This paper draws on classical theories of wisdom to explore the organisational impact of nurses on Australian general practice. Between 2004 and 2008, numbers of general practice nurses doubled, the most rapid influx of nurses into any Australian workplace over the decade. Using data from the Australian General Practice Nurses Study, we argue that nurses had a positive impact because they introduced techne at the organisational level and amplified phronesis in clinical activities. In its Hippocratic formulation, techne refers to a (...) field of definable knowledge, which is purposeful and useful and requires mastery of rational principles. Nursing, with its focus on system and accountability, brought techne out of the GP’s consulting room and into the general practice as a whole. Nurses also exemplify phronesis, an Aristotelian virtue connoting a reasoned and honourable capacity to make judgements: the practical wisdom that defines the interaction between clinician and patient in general practice. At a time of significant GP shortage, doctors and nurses began to collaborate around their more complex and time-consuming patients, leading to a deepening of phronesis in the workplace. By bringing techne to bear on the organisation, and complementing and enhancing phronesis, nurses propel organisational wisdom in general practices. (shrink)

The pandemic period has placed the organizations in a state of great tension. It has generated a situation of confusion, lack of rules, and production-related criticalities that have called into question the very existence of many productive realities. This article aims to highlight the dimensions of care and ethics put in place by HR managers in COVID-19. The objective that animated the authors have focused on the HRM level of medium and large companies in Italy to highlight the protective (...) actions toward people and the organization in the period COVID 19, highlighting what were the ethical values and actions of care put in place. In this article, we wanted to give voice to managers who had management tasks in their organizations by asking them to tell us how they dealt with the challenges imposed by the emergency. In the research, we start from a way of understanding workplaces understood as a “process of ongoing social relationship” within which the HR function is dedicated to the care of the quality of relationships. HR managers have to manage a complex role of mediating between the interests of people and employers by trying to find good mediations. (shrink)

This study examined the relationship between person–organization (PO) fit on prosocial identity (prosocial PO fit) and various employee outcomes. The results of polynomial regression analysis based on a sample of 589 hospital employees, which included medical doctors, nurses, and staff, indicate joint effects of personal and organizational prosocial identity on the development of a sense of organizational identification and on the engagement in prosocial behaviors toward colleagues, organizations, and patients. Specifically, prosocial PO fit had a curvilinear relationship with organizational (...) identification, such that organizational identification increased as organizational prosocial characteristics increased toward personal prosocial identity and then decreased when the organizational prosocial characteristics exceeded the personal prosocial identity. In addition, organizational identification and prosocial behaviors increased as both personal and organizational prosocial identity increased from low to high. (shrink)

In recent years sense–datum theories have received much criticism, but there is one type of error frequently involved in the sense–datum concept which is in need of further consideration. This error consists in a category confusion of such a nature that what is properly regarded as perceptual mode is treated as though it were the attribute of a thing. The mode or manner of perception is mistakenly transferred to the sense–datum with results which a little careful reflection shows to be (...) absurd. In what follows a specific case of this error connected with the notion of phenomenal organization will be discussed. (shrink)

We study how messages on Twitter by large non-governmental organizations (NGOs), targeting companies from the S&P500, affect these companies’ stock prices. With a sample of 1,611 tweets between 2009 and 2017 by 18 large NGOs, we observe significant changes in the stock prices of the targeted firms. More specifically, NGO tweets stating a positive message about the environmental, social, or governance (ESG). Actions of the firm have a positive effect on stock prices, while negative tweets have a negative effect. Nevertheless, (...) we find that the presence of institutional owners hampers this effect: firms with high institutional ownership value positive tweets more negatively, and negative tweets more positively. These results support the idea that shareholders react significantly to NGO tweets but they react differently depending on their time horizon: for shareholders who have a more short-term horizon, typically institutional owners, the reaction diverges societal expectations about how firms should contribute to society. (shrink)

Management and organization researchers are being called to conduct research that is more caring, yet the concept of care and how to practice it within the profession is undertheorized. Adopting a feminist epistemology and methodology, we develop the concept of care by weaving the personal, ethical, and political into the research process. First, we reflect critically on how aspects of care—attentiveness, responsibility, competence, and responsiveness (Tronto, Moral boundaries: a political argument for an ethic of care, (...) Routledge, 1993; Tronto, Caring democracy: markets, equality, and justice, New York University Press, 2013)—unfolded in our personal research experiences, and secondly, we conduct a review of articles published in management and organization studies and analyse expressed or concealed conceptions of care in scholars’ accounts of research purpose and ethics. We find three ethical sensibilities at the heart of enacting care: encountering the ‘other’, interpreting roles and responsibilities, and deliberating needs and resources. We contribute to a feminist research ethics by highlighting issues related to care that are concealed in dominant ethos guiding management and organization research. Further, we develop methodological insights for implementing an ethic of care as an alternative ethical standpoint in business research ethics. Finally, we provide suggestions for how to embed more care within research ethics practices in academic institutions. (shrink)

The social organization of insect colonies has fascinated biologists and natural historians for centuries. Aristotle wrote in History of Animals about a division of labor among workers within the hive that is based on age. He observed that the field bees foraging for nectar and pollen have less “hair” on their bodies than the hive bees that care for young larvae and tend the nest. He concluded that the more pubescent hive bees must be older. We now know (...) that, in fact, the field bees are older and have less hair because the hairs break off as the bees age. The phenomenon of age related changes in behavior, age-polyethism, is now well documented for many social insects (Oster and Wilson 1978).Evidence of the ecological success of social insects is inescapable. Virtually everywhere you look you see them or the results of their activities. (shrink)

It was October 2014, and Ebola was raging out of control in Guinea, Liberia, and Sierra Leone. Margaret Chan, the World Health Organization's director‐general, defended the organization against charges that its response was late and ineffective: “We are a technical agency, with governments having first priority to take care of their people.” In January 2015, the WHO executive board undertook a systematic reform of the agency's performance, and Chan again offered a defense: I followed protocol, leaving it (...) to the Africa office (AFRO) to respond. Yet the three nations could not possibly have stemmed the outbreak alone, and AFRO was known to be dysfunctional.Ebola represents an inflection point requiring fundamental reform for the WHO. A failure of leadership will impact its status and legitimacy for a generation. Here, I offer five reforms that would transform it and ensure that it fulfills its constitutional mission as “the directing and coordinating authority on international health work.”. (shrink)

For the last 20 years, there has been a growing interest in researching faith-based organisations in international development. Much of the research on FBOs tries to analyse whether faith has a positive or negative impact on development. This often leads to contradictory results. This case study shows insights into tensions that FBO staff face on issues such as gender, evangelism and donor pressure. The results show that the picture of faith’s role in development is much more nuanced than portrayed by (...) much of the existing literature. The conclusion offers recommendations for policy makers and member care personnel. (shrink)

Bioethics, clinical ethics, and professional ethics are mature, well-developed fields of applied ethics that focus on medical research, patient autonomy and patient care, patient–healthcare professional relationships, and issues that arise in clinical and other medical settings. However, despite these developments, little attention has been paid to the organizational aspects of healthcare in these fields. This is surprising, because in the last 30 years healthcare has become more and more institutionalized in provider, management, and insurer organizations. Despite JCAHO's preoccupation with (...) organizational ethics during the last decade, the philosophical underpinnings of their requirements have been less explored in the literature. Clinical ethics remains preoccupied with clinical patient care and professional ethics with individual professional guidelines; even the American College of Healthcare Executives focuses primarily on healthcare managers, not on healthcare organizations. (shrink)

Ultimately we will only understand biological agency when we have developed a theory of the organization of biological processes, and science is still a long way from attaining that goal. It may be possible nonetheless to develop a list of necessary conditions for the emergence of minimal biological agency. The authors offer a model of molecular autonomous agents which meets the five minimal physical conditions that are necessary (and, we believe, conjointly sufficient) for applying agential language in biology: autocatalytic (...) reproduction; work cycles; boundaries for reproducing individuals; self-propagating work and constraint construction; and choice and action that have evolved to respond to food or poison. When combined with the arguments from preadaptation and multiple realizability, the existence of these agents is sufficient to establish ontological emergence as against what one might call Weinbergian reductionism. Minimal biological agents are emphatically not conscious agents, and accepting their existence does not commit one to any robust theory of human agency. Nor is there anything mystical, dualistic, or non-empirical about the emergence of agency in the biosphere. Hence the emergence of molecular autonomous agents, and indeed ontological emergence in general, is not a negation of or limitation on careful biological study but simply one of its implications. (shrink)

While tens of thousands of people across the United States serve on hospital and other healthcare ethics committees, almost no carefully prepared educational material exists for HEC members. Ethics by Committee is a one volume collection of chapters developed exclusively for this educational purpose. Experts in bioethics, clinical consultation, health law, and social psychology from across the country contribute chapters on ethics consultation, education, and policy development.

We vindicate the widespread intuition that there is something morally problematic with for-profit corporations providing care to young children and elders. But instead of putting forward an empirical argument showing that for-profit corporations score worse than not-for-profits when it comes to meeting the basic needs of these vulnerable groups, we develop a philosophical argument about the nature of the relationship between a care organisation, its role-occupants, and care recipients. We argue that the correlation between profit and lower-quality (...) care is a result of intrinsic features of a for-profit model, combined with conceptual features of meaningful caring relationships, such that non-profits are the most reliable institutional providers of adequate care. Our claim is that care requires a kind of commitment that for-profit institutions are constituted to avoid, and that non-profit institutions are constituted to embrace. (shrink)

The question of corporate moral responsibility – of whether it makes sense to hold an organisation corporately morally responsible for its actions,rather than holding responsible the individuals who contributed to that action – has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom(UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant in the (...) health care context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially a moral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish. (shrink)

Background: Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses’ intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses’ beliefs regarding the use of physical restraints would provide additional social information about nurses’ intention to perform this practice. Aim: To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of (...) planned behaviour. Research design: A belief elicitation study was conducted. Participants and research context: Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed. Ethical considerations: Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary. Findings: Nurses framed the use of restraints as a way of prioritising patients’ physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients’ relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients’ medical condition, availability of alternative solutions, analgo-sedation policies and work organisation. Discussion: Safety arguments based on the surrounding work environment were discussed. Conclusion: Nurses’ behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives’ involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice. (shrink)

Nurses make an important contribution to the organisation and coordination of patient care but receive little formal educational preparation for this work. This paper builds on Allen's care trajectory management framework to specify evidence‐based and theoretically informed competencies for this component of the nursing role and proposes how these might be incorporated into nursing curricula. This is necessary so that at the point of registration nurses have the expertise to realise their potential as both providersandorganisers of patient (...) class='Hi'>care and are better able to articulate and develop this aspect of nursing practice. (shrink)

This paper is an attempt to address the limited amount of research in the realm of organizational ethical climate in the not-for-profit sector. The paper draws from Victor and Cullen's (1988) theoretical framework which, combines the constructs of cognitive moral development, ethical theory, and locus of analysis. However, as a point of departure from Victor and Cullen's work, the authors propose an alternative methodology to extract ethical climate dimensions based on theoretical considerations. Using the Ethical Climate Questionnaire (ECQ), an exploratory (...) factor analysis is conducted followed by a confirmatory factor analysis using LISREL. The resulting five dimensions are labelled as: individual caring, machiavellianism, independence, social caring, and law and code. Findings provide a somewhat disparate perspective of the ethical climates in a not-for-profit context. First, there is a more discriminating perception of benevolent climate than its for-profit counterpart. Second, the dimensions are polarized between the individual and the cosmopolitan loci of analysis. These findings are then discussed with implications and direction for future research. (shrink)

Mind Lumen (a non-profit) is an ethics-focused education, research, and policy advocacy organization. We also create tools to make ethics observable, measurable, and auditable.As a neurodivergent I...

BackgroundPatient-centred care and patient autonomy is one of the key factors to better quality of service provision, hence patient outcomes. It enables the development of patients’ trusts which is an important element to a better doctor-patient relationship. Given the increasing number of patient disputes and conflicts between patients and doctors in Chinese public hospital, it is timely to ensure patient-centred care is fully and successfully implemented. However, limited studies have examined the views and practice in different aspects of (...) patient-centred care among doctors in the Chinese public hospitals.MethodsA quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China.ResultsIn total, 614 doctors from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the inconsistent views among doctors in terms of their perception and practice in various aspects patient-centred care and patient autonomy regardless of the hospital where they work (category II or category III), their unit speciality (surgical or non-surgical), their gender or seniority. The high proportion of doctors (more than 20%) who did not perceive the importance of patient consultation prior to determining diagnostic and treatment procedure is alarming. This in in part due to the belief held by more than half of the doctors that patients were unable to make rational decisions and their involvement in treatment planning process did not necessarily lead to better treatment outcomes.ConclusionThe study calls for the development of system level policy and organisation wide strategies in encouraging and enabling the practice of patient-centred care and patient autonomy with the purposes of improving the quality of the service provided to patients by Chinese hospitals. (shrink)

Background: Palliative care is acknowledged as an appropriate approach to support older people in nursing homes. Ethical issues arise from many aspects of palliative care provision in nursing homes; however, they have not been investigated in this context. Aim: To explore the ethical issues associated with palliative care in nursing homes in the United Kingdom. Design: Exploratory, sequential, mixed-methods design. Methods: Semi-structured interviews with 13 registered nurses and 10 healthcare assistants (HCAs) working in 13 nursing homes in (...) the United Kingdom were used to explore ethical issues in palliative care. The ‘Ethical Issues in Palliative Care for Nursing Homes’ instrument was used to measure the frequency and level of distress arising from ethical issues through a cross-sectional survey with 69 registered nurses and 129 healthcare assistants. Data collection occurred between December 2014 and November 2015. Ethical considerations: Ethical approval was granted by Queen’s University’s School of Nursing and Midwifery Research Ethics Committee and governance sought from each nursing home’s manager. Findings: The interviews revealed three themes: ethical issues in practice; relational issues; and organisational issues. No significant differences between registered nurses and healthcare assistants were evident, confirming the patterns emerging from the interviews. Relational issues, primarily issues with residents and families, occurred most frequently and caused greater distress. Conclusion: The shared environment is key in the experience of ethical issues; therefore, multidisciplinary education is needed for ethical decision making in palliative care. Addressing staff knowledge and service organisation may reduce ethical issues locally and provide a benchmark for global change. (shrink)

This paper argues that biological organisation can be legitimately conceived of as an intrinsically teleological causal regime. The core of the argument consists in establishing a connection between organisation and teleology through the concept of self-determination: biological organisation determines itself in the sense that the effects of its activity contribute to determine its own conditions of existence. We suggest that not any kind of circular regime realises self-determination, which should be specifically understood as self-constraint: in biological systems, in particular, self-constraint (...) takes the form of closure, i.e. a network of mutually dependent constitutive constraints. We then explore the occurrence of intrinsic teleology in the biological domain and beyond. On the one hand, the organisational account might possibly concede that supra-organismal biological systems could realise closure, and hence be teleological. On the other hand, the realisation of closure beyond the biological realm appears to be highly unlikely. In turn, the occurrence of simpler forms of self-determination remains a controversial issue, in particular with respect to the case of self-organising dissipative systems. (shrink)

There is presently considerable interest in the phenomenon of "self-organisation" in dynamical systems. The rough idea of self-organisation is that a structure appears "by itself in a dynamical system, with reasonably high probability, in a reasonably short time, with no help from a special initial state, or interaction with an external system. What is often missed, however, is that the standard evolutionary account of the origin of multi-cellular life fits this definition, so that higher living organisms are also products of (...) self-organisation. Very few kinds of object can selforganise, and the question of what such objects are like is a suitable mathematical problem. Extending the familiar notion of algorithmic complexity into the context of dynamical systems, we obtain a notion of "dynamical complexity". A simple theorem then shows that only objects of very low dynamical complexity can self organise, so that living organisms must be of low dynamical complexity. On the other hand, symmetry considerations suggest that living organisms are highly complex, relative to the dynamical laws, due to their large size and high degree of irregularity. In particular, it is shown that since dynamical laws operate locally, and do not vary across space and time, they cannot produce any specific large and irregular structure with high probability in a short time. These arguments suggest that standard evolutionary theories of the origin of higher organisms are incomplete. (shrink)

Using interviews with activists and Lisa Sowle Cahill's concept of participatory discourse, this article examines how the Greater Boston Interfaith Organization (GBIO) built solidarity for the 2006 Massachusetts health care reform law. The analysis explores the morally formative connections between GBIO's activist strategies and its public liturgy for reform. The solidarity generated through this interfaith coalition's activities and religious arguments contrasts with two standard types of policy discourse, economics and liberalism. Arguments for health care reform based on (...) economic efficiency or positive rights are hampered by the lack of solidarity in U.S. political culture. GBIO's congregation-based organizing offers a performative model of public argumentation for religious groups committed to achieving affordable, quality health care for all Americans. (shrink)

How international research might contribute to justice in global health has not been substantively addressed by bioethics. This article describes how the provision of ancillary care can link international clinical research to the reduction of global health disparities. It identifies the ancillary care obligations supported by a theory of global justice, showing that Jennifer Ruger’s health capability paradigm requires the delivery of ancillary care to trial participants for a limited subset of conditions that cause severe morbidity and (...) mortality. Empirical research on the Shoklo Malaria Research Unit’s (SMRU) vivax malaria treatment trial was then undertaken to demonstrate whether and how these obligations might be upheld in a resource-poor setting. Our findings show that fulfilment of the ancillary care obligations is feasible where there is commitment from chief investigators and funders and is strongly facilitated by SMRU’s dual role as a research unit and medical non-governmental organization. (shrink)

The article provides a context for the discussion of development coalitions as a key feature of modern political and economic life. It traces the history of research programmes in work organisation over the past four decades, especially in North Western Europe, and challenges conventional views on the status of research in the social sciences.