Background Rapid Ethical Assessment is a form of rapid ethnographic assessment conducted at the beginning of research project to guide the consent process with the objective of reconciling universal ethical guidance with specific research contexts. The current study is conducted to assess the perceived relevance of introducing REA as a mainstream tool in Ethiopia. Methods Mixed methods research using a sequential explanatory approach was conducted from July to September 2012, including 241 cross-sectional, self-administered and 19 qualitative, in-depth interviews (...) among health researchers and regulators including ethics committee members in Ethiopian health research institutions and universities. Results In their evaluation of the consent process, only 40.2% thought that the consent process and information given were adequately understood by study participants; 84.6% claimed they were not satisfied with the current consent process and 85.5% thought the best interests of study participants were not adequately considered. Commonly mentioned consent-related problems included lack of clarity, inadequate information, language barriers, cultural differences, undue expectations and power imbalances. About 95.4% believed that consent should be contextualized to the study setting and 39.4% thought REA would be an appropriate approach to improve the perceived problems. Qualitative findings helped to further explore the gaps identified in the quantitative findings and to map-out concerns related to the current research consent process in Ethiopia. Suggestions included, conducting REA during the pre-test phase of studies when applicable. The need for clear guidance for researchers on issues such as when and how to apply the REA tools was stressed. Conclusion The study findings clearly indicated that there are perceived to be correctable gaps in the consent process of medical research in Ethiopia. REA is considered relevant by researchers and stakeholders to address these gaps. Exploring further the feasibility and applicability of REA is recommended. (shrink)

Physical education is often selected for applying multilingual initiatives through the use of the content and language integrated learning (CLIL) approach. However, it is still unclear whether the introduction of such approach might entail losing Physical Education’s essence and distorting its basic purposes. The aim of this study is to analyse the impact of CLIL on the Physical Education lessons. Given the purpose of this study, a mixed methodological approach based on a sequential exploratory design divided in (...) two different phases is used. We begin with an initial qualitative data collection (phase I) consisting in the analysis of interviews with 12 participants (8 teachers and 4 students). Based on its analysis, two foci are identified: social relationships and physical activity. Then, informed by the results obtained, a quantitative approach is used (phase II), differentiating these two sets of data to deepen on them. On one part, a sociometric questionnaire was applied to analyse the social relationships among CLIL students. On the other part, a quasi-experimental design (n = 49) was implemented using accelerometry to measure the MVPA of the PE sessions. Regarding physical activity, the results show that levels of MVPA are higher in the experimental group (CLIL) than in the control group showing light to the divergent viewpoints of interviewees. However, focusing on social relationships, the sociometric questionnaire results show that there were no statistical significative changes, although some signs of a slight effect on students’ relationships arise depending on their gender. Therefore, more research would be necessary to deepen on how CLIL affects in this regard. (shrink)

The future of work is forcing the world to adjust to a new paradigm of working. New skills will be required to create and adopt new technology and working methods. Additionally, cognitive skills, particularly creative problem-solving, will be highly sought after. The future of work paradigm has threatened many occupations but bolstered others such as engineering. Engineers must keep up to date with the technological and cognitive demands brought on by the future of work. Using an exploratory mixed-methods approach, (...) our study sought to make sense of how engineers understand and use creative problem solving. We found significant associations between engineers’ implicit knowledge of creativity, exemplified creative problem solving, and the perceived value of creativity. We considered that the work environment is a potential facilitator of creative problem-solving. We used an innovative exceptional cases analysis and found that the highest functioning engineers in terms of knowledge, skills, and perceived value of creativity, also reported working in places that facilitate psychosocially safe environments to support creativity. We propose a new theoretical framework for a creative environment by integrating the Four Ps and psychosocial safety climate theory that management could apply to facilitate creative problem solving. Through the acquisition of knowledge to engage in creative problem solving as individuals or a team, a perception of value must be present to enforce the benefit of creativity to the engineering role. The future of work paradigm requires that organisations provide an environment, a psychosocially safe climate, for engineers to grow and hone their sought-after skills that artificial technologies cannot currently replace. (shrink)

This research was carried out within the framework of the question of the level of technical competencies of 4-6 age Quran course teachers and the factors that affect this competence positively or negatively. The main reason for creating such an issue as a problem and working is to draw attention to the importance of using technology in education and training processes that emerged with the pandemic process. In the study, an explanatory sequential design which is one of the (...) class='Hi'>mixed methods research models was adopted. The relational screening model, one of the quantitative research methods, was used as the primary data set of the study. In this context, the "Technological Pedagogical Content Knowledge (TPCK)" developed by Horzum et al. (2014) was used as a data collection tool and applied to 528 participants. The case study design, one of the qualitative research methods, was used as the secondary data set of the study. In this context, focus group interviews were held with a total of 20 participants in the form of two sessions and 10 participants in each session. The focus of the interviews was on the fact that the participants' general statements about their experiences with technology usage in 4-6 age group Quran course distance education process and their evaluations of the advantages and disadvantages of the process. In the light of the quantitative findings obtained in the study, it is noteworthy that the general average of the TPCK scale of the teachers is good. However, it is seen that the scores of the teachers from the sub-dimensions related to technology are below the general average. Within the framework of qualitative findings, it was determined that technology literacy awareness increased with the distance education process. Teachers state that they need in-service training seminars to maintain awareness of this technology that emerges in them. (shrink)

This study’s objective was to understand Colombian adolescents’ experiences and preferences regarding access to sexual and reproductive health services (SRHS), either alone or accompanied. A mixed-method approach was used, involving a survey of 812 participants aged eleven to twenty-four years old and forty-five semi-structured interviews with participants aged fourteen to twenty-three. Previous research shows that adolescents prefer privacy when accessing SRHS and often do not want their parents involved. Such findings align with the longstanding tendency to frame (...) the ethical principle of autonomy as based on independence in decision-making. However, the present study shows that such a conceptualization and application of autonomy does not adequately explain Colombian adolescent participants’ preferences regarding access to SRHS. Participants shared a variety of preferences to access SRHS, with the majority of participants attaching great importance to having their parents involved, to varying degrees. What emerges is a more complex and non-homogenous conceptualization of autonomy that is not inherently grounded in independence from parental involvement in access to care. We thus argue that when developing policies involving adolescents, policymakers and health professionals should adopt a nuanced “relational autonomy” approach to better respect the myriad of preferences that Colombian (and other) adolescents may have regarding their access to SRHS. (shrink)

Background Moral distress is a well-recognized term for emotional, cognitive, and physical reactions of professionals, when facing conflicts between perceived obligations and institutional constraints. Though studied across medical roles, limited research exists among physiotherapists. Research Question What factors contribute to Moral distress among physiotherapists and how do they cope? Objectives To develop and test a multifaceted model of Moral distress and gain an in-depth understanding of the phenomena. Research Design A 2017–2022 mixed-methods study: (1) Survey of 407 physiotherapists (...) quantitatively testing a literature-based model analyzing relationships between Moral distress, Moral sensitivity, Locus of control, Self-efficacy, Ethical climate perceptions and demographics, analyzed by descriptive and inferential statistics, multiple comparisons and structural equation modelling (SPSS26, SAS, AMOS); (2) Semi-structured interviews with 21 physiotherapists examining Moral distress experiences using meticulous phenomenological analysis. Participants and Context Israeli physiotherapists from various occupational settings recruited via professional networks. Ethical Considerations The Haifa University Ethics Committee authorized the study. Informed consent was obtained for the anonymous survey and before interviews regarding recording, and quote use. Findings Quantitative results showed moderately high average Moral distress, significantly higher among women and paediatric physiotherapists, positively correlating with Moral sensitivity. Qualitative findings revealed intense emotions around Moral distress experiences, inner conflicts between care ideals and constraints, and coping strategies like reflective skills. Senior therapists, despite higher self-efficacy and moral sensitivity, still reported persistent high distress. Discussion Moral distress has complex links with moral sensitivity, self-efficacy, perceived professional autonomy and organizational support. A renewed framework emerged explaining relations between moral distress and personal, professional and organizational factors. Conclusions Multidimensional insights help identify Moral distress causes and coping strategies among physiotherapists, advancing theory. Conclusions can shape ethics training programs and competencies. (shrink)

Rapid Ethical Assessment (REA) is a form of rapid ethnographic assessment conducted at the beginning of research project to guide the consent process with the objective of reconciling universal ethical guidance with specific research contexts. The current study is conducted to assess the perceived relevance of introducing REA as a mainstream tool in Ethiopia.

BackgroundFamily consent is a prerequisite for the organ donation of the deceased in China. However, a large number of donors are individuals who died due to accidental injuries or unanticipated diseases, which means that most of the families of such donors have just experienced the sudden death of their loved one and have to make a donation decision in a short time. This decision may cause psychological stress and some psychological damage to the minds of relatives of the donors. In (...) addition, cultural sensitivity also has largely caused the relatives of donors inner conflicts and contradictions. And sometimes organ donation may still be stigmatized. However, have they received any emotional support and what is their emotional support needs are some questions that need to be answered. Therefore, this study aims to investigate the emotional support, influencing factors, and needs of the family members of organ donors in Hunan Province, China.Materials and methodsThis is mixed-methods research that combines quantitative and qualitative research methods. A cross-sectional survey was conducted among 102 donor families using a questionnaire to investigate their emotional support status. To further understand their emotional support needs, 12 donor families participated in the semi-structured interview.ResultsThe results confirmed that: A total of 67.7% of the 102 respondents received emotional support or psychological comfort. Thus, only a small number of respondents felt respected by the public. Emotional support came mainly from immediate family members, and official organizations such as the Red Cross. Marital status, health status, occupation, and coping style can affect the emotional support of the donor families. Interview showed that the families of donors need emotional support and psychological aid from psychological professionals mostly. And they also wish to receive the understanding and respect of the public.ConclusionMost families of organ donors received emotional support from family, Red Cross, and friends, but only a minority of families of donors reported receiving respect from the public after the donation. And families of donor showed a strong need for emotional support and professional psychological aid from institutions. (shrink)

Mass violence in the United States has been shown to cause trauma for survivors. These events may also create for survivors the experience of posttraumatic growth (PTG), the facets of which include personal strength, appreciation for life, new possibilities in life, spiritual change, and enhanced relationships with others. However, the role of collective efficacy and agency in the development of PTG following mass violence remains unknown. The purpose of this study is to assess the relationship between PTG and experiences (...) of collective efficacy and agency among survivors of the Isla Vista, California tragedy of 2014. The mixed methods objective was to explore the interpretive context within which the agency and collective efficacy experiences occurred. Quantitative data collected in a questionnaire (n = 166) were used to inform the collection of qualitative interview data (n = 12). Participating in therapy, organizing community events, and making the decision to either leave or stay in Isla Vista positively correlated with PTG based on hierarchical regression analysis. Themes of personal agency, the importance of role, and participating in collective action emerged from interviews. This study offers unique methodological approaches to using mixed methods data to understand the experiences which contributed to PTG among survivors of a mass shooting. (shrink)

Treating physicians have key roles to play in expanded access to investigational drugs, by identifying investigational treatment options, assessing the balance of risks and potential benefits, informing their patients, and applying to the regulatory authorities. This study is the first to explore physicians’ experiences and moral views, with the aim of understanding the conditions under which doctors decide to pursue expanded access for their patients and the obstacles and facilitators they encounter in the Netherlands. In this mixed-methods (...) class='Hi'>study, semi-structured interviews and a questionnaire were conducted with medical specialists across the country and analysed thematically. Typically, our respondents pursue expanded access in “back against the wall” situations and broadly support its classic requirements. They indicate practical hurdles related to reimbursement, the amount of time and effort required for the application, and unfamiliarity with the regulatory process. Some physicians are morally opposed to expanded access, with an appeal to safety risks, lack of evidence, and “false hope.” Some of these moral concerns and practical obstacles may be essential targets for change, if expanded access to unapproved drugs is to become available for wider groups of patients for whom standard treatment options are not—or no longer—available, on a more consistent and equal basis. (shrink)

Background Ensuring individual free and informed decision‐making for research participation is challenging. It is thought that preliminarily informing communities through ‘community sensitization’ procedures may improve individual decision‐making. This study set out to assess the relevance of community sensitization for individual decision‐making in research participation in rural Gambia. Methods This anthropological mixed‐methods study triangulated qualitative methods and quantitative survey methods in the context of an observational study and a clinical trial on malaria carried out by the Medical (...) Research Council Unit Gambia. Results/discussion Although 38.7% of the respondents were present during sensitization sessions, 91.1% of the respondents were inclined to participate in the trial when surveyed after the sensitization and prior to the informed consent process. This difference can be explained by the informal transmission of information within the community after the community sensitization, expectations such as the benefits of participation based on previous research experiences, and the positive reputation of the research institute. Commonly mentioned barriers to participation were blood sampling and the potential disapproval of the household head. Conclusion Community sensitization is effective in providing first‐hand, reliable information to communities as the information is cascaded to those who could not attend the sessions. However, further research is needed to assess how the informal spread of information further shapes people's expectations, how the process engages with existing social relations and hierarchies (e.g. local political power structures; permissions of heads of households) and how this influences or changes individual consent. (shrink)

Background: Nursing students experience ethical conflicts and challenges during their clinical education. These may lead to moral distress and disturb the learning process. Objectives: This study aimed to explore and to evaluate the nursing students’ ethical challenges in the clinical settings in Iran. Research design: This was a mixed-methods study with an exploratory sequential design. Participants and research context: A total of 37 and 120 Iranian nursing students participated in the qualitative and quantitative phases, respectively. Ethical considerations: (...) The ethical committee of Kerman University of Medical Sciences, Iran, approved the protocol of the study. Findings: Three main categories were extracted from qualitative data including Low attention of nurses to the patients’ preferences; Lack of authority; and Inadequate support. A total of 97% of the students had more than one ethical challenge in clinical settings and 48% of them stated that their challenges did not resolve. The total score of perceived ethical challenges was 62.03 ± 9.17, which was moderate. The highest mean score related to the “Low attention of nurses to the patients’ preferences” subscale. Discussion: The finding confirmed most of the existing results of other international researches about the frequency and kinds of baccalaureate nursing students’ ethical challenges. Conclusion: Identifying student ethical challenges helps teachers to manage their clinical learning process better. This study may provide a view for the nurses, clinical educators, and managers toward nursing students’ ethical challenges and their impact on nursing students’ clinical experiences. (shrink)

Background: Infectious disease outbreaks such as COVID-19 and MERS pose a major threat to healthcare workers' physical and mental health. Studies exploring the positive changes gained from adapting to traumatic events, known as post-traumatic growth, have attracted much attention. However, it is unclear which factors or experiences lead to PTG among HCWs. The purpose of this mixed-method study was to investigate factors associated with PTG among HCWs who experienced the MERS outbreak in South Korea, and fully describe (...) their experience of developing PTG.Methods: Quantitative data from 78 participants were collected using psychometric tools for Psychological distress, Resilience, and Support for coping, and Post-traumatic growth. Qualitative interviews were conducted with seven nurses. Data were analyzed using the qualitative content analysis method according to the sub-themes of resilience, which was the main factor associated with PTG.Results: We found resilience to have a significant impact on PTG. Thus the qualitative interviews were analyzed using the core concepts of resilience. Qualitative interviews with nurses illustrated how participants experienced the development of resilience in terms of its sub-factors: hardiness, persistence, optimism, and support.Conclusion: HCWs who endured the MERS outbreak showed high levels of PTG, and the analysis of the interview data provided a fuller understanding on the experience of remaining resilient and developing PTG. These results provide practical and pragmatic information helpful for developing intervention strategies and protocols that can help HCWs transform adversity into growth and development. (shrink)

This study developed a cognitive behavioral therapy -based psychoeducation practice aimed at reducing obsessive-compulsive symptom levels in adolescents in Turkey and tested its effectiveness with a mixed-methods study. After the study was constructed as a pretest-posttest control group experimental application consisting of qualitative stages. The experimental application of the study was carried out with high school students in Turkey. In the sampling process, the schools, where the study will be carried out, were determined with (...) the cluster sampling method. The experimental and control groups were formed with 30 students with high obsessive-compulsive disorder symptoms from these schools, and the developed CBT-based psychoeducation practice was applied to the experimental group for 12 weeks. Quantitative data were collected through the “Child Version of the Obsessive-Compulsive Inventory,” and normality analysis, t-test for dependent samples, and Single Factor Analysis of Covariance were used. Qualitative data of the study were collected through document review, session evaluation forms, and semi-structured interview protocol; content and descriptive analysis techniques were used in the analysis. It was concluded that the developed CBT-based psychoeducation application was an effective approach in reducing OCD symptoms in the Turkish adolescent sample, except for the neutralizing dimension. It was also determined that the findings obtained from the analysis during the application and the interviews after the application are parallel with the findings obtained by quantitative methods, and the qualitative and quantitative findings adequately explained the quantitative documents findings. (shrink)

The search for meaningful work has been of interest to researchers from a variety of disciplines for decades and seems to have grown even more recently. Much of the literature assumes that employees share a sense of what is meaningful in work and there isn’t much attention given to how and why meanings might differ. Researchers have not only called for more research studying demographic differences in definitions of meaning :77–90, 2014), but also more research utilizing mixed methods to (...) study psychological concepts like meaningful work Handbook of multimethod measurement in psychology, American Psychological Association, Washington, 2006). This study specifically examines differences across generational cohorts on their prioritization of sources of meaningful work through qualitative, in-depth interviews followed by a more generalizable, quantitative survey. Findings from the qualitative study show that generational cohorts define the meaning in their jobs differently, and they hold negative perceptions about the lack of desire for meaning in each of the other cohorts. Study 2 maps generational cohorts on the comprehensive model of meaningful work designed by Lips-Wiersma and Morris :491–511, 2009) to reveal that although there are some differences in prioritization of sources of meaningful work, all generational cohorts share similar desire to “develop and become themselves” when asked about their definitions of meaningful work. Implications and future research are discussed. (shrink)

The objective of this study was to review the design and delivery of medical ethics education within medical programs across Australia and New Zealand, how current teaching has been informed by the proposed core curriculum published in 2001 by the ATEAM and how it could look moving forward. We conducted a mixed methods study using an online questionnaire consisting of 51 items. This included both binary and open-ended questions to categorise and explore similarities and differences in medical (...) ethics curricula in medical programs accredited by the Australian Medical Council across ANZ. Participants were asked about curriculum design format, duration, goals, assessments, content areas of their own ME curriculum. Convenors from 18 universities responded. The main commonality was that ME curricula were integrated both longitudinally and laterally with other content. There was also commonality in content areas addressed. The goals, format, educators, and assessments of the ME curricula were highly variable. Most respondents described a curriculum which prioritised knowledge and skill development related to ME. Although the core goals of including knowledge, skills, and attitudinal development in ME curricula are still present, there is no uniformity in terms of format, delivery, or assessment across medical programs in ANZ. This is an area for collaborative development. (shrink)

The mixed-method study investigates the effectiveness of the ARSC model. The objective of this investigation is to measure the impact of the ARCS model on the engagement levels of students in vocational college settings within a blended learning framework. It includes a pre-intervention and a post-intervention survey (n=255) along with a semi-structured interview (n=10). Students of Jiangsu Vocational College of Medicine have been involved in pre-intervention surveys, followed by a month of training implementing the ARCS model in (...) blended media. Post-intervention surveys have also been conducted. Furthermore, ten students have been interviewed in-depth, individually. The quantitative analysis using paired t-test and regression analysis indicates that the engagement levels of the vocational students significantly increase after implementation of the ARCS model in blended mode, and all the elements of the model collectively significantly predict the change in the student engagement. The interview reveals certain challenges faced by the students, of which some significant ones are technical glitches, time management, confusing and unclear assignments, and so on. The findings of the study will guide the vocational teachers to tailor their blended instruction by incorporating ARCS elements to improve overall student engagement, leading to a better learning outcome. (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)

Metacognition, otherwise known as ‘thinking about one’s thinking,’ leads to greater academic success and is foundational. Given this importance, metacognitive behaviors need to be developed within early years contexts to provide young children the opportunity to practice these behaviors and receive feedback. However, literature continues to focus on the development of metacognition in later grades. This mixed methods study explored metacognition in eight Kindergarten classrooms. Participants included eight Kindergarten teachers, six early childhood educators (ECEs), and 80 students. Data (...) collection was conducted at two time periods separated by 12 weeks. Data collection included the Children’s Independent Learning Development (CHILD) measure, semi-structured interviews, and classroom observations. The quantitative data from the CHILD were analyzed using a paired samplest-test in SPSS. All qualitative data were analyzed thematically. Qualitatively, three themes were identified: (1) Conceptualization of metacognition, (2) Barriers to developing metacognition, and (3) Operationalization of strategies to facilitate metacognitive development. Evidence demonstrated that participants had incomplete conceptualizations of metacognition. Some articulated simple understandings by reporting the literal translation and were unable to articulate more fulsome conceptions. However, some teachers had more developed conceptions of metacognition that included different facets such as planning and reflective thinking. All participants were forthcoming with identifying ways in which they struggled with implementing metacognitive practices or encouraging the development of metacognition. These barriers included large classroom sizes, developmental readiness, and wide student ability. Despite having an incomplete understanding of metacognition, early years educators were trying a variety of different strategies to help promote metacognitive thinking within their Kindergarten classrooms. Surprisingly, teacher ratings using the CHILD did not change significantly from Time 1 (M= 1.88, SD = 0.744) to Time 2 (M= 1.85, SD = 0.66),t(72) = 0.72,p> 0.05. A similar trend was observed for ECE ratings using the CHILD as they did not change significantly from Time 1 (M= 1.89, SD = 0.70) to Time 2 (M= 1.80, SD = 0.79),t(52) = 1.36,p> 0.05. This research highlights empirical practices that Kindergarten educators can use to help facilitate metacognitive thinking. Furthermore, it identifies a need to better support Kindergarten educators by integrating practices aimed at developing metacognitive thinking in their students through explicit examples of strategies. (shrink)

BackgroundCommunity engagement is a key component in health research. One of the ways health researchers ensure community engagement is through Community Advisory Boards (CABs). The capacity of CABs to properly perform their role in clinical research has not been well described in many resource limited settings. In this study, we assessed the capacity of CABs for effective community engagement in Uganda.MethodsWe conducted a cross sectional study with mixed methods. We used structured questionnaires and key informant interviews (KII) (...) to collect data from CAB members, trial investigators, and community liaison officers. For quantitative data, we used descriptive statistics while for qualitative data we used content analysis.ResultsSeventy three CAB members were interviewed using structured questionnaires; 58.9% males, median age 49 years (IQR 24–70), 71.2% had attained tertiary education, 42.5% never attended any research ethics training, only 26% had a training in human subject protection, 30.1% had training in health research, 50.7% never attended any training about the role of CABs, and 72.6% had no guidelines for their operation. On the qualitative aspect, 24 KIIs cited CAB members to have some skills and ability to understand and review study documents, offer guidance on community norms and expectations and give valuable feedback to the investigators. However, challenges like limited resources, lack of independence and guidelines, and knowledge gaps about research ethics were cited as hindrances of CABs capacity.ConclusionThough CABs have some capacity to perform their role in the Ugandan setting, their functionality is limited by lack of resources to facilitate their work, lack of independence, lack of guidelines for their operations and limited knowledge regarding issues of research ethics and protection of the rights of trial participants. (shrink)

BackgroundMedical education is currently more considerate about the human dimension. The present qualitative study aimed to explain the experiences of clinical professors with regard to humanism in clinical education in Iran.MethodsThis mixed methods study had two phases, a quanitative phase of scientometrics and a qualitative phase of a content analysis. In the scientometrics phase, Ravar PreMap and VOSviewer software programs were utilized for plotting the conceptual networks. The networks were analyzed at the micro-level based on centrality indices. (...) The conceptual network was plotted and the prominent topics in clinical education were identified using co-word analysis. In the second qualitative phase on the topic, based on the scientometrics phase, semi-structured interviews were conducted with clinical professors. The interviews were transcribed verbatim and analyzed.ResultsOn the basis of the analysis of titles, abstracts, and keywords of the retrieved articles on clinical education from ISI Web of Science, Scopus, and PubMed, 1412 keywords were extracted. After the refining process, 356 keywords with 6741 relations remained. Upon plotting the conceptual network, 19 conceptual clusters related to clinical education were obtained. Then, micro-level network analysis indicated that the keyword humanism with the frequency of 137 had the highest rate, closeness, and betweenness. Moreover, from the interview data analysis, two themes of “intertwined nature of the human spirit in clinical education” and “humanistic behavior of professors in clinical education” were extracted.ConclusionAs a part of the educational culture, humanistic values must be intertwined with the medical education curriculum. In this regard, humanism and clinical reasoning are the two major clusters of clinical teaching; moreover, altruism and adherence to humanistic values, and scientific qualification are other main pillars that should be considered as the criteria for the selection of clinical professors and medical students. (shrink)

Agrifood scholars have long investigated the relationship between farm size and a wide variety of social and ecological outcomes. Yet neither this scholarship nor the extensive research on farmworkers has addressed the relationship between farm size and job quality for hired workers. Moreover, although this question has not been systematically investigated, many advocates, popular food writers, and documentaries appear to have the answer—portraying precarious work as common on large farms and nonexistent on small farms. In this paper, we take on (...) this question by describing and explaining the relationship between farm size and job quality for hired farm workers. To do so, we draw on data from two independently conducted, mixed-methods case studies—organic fruit and vegetable production in California, and dairy farming in Wisconsin—each of which offers a different set of insights into the farm size-job quality relationship. In both cases, larger farms fared better than or no worse than their smaller-scale counterparts for most job quality metrics investigated, though many of the advantages of working on large farms accrue disproportionately to white, U.S.-born workers. We explain that these patterns stem from economies of scale, industrialization, firm size itself, the dominant class identities and aspirations of farmers and their peers, as well as farmers’ and immigrant workers’ fears of immigration enforcement. (shrink)

This mixed methods study examines how college students’ perceptions and experiences affect their understanding of academic integrity. Using qualitative and quantitative responses from the Personal and Social Responsibility Institutional Inventory, both quantitative and qualitative results demonstrate that while campuses may see a reduction in overall levels of cheating when punitive academic integrity policies are present, students may develop higher levels of personal and academic integrity through the use of more holistic and community-focused practices.

ObjectiveCaring for patients with Alzheimer’s disease is a stressful situation and an overwhelming task for family caregivers. Therefore, these caregivers need to have their hardiness empowered to provide proper and appropriate care to these older adults. From the introduction of the concept of hardiness, few studies have been conducted to assess the hardiness of caregivers of patients with AD. Presumably, one reason for this knowledge gap is the lack of a proper scale to evaluate hardiness in this group. This (...) class='Hi'>study was conducted to develop a reliable and valid Family Caregivers’ Hardiness Scale to measure this concept accurately among Iranian family caregivers sample.MethodsThis study is a cross-sectional study with a sequential-exploratory mixed-method approach. The concept of family caregivers’ hardiness was clarified using deductive content analysis, and item pools were generated. In the psychometric step, the samples were 435 family caregivers with a mean age of 50.26, and the data were gathered via an online form questionnaire. In this step, the items of the FCHS were evaluated using face and content validity. Then, the factor structure was determined and confirmed using exploratory factor analysis and confirmatory factor analysis followed by convergent and divergent validity, respectively. Finally, scale reliability, including stability, and internal consistency were evaluated.ResultsThe finding revealed that FCHS consists of five factors, namely, “Religious Coping”, “Self-Management”, “Empathic Communication”, “Family Affective Commitment”, and “Purposeful Interaction” that explained 58.72% of the total variance. The results of CFA showed a good model fit. Reliability showed acceptable internal consistency and stability.ConclusionBased on the results of the psychometric evaluation of the FCHS, turned out that the concept of hardiness in Iranian family caregivers is a multidimensional concept that is most focused on individual-cultural values, emotional family relationships, and social relationships. The designed scale also has acceptable validity and reliability features that can be used in future studies to measure this concept in family caregivers. (shrink)

Background and aim Healthcare professionals are regularly exposed to moral challenges in patient care potentially compromising quality of care and safety of patients. Preventive clinical ethics support aims to identify and address moral problems in patient care at an early stage of their development. This study investigates the occurrence, risk factors, early indicators, decision parameters, consequences and preventive measures of moral problems. Method Semi-structured expert interviews were conducted with 20 interprofessional healthcare professionals from 2 university hospitals in Basel, (...) Switzerland. A Likert scale questionnaire was completed by the interviewees and analysed using descriptive and inferential statistics. Results Healthcare professionals are frequently exposed to a variety of moral problems, such as end-of-life decisions, resource allocation and assessing the patient's will or decisional capacity. Thirty-four different risk factors for moral problems are identified, e.g. patient vulnerability, divergent values or world views, inadequate resources or poor ethical climate. Twenty-one early indicators are recognised such as disagreement between healthcare professionals, patients and relatives, emotional disturbances, gut feeling or conflict of conscience. A variety of preventive measures are suggested and presented in a preventive clinical ethics support process model. The most helpful measures are early ethical conversations with colleagues, early team-internal ethical case discussions and an ethics-trained contact person on the ward. Ethics training, kerbside consultations, proactive ethics consultations, ethics screening and rounds are also considered helpful. Conclusions Clinical ethics support services should not only offer reactive and complex, but also proactive and low-threshold support for healthcare professionals, patients and relatives. (shrink)

Due to huge advancements in natural language processing (NLP) and machine learning, chatbots are gaining significance in the field of customer service. For users, it may be hard to distinguish whether they are communicating with a human or a chatbot. This brings ethical issues, as users have the right to know who or what they are interacting with (European Commission in Regulatory framework proposal on artificial intelligence. https://digital-strategy.ec.europa.eu/en/policies/regulatory-framework-ai, 2022). One of the solutions is to include a disclosure at the start (...) of the interaction (e.g., “this is a chatbot”). However, companies are reluctant to use disclosures, as consumers may perceive artificial agents as less knowledgeable and empathetic than their human counterparts (Luo et al. in Market Sci 38(6):937–947, 2019). The current mixed methods study, combining qualitative interviews (n = 8) and a quantitative experiment (n = 194), delves into users’ responses to a disclosed vs. undisclosed customer service chatbot, focusing on source orientation, anthropomorphism, and social presence. The qualitative interviews reveal that it is the willingness to help the customer and the friendly tone of voice that matters to the users, regardless of the artificial status of the customer care representative. The experiment did not show significant effects of the disclosure (vs. non-disclosure). Implications for research, legislators and businesses are discussed. (shrink)

The study tested how the use of positive- (e.g. beautiful) and negative-valenced (e.g. horrible) words in natural language and its change in time affects the severity of depression and anxiety symptoms among depressed and non-depressed individuals. This longitudinal mixed methods study (N = 40 participants, n = 1440 narratives) with three measurements within a year showed that at the between-person level the use of negative-valenced words was strongly associated with the increase in anxiety and depression symptoms over (...) time while the use of positive-valenced words was slightly associated with the decrease in anxiety and depression symptom. These effects were not supported for within-person level (i.e. changes in word usage). No significant differences were observed in the effects between depressed and non-depressed groups. Summing up, the overall use of positive- and negative-valenced words (particularly negative-valenced words) had a stronger effect on the severity of psychopathological symptoms than their change over time. The results were discussed in the context of natural language processing and its application in diagnosing depression and anxiety symptoms. (shrink)

This study investigated the reasons that leaders have given for their leader role occupancy. By using a mixed-method approach and large leader data, we aimed to provide a more nuanced picture of how leader positions are occupied in real life. We examined how individual leadership motivation may associate with other reasons for leader role occupancy. In addition, we aimed to integrate the different reasons behind leader role occupancy into the framework of sustainable leader careers and its two (...) indicators: leader’s health and performance. The survey data consisted of 1,031 leaders from various sectors of working life. Qualitative analysis revealed that leaders mention various factors behind their leader role occupancy, resulting 26 themes. After inductive investigation of the data, theory-driven analysis focused on the sustainable career components and agency vs. non-agency. Qualitative data was quantitized based on the theory-driven categories for statistical analysis. Based on the these analysis, we found out that only Affective-Identity MTL predicted all of the studied reasons behind leader role occupancy, whereas the other motivation types did not. All of the reasons for leader role occupancy except non-agentic ones were related to both leaders’ own and their followers’ occupational well-being. Leaders with more person-related and agentic reasons for leader role occupancy experienced better occupational well-being. Person- and context-related and agentic reasons behind leader role occupancy associated also with followers’ occupational well-being, but the associations differed from those of leaders’ well-being: person-related and agentic reasons associated with followers’ exhaustion, but this association was not found among leaders. Our study provided important information for practitioners in the field of human resources and development, as it has shown that if the reasons for leader role occupancy mainly reflect circumstances or other non-person-related reasons, the experienced occupational well-being and person-career fit may remain weak. It is necessary to try to support the leadership motivation for those leaders, or to shape the job description in such a way that it can also offer the experiences of meaningfulness from aspects other than self-realization through a managerial role. (shrink)

This article contributes to our understanding of how communication of ethical guidelines by managers may reduce the likelihood of employee unethical behavior. We conduct two vignette experiments to assess the impact of communicating two types of ethical guidelines—general and specific. The second study employs mixed methods experimental design, collecting qualitative data during the experiment. We find that communicating ethical guidelines by managers reduces the likelihood of unethical behavior, but contrary to our hypothesis and prior literature, we observe that (...) general ethical guidelines are more effective than specific ethical guidelines. We conduct thematic coding of open-ended qualitative responses and integrate the findings of qualitative analysis with the quantitative analyses to provide insights into the counter-hypothetical finding. With specific guidelines, we observe that participants use specific details to negate or rationalize ethical concerns, and with general guidelines, participants recognize ethical concerns and are less likely to downplay them. We conclude by discussing the implications of these findings for research on ethical leadership. (shrink)

Specialist Sport Programs are an underexamined activity that combines the best features of two different contexts for adolescent development: a sporting program and a secondary school. A mixed-methods study was conducted to determine the influence of participation in SSPs on the educational outcomes of lower secondary students in Western Australia. The results demonstrated a significant improvement in specialist students' mean grade for Mathematics over the course of a year, while their mean grade for all other subjects, and their (...) level of engagement with school, remained stable over the same period of time. Semi-structured interviews were also conducted with key stakeholders. Overall, the participants felt that SSPs had a positive influence on students' engagement with school, and that this engagement had a positive impact on their academic achievement. Taken together, the results of this research suggest that there is a role for SSPs in promoting positive educational outcomes for lower secondary students attending public schools located in low SES areas. (shrink)

Background: Moral distress is recognized as a problem affecting healthcare professionals globally. Unaddressed moral distress may lead to withdrawal from the moral dimensions of patient care, burnout, or leaving the profession. Despite the importance, studies related to moral distress are scant in Thailand. Objective: This study aims to describe the experience of moral distress and related factors among Thai nurses. Design: A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the (...) Measure of Moral Distress for Healthcare Professionals and interview guide. The analysis was conducted separately and then integrated. Participants: Participants were Thai nurses from two large tertiary care institutions in a Southern province of Thailand. Ethical considerations: This study was approved by our organization's Institutional Review Board for Health Sciences Research, and by the Institutional Review Boards of the two local institutions in Thailand. Permission from the publisher was received to translate and utilize the Measure of Moral Distress (MMD-HP) under the license number: 4676990097151. Results: A total of 462 participants completed the survey questions. The top 7 causes of moral distress were related to system-level root causes and end-of-life care situations. Hierarchical multiple regression showed that work units, considering leaving position, and number of moral distress episodes in the past year were significant predictors of moral distress. Twenty interviews demonstrated three main themes of distressing causes: (1) powerlessness (at patients/family-, team-, and organizational-levels), (2) end-of-life issues, and (3) poor team function (poor communication and collaboration, incompetent healthcare providers, and inappropriate behavior of colleagues). The integration of data from both components indicated that the qualitative interviews enrich the quantitative findings, especially as related to the top 7 causes of moral distress. Discussion: Although the experience of moral distress among Thai nurses is similar to studies conducted elsewhere, the patient’s and family’s religious perspective that ties into the concept of moral distress needs to be explored. Conclusions: Although the root causes of moral distress are similar among different cultures, the experience of Thai nurses may vary according to culture and context. (shrink)

This article aims to explore contemplative practitioners’ direct lived experiences of enlightenment and develop a multi-item scale measuring these experiences. A mixed-method approach was adopted. The first study is a phenomenological study that interviewed 24 participants with enlightenment experiences and the second study is a scale-development study that recruited 1130 participants for scale validation. Two major clusters of the enlightenment experiences including sensory feelings and nondual realizations emerged from the phenomenological study and the (...) four main themes of the realizations were formed: intrapersonal insights, inspiration internalization, interpersonal compassion, and interconnectedness. After exploratory factor analysis and confirmatory factor analysis, a three-factor structure of the Spiritual Enlightenment Experience Scale, including nonduality, sensory clarity, and sensory disappearance were revealed. The findings of the research depicted a fuller picture of spiritual enlightenment experiences which may contribute to the current knowledge of religiosity and spirituality, as well as transpersonal psychology. The results suggest that the core components of spiritual enlightenment experiences include sensory clarity and disappearance experiences and realizations of nonduality. (shrink)

It is common practice within primary classrooms for teachers to spilt children into different ability groups so that children of similar level are taught together. Whilst this practice is used across the globe, research is mixed on the benefits of such grouping strategy. This paper presents data collected from mixed methods research which investigated teachers use of grouping strategies and social comparison, the act of comparing oneself with others. It focuses on when, why and with whom children from (...) different ability groups compare themselves and the impact this has on their self-perceptions. Drawing upon data from children aged between 10 and 11 years from 12 primary schools, social comparison was found to play a significant role in daily classroom life for some children. The study identified different strands of the social comparison process including acknowledgment, topic, target, and direction, and it revealed positive and negative effects of social comparison. A difference by ability group was identified. Children within the low ability group were particularly vulnerable to the negative effects of social comparison and found to engage in more frequent and intentional social comparisons which were heavily relied upon for self-evaluation and performance evaluation. The paper discusses the educational implications of social comparison regarding pupil ability grouping strategies, motivation, engagement, and academic performance. Implications for teacher education and professional development is discussed. (shrink)

IntroductionDrug-related deaths are a major public health challenge. Losing a child to a DRD can be a very stressful life event, which places parents at risk of mental and physical health problems. However, traumatic experiences like losing a child to DRD can paradoxically also lead to positive psychological changes. A mixed-method approach was used to understand the complexity of the phenomenon of post-traumatic growth experienced by parents following a DRD.MethodBy combining data from a survey and interviews, we explored (...) positive growth experiences among Norwegian parents. We conducted descriptive analyses of the sample’s demographic characteristics and mean scores for Post-traumatic Growth Inventory items. Hierarchical multiple regression was used to examine the influence of the ability to perform daily activities, self-efficacy, social support, and symptoms of prolonged grief on the outcome variable of post-traumatic growth. Reflexive thematic analysis was applied to analyze the qualitative data. Finally, we integrated the results of the survey and the interviews.ResultsFor items measuring post-traumatic growth, parents scored highest on the item “I discovered that I’m stronger than I thought I was” and lowest on the item “I am able to do better things with my life.” Self-efficacy and social support had a statistically significant relation with post-traumatic growth. Two themes were generated from the interviews: new perspectives on life and new paths in life. Even though the “New Possibilities” subscale had the lowest mean score for the PTGI-SF, new paths in life were important for many of the interviewed parents.DiscussionParents described traumatic stressors associated with having a child who uses narcotics and hence experienced positive changes even before losing their child. We argue that on an individual level, the consequences of spillover stigma, low self-efficacy, and intrusive rumination can hinder potential post-traumatic growth. On a group level, enhancing network support may increase post-traumatic growth experiences. Hence, parents who have experienced a DRD can benefit from help to activate their social networks and strengthen their self-efficacy. (shrink)

Due to the COVID-19 pandemic, most employees face increasing career-related stress, particularly those who work in multinational corporations, because the international travel constraints prevent them from going back to their families. Hence, it is imperative to investigate the critical impact of employees’ occupational burnout on career-related outcomes. In response, this research explores the moderating effect of OB on the relationships between career competencies and career sustainability. To achieve a more comprehensive understanding of relevant issues, we adopted a mixed-method (...) research design that includes both qualitative and quantitative analyses. Findings indicate that all the three dimensions of CCs were positively related to CS; moreover, OB negatively moderated the individual relationships of CC and BC with CS. The main contribution of this study is to enrich the existing career literature by addressing the critical moderating role of OB in the links of CC and BC individually with CS. Practical implications are also discussed in this study. (shrink)

AimsIn this pilot mixed-methods study, we examined the participants experiences of engaging in virtual drawing tasks and the impact of an olfactory stimulus on outcomes of affect, stress, self-efficacy, anxiety, creative agency, and well-being.MethodsThis study used a parallel mixed-methods, simple block randomization design. The study participants included 24 healthy adults aged 18 to 54 years, including 18 women and six men. The participants completed two 1-h immersive virtual art making sessions and were randomly assigned to (...) receive either a fragrance or a non-fragrance condition for the first session. Quantitative and qualitative datasets were collected concurrently and integrated during data analysis.ResultsThe quantitative results indicated that the fragrance condition demonstrated a significant reduction in negative affect, namely, reduced feelings of negativity when compared to the non-fragrance condition. A trend toward improvement in self-efficacy was also seen in the fragrance condition. No significant changes were found for fragrance or non-fragrance conditions for positive affect, anxiety, and creative agency. The qualitative findings included five themes related to art making experiences in virtual reality in both conditions: fun and joy; novelty of virtual media, experimentation, and play; relaxation and calm; learning curve; and physical discomfort and disorientation. Four themes were identified for virtual art content and visual qualities: nature imagery, references to memories and personal symbols, fantasy and play within imagery, and depiction of everyday objects.ConclusionsOverall, the participants reported positive responses to the novel virtual art making experiences which were further heightened by the inclusion of the fragrance stimulus for negative affect. These preliminary findings need to be replicated with larger sample sizes to confirm the outcomes and the trends that were seen in this pilot study. Further research is recommended to examine the differences between experiences of virtual and traditional art media and to examine different olfactory stimuli promoting focus and concentration. (shrink)

Medeiros et al. implement a mixed methods approach to explore the mechanisms underlying individual transformation during mindfulness-based interventions. We provide critiques, questions and ….

Early intervention is developed following different types of service organization, which in turn require different professional and family roles. The aim of this study was to compare the perceived satisfaction and family quality of life amongst families receiving early intervention developed at centers in comparison to those receiving the routines-based early intervention in families’ homes, that is a family centered intervention in ecological environments. Under a transformative paradigm, a mixed methods design was used, using the Consumer Report Effectiveness (...) Scale (CRES-4) and the Beach Center Family Quality of Life Scale (FQOLS) and two focus groups as data collection instruments. The sample comprised 166 parents in the quantitative phase and 16 parents in the qualitative phase. Results showed that families receiving routines-based early intervention had greater satisfaction with the service although both groups showed similar scores for family quality of life in most of the analyzed domains. Three dimensions were identified throughout the qualitative phase: problem solving, professional team and service organization. Both the models analyzed have an impact on family quality of life and parents are in general satisfied. Strengths and weaknesses were found related to the problem-solving process, the role of the professional team, family empowerment and the service’s organization. The areas requiring further development are the effective training of professionals focused on family practices, the exchange of information with the family and a more participatory organization that takes parent’s perspectives into consideration. The value given to a combined model is another aspect highlighted in this study, as well as the need for a more agile assessment period to avoid unnecessary delays. (shrink)

In contemporary society, childhood is characterized as mediatized and commercialized. Media consumption worlds (MCWs) are a phenomenon that mirrors both aspects. They are narratives that are presented through various media platforms, games, and merchandising products. In this paper, the concept of children’s MCWs is developed theoretically and investigated empirically using the case of primary school children’s appropriation of MCWs as well as parental mediation and attitude in Austria and Germany. A mixed-methods design was applied, starting with qualitative interviews with (...) children and their parents and followed by an online survey for parents (N=327). The study revealed that children find individual ways to deal with MCWs, some of which foster creativity and self-expression but also consumerism. The parents’ attitude is ambivalent. They view MCWs as beneficial in terms of creativity, positive values, and as peer group experience. However, parents observe critically that MCWs lure children to the media and to consumption. (shrink)

The primary objective of this study was to conduct a comprehensive questionnaire survey on the practices of research ethics committees reviewing academic research projects in Czechia. The study aims to provide an unbiased and objective assessment of the current practices of research ethics committees, namely to obtain the missing data on their functioning in the context of academic research, to identify difficulties and shortages that threaten the responsible functioning of research ethics committees in the country and to investigate (...) the implementation of Additional Protocol on Biomedical Research CETS No. 195 in their practice. Such research has never been conducted in Czechia. This was a mixed-methods study, in which the online survey with closed and open-ended questions was chosen to explore the situation regarding ethics assessment of research involving human participants. We developed a questionnaire containing 18 questions concerning several aspects of the functioning of research ethics committees. The questionnaire was in Czech language and was administered through the Qualtrics platform anonymously. The target group of 61 research ethics committees at research institutions was approached by emails and we received 43 completely filled questionnaires, i.e., response rate of 67%. We obtained valuable data on the functioning of research ethics committees in Czechia in three main domains: the mandate and composition of the committee; the scope of its agenda; the process of evaluation including the voting procedure. In addition, the final set of open-ended questions provided an in-depth look at the problems faced by research ethics committees in Czechia. From the results is evident that the responsible assessment of the ethics of research involving human subjects is still not satisfactorily addressed and established for routine practice in the country. The outcomes of our study revealed that the main problem of research ethics in Czechia is the lack of national legislation on research ethics governance. To address this problem, the country requires a legislative framework accompanied by supportive measures aimed at educating, guiding and advising research ethics committees, especially in the Czech academic environment. Not applicable. (shrink)

Background: Previous studies on the effectiveness of psychological interventions in oncology mainly used quantitative measures and no study was conducted with regard to both caregivers and patients. Aim: This study evaluates the effectiveness of psychoeducational support groups, both for women with breast cancer, and for their informal caregivers through the use of quantitative and qualitative measures. Methods: A longitudinal design was used comparing two psychoeducational support groups with other two groups in a standard care control condition. Participants were (...) 28 women with a diagnosis of breast cancer in the care of a hospital in Northern Italy, and 21 family caregivers. The quantitative data were collected by Cognitive Behavioral Assessment for Outcome Evaluation (CBA-OE) and the qualitative data through the use of semi-structured interviews. Results: The statistical analysis showed a significant change attributable to the psychological intervention that proves the effectiveness of such an intervention in the patients’ and caregivers’ group. The qualitative analysis allowed us to interpret the behavioral and psychological profile emerging from CBA-OE, by considering the subjective experience of the treatment groups. The group experience offered affective, relational and informative support, and allowed participants to create a network and to feel understood and reassured. Conclusions: The results suggest the usefulness of psychoeducational support groups for women with breast cancer and for their caregivers. The value of this kind of intervention is not only at an individual level but also at a systems level, and family involvement ensures the best positive outcomes. (shrink)

AimHealthcare workers have directly provided care for COVID-19 patients, and have faced many additional sources leading to poor mental health. The study aimed to investigate the mental health problems and related factors among healthcare staff in Vietnam.MethodsA descriptive cross-sectional mixed methods study, combining quantitative and qualitative research methods, was performed among 400 healthcare workers working at the National Hospital for Tropical Diseases and Ninh Binh General Hospital from the first day of treatment for COVID-19 patients to May (...) 01, 2020.ResultsThe results showed that 8.0% of participants had stress, 17.5% of participants had anxiety, and 14.8% of participants had depression. Approximately 50% of participants reported that they had at least one of these symptoms. The findings illustrated that stress, anxiety, and depression were associated with the position in a hospital, health status during the COVID-19 pandemic, family members/relatives infected with COVID-19, physical and mental support from friends, family, and community, department, years of working, and the average work hours per day of healthcare workers exposed to COVID-19.ConclusionDuring the COVID-19 pandemic, healthcare workers who worked in the hospital providing treatment and care for COVID-19 patients dealt with mental health problems such as stress, anxiety, and depression. It is necessary to promote mental health among healthcare workers, to contribute to the fight against the COVID-19 outbreak in Vietnam. (shrink)

Background Assisted death, including euthanasia and physician-assisted suicide (PAS), is under debate worldwide, and these practices are adopted in many Western countries. Physicians’ attitudes toward assisted death vary across the globe, but little is known about physicians’ actual reactions when facing a request for assisted death. There is a clear gap in evidence on how physicians act and respond to patients’ requests for assisted death in countries where these actions are not legal. Methods A survey including statements concerning euthanasia and (...) PAS and an open question about their actions when facing a request for assisted death was sent to all Finnish physicians. Quantitative data are presented as numbers and percentages. Statistical significance was tested by using the Pearson chi-square test, when appropriate. The qualitative analysis was performed by using an inductive content analysis approach, where categories emerge from the data. Results Altogether, 6889 physicians or medical students answered the survey, yielding a response rate of 26%. One-third of participants agreed or partly agreed that they could assist a patient in a suicide. The majority (69%) of the participants fully or partly agreed that euthanasia should only be accepted due to difficult physical symptoms, while 12% fully or partly agreed that life turning into a burden should be an acceptable reason for euthanasia. Of the participants, 16% had faced a request for euthanasia or PAS, and 3033 answers from 2565 respondents were achieved to the open questions concerning their actions regarding the request and ethical aspects of assisted death. In the qualitative analysis, six main categories, including 22 subcategories, were formed regarding the phenomenon of how physicians act when facing this request. The six main categories were as follows: providing an alternative to the request, enabling care and support, ignoring the request, giving a reasoned refusal, complying with the request, and seeing the request as a possibility. Conclusions Finnish physicians’ actions regarding the requests for assisted death, and attitudes toward euthanasia and PAS vary substantially. Open discussion, education, and recommendations concerning a request for assisted death and ethics around it are also highly needed in countries where euthanasia and PAS are not legal. (shrink)

The importance of ethics education for undergraduate engineering students has been emphasized due to the manifold impacts of engineering on society. However, little is known about moral disengagement among engineering students, which could potentially lead to unethical engineering practice. Especially, it is not known how engineering students’ moral disengagement changes over the course of their college studies. In this paper, we conducted a longitudinal, mixed-methods study to investigate moral disengagement among undergraduate engineering students (n = 274) using Bandura’s (...) theory of moral disengagement as a theoretical framework. We found engineering students’ overall propensity to morally disengage did not change over time, but there were statistically significant differences in student responses to three mechanisms of moral disengagement. We further investigated these findings with students’ interviews. Based on our results, we discuss various theoretical and practical implications. (shrink)

BackgroundRelatives have no formal position in the practice of euthanasia and physician-assisted suicide (EAS) according to Dutch legislation. However, research shows that physicians often involve relatives in EAS decision-making. It remains unclear why physicians do (not) want to involve relatives. Therefore, we examined how many physicians in the Netherlands involve relatives in EAS decision-making and explored reasons for (not) involving relatives and what involvement entails.MethodsIn a mixed-methods study, 746 physicians (33% response rate) completed a questionnaire, and 20 were (...) interviewed. The questionnaire included two statements on relatives’ involvement in EAS decision-making. Descriptive statistics were used, and multivariable logistic regression analyses to explore characteristics associated with involving relatives. In subsequent interviews, we explored physicians’ views on involving relatives in EAS decision-making. Interviews were thematically analysed.ResultsThe majority of physicians want to know relatives’ opinions about an EAS request (80%); a smaller group also takes these opinions into account in EAS decision-making (35%). Physicians who had ever received an explicit EAS request were more likely to want to know opinions and clinical specialists and elderly care physicians were more likely to take these opinions into account. In interviews, physicians mentioned several reasons for involving relatives: e.g. to give relatives space and help them in their acceptance, to tailor support, to be able to perform EAS in harmony, and to mediate in case of conflicting views. Furthermore, physicians explained that relatives’ opinions can influence the decision-making process but cannot be a decisive factor. If relatives oppose the EAS request, physicians find the process more difficult and try to mediate between patients and relatives by investigating relatives’ objections and providing appropriate information. Reasons for not taking relatives’ opinions into account include not wanting to undermine patient autonomy and protecting relatives from a potential burdensome decision.ConclusionsAlthough physicians know that relatives have no formal role, involving relatives in EAS decision-making is common practice in the Netherlands. Physicians consider this important as relatives need to continue with their lives and may need bereavement support. Additionally, physicians want to perform EAS in harmony with everyone involved. However, relatives’ opinions are not decisive. (shrink)

This article discusses how existential phenomenology may serve as a frame in a mixed‐methods study of changes in weight and body composition among women in adjuvant treatment for breast cancer. In accordance with ontologically and epistemologically fundamental assumptions in nursing, we link mixed‐methods and existential phenomenology from the perspective of the French philosopher Maurice Merleau‐Ponty and his notion of a unified body subject. Letting this perspective permeate our philosophy, methodology and issues at the method level in (...) mixed‐method research undermines the distinction between first‐ and third‐person perspective when applying and integrating different data sources in a mixed‐methods study. Applying Merleau‐Ponty's third way, the women's bodily experiences appear as gestalt; a ‘figure’ against a ground of existential threats that are grasped through insight from data integrating in joint displays, which revealed the women's experiences on a deep existential level. Existential phenomenology as a frame in mixed‐method studies can speak not only to nurses but also to a multidisciplinary audience in a shared attempt to deepen the understanding of a patient's healthcare problem. (shrink)

The world is going through unprecedented environmental crisis. The type of destruction and dissolution of natural resources and elements by individuals and institutions that has been witnessed in the last century is much more than that witnessed in the previous millennia. To tackle this, for more than three decades, a number of discussions have taken place at diverse international fora, and frameworks and propositions have been put forth for corporate implementation. Consequently, a perceptible change has come about in the understanding (...) of corporations and their approach towards the Natural Environment, as a vital organizational stakeholder. While many companies use the pro-tection and preservation of the Natural Environment as a tool for brand building and corporate communications, many others have integrated economic and environmental goals to create mutually beneficial win-win situations. This article attempts to study such Natural Environmental Responsibility (NER) practices in corporate India. Through a mixed-method inductive study the article also proposes ‘Natural Environmental Responsibility Framework’. This is based on the triangulation of data wherein the quantitative data has been gathered through responses to an Executive Perception Survey with 400 responses from 125 organizations; and qualitative data has been gathered through personal interactions with 40 senior management executives from six eminent corporations across industry categories in India. The framework and its major components are based on empirical data of practices as existent in corporate India in contemporary times. Hence, the framework could be considered as a working model of NER in India. (shrink)

In India, society and social welfare has always been an important part of business and its broad objectives. From Merchant Charity to Corporate Citizenship, Corporate Social Responsibility has undergone a lot of change over the past many centuries. Whatever be the nomenclature, the objective remains the same—ensuring the welfare of the society and local community as an important stakeholder of an organization. While many companies use CSR as a strategic tool, many others undertake CSR activities for genuine altruism. In both (...) cases, CSR can be a very powerful tool for inclusive growth—the need of the hour. In this article, an attempt has been made through a mixed method study of proposing a Society and Local Community Welfare Framework. The quantitative data is gathered through an Executive Perception Survey wherein 400 responses from 125 organizations were gained and statistical analyses of the same were undertaken by the author. The qualitative data was gathered through personal interactions with senior management executives from nine eminent corporate organizations across industry categories. The framework and its major components are thus based on empirical data of practices as existent in corporate India today. Thus, the framework could be considered as a working model of CSR in India. (shrink)

Agri-environmental policies programmes mainly focus on economic incentives for the agri-environmental transition in grassland use. However, barriers rooted in farmers’ self-identities, which determine their behavioural intentions toward environmentally friendly practices, are often unaddressed in policy design. We conceptualise two self-identity gradients, productivist–multifunctionalist–conservationist and traditionalist–innovationist, to analyse drivers and barriers of agri-environmental transition processes among farmers. In order to grasp the complex multidimensional and hierarchical concept of self-identity as initially proposed by Stryker (_Journal of Marriage and Family_ 30: 558–564, 1968 ), (...) our analysis comprises a triangulation of qualitative and quantitative methods on a comprehensive dataset of 75 interviews with Swiss alpine grassland farmers. Through the semi-deductive coding of responses to open questions (revealing hierarchical aspects) and a factor analysis of closed, Likert-scale questions (revealing multidimensional aspects), we positioned each farmer along the conceptualised self-identity gradients. Our framework allows to explain contradictory behaviours exhibited by farmers: Our results revealed a mismatch between the farmers’ prevailing conservationist-innovationist self-identity and their actual intensification behaviour. This mismatch can be explained by the discrepancy between the individual self-identity and the prevailing productivist–innovationist idea of a good farmer, on which farmers continue to base their decisions. Within this discrepancy, however, lies the potential for a shift in the idea of what constitutes a good farmer and a consequential agri-environmental transition. (shrink)

BackgroundThere is increasing evidence that research misbehaviour is common, especially the minor forms. Previous studies on research misbehaviour primarily focused on biomedical and social sciences, and evidence from natural sciences and humanities is scarce. We investigated what academic researchers in Amsterdam perceived to be detrimental research misbehaviours in their respective disciplinary fields.MethodsWe used an explanatory sequential mixed methods design. First, survey participants from four disciplinary fields rated perceived frequency and impact of research misbehaviours from a list of 60. We (...) then combined these into a top five ranking of most detrimental research misbehaviours at the aggregate level, stratified by disciplinary field. Second, in focus group interviews, participants from each academic rank and disciplinary field were asked to reflect on the most relevant research misbehaviours for their disciplinary field. We used participative ranking methodology inducing participants to obtain consensus on which research misbehaviours are most detrimental.ResultsIn total, 1080 researchers completed the survey (response rate: 15%) and 61 participated in the focus groups (3 three to 8 eight researchers per group). Insufficient supervision consistently ranked highest in the survey regardless of disciplinary field and the focus groups confirmed this. Important themes in the focus groups were insufficient supervision, sloppy science, and sloppy peer review. Biomedical researchers and social science researchers were primarily concerned with sloppy science and insufficient supervision. Natural sciences and humanities researchers discussed sloppy reviewing and theft of ideas by reviewers, a form of plagiarism. Focus group participants further provided examples of particular research misbehaviours they were confronted with and how these impacted their work as a researcher.ConclusionWe found insufficient supervision and various forms of sloppy science to score highly on aggregate detrimental impact throughout all disciplinary fields. Researchers from the natural sciences and humanities also perceived nepotism to be of major impact on the aggregate level. The natural sciences regarded fabrication of data of major impact as well. The focus group interviews helped to understand how researchers interpreted ‘insufficient supervision’. Besides, the focus group participants added insight into sloppy science in practice. Researchers from the natural sciences and humanities added new research misbehaviours concerning their disciplinary fields to the list, such as the stealing of ideas before publication. This improves our understanding of research misbehaviour beyond the social and biomedical fields. (shrink)