For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (...) (73/80) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress. (shrink)

We are grateful to the commentators on our article1 for their thoughtful engagement with the ethical and clinical complexity of expanded terminal sedation (ETS) in end-of-life care. We will start by noting some points of common ground, before moving on to the more challenging ways in which TS might be permissibly expanded. First, several commentators pointed out, and we completely concur, that it is important to provide patients with full information about their end-of-life options, including the ‘outcomes, uncertainties and costs (...) of ETS’.2 Where possible, they should be given time to ‘process their feelings and to reflect on how they wish to live in their last few days, weeks or months’.3 Furthermore, where patients receive sedation, it will be critical that they receive appropriate medical and nursing care to prevent physical complications such as pressure ulcers.2 This would be no different from other patients who are in states of reduced consciousness from disease. We acknowledge that there are heightened risks with earlier and more rapid TS, including the potential loss of spiritual and social moments,4 as well as the meaning that can be derived from conscious existential distress.3 However, while these conscious experiences might be valuable to some, others might weigh them less highly against the foreseen …. (shrink)

Can a competent individual refuse care in order to make their natural death reasonably foreseeable in order to qualify for medical assistance in dying (MAiD)? Consider a competent patient with left-side paralysis following a right brain stroke who is not expected to die for many years; normally his cause of death would not be predictable. However, he refuses regular turning, so his physician can predict that pressure ulcers will develop, leading to infection for which he will refuse treatment and (...) consequently die. Is he now eligible for MAiD? Consider a competent patient with spinal stenosis (a non-fatal condition) who refuses food (but not liquids in order not to lose capacity from dehydration). Consequently, her physician can predict death from starvation. Is she now eligible for MAiD? Answering these questions requires that we answer three sub-questions: 1) do competent patients have the right to refuse care?; 2) do healthcare providers have a duty to respect such refusals?; and 3) are deaths resulting from refusals of care natural for the purposes of determining whether a patient is eligible for MAiD? If a competent patient has the right to refuse some particular care, and healthcare providers have a duty to respect that refusal, and if the death that would result from the refusal of that care is natural, then that refusal of care is a legal pathway to MAiD. However, if the competent patient does not have the right to refuse some particular care, or if healthcare providers do not have a duty to respect that refusal, or if the death that would result from the refusal of that care is not natural, then that refusal of care is not a legal pathway to MAiD. In this paper, we explore this complex legal terrain with the most profound of ethical implications – access to MAiD. (shrink)

It is a rare patient who always does everything healthcare providers advise. Sometimes no harm comes from this; sometimes good does. But occasionally, great harm comes from not listening, as when it results in patients returning time and again for costly and invasive treatments of, say, infections, valve replacements, pressure ulcers, and so forth. No class of patients arouses more anger and resentment in healthcare providers, who often put out a call to invoke some version of the three strikes (...) rule and refuse care. And if the patients are also unemployed substance abusers who live in a local park, impolite or dangerous to staff, disruptive to other patients, and have intimidating visitors, the call to say “No” is louder. Can care ever be refused? If so, when? These are the questions we take up in this article. The answers we provide were developed as part of a Paraplegics and Quadriplegics with Pressure Ulcers Project carried out at Vancouver Hospital and Health Sciences Centre. Following an established usage, we refer to patients who exhibit a cluster of the above characteristics, the dominant one of which is a reluctance to heed medical advice, as “noncompliant patients.” This term is offensive to some, but the politically correct lexicon does not provide any alternative which is as short and clear or substantially different. We use the term as a convenient way of referring to a familiar class of patients and without any imputation of blame. (shrink)

In psychology, stress is a feeling of emotional strain and pressure. Stress is a type of psychological pain. Small amounts of stress may be beneficial, as it can improve athletic performance, motivation and reaction to the environment. Excessive amounts of stress, however, can increase the risk of strokes, heart attacks, ulcers, and mental illnesses such as depression and also aggravation of a pre-existing condition. Psychological stress can be external and related to the environment but may also be caused by (...) internal perceptions that cause an individual to experience anxiety or other negative emotions surrounding a situation, such as pressure, discomfort, etc., which they then deem stressful. (shrink)

In 1983, Dr. J. Robin Warren and Dr. Barry Marshall reported finding a new kind of bacteria in the stomachs of people with gastritis. Warren and Marshall were soon led to the hypothesis that peptic ulcers are generally caused, not by excess acidity or stress, but by a bacterial infection. Initially, this hypothesis was viewed as preposterous, and it is still somewhat controversial. In 1994, however, a U. S. National Institutes of Health Consensus Development Panel concluded that infection appears to (...) play an important contributory role in the pathogenesis of peptic ulcers, and recommended that antibiotics be used in their treatment. Peptic ulcers are common, affecting up to 10% of the population, and evidence has mounted that many ulcers can be cured by eradicating the bacteria responsible for them. (shrink)

My description of the cognitive processes involved in the discovery, development, and acceptance of the bacterial theory of ulcers might have left the impression that science is all in the mind (Thagard, forthcoming-b). But only part of the story of the bacterial theory of ulcers is psychological. This paper discusses the important role of physical interaction with the world by means of instruments and experiments, and the equally important role of social interactions among the medical researchers who developed the theory. (...) The main questions I want to answer are the following: 1. What instruments contributed to the development and acceptance of the new theory? 2. What kinds of experiments contributed to the development and acceptance of the new theory? 3. How did theorizing and experimentation interact in the development of new experiments and hypotheses? 4. How did social processes such as collaboration, communication, and consensus contribute to the development and widespread acceptance of the bacterial theory of ulcers? I conclude with a sketch of science as a complex system of interacting psychological, physical, and social processes. (shrink)

There is a widespread view that well-learned skills are automated, and that attention to the performance of these skills is damaging because it disrupts the automatic processes involved in their execution. This idea serves as the basis for an account of choking in high pressure situations. On this view, choking is the result of self-focused attention induced by anxiety. Recent research in sports psychology has produced a significant body of experimental evidence widely interpreted as supporting this account of choking (...) in certain kinds of complex sensorimotor skills. We argue against this interpretation, pointing to problems with both the empirical evidence and the underlying theory. The experimental research fails to provide direct support for the central claims of the self-focus approach, contains inconsistencies, and suffers from problems of ecological validity. In addition, qualitative studies of choking have yielded contrary results. We further argue that in their current forms the self-focus and rival distraction approaches both lack the theoretical resources to provide a good theory of choking, and we argue for an expanded approach. Some of the elements that should be in an expanded approach include accounts of the features of pressure situations that influence the psychological response, the processes of situation appraisal, and the ways that attentional control can be overwhelmed, leading to distraction in some cases, and in others, perhaps, to damaging attention to skill execution. We also suggest that choking may sometimes involve performance-impairing mechanisms other than distraction or self-focus. (shrink)

This article has already been published in Zuzanek, Jiri & Veal, Anthony J. : Time-pressure, Stress, Leisure Participation and Well-being : Leisure and life-style connections, Special Issue of Society & Leisure, Vol. 21, N°. 2, Frühling 1998, Québec/Kanada : Presses de l´Université du Québec, S. 324-354, and in Loisir et Société, October 2013.: This article examines the issue of time pressure from a historical, theoretical, and policy perspective. It is divided into five - Sociologie – Nouvel article.

There is a widespread view that well-learned skills are automated, and that attention to the performance of these skills is damaging because it disrupts the automatic processes involved in their execution. This idea serves as the basis for an account of choking in high pressure situations. On this view, choking is the result of self-focused attention induced by anxiety. Recent research in sports psychology has produced a significant body of experimental evidence widely interpreted as supporting this account of choking (...) in certain kinds of complex sensorimotor skills. We argue against this interpretation, pointing to problems with both the empirical evidence and the underlying theory. The experimental research fails to provide direct support for the central claims of the self-focus approach, contains inconsistencies, and suffers from problems of ecological validity. In addition, qualitative studies of choking have yielded contrary results. We further argue that in their current forms the self-focus and rival distraction approaches both lack the theoretical resources to provide a good theory of choking, and we argue for an expanded approach. Some of the elements that should be in an expanded approach include accounts of the features of pressure situations that influence the psychological response, the processes of situation appraisal, and the ways that attentional control can be overwhelmed, leading to distraction in some cases, and in others, perhaps, to damaging attention to skill execution. We also suggest that choking may sometimes involve performance-impairing mechanisms other than distraction or self-focus. (shrink)

Based upon the Decision Field Theory (Busemeyer and Townsend 1993), we tested a model of dynamic reasoning to predict the effect of time pressure on analytical and experiential processing during decision-making. Forty-six participants were required to make investment decisions under four levels of time pressure. In each decision, participants were presented with experiential cues which were either congruent or incongruent with the analytical information. The congruent/incongruent conditions allowed us to examine how many decisions were based upon the experiential (...) versus the analytical information, and to see if this was affected by the varying degrees of time pressure. As expected, the overall accuracy was reduced with greater time pressure and accuracy was higher when the experiential and analytical cues were congruent than when they were incongruent. Of great interest was the data showing that under high time pressure participants used more experiential cues than at other time pressures. We suggest that the dynamic reasoning paradigm has some future potential for predicting the effects of experiential biases in general, and specifically under time pressure. (shrink)

Does environmental management help foreign firms outperform local firms in emerging economies? While existing research suggests that environmental management may or may not benefit firm performance, the question is particularly under-investigated in the emerging economy context. Using the data on foreign investment into China, this study explores whether foreign firms that are under greater environmental pressure, at home or at the host, outperform comparable local firms in an emerging host country. In making this comparison, we use propensity-score matching and (...) a difference-in-differences approach to handle the problem of endogeneity inherent in comparing the performances of foreign versus local firms. We find empirical support that foreign firms perform better than local firms when they are under high environmental pressure in the emerging host country, and this result is driven by the foreign firms originating from countries with high environmental pressure. (shrink)

In this paper, I seek to theorise the concept of pressure in relation to families’ experiences of organ donation during COVID-19. Drawing on Australia-based fieldwork, I follow circuitries of pressure in and beyond interiorities of bodies, biographies and infrastructures of care to ask what happens when pressure builds to such an extent that there is no capacity left in bodies and in institutions. Pressure concentrates in some spaces and bodies more than others revealing uneven flows and (...) restrictions to care. But how might a theorisation of pressure enable care to be imagined otherwise – to circulate differently? Extending recent care scholarship, I explore alternative versions of care enacted by families and clinicians involved in organ donation. This is an expansive and capacious care, which may offer potential to diffuse the force of pressure through radical interdependence. (shrink)

Human microbiome research makes causal connections between entire microbial communities and a wide array of traits that range from physiological diseases to psychological states. To evaluate these causal claims, we first examine a well-known single-microbe causal explanation: of Helicobacter pylori causing ulcers. This apparently straightforward causal explanation is not so simple, however. It does not achieve a key explanatory standard in microbiology, of Koch’s postulates, which rely on manipulations of single-microorganism cultures to infer causal relationships to disease. When Koch’s postulates (...) are framed by an interventionist causal framework, it is clearer what the H. pylori explanation achieves and where its explanatory strengths lie. After assessing this ‘simple’, single-microbe case, we apply the interventionist framework to two key areas of microbiome research, in which obesity and mental health states are purportedly explained by microbiomes. Despite the experimental data available, interventionist criteria for explanation show that many of the causal claims generated by microbiome research are weak or misleading. We focus on the stability, specificity and proportionality of proposed microbiome causal explanations, and evaluate how effectively these dimensions of causal explanation are achieved in some promising avenues of research. We suggest some conceptual and explanatory strategies to improve how causal claims about microbiomes are made. (shrink)

When can exerting pressure in a public controversy promote reasonable outcomes, and when is it rather a hindrance? We show how negotiation and persuasion dialogue can be intertwined. Then, we examine in what ways one can in a public controversy exert pressure on others through sanctions or rewards. Finally, we discuss from the viewpoints of persuasion and negotiation whether and, if so, how pressure hinders the achievement of a reasonable outcome.

Competitive pressures, resource constraints, high shareholder/stakeholder expectations, and other dynamics may lead to organizations putting pressure on employees to act unethically to meet goals. Yet, the effects of this pressure on employee health and factors that can abate it are unclear. Based on the job demands-resources model, this study examines whether, how, and when organizational ethical pressure harms employees' psychological and physical health and what factors can buffer its negative effects. According to the findings of a two-wave (...) lagged data study involving 212 healthcare employees, results show that organizational ethical pressure causes ethical strain in employees, resulting in both psychological and physical health problems, with these effects less pronounced when employees have higher levels of ethical efficacy. An integrated effect was also discovered, in which employees' ethical efficacy increases when led by a more ethical leader, thereby buffering the effect of ethical pressure on ethical strain and health problems. Overall, our research identifies organizational ethical pressure as a significant threat to employee health and provides preliminary approaches to mitigate its effects. (shrink)

This article focusses on corporate attitudes to stakeholder environmental pressures in Argentina. It uses a cross section survey of 505 CEOs of Argentinean firms to gather information on environmental attitudes and a stakeholder theory framework to design and interpret the statistical analyses. It is underpinned by theoretical and empirical findings in the literature on stakeholder management, targeting in particular studies that deal with corporate social responsibility (CSR) in Latin America. Its general aim is to gain a deeper empirical understanding of (...) the coherence between managers' perceptions of stakeholder pressures and the importance they are given in corporate CSR strategies through an empirical investigation of environmental management (EM) decisions. In doing so, it uncovers general differences in the way firms perceive and treat groups of stakeholders. It also detects variations across firms, observing that some are typically proactive in their response to stakeholder pressures whilst others are less responsive. Profiling the various stakeholder networks and the corporate response strategies in this way encourages the development of stakeholder-focussed policies and corporate strategies that emphasise communications, awareness and a clear sense of direction. It concludes that CSR appears to be more effective in the protection of the environment than previously reported. Although this study focusses on EM in Argentina, the findings are more generally applicable. (shrink)

Prior studies have provided explanations for the presence, use and dissemination of codes of corporate ethics or codes of corporate conduct of business corporations. Most such explanations are functional in nature, and are descriptive as they are derived from the codes and their associated documents. We search for more underlying explanations using two complementary theories: first, social contract theories explaining the exogenous and endogenous reasons of organizational behavior, and then institutional theory explaining why organizations take similar measures in response to (...) institutional pressures. Based on our explanations, we contend that the codes and their use and dissemination are arising from underlying social and institutional pressures for firms to continuously validate their existence in the face of increasing changes and recurrent uncertainties. (shrink)

Conversational Pressure: Normativity in Speech Exchanges. By Sanford C. Goldberg.

This study seeks to advance the understanding of controversy resolution in science. I take as a case study conceptualization and treatment of ulcer disease. Analysis of causal accounts and effective treatments illustrate the ways in which competing parallel research programs in medicine embody opposing social, political, and economic forces which are bound to the epistemological dimensions of scientific controversy (e.g., standards of evidence, reference, and inference), and which in turn shift perception of the burden of proof. The analysis illustrates (...) the ways in which (1) medical diagnoses create as much as discover useful distinctions and (2) epistemic and non epistemic values divide scientists into competing research programs, as well as (3) the ways in which these structures often effectively prevent scientific controversy closure. (shrink)

The aim of this study was to illuminate nurses’ reflections on obstacles to and possibilities for providing care as desired by people with malodorous exuding ulcers. Six nurses who took part in a previous study were interviewed. The participants were shown an illustration with findings from a study that elucidated the meaning of living with malodorous exuding ulcers. They were asked to reflect on the obstacles to and possibilities of providing the care desired by the patients. Twelve audio-recorded transcribed interviews (...) were analysed using qualitative content analysis. Our interpretations of participants’ reflections on the obstacles and possibilities while caring for such patients revealed one theme: striving to ‘do good’ and ‘be good’. The obstacles were formulated as subthemes: experiencing clinical competence constraints, experiencing organizational constraints, experiencing ineffective communication, fearing failure, and experiencing powerlessness. The possibilities were formulated by the subthemes: spreading knowledge about ulcer treatments, considering wholeness, and creating clear channels of communication. A multiprofessional team could overcome the identified obstacles and provide structure, competencies, commitment and support to ‘do good’ for patients and ‘be good’ nurses. (shrink)

To encourage corporations to contribute positively to the environment in which they operate, voluntary self-regulatory codes (SRC) have been enacted and refined over the past 15 years. Two of the most prominent are the United Nations Global Compact and the Global Reporting Initiative. In this paper, we explore the impact of different stakeholders' pressures on the selection of strategic choices to join SRCs. Our results show that corporations react differently to different sets of stakeholder pressures and that the SRC selection (...) depends on the type and intensiveness of the stakeholder pressures as well as the resources at hand to respond to those pressures. Our contribution offers a more specific and finely variegated analysis of firmstakeholder interactions. (shrink)

Taylor’s landmark work, A Secular Age, tells a complex story about the fate of religion in the West over the past 500 years. Taking issue with an overly-simplistic secularization theory, Taylor portrays a cultural landscape that, rather than speeding the withering of religion, has instead proliferated a dizzying array of spiritual options. This pluralistic reality places “cross-pressure” on those who inhabit these spiritual positions, fragilizing them through exposure to other lived possibilities. The widely adopted modern value of authenticity increases (...) this pressure, encouraging people to carve out their own unique spiritual path and to eschew traditional, ‘spoon-fed’ answers to life’s existential questions. Yet what remains throughout these modern challenges to religion, says Taylor, is the quintessentially human quest for meaning, and the struggle against a modern nihilism that threatens to deny it. In this contested space, he suggests, humanity’s religious past is being called into an as yet unimagined future. (shrink)

This paper is based on case-study research in four English secondary schools. It explores the pressure placed on English and mathematics departments because of their results being reported in annual performance tables. It examines how English and maths departments enact policies of achievement, the additional power and extra resources the pressure to achieve brings and the possibility of resistance.

Treatment pressures are communicative strategies that mental health professionals use to influence the decision-making of mental health service users and improve their adherence to recommended treatment. Szmukler and Appelbaum describe a spectrum of treatment pressures, which encompasses persuasion, interpersonal leverage, offers and threats, arguing that only a particular type of threat amounts to informal coercion. We contend that this account of informal coercion is insufficiently sensitive to context and fails to recognize the fundamental power imbalance in mental healthcare. Based on (...) a set of counterexamples, we argue that what makes a proposal coercive is not whether service users will actually be made worse off if they reject the proposal, but rather whether they have the justified belief that this is the case. Whether this belief is justified depends on the presence of certain contextual factors, such as strong dependency on professionals and the salient possibility of formal coercion. (shrink)

In this article, we hypothesize that the level of environmentally oriented noncompliance regulatory fines and penalties levied on companies and on their industry counterparts will be associated with the development of an environmental infrastructure and practices within these companies. We find that the presence of these regulatory actions is associated with the likelihood of companies reporting environmental policies and activities and with the presence of a separate board of directors’ committee that monitors company environmental concerns. Our findings suggest that environmental (...) regulatory pressure may serve as a driver of environmental action but is not its only determinant. (shrink)

This study investigated the relationship between publication pressure and questionable research practices (QRPs), focusing on moral disengagement (MD) and lab research ethics climate. A survey of 269 Chinese PhD students revealed that (1) publication pressure is significantly positively correlated with QRPs and MD; (2) MD mediates the relationship between publication pressure and QRPs; lab research ethics climate moderates both (3) the relationship between publication pressure and MD, and (4) the mediating role of MD between publication (...) class='Hi'>pressure and QRPs. Responsible conduct of research education should emphasize potential ethical conflicts in publication, the impact of cognitive patterns of MD, and lab-based interventions for QRPs. (shrink)

It is argued in the target article that hemispheric lateralization is advantageous when faced with conflicting choices. As decision-making processes must have been subject to a strong selection pressure, the sensitivity of response latencies could suggest a modular and hierarchical organization of behavioral execution, as was formulated by Tinbergen (1951).