualitative workshops we explored students’ understanding of (...) the term “wellbeing,” and how this relates to “success.” Over half new music students believed the institution has 40–60% responsibility for their wellbeing. A simple linear regression showed that self-efficacy could predict better wellbeing, explaining 12% of the variance. Self-efficacy predicts wellbeing for new music students. The 17 flipcharts generated 121 inputs clustered into themes. Four themes solely described “wellbeing” and four separately depict “success”. Some themes intersected as elements of both constructs. Four further themes illustrated the relationship between the two. Music students believe responsibility for wellbeing is shared between themselves and their institution. As they scored low on both self-efficacy and wellbeing, these findings are an urgent call for action for school management and stakeholders of the music student population. (shrink)

As occupational health management (OHM) and work health promotion (WHP) become increasingly prominent in companies worldwide, little is known about consumers' attitudes towards work health‐related issues. Do consumers consider the health of employees in German companies to be important? Do German companies consider consumers to be relevant stakeholders in voluntary occupational health (OH) and well‐being activities? In the first of two qualitative interview studies, German consumers were asked which actors they consider to be (...) responsible in OH contexts and whether or not they prefer OH‐related product attributes to other socially desirable ones. During a second qualitative interview study with representatives from German companies, suppliers, institutions, and organizations concerned with voluntary and legally mandatory OH, participants were asked about their expectations regarding whether or not consumers are interested in such OH activities. Both studies highlight the difference between the consumers' perspective on OH issues and responsibilities on the one hand and what companies and stakeholders believe consumers think about OH issues and responsibilities on the other. The findings show that consumers can recognize non‐mandatory OH and well‐being activities as elements of their own social responsibility (ConSR), while companies usually do not consider this perspective in their corporate social responsibility (CSR). (shrink)

Global Health involves, among many things the intensified travelling of people, resources, technologies, knowledge, standards, and ideas. This book describes what happens when innovations are transferred to new settings: What work is needed to make them work, but also how they change the setting into which they are introduced.

This study examines the effectiveness of the inoculation strategy in countering vaccine-related misinformation among Hong Kong college students. A three-phase between-subject experiment was conducted to compare the persuasive effects of inoculation messages, supportive messages, and no message control. The results show that inoculation messages were superior to supportive messages at generating resistance to misinformation, as evidenced by more positive vaccine attitudes and stronger vaccine intention. Notably, while we expected the inoculation condition would produce more resistance than the control condition, there (...) was little evidence in favor of this prediction. Attitudinal threat and counterarguing moderated the experimental effects; issue involvement and political trust were found to directly predict vaccine attitudes and intention. The findings suggest that future interventions focus on developing preventive mechanisms to counter misinformation and spreading inoculation over the issue is an effective strategy to generate resistance to misinformation. Interventions should be cautious about using health advocacy initiated by governments among populations with low political trust. (shrink)

There is a rapid growth in published knowledge about different aspects of age and aging. While this is highly welcome, it becomes increasingly difficult to keep up even with the main insights provided by this literature. Our review thus aims to provide a compact overview of current social science research in three major domains of older people’s life: health, families, and work. Moreover, we briefly discuss some theoretical issues and introduce the Survey of Health, Ageing, and Retirement (...) in Europe (SHARE). The research findings discussed here demonstrate both the challenges and opportunities lying ahead of us as life expectancy is increasing steadily and as the proportion of older people in our societies will grow further. More generally, we find a great value of life course and cross-nationally comparative perspectives in aging research. We conclude with an outlook on perspectives for future studies in this field. (shrink)

BackgroundHealth service delivery should ensure ethical principles are observed at all levels of healthcare. Working towards this goal requires understanding the ethics-related priorities and concerns in the day-to-day activities among different health practitioners. These practitioners include community health workers (CHWs) who are involved in healthcare delivery in communities in many low-and middle-income countries such as Uganda. In this study, we used photovoice, an innovative community based participatory research method that uses photography, to examine CHWs' perspectives on ethical concerns (...) in their work.MethodsWe explored perspectives of 10 CHWs (5 females and 5 males) on ethical dimensions of their work for 5 months using photovoice in a rural community in Wakiso district, Uganda. As part of the study, we: 1. Oriented CHWs on photovoice research and ethics; 2. Asked CHWs to take photographs of key ethical dimensions of their work; 3. Held monthly meetings to discuss and reflect on the photos; and 4. Disseminated the findings. The discussions from the monthly meetings were audio recorded, transcribed, and emerging data analysed using conventional content analysis with the help of Atlas ti version 6.0.15.ResultsCHWs were aware of and highly concerned about the need to observe ethical principles while carrying out their roles. The ethical principles CHWs were aware of and endeavoured to observe during their work were: maintaining professional integrity and abiding by ethical principles of practice; ethical responsibility in patient care; maintaining confidentiality while handling clients; respect for persons and communities; and enhancing their knowledge and skills for better practice. However, CHWs also identified challenges concerning their observance of ethical principles including: low commitment to their work due to other obligations; availability of some reference materials and guidelines in English yet majority could only read in the local language; and minimal avenues for knowledge enhancement such as trainings.ConclusionsCHWs were aware of and keen to discuss ethical issues in their work. However, there is need to address the challenges they face so as to facilitate observing ethical principles during the course of their work in communities. (shrink)

In this article the authors examine the ways in which the definition of work as paid employment has affected women's health research, the knowledge and understanding of the relationships between women's work and health, and health and social policies. The authors argue for research and public policy based on an expanded definition of women's work, a redefinition that goes beyond employment to reflect the multiple contexts and dimensions of women's work as well as (...) the diversity and differences among women. (shrink)

This article contributes empirical findings and sociological theoretical perspectives to discussions of the role of community lay health workers, including in improving the health of individuals and communities. We focus on the role of the Health Trainer (HT), at its inception described as one of the most innovative developments in UK Public Health policy. As lay health workers, HTs are tasked with reducing health inequalities in disadvantaged communities by supporting clients to engage in healthier (...) lifestyles. HTs are currently sociologically under-researched, particularly in relation to occupational identity work, and the boundary work undertaken inter-occupationally with other health workers. To address this research lacuna, a qualitative study was undertaken with 25 HTs based in the Midlands region of the UK. In theorising our findings, we employ a novel combination of symbolic interactionist conceptualisation of 1) identity work, and of 2) boundary work. The article advances knowledge in the field of health and exercise by investigating and theorising how HTs construct, work at, manage, and communicate about professional/occupational boundaries, in order to provide personalised support to their clients in achieving and sustaining healthy behaviour change within the constraints of clients’ lifeworlds. (shrink)

Social work is underpinned by values of anti-oppressive practice and social justice. Our professional standards require social workers to consider their personal and professional development. Thus, this article combines a reflection on both our professional role as academics and our existential identity as social workers in challenging racism and mental health stigma. To progress equality of opportunity, we argue it is necessary to understand first what we mean by an ‘integrated society’ before we can secondly challenge diverse forms (...) of oppression. We conclude by positing that a community free of interpersonal, institutional and structural oppression may only be possible within a virtual world. (shrink)

Individuals in managerial and professional jobs now work long hours for a variety of reasons. Building on previous research on workaholism and on types of passion, the results of three exploratory studies of correlates of work-based Passion and Addiction are presented. Data were collected in three samples using anonymously completed questionnaires: Canadian managers and professionals, Australian psychologists, and Norwegian journalists. A common pattern of findings was observed in the three samples. First, respondents scoring higher on Passion and on (...) Addiction were more heavily invested in their work. Second, respondents scoring higher on Passion also indicated less obsessive job behaviors, greater work satisfactions, and higher levels of psychological well-being. Third, respondents scoring higher on Addiction indicated more obsessive job behaviors, lower work satisfaction, and lower levels of psychological well-being. (shrink)

Funding agencies in Canada are attempting to break down the organizational boundaries between disciplines to promote interdisciplinary research and foster the integration of the social sciences into the health research field. This paper explores the extent to which biomedical and clinician scientists’ perceptions of social science research operate as a cultural boundary to the inclusion of social scientists into this field. Results indicated that cultural boundaries may impede social scientists’ entry into the health research field through three modalities: (...) (1) biomedical and clinician scientists’ unfavourable and ambivalent posture towards social science research; (2) their opposition to a resource increase for the social sciences; and (3) clinician scientists procedural assessment criteria for social science. The paper also discusses the merits and limitations of Tom Gieryn’s concept of boundary-work for studying social dynamics within the field of science. (shrink)

Those considering careers in medicine and other health and humanitarian disciplines as well as those concerned about the growing presence of militarized ...

In evidence-based medicine (EBM), methodology has become the central means of determining the quality of the evidence base. The “gold standard” method, the randomised, controlled trial (RCT), imbues medical research with an ethos of disinterestedness; yet, as this essay argues, the RCT is itself a rhetorically interested construct essential to medical-professional boundary work. Using the example of debates about methodology in EBM-oriented research on complementary and alternative medicine (CAM), practices not easily tested by RCTs, I frame the problem of (...) method as a fundamentally rhetorical problem, situated within a boundary drama, and deeply rooted in the discursive practices of science and medicine. The genre of the RCT report, for example, idealises the research process and can tilt the course of arguments about CAM, while the notion of efficacy can function as a rhetorically mobile boundary object that can redefine the very terms of debate. I suggest herein that arguments about method in CAM debates can productively be read, metonymically, as expressions of more general anxieties in medicine about knowledge and evidence, community values, and professional boundaries; as such, these debates can illuminate some of the rhetorical dimensions of EBM. (shrink)

Health professionals are involved in humanitarian assistance and development work in many regions of the world. They participate in primary health care, immunization campaigns, clinic- and hospital-based care, rehabilitation and feeding programs. In the course of this work, clinicians are frequently exposed to complex ethical issues. This paper examines how health workers experience ethics in the course of humanitarian assistance and development work. A qualitative study was conducted to consider this question. Five core themes (...) emerged from the data, including: tension between respecting local customs and imposing values; obstacles to providing adequate care; differing understandings of health and illness; questions of identity for health workers; and issues of trust and distrust. Recommendations are made for organizational strategies that could help aid agencies support and equip their staff as they respond to ethical issues. (shrink)

Professional providers of mental health services are motivated to help people, including, or especially, vulnerable people. We analyse the ethical implications of mental health providers accepting employment at detention centres that operate out of the normal regulatory structure of the modern state. Specifically, we examine tensions and moral harms experienced by providers at the Australian immigration detention centre on the island of Nauru. Australia has adopted indefinite offshore detention for asylum-seekers arriving by boat as part of a deterrence (...) strategy that relies on making detainment conditions harsh. This has known deleterious mental health effects. As a token to fiduciary care obligations, Australia employs mental health professionals to work on Nauru. These providers are often motivated to make a positive difference for detainees’ lives. We examine the overall impact of the providers’ work with detainees and the implications of their presence. The strongest evidence supports that the small mitigation of harms offered by these providers does not outweigh the harms of supporting a system designed to perpetuate human suffering. For mental health professionals considering working in offshore detention, we offer specific topics to scrutinise and weigh prior to employment. Because optimising detainee’s mental health is beyond the capacity of individual providers, we call for the organisations standardising and supporting mental health professionals to oppose employment of their associates in offshore detention. Lessons from this case study are generalisable to other jurisdictions to help inform organisations that licence and support mental health providers and individual providers considering work in similar settings. (shrink)

BackgroundThe role of consent for research use of health information is contentious. Most discussion has focused on when project-specific consent may be waived but, recently, a broader range of consent options has been entertained, including broad opt-in for multiple studies with restrictions and notification with opt-out. We sought to elicit public values in this matter and to work toward an agreement about a common approach to consent for use of personal information for health research through deliberative public (...) dialogues.MethodsWe conducted seven day-long public dialogues, involving 98 participants across Canada. Immediately before and after each dialogue, participants completed a fixed-response questionnaire rating individuals' support for 3 approaches to consent in the abstract and their consent choices for 5 health research scenarios using personal information. They also rated how confident different safeguards made them feel that their information was being used responsibly.ResultsBroad opt-in consent for use of personal information garnered the greatest support in the abstract. When presented with specific research scenarios, no one approach to consent predominated. When profit was introduced into the scenarios, consent choices shifted toward greater control over use. Despite lively and constructive dialogues, and considerable shifting in opinion at the individual level, at the end of the day, there was no substantive aggregate movement in opinion. Personal controls were among the most commonly cited approaches to improving people's confidence in the responsible use of their information for research.ConclusionBecause no one approach to consent satisfied even a simple majority of dialogue participants and the importance placed on personal controls, a mechanism should be developed for documenting consent choice for different types of research, including ways for individuals to check who has accessed their medical record for purposes other than clinical care. This could be done, for example, through a web-based patient portal to their electronic health record. Researchers and policy makers should continue to engage the public to promote greater public understanding of the research process and to look for feasible alternatives to existing approaches to project-specific consent for observational research. (shrink)

Background: Healthcare organizations are now challenged to retain nurses’ generation and understand why they are leaving their nursing career prematurely. Acquiring knowledge about the effect of ethical work climate and level of perceived organizational support can help organizational leaders to deal effectively with dysfunctional behaviors and make a difference in enhancing nurses’ dedication, commitment, satisfaction, and loyalty to their organization. Purpose: This study aims to determine the relationship between ethical work climate, and perceived organizational support and nurses’ organizational (...) commitment, job satisfaction, and turnover intention. Methods: A descriptive correlational research design was conducted in all inpatient care units at three major hospitals affiliated to different health sectors at Alexandria governorate. All nurses working in these previous hospitals were included in the study (N = 500). Ethical Climate Questionnaire, Survey of Perceived Organizational Support, Organizational Commitment Questionnaire, Index of Job Satisfaction, and Intention to Turnover scale were used to measure study variables. Ethical considerations: Approval was obtained from Ethics Committee at Faculty of Nursing, Alexandria University. Privacy and confidentiality of data were maintained and assured by obtaining subjects’ informed consent to participate in the research before data collection. Findings: The result revealed positive significant correlations between nurses’ perception of overall ethical work climate and each of perceived organizational support, commitment, as well as their job satisfaction. However, negative significant correlations were found between nurses’ turnover intention and each of these variables. Also, approximately 33% of the explained variance of turnover intention is accounted by ethical work climate, organizational support, organizational commitment, and job satisfaction, and these variables independently contributed significantly in the prediction of turnover intention. Recommendation: Strategies to foster and enhance ethical and supportive work climates as well as job-related benefits are considered significant factors in increasing nurses’ commitment and satisfaction and decreasing their turnover intention. (shrink)

In this companion volume to their 1981 work, A Philosophical Basis of Medical Practice, Pellegrino and Thomasma examine the principle of beneficence and its role in the practice of medicine. Their analysis, which is grounded in a thorough-going philosophy of medicine, addresses a wide array of practical and ethical concerns that are a part of health care decision-making today. Among these issues are the withdrawing and withholding of nutrition and hydration, competency assessment, the requirements for valid surrogate decision-making, (...) quality-of-life determinations, the allocation of scarce health care resources, medical gatekeeping, and for-profit medicine. The authors argue for the restoration of beneficence to its place as the fundamental principle of medical ethics. They maintain that to be guided by beneficence a physician must perform a right and good healing action which is consonant with the individual patient 's values. In order to act in the patient 's best interests, or the patient 's good, the physician and patient must discern what that good is. This knowledge is gained only through a process of dialogue between patient and/or family and physician which respects and honors the patient 's autonomous self-understanding and choice in the matter of treatment options. This emphasis on a dialogical discernment of the patient 's good rejects the assumption long held in medicine that what is considered to be the medical good is necessarily the good for this patient. In viewing autonomy as a necessary condition of beneficence, the authors move beyond a trend in the medical ethics literature which identifies beneficence with paternalism. In their analysis of beneficence, the authors reject the current emphasis on rights- and duty-based ethical systems in favor of a virtue-based theory which is grounded in the physician- patient relationship. This book's provocative contributions to medical ethics will be of great interest not only to physicians and other health professionals, but also to ethicists, students, patients, families, and all others concerned with the relationship of professional to patient and patient to professional in health care today. (shrink)

Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures (...) to keep this “essential industry” producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry’s implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities. (shrink)

Environmental chemicals accumulate in all human bodies and have the potential to affect the health of men and women, adults, and children. This article advances “precautionary consumption”—the effort to mediate personal exposure to environmental chemicals through vigilant consumption—as a new empirical site for understanding the intersections between maternal embodiment and contemporary motherhood as a consumer project. Using in-depth interviews, I explore how a group of 25 mothers employ precautionary consumption to mediate their children’s exposure to chemicals found in food, (...) consumer products, and the home. Most of the mothers in the study situate their children’s chemical “burdens” within their own bodies and undertake the labor of precautionary consumption as part of a larger and commodity-based motherhood project. In actively expanding the sphere of responsible motherhood to include managing children’s body burdens, these mothers navigate multiple and overlapping contexts that hold women accountable for children’s futures and value the agency of the proactive consumer. Yet, as the sphere of responsible mothering expands, women without financial resources, time, and family stability are pushed to the margins of normative motherhood. (shrink)

I read with interest the article by Grill and Hansson1 on epistemic paternalism in public health. It focuses on the important issue of the patient’s right to know and receive information about uncertain threats to public health. However, health and environmental scientists, professional risk managers and the general public strongly disagree about the seriousness of many risks.2 Moreover, risk is an intricate concept to give information about.There are framing effects, ….

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients’ homes. This greatly impacts nurses’ work in home care, making their work increasingly diverse and demanding. In this study, we explore home‐care nursing through a critical discourse analysis of focus group interviews with home‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. Nurses (...) hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home‐care nurses’ work. Changes have made nurses’ work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses’ work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses’ work to help shape the further development of home‐care nursing. (shrink)