Many Western nations are emphasizing the importance of population health across health care delivery organizations and education systems. Despite significant momentum to integrate population health into nursing practice, a parallel effort to examine how these efforts impact practicing nurses' views of their professional role and work identity has not occurred. This secondary qualitative analysis, employing an abductive approach, explored processes public health nurses use in creating and maintaining their work identity through three organizing themes: narrative self‐identity, mandated (...) identity, and identity as struggle. The analysis was based on interview data collected from 30 US public health nurses residing in 17 states. ‘Being a real nurse’ describes public health nurses' efforts to balance a contradictory work identity where at times they are expected to focus on populations and at other times, on individuals. The identity work revealed through this study should be further explicated and specific strategies developed for stabilizing a work identity for public health nurses, as well as for any nurse charged with a population health role. (shrink)

Being able to measure informed choice represents a mechanism for service evaluation to monitor whether informed choice is achieved in practice. Approaches to measuring informed choice to date have been based in the biomedical hegemony. Overlooked is the effect of epistemic positioning, that is, how people are positioned as credible knowers in relation to knowledge tested as being relevant for informed choice. To identify and describe studies that have measured informed choice in the context of prenatal screening and to describe (...) epistemic positioning of pregnant people in these studies. Online databases to identify papers published from 2005 to 2021. The PRISMA-ScR checklist guided data collection, analysis and reporting. Secondary analysis that considered hermeneutics (e.g., knowledge that was tested, study design) and testimony (e.g., population descriptors) developed a priori. Twenty-nine studies explored the measurement of informed choice. None reported that pregnant people were involved in the design of the study. Two studies reported pregnant people had some involvement in the design of the measurement. Knowledge tested for informed choice included technical aspects of screening, conditions screened and mathematical concepts. Twenty-seven studies attributed informed choice to population descriptors (e.g., race/ethnicity, age, education). Population descriptors were reified as characteristics of epistemic credibility for informed choice obtained. For example, when compared to a high school qualification, a tertiary qualification was a statistically significant characteristic of informed choice. When compared by race, white people were found to be significantly more likely to make an informed choice. Additional demographic descriptors such as age, language spoken, faith and previous pregnancies were used to further explain differences for informed choice obtained. Explanations about underlying assumptions of population descriptors were infrequent. Using population descriptors in the biomedical hegemony as explanatory variables for informed choice can position (groups of) people as more, or less, epistemically credible. Such positioning could perpetuate epistemic injustices in practice leading to inequitable access to healthcare. To better uphold (pregnant) people as credible knowers population descriptors should instead be contextual (and contextualising) variables. For example, as indicators of social privilege. Further, making room for ways of knowing that go beyond the biomedical hegemony requires the development of epistemically just ‘measures’ through intentional, inclusive design. (shrink)

The arrival of refugee pupils in UK schools has presented significant challenges to staff, pupils and families. The aim of this study was to record and analyse the views of teaching staff regarding their experiences of integrating these pupils into schools in Newcastle upon Tyne. A questionnaire was sent to 53 schools in the city known to have pupils who are refugees or asylum seekers. Questions focused on key issues identified by the Local Education Authority Working Group for Refugees and (...) Asylum Seekers, including the dissemination of information prior to the arrival of new pupils, staff training and the response of the school community as a whole. Twenty?four questionnaires were completed (response rate 45.3%), from two nurseries, 13 primary schools, seven secondary schools and one special school. The overwhelming need identified was for improved access to interpreting services, and more reliable information about pupils? backgrounds. It was evident that integration is approached differently by individual schools depending on their overall ethnic mix and the availability of resources and support networks. (shrink)

Introduction: Uncertainty is omnipresent in cancer care, including the ambiguity of diagnostic tests, efficacy and side effects of treatments, and/or patients' long-term prognosis. During second opinion consultations, uncertainty may be particularly tangible: doubts and uncertainty may drive patients to seek more information and request a second opinion, whereas the second opinion in turn may also affect patients' level of uncertainty. Providers are tasked to clearly discuss all of these uncertainties with patients who may feel overwhelmed by it. The aim of (...) this study was to explore how oncologists communicate about uncertainty during second opinion consultations in medical oncology.Methods: We performed a secondary qualitative analysis of audio-recorded consultations collected in a prospective study among cancer patients who sought a second opinion in medical oncology. We purposively selected 12 audio-recorded second opinion consultations. Any communication about uncertainty by the oncologist was double coded by two researchers and an inductive analytic approach was chosen to allow for novel insights to arise.Results: Seven approaches in which oncologists conveyed or addressed uncertainty were identified: specifying the degree of uncertainty, explaining reasons of uncertainty, providing personalized estimates of uncertainty to patients, downplaying or magnifying uncertainty, reducing or counterbalancing uncertainty, and providing support to facilitate patients in coping with uncertainty. Moreover, oncologists varied in their choice of words/language to convey uncertainty.Discussion: This study identified various approaches of how oncologists communicated uncertain issues during second opinion consultations. These different approaches could affect patients' perception of uncertainty, emotions provoked by it, and possibly even patients' behavior. For example, by minimizing uncertainty, oncologists may consciously steer patients toward specific medical decisions). Future research is needed to examine how these different ways of communicating about uncertainty affect patients. This could also facilitate a discussion about the desirability of certain communication strategies. Eventually, practical and evidence-based guidance needs to be developed for clinicians to optimally inform patients about uncertain issues and support patients in dealing with these. (shrink)

ObjectiveTo increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.SettingThree tertiary hospitals in metropolitan Brisbane, Australia.DesignQualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic (...) analysis.ResultsDoctors’ perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing.ConclusionsDoctors’ ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors’ role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making. (shrink)

Background: Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the “Guide on the decision-making process regarding medical treatment in end-of-life situations” (hereinafter, Guide), aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly. Objectives: To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate if (...) they are consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses’ current end-of-life care practices. Design: Qualitative secondary analysis. Participants/context: Three qualitative datasets including 32 interviews from previous studies with nurses working in palliative care in Portugal. Ethical consideration: Ethical approval was obtained from the Ethics Research Lab of the Instituto de Bioética (Ethics Research Lab of the Institute of Bioethics) (Ref.04.2015). Ethical procedures are thoroughly described. Findings: All participant nurses referred to autonomy as an ethical principle paramount in end-of-life decision-making. They were commonly involved in end-of-life decision-making. Palliative sedation and communication were the most mentioned disputed/controversial issues. Discussion: Autonomy was highly valued in end-of-life care and decision-making. Nurses expressed major concerns in assessing patients’ preferences, wishes, and promoting advance care planning. Nurses working in palliative care in Portugal were highly involved in end-of-life decision-making. These processes embraced a collective, inclusive approach. Palliative sedation was the most mentioned disputed issue, which is aligned with previous findings. Communication also emerged as a sensitive ethical issue; it is surprising, however, that only three nurses referred to it. Conclusion: While the Guide does not explicitly mention nurses in its content, this study shows that nurses working in palliative care in Portugal are involved in these processes. Further research is needed on nurses’ involvement and practices in end-of-life decision-making. (shrink)

Background Gerontechnologies are increasingly used in the care for older people. Many studies on their acceptability and ethical implications are conducted, but mainly from the perspective of principlism. This narrows our ethical gaze on the implications the use of these technologies have. Research question How do participants speak about the impact that gerontechnologies have on the different phases of care, and care as a process? What are the moral implications from an ethic of care perspective? Research design Secondary (...) class='Hi'>analysis of semi-structure interviews, whose segments on specific technologies were analysed through reflexive thematic analysis. Participants and research context Sixty-seven Swiss stakeholders involved in the use of gerontechnologies, including professional caregivers, informal caregivers, and older persons themselves. Ethical considerations The research study was evaluated by the Ethics Commission of Northwest and Central Switzerland (EKNZ). All participants received an information document before the interview date detailing the purpose, procedure, and anonymization measures. After explaining the study during the agreed upon interview time and upon receiving their written informed consent, the interview process began. Findings/results Four themes are identified: Identifying care needs, Taking responsibility, Hands-on work, Responding to care. As part of these themes, many codes highlighting the ambivalent impact of gerontechnologies are created, ranging from ‘Expanded capacity for…identifying care needs’ to ‘Create new & (un)necessary…hands-on work’. The moral implications of these results from the care ethics perspective are discussed, through the ethical elements of: attentiveness, responsibility, competence, and responsiveness. Conclusions The moral implications of gerontechnologies on care phases from the care ethics perspective open up several questions on whether they actually help give care a central role in social life and provide more competent care. (shrink)

BackgroundEvaluation of decision-making capacity to consent to medical treatment has proved to be difficult in patients with dementia. Studies showed that physicians are often insufficiently trained in the evaluation of decision-making capacity. In this study, we present findings from a secondary analysis of a qualitative interviews with physicians. These interviews were initially used to assess usability of an instrument for the evaluation of decision-making capacity. By looking at difficult cases of decision-making capacity evaluation in patients with dementia, (...) we provide recommendations for such evaluations in clinical practice.MethodsWe used thematic coding to analyse physicians’ narratives of problematic decision-making capacity evaluations in patients with dementia to uncover challenging issues of decision-making capacity evaluation.ResultsIn this study, decision-making capacity evaluations in patients with dementia were mainly perceived as challenging when they pertained to treatment refusals and treatment unrelated circumstances, such as psychiatric consultation, advance directives, and new living arrangements. Furthermore, the physicians reported training needs regarding situation-independent challenges with decision-making capacity evaluation.ConclusionsUpon further examining self-reported training needs and challenging cases, we have developed recommendations to improve decision-making capacity evaluations in clinical practice. In these recommendations, we argue that being able to evaluate decision-making capacity is an integral part of the informed consent process. (shrink)

Protecting human subjects from being exploited is one of the main ethical challenges for clinical research. However, there is also a responsibility to protect and respect the communities who are hosting the research. Recently, attention has focused on the most efficient way of carrying out clinical research, so that it benefits society by providing valuable research while simultaneously protecting and respecting the human subjects and the communities where the research is conducted. Collaboration between partners plays an important role and that (...) is why we carried out a study to describe how collaborative partnership and social value are emerging in clinical research. A supra-analysis design for qualitative descriptive secondary analysis was employed to consider a novel research question that pertained to nurse leaders’ perceptions of ethical recruitment in clinical research and the ethics-related aspects of clinical research from the perspective of administrative staff. The data consisted of two separate pre-existing datasets, comprising 451 pages from 41 interviews, and we considered the research question by using deductive-inductive content analysis with NVivo software. A deductive analysis matrix was generated on the basis of two requirements, namely collaborative partnership and social value, as presented in An Ethical Framework for Biomedical Research by Emanuel et al. The findings showed that collaborative partnership was a cornerstone for ethical clinical research and ways to foster inter-partner collaboration were indicated, such as supporting mutual respect and equality, shared goals and clearly defined roles and responsibilities. In addition, the social value of clinical research was an important precondition for ethical clinical research and its realisation required the research partners to demonstrate collaboration and shared responsibility during the research process. However, concerns emerged that the multidimensional meaning of clinical research for society was not fully recognised. Achieving greater social value for clinical research required greater transparency, setting research priorities, shared responsibility for the dissemination and use of the findings and stronger community awareness of the ethics-related aspects of clinical research. Collaborative partnership and social values are essential for protecting the human subjects and communities involved in clinical research. (shrink)

BackgroundThe advent of learning healthcare systems (LHSs) raises an important implementation challenge concerning how to request and manage consent to support secondary use of data in learning cycles, particularly research activities. Current consent models in Quebec were not established with the context of LHSs in mind and do not support the agility and transparency required to obtain consent from all involved, especially the citizens. Therefore, a new approach to consent is needed. Previous work identified the meta-consent model as a (...) promising alternative to fulfill the requirements of LHSs, particularly large-scale deployments. We elicited the public’s attitude toward the meta-consent model to evaluate if the model could be understood by the citizens and would be deemed acceptable to prepare for its possible implementation in Quebec.MethodsEight focus groups, with a total of 63 members of the general public from various backgrounds were conducted in Quebec, Canada, in 2019. Explicit attention was given to literacy levels, language spoken at home and rural vs urban settings. We assessed attitudes, concerns and facilitators regarding key components of the meta-consent model: predefined categories to personalized consent requests, a dynamic web-based infrastructure to record meta-consent, and default settings. To analyse the discussions, a thematic content analysis was performed using a qualitative software.ResultsOur findings showed that participants were supportive of this new approach of consent as it promotes transparency and offers autonomy for the management of their health data. Key facilitators were identified to be considered in the implementation of a meta-consent model in the Quebec LHSs: information and transparency, awareness campaigns, development of educational tools, collaboration of front-line healthcare professionals, default settings deemed acceptable by the society as well as close partnerships with recognized and trusted institutions.ConclusionsThis qualitative study reveals the openness of a sample of the Quebec population regarding the meta-consent model for secondary use of health data for research. This first exploratory study conducted with the public is an important step in guiding decision-makers in the next phases of implementing the various strategies to support access and use of health data in Quebec. (shrink)

This paper explores ethical concerns arising in healthcare integration. We argue that integration is necessary imperative for meeting contemporary and future healthcare challenges, a far stronger evidence base for the conditions of its effectiveness is required. In particular, given the increasing emphasis at the policy level for the entire healthcare infrastructure to become better integrated, our analysis of the ethical challenges that follow from the logic of integration itself is timely and important and has hitherto received insufficient attention. We (...) evaluated an educational intervention which aims to improve child health outcomes by making transitions between primary to secondary care more efficient, ensuring children and parents are better supported throughout. The programme provided skills for trainee paediatricians and general practitioners (GPs) in co-designing integrated clinical services. The key ethical challenges of integrated care that arose from a clinical perspective are: professional identity and autonomy in an integrated working environment; the concomitant extent of professional responsibility in such an environment; and the urgent need for more evidence to be produced on which strategies for integrating at scale can be based. From our analysis we suggest a tentative way forward, viewed from a normative position broadly situated at the intersection of deontology and care ethics. We adopt this position because the primary clinical ethical issues in the context of integrated care concern: how to ensure that all duties of care to individual patients are met in a newly orientated working environment where clinical responsibility may be ambiguous; and the need to orientate care around the patient by foregrounding their autonomous preferences and ensuring good patient clinician relationships in clinical decision-making. (shrink)

This contribution presents the process of co-creating a teaching sequence in a research-design project. The sequence focuses on the transformation of a literary tweet into an enriched spontaneous oral narrative. After outlining the didactic model of the genre, we detail the characteristics of the sequence, co-constructed with lower secondary school teachers in French-speaking Switzerland. Then, through a qualitative analysis of the pupils' productions at the beginning and end of the experiment, we examine the effects of the teaching (...) sequence proposed as the design to be experimented with. The findings of this analysis enable us to formulate ways of transforming the engineering of the sequence, in line with the logic of the research-design approach. (shrink)

Background: Compassion is seen as a core professional value in nursing and as essential in the effort of relieving suffering and promoting well-being in palliative care patients. Despite the advances in modern healthcare systems, there is a growing clinical and scientific concern that the value of compassion in palliative care is being less emphasised. Objective: This study aimed to explore nurses’ experiences of compassion when caring for palliative patients in home nursing care. Design and participants: A secondary qualitative (...) analysis inspired by hermeneutic circling was performed on narrative interviews with 10 registered nurses recruited from municipal home nursing care facilities in Mid-Norway. Ethical considerations: The Norwegian Social Science Data Services granted permission for the study (No. 34299) and the re-use of the data. Findings: The compassionate experience was illuminated by one overarching theme: valuing caring interactions as positive, negative or neutral, which entailed three themes: (1) perceiving the patient’s plea, (2) interpreting feelings and (3) reasoning about accountability and action, with subsequent subthemes. Discussion: In contrast to most studies on compassion, our results highlight that a lack of compassion entails experiences of both negative and neutral content. Conclusion: The phenomenon of neutral caring interactions and lack of compassion demands further explorations from both a patient – and a nurse perspective. (shrink)

Background: Withdrawal of treatment is a common practice in intensive care units when treatment is considered futile. Compassion is an important aspect of care; however, it has not been explored much within the context of treatment withdrawal in intensive care units. Objectives: The aim was to examine how concepts of compassion are framed, utilised and communicated by intensive care nurses in the context of treatment withdrawal. Design: The study employed a qualitative approach conducting secondary analysis of an (...) original data set. In the primary study, 13 nurses were recruited from three intensive care units within a large hospital in United Kingdom. Deductive framework analysis was used to analyse the data in relation to compassionate care. Ethical considerations: The primary study was approved by the local Research Ethics Committee and the hospital’s Research and Development services. Findings: Compassionate care was mostly directed to the patient’s family and was demonstrated through care and emotional support to the family. It was predominantly expressed through attempts to maintain the patient’s dignity by controlling symptoms, maintaining patient cleanliness and removing technical apparatus. Conclusion: This study’s findings provide insight about compassionate care during treatment withdrawal which could help to understand and develop further clinicians’ roles. Prioritising the family over the patient raised concerns among nurses, who motivated by compassion, may feel justified in taking measures that are in the interests of the family rather than the patient. Further work is needed to explore the ethics of this. (shrink)

Next SectionPurpose The importance of recognising patient dignity has been realised in recent years. Despite being a central phenomenon in medicine, dignity is a controversial concept, the definition of which in healthcare centres is influenced by a multitude of factors. The aim of this study was to explore the perspective of Iranian patients on respect for their dignity in healthcare centres. Methods With the use of purposeful sampling, 20 patients were interviewed over an 11-month period in three educational hospitals affiliated (...) with the government. They were questioned about experiences related to respect for their dignity during their hospital encounter. Data were processed by qualitative content analysis. Results Data analysis identified nine categories and four themes. Respondents expressed their expectations and attitudes about dignity by the following themes: seeking a haven; disrespecting privacy; communicating in a vacuum; and disregard for secondary caregivers. They described how respect for their privacy, effective communication, access to facilities, and a regard for the requirements of their companions made them feel that their dignity had been conserved. Conclusions The findings indicate that almost no patient is satisfied with the quality of services with respect to maintenance of their dignity. Regardless of their hospital location and state of health, most participants had common complaints. These findings agree with the literature and confirm that grounds should be provided for conserving dignity in the healthcare system. To reach this goal, healthcare professionals should be aware of the factors that violate or preserve dignity from the patient's perspective. (shrink)

Heideggerian philosophy is frequently chosen as a philosophical framing, and/or a hermeneutic analytical structure in qualitative nursing research. As Heideggerian philosophy is dense, there is merit in the development of scholarly resources that help to explain discrete Heideggerian concepts and to uncover their relevance to contemporary human experience. This paper uses a meta-synthesis methodology to pool and synthesise findings from 29 phenomenological research reports on Being-with in the nurse–patient relationship. We firstly considered and secured the most relevant Heideggerian elements (...) to nurse–patient Being-with. Under these deductive codes, we then inductively developed sub-themes that seemed to explain the multifaceted nature of Being-with, through a secondary analysis and synthesis of published data from 417 patient, carer and nurse participants. Dasein-with was enhanced when nurses had first-hand experience with a phenomenon. Nurses moved between the inauthentic they-mode, and the authentic self-mode. Through circumspection, technology and people were encountered environmentally feeding into nursing attention, assessment and communication. Nursing as a social arrangement was expressed through either leaping-in care or leaping-ahead care. There was a place for both inauthentic and authentic discourse that nurses wove through the ontic everydayness of nursing tasks. (shrink)

BackgroundThere has been media coverage surrounding the dangers of heavy drinking and benefits of moderation, with TV and radio presenter, Adrian Chiles, documenting his experience of moderating alcohol consumption in an online article for the Guardian. By analysing the comments in response to Chiles’ article, this study aimed to explore posters’ attitudes or beliefs toward moderating alcohol and posters’ experiences of moderating or abstaining from alcohol.MethodA secondary qualitative analysis of online comments in response to an article about (...) moderating alcohol consumption. Main outcome measures: Comments in response to a United Kingdom online news article about moderating alcohol consumption were extracted and inductive thematic analysis was used.ResultsFor aim one, two themes were developed; “general attitudes toward drinking” and “general attitudes toward reducing consumption”. These themes reflect negative perceptions of alcohol and issues around changing attitudes. For aim two, three themes were developed: “moderation vs. abstention”, “reflection on past drinking behaviours”, and “current drinking behaviours”. These themes represent posters’ experiences and implications changing their drinking habits.ConclusionOur analysis provides a novel insight into perceptions and experiences of moderating or abstaining from alcohol. Alcohol is embedded within United Kingdom culture, creating difficulties for those who choose to moderate or abstain from alcohol. Our analysis highlights the need for public health to focus on shifting the current drinking culture, through clearer drinking guidelines and a wider availability of alcohol-free alternatives. (shrink)

The aim of this study was to explore the ethical challenges in home mechanical ventilation based on a secondary analysis of qualitative empirical data. The data included perceptions of healthcare professionals in hospitals and community health services and family members of children and adults using home mechanical ventilation. The findings show that a number of ethical challenges, or dilemmas, arise at all levels in the course of treatment: deciding who should be offered home mechanical ventilation, respect for (...) patient and family wishes, quality of life, dignity and equal access to home mechanical ventilation. Other challenges were the impacts home mechanical ventilation had on the patient, the family, the healthcare services and the allocation of resources. A better and broader understanding of these issues is crucial in order to improve the quality of care for both patient and family and assist healthcare professionals involved in home mechanical ventilation to make decisions for the good of the patient and his or her family. (shrink)

Skin conditions such as eczema and psoriasis are relatively prevalent health concerns in children, adolescents and young adults. Experiences of these dermatology diagnoses in adolescence have hitherto not been the focus of research, perhaps owing to assumptions that these diagnoses are not particularly impactful or intricate processes, events or labels. We draw on a thematic secondary analysis of in-depth interviews with 42 adolescents and young people living in the United Kingdom and, influenced by the sociologies of diagnosis and (...) time, highlight the psychological, emotional, social and temporal complexities involved in their diagnosis experiences. Firstly, we describe how participants remembered, re- and co-constructed their diagnosis experiences during the interview. Secondly, we explore the pace and rhythm of diagnosis, including mis-diagnoses, highlighting the jarring potential for adolescents on being diagnosed, even for conditions typically deemed minor. Thirdly, we consider the ways in which these diagnoses have the capacity to reformulate notions of past, present and future, including projecting into imagined futures and reinterpreting past bodily sensations. Finally, we examine how memories about and the meaning of diagnosis are revisited, revised and potentially replaced as a child or adolescent grows older, and increases their management of their condition and encounters with healthcare professionals. In unsettling an assumption that diagnosis experiences for adolescents of common skin conditions is unproblematic or straightforward, our qualitative analysis critically engages with and contribute to tenets of health research that are of interest to quantitative and qualitative researchers, clinicians and patients. (shrink)

Background There is ongoing debate regarding whether and under which circumstances secondary findings (SF) should be offered in the pediatric context. Although studies have examined patient perspectives on receiving SF, little research has been conducted examining the experiences of clinicians offering SF to parents of newborns receiving genomic sequencing for a recently diagnosed medical condition.Methods To address this, we conducted qualitative interviews exploring the views and experiences of 12 clinicians who offered SF to parents of infants who had (...) diagnostic exome sequencing (ES) to identify the cause of their hearing loss. Interviews explored clinicians’ accounts of parents’ choices and decision-making about receiving SF, their views on whether and when to offer SF, their experiences returning SF, and any ethical challenges they encountered. Interviews were audio-recorded, transcribed and analyzed using inductive content analysis.Results Clinicians reported parents who declined all SF often felt finding out about future conditions unrelated to their child’s hearing loss may be unhelpful, or even harmful, or were overwhelmed by their child’s diagnosis. Clinicians also reported that some parents chose SF because they felt obliged to, even if they did not want to receive them. They explained that while some parents experienced decision-making regarding SF as positive, for others, this process was challenging or distressing. While clinicians generally agreed SF should be offered, mainly to promote parental choice, most felt SF should be offered after disclosing diagnostic results, primarily to avoid overwhelming parents. Clinicians encountered several ethical challenges, including balancing parental autonomy with non-maleficence, wanting to report or not report certain SF, and questioning whether parents can make an autonomous choice regarding SF.Conclusions Our findings, which are novel as they relate to parents of young infants with a recent diagnosis of hearing loss, add new insights into clinicians’ and parents’ decision-making regarding SF in pediatrics. (shrink)

The purpose of this study was to explore the views of members of the general public regarding ethical issues in adult predictive genetic testing. The literature pertaining to ethical issues regarding to adult predictive genetic testing is largely restricted to the views of ‘experts’ who have emphasized informed consent, patent issues, and insurance discrimination. Occasionally the views of patients who have undergone genetic counselling and testing have been elicited, adding psychosocial and family issues. However, the general public has not had (...) the opportunity to contribute. In order to explore theatre as a health policy research tool, 1,200 audience members attended the play ‘Sarah’s Daughters’ in seven Canadian cities, following which audience discussions were audiotaped. This study performed a secondary qualitative analysis of the data to identify the ethical issues of adult predictive genetic testing important to members of the general public. The identified issues were: (1) need for public education; (2) choice to undergo genetic counselling and testing; (3) access to genetic counselling and testing; and (4) obligations regarding the handling of genetic information. Audience members emphasized public education and access to information regarding potential choices, which was different from the emphasis on informed consent and other ethical issues prominent in the literature. Members of the general public emphasized ethical issues that were different than those identified by experts and patients. It is essential that members of the public be included in complex and controversial public policy decisions. (shrink)

BackgroundBiobanking biospecimens and consent are common practice in paediatric research. We need to explore children and young people’s (CYP) knowledge and perspectives around the use of and consent to biobanking. This will ensure meaningful informed consent can be obtained and improve current consent procedures.MethodsWe designed a survey, in co-production with CYP, collecting demographic data, views on biobanking, and consent using three scenarios: 1) prospective consent, 2) deferred consent, and 3) reconsent and assent at age of capacity. The survey was disseminated (...) via the Young Person’s Advisory Group North England (YPAGne) and participating CYP’s secondary schools. Data were analysed using a qualitative thematic approach by three independent reviewers (including CYP) to identify common themes. Data triangulation occurred independently by a fourth reviewer.ResultsOne hundred two CYP completed the survey. Most were between 16–18 years (63.7%, N = 65) and female (66.7%, N = 68). 72.3% had no prior knowledge of biobanking (N = 73).Acceptability of prospective consent for biobanking was high (91.2%, N = 93) with common themes: ‘altruism’, ‘potential benefits outweigh individual risk’, 'frugality', and ‘(in)convenience’.Deferred consent was also deemed acceptable in the large majority (84.3%, N = 86), with common themes: ‘altruism’, ‘body integrity’ and ‘sample frugality’. 76.5% preferred to reconsent when cognitively mature enough to give assent (N = 78), even if parental consent was previously in place. 79.2% wanted to be informed if their biobanked biospecimen is reused (N = 80).ConclusionProspective and deferred consent acceptability for biobanking is high among CYP in the UK. Altruism, frugality, body integrity, and privacy are the most important themes. Clear communication and justification are paramount to obtain consent. Any CYP with capacity should be part of the consenting procedure, if possible. (shrink)

The use of informed consent for surgery or research has been widely studied; however, its use in other areas of clinical practice has received less attention. This study investigates how doctors and nurses understand informed consent in relation to the prescription and administration of medicines in secondary care. It uses a qualitative analysis of semi-structured in-depth interviews with 19 doctors and 6 nurses recruited from various specialties in a teaching hospital. The results indicate a striking gap between (...) official and actual standards of practice. Providing information, assuring adherence and communication about potential treatment harms were raised as key issues instead of the principal goals of informed consent. Rather than simply treating these findings as support for a 'deficit' account of professionalism, the paper concludes that we need a richer and more grounded account of exactly when hospital medication decisions need to be subjected to the highest standards of informed consent. (shrink)

One of the environments where values education takes place is school. The education system implemented in Turkey aims to raise individuals who embrace basic values as well as being academically successful. To achieve this goal, a systematic values education carried out together with academic education is needed. The educational programs currently implemented in our country have been created to fulfill this function, and ten root values have been determined to be taught to students at school. These values are justice, friendship, (...) honesty, self-control, patience, respect, love, responsibility, patriotism and helpfulness. These values, determined in line with the basic objectives of Turkish National Education, are reflected in the curriculum and textbooks of all courses at the school. In this study, textbooks prepared for the Life of Our Prophet course, which is an elective course in secondary schools and a compulsory course in Imam Hatip secondary schools, were examined in terms of root values. The main purpose of the study is to determine to what extent root values are included in the Life of Our Prophet (5-8) textbooks. Within the framework of this purpose, the following questions were tried to be answered in the study: 1. What root values are included in secondary school Life of Our Prophet textbooks? 2. What are the frequency and rates of inclusion of root values in secondary school Life of Our Prophet textbooks? 3. What is the distribution of the root values in the Secondary School Life of Our Prophet textbooks according to grade levels? The study is of a qualitative type and is in the survey model most commonly used in research in the field of education. The data of the study was obtained by document review technique. The data of the study was obtained from the Life of Our Prophet textbooks taught in secondary and imam hatip secondary schools in the 2022-2023 academic year. While examining the textbooks, the root values specified in the course curriculum and the attitudes and behaviors associated with these values were taken into account. The analysis of the collected data was done with the descriptive analysis approach used in qualitative research. The distribution of root values in the textbooks according to grade level was tabulated by specifying page numbers and frequency values. In order to support the findings, quotations reflecting the relevant value are included from the textbook in which each root value is included at least and most. According to the research results, the root values specified in the program are included in the textbooks of each grade level. The most frequently mentioned root value in textbooks is love, and the least frequently mentioned root value is self-control. The inclusion of root values in the textbooks of each grade level is compatible with the understanding of values education envisaged in the program. In textbooks, root values are generally touched upon in subject texts, reading texts, activities and visual explanations. It can be said that the Life of Our Prophet (5-8) textbooks have a rich content in terms of root values. (shrink)

The aim of this study is to investigate students’ conceptions about proof in mathematics and mathematics teaching. A five‐point Likert‐type questionnaire was administered in order to gather data. The sample of the study included 33 first‐year secondary school mathematics students . The data collected were analysed and interpreted using the methods of qualitative and quantitative analysis. The results have revealed that the students think that mathematical proof has an important place in mathematics and mathematics education. The students’ (...) studying methods for exams based on imitative reasoning which can be described as a type of reasoning built on copying proof, for example, by looking at a textbook or course notes proof or through remembering a proof algorithm. Moreover, they addressed to the differences between mathematics taught in high school and university as the main cause of their difficulties in proof and proving. (shrink)

The conceptualisation of schooling is often based on “ideal children” in “ideal situations.” However, in determining the level of participation for children who are considered vulnerable in schooling, it is important to understand the lived experiences of these children. In this study, migrant children (particularly undocumented ones) in South Africa are the focus, and their lived experiences were considered through reflections from their parents and teachers. Data were collected using semi-structured interviews, and analysed using a constant comparative method of (...) class='Hi'>qualitative analysis within a grounded theory approach. The study found that challenges affecting migrant children’s schooling include the lack of documentation, language barriers, issues of transition and adaptation (discrimination), and the inability to access further education. Strategies were identified to address the challenges, including schools liaising with the Department of Home Affairs, implementing cultural diversity programmes within the school, and through deliberate inclusive programmes. (shrink)

Objective: To increase our understanding of moral distress experienced by neonatal registered nurses when directly or indirectly involved in the decision-making process of resuscitating infants who are born extremely premature. Design: A secondary qualitative analysis was conducted on a portion of the data collected from an earlier study which explored the ethical decision-making process among health professionals and parents concerning resuscitation of extremely premature infants. Setting: A regional, tertiary academic referral hospital in Ontario offering a perinatal program. (...) Participants: A total of 15 registered nurses were directly or indirectly involved in the resuscitation of extremely premature infants. Methods: Interview transcripts of nurses from the original study were purposefully selected from the original 42 transcripts of health professionals. Inductive content analysis was conducted to identify themes describing factors and situations contributing to moral distress experienced by nurses regarding resuscitation of extremely premature infants. Ethical considerations: Ethical approval was obtained from the research ethics review board for both the initial study and this secondary data analysis. Results: Five themes, uncertainty, questioning of informed consent, differing perspectives, perceptions of harm and suffering, and being with the family, contribute to the moral distress felt by nurses when exposed to neonatal resuscitation of extremely premature infants. An interesting finding was the nurses’ perceived lack of power and influence in the neonatal resuscitation decision-making process. Conclusion: Moral distress continues to be a significant issue for nursing practice, particularly among neonatal nurses. Strategies are needed to help mediate the moral distress experienced by nurses, such as debriefing sessions, effective communication, role clarification, and interprofessional education and collaboration. (shrink)

Background Despite news reports of morally distressing situations resulting from complex and demanding community-care delivery in Canada, there has been little research on the topic of ethical conflicts experienced by community-based health care professionals. Research aim To identify ethical conflicts experienced by community nurses. Research design Data were collected using semi-structured interviews and then relevant text was extracted and condensed using qualitative content analysis. This research was part of a larger grounded theory project examining how community nurses manage (...) ethical conflict. Research context and participants Community nurses, including 13 public health nurses and 11 home care nurses from two Canadian provinces, were interviewed. Ethical considerations Study approval was granted by the Health Research Ethics Authority of Newfoundland and Labrador and by provincial health authorities. Findings Seven ethical conflicts were identified and assigned to one of two groups. In the grouping categorized as challenges with obligations or risks, the ethical conflicts were: (1) screening for child developmental issues knowing there is a lack of timely early intervention services; (2) encountering inequities in the health care system; (3) not fulfilling principles, goals, and initiatives of primary and secondary prevention; and (4) feeling powerless to advocate for clients. The remaining ethical conflicts were categorized as challenges with process, risks, and consequences, and were: (5) jeopardizing therapeutic relationships while reporting signs of a child at risk; (6) managing confidentiality when neighbors are clients; and (7) supporting client autonomy and decision-making but uncertain of the consequences. Conclusions Research investigation will continue to be important to raise awareness and mobilize ethics supports as health care services are steadily shifted from institutional to community settings. Moreover, with heightened potential for communicable disease outbreaks across international borders from global warming, community nurses around the world will continue to be required to address ethically-difficult care situations with competence and compassion. (shrink)

Neo-Aristotelian forms of character education often draw on literary sources as materials, although rarely poetry. This article offers retrospective reflections on a poetry-based character-education intervention, conducted in an Icelandic secondary-school setting. Having run into practical difficulties during the implementation phase, the challenges of implementation were reflected upon through consultation with ten subject experts who shared their views about the enablers and barriers encountered when running such an intervention. The interviews yielded a rich data set, which often took interviewees beyond (...) the boundaries of a poetry-based curricular context to focus on more general conditions for effective, character-inspiring school-work. Through thematic analysis, four themes were identified: freedom, time, creativity, and wonderment. Of these four, creativity had been identified in advance as an interview theme, meaning that the researchers expected to find it. The remaining three provide an insight into how, according to the interviewees, the ideal Icelandic school system should be designed. The theme of freedom addresses both negative and positive aspects of the current state of affairs, while the theme of time mostly reflects negative aspects of the Icelandic curriculum. The theme of wonderment has solely positive connotations in the minds of interviewees, and is the core of this analysis because it seems to hold the key to the question: what factors would enable an effective intervention of the sort under scrutiny here? This theme is analysed in detail, and some specific and general educational implications are elicited. (shrink)

This study employs a qualitative approach to investigate the factors influencing engagement in Irish employee wellbeing programmes. Two stages of data collection were conducted, involving 52 employees completing open-ended questionnaires in Stage 1 and 23 participants interviewed in Stage 2. Three themes emerged from the thematic analysis of the data: (1) communicating wellbeing initiatives; (2) creating and maintaining interest in wellbeing; and (3) challenges to employee wellbeing. The three themes and their subthemes provide qualitative evidence from employees (...) on the barriers to and drivers of workplace wellbeing initiative utilisation through the lenses of Resource utilisation Theory and Culture of Health. The findings underscore the importance of supportive environments and effective design in enhancing programme utilisation, along with the need to offer targeted initiatives addressing secondary and tertiary wellbeing issues. By addressing shortcomings in Irish workplaces, this research contributes to advancing the effectiveness and impact of workplace wellbeing initiatives at multiple levels: organisational, individual, and governmental. (shrink)

Ethics consultation is a service provided to patients, families, and clinicians to support decisions during ethical dilemmas. This study is a secondary qualitative analysis of 48 interviews from clinicians involved in an ethics consultation at a large academic health center. An inductive secondary analysis of this data set led to the emergence of one key theme, the apparent perspective the clinicians adopted as they recalled a specific ethics case. This article presents a qualitative (...) class='Hi'>analysis of the propensity of clinicians involved in an ethics consultation to adopt the subjective viewpoints of their team, their patient, or both simultaneously. Clinicians demonstrated an ability to take the patient perspective (42%), the clinician perspective (31%), or the clinician-patient perspective (25%). Our analysis suggests the potential for narrative medicine to build the empathy and moral imagination necessary to bridge the gap in perspectives between key stakeholders. (shrink)

This paper reports the findings of a predominantly qualitative study that explored the effects of the practice of Philosophy for Children on pupils’ affective engagement.[1] From its conception, the practice of P4C has been linked to the development of caring and collaborative thinking and the study aimed to closely consider that relationship. An appropriate self-designed P4C program was implemented with 75 Year 9 pupils of Religious Education at an independent secondary school in the United Kingdom. An interpretive research (...) approach was taken and thematic analysis was appropriated to analyse the data. Findings supported the claims of previous research that P4C can foster affective engagement in many pupils, particularly those pupils who find emotional expression and interpersonal interactions challenging. A tentative conclusion reached supposes that P4C has the potential to contribute to the affective engagement of pupils, but with the recommendation that implementing a P4C program must be executed carefully and with the mindfulness that it may not have the same potential or usefulness for all pupils universally. (shrink)

Ethical decision-making in school administration has received considerable attention in educational leadership literature. However, most research has focused on principals working in secondary school settings while studies that explore ethical reasoning processes of academic deans have been significantly few. This qualitative study aims to describe the ethical decision-making processes employed by a select group of Filipino college deans in solving ethical dilemmas using the ethical paradigms proposed in the works of Starratt (Educ Adm Q 27:185–202, 1991) and Shapiro (...) and Stefkovich (Ethical leadership and decision-making in education: applying theoretical perspectives to complex dilemmas, 2005) as frameworks for the analysis. Data was gathered using semi-structured interviews and field text was analyzed using deductive thematic analysis. Findings of this study show that majority of the deans chose to share ethical dilemmas involving students and teachers. The findings also show the ethical frameworks of care, justice, and profession as the dominant paradigms utilized by Filipino deans and their preference for adopting multiple ethical frameworks when making their decisions. Most of the ethical dilemmas which the deans narrated relate to their tasks of academic administration such as monitoring student performance, faculty evaluation and maintaining school discipline. Interestingly, only a few dilemmas involving university administrators were expressed, and dilemmas that refer to broader societal issues usually associated with school administrators’ utilization of the ethic of critique were also significantly left out in the narratives of this study. This paper intends to contribute to current literature by expanding research to administrators working in the context of higher education in the Philippine setting. The findings of this study could serve as knowledge base in designing ethics courses to enhance educational leaders’ ethical decision-making skills. The study also provides useful insights of ethical decisions and reasoning processes employed by academic administrators in resolving real life ethical dilemmas that could be useful at the practical level for aspiring and practicing deans. (shrink)

The main objective of this study was to explore the perception of students on challenges that hindered the implementation of Civics and Ethical Education in Aleta Wondo secondary school. To achieve this objective, the study employed a cross sectional survey research design with a combination of mixed research approach. The quantitative data collected through survey was analyzed via mean and standard deviation while the qualitative data obtained from key informant interviews and document analysis was presented using narration. (...) The findings of the study indicated that content and context related problems such as repetition of the content, deformity of contents and improper mode of delivery of the course were identified as major factors that influenced the implementation of the discipline. Moreover, external environment related challenges such as engagement of a number of students in harmful activities, lack of parental involvement in the school activities, and mass media were major reasons for Civics and Ethical Education to meet its objectives ineffectively. Therefore, this study demanded all stakeholders to be highly committed to the effectiveness of the subject, and responsible to curb those challenges that affected the implementation of the discipline. (shrink)

El presente artículo pretende indagar desde el marco teórico-epistemológico de "imaginario social" de Cornelius Castoriadis (1922-1997), la subjetivación de la mujer trabajadora en el sistema de educación técnico-profesional en Chile. Se desarrolla una investigación filosófica y cualitativa que incluye análisis documental y entrevistas a sujetos del ámbito técnico-profesional secundario. A través de este marco teórico, desarrollamos las herramientas analíticas necesarias para poder leer e interpretar cómo a pesar de los aires de renovación del sistema técnico-profesional, la oferta política hacia la (...) mujer chilena trabajadora no cambia en realidad el "destino" que pesa sobre ella: ser, dicho peyorativamente "¡Buenas Trabajadoras, Buenas Madres!". This article seeks to investigate since the theoretical-epistemological frame of "social imaginary" of Cornelius Castoriadis (1922-1997), the subjectivity of the hard-working woman in the system of technical-professional education in Chile. It is carried out a philosophical and qualitative investigation including documentary analysis and interviews to subjects of the technical-professional secondary area. Through this theoretical frame, we develop the analytical tools needed to read and interpret how, despite the air of renewal of the technical-professional system, the political supply towards the Chilean woman worker in fact does not actually change the "destiny" hanging over her: to be, pejoratively said "Good Workers, Good Mothers"! (shrink)

Introduction: Vulnerability is a poorly understood concept in research ethics, often aligned to autonomy and consent. A recent addition to the literature represents a taxonomy of vulnerability developed by Kipnis, but this refers to the conduct of clinical trials rather than qualitative research, which may raise different issues. Aim: To examine issues of vulnerability in cancer and palliative care research obtained through qualitative interviews. Method: Secondary analysis of qualitative data from 26 black Caribbean and 19 (...) white British patients with advanced cancer. Results: Four domains of vulnerability derived from Kipnis’s taxonomy were identified and included: (i) communicative vulnerability, represented by participants impaired in their ability to communicate because of distressing symptoms; (ii) institutional vulnerability, which referred to participants who existed under the authority of others—for example, in hospital; (iii) deferential vulnerability, which included participants who were subject to the informal authority or the independent interests of others; (iv) medical vulnerability, which referred to participants with distressing medical conditions; and (v) social vulnerability, which included participants considered to belong to an undervalued social group. Participants from both ethnic groups populated all these domains, but those who were black Caribbean were more present among the socially vulnerable. Conclusions: Current classifications of vulnerability require reinterpretation when applied to qualitative research at the end of life. We recommend that researchers and research ethics committees reconceptualise vulnerability using the domains identified in this study and consider the research context and interviewers’ skills. (shrink)

Understanding the 'making-up' relations, to put things neutrally, posited in mechanistic explanations the sciences is finally an explicit topic of debate amongst philosophers of science. In particular, there is now lively debate over the nature of the so-called 'realization' relations between properties posited in such explanations. Despite criticism (Gillett, Analysis 62: 316-323, 2002a), the most common approach continues to be that of applying machinery developed in the philosophy of mind to scientific concepts in what is known as the 'Flat' (...) or 'Subset' model of 'realization' (Kim, Mind in a physical world, 1998; Shapiro, J Philos XCVII: 635-654, 2000; Clapp, J Philos XCVIII: 111-136,2001 ; Wilson, Philos Stud 145: 149-169,2009). My primary goal in this paper is to show in still more detail that the Subset model of realization is inadequate for the descriptive task of describing the 'making-up' relations posited between properties or their instances in mechanistic explanations in the higher sciences. And my secondary goal is to highlight why this critique of the Subset view as a first-order descriptive account also shows there are deep difficulties in using the Subset account to address second-order issues in the philosophy of science as well. (shrink)

The religious crisis in Nigeria dates back to the colonial era. The amalgamation of two distinct nationalities for the purpose of administrative convenience by the colonial government, irrespective of their cultural and educational differences, not only created a hitch in assimilation but also mistrust and bitter rivalry that has accentuated to conflict. In the same vein, most of the communal crises taking place today could be traced to colonial making as they created artificial boundaries that did not take cognisance of (...) kith and kin, consanguinity and linguistic identity. It rather brazenly demarcated people to suit their exploitative governance. The above built-up grievances and tensions spark off a crisis at the slightest provocation or misunderstanding. The objectives of the study are as follows: to identify the factors responsible for the crises, to trace and analyse the antecedents of the crises, and finally to proffer solutions to this seemingly intractable national problem. The methodology adopted for the study is the qualitative phenomenological approach, whereby data were collected from secondary sources and treated analytically. The work found that religion and inter-communal conflict have hindered sustainable development, taking a large toll of lives and property amongst others. (shrink)

The introduction of genomics and biobanking methodologies to the African research context has also introduced novel ways of doing science, based on values of sharing and reuse of data and samples. This shift raises ethical challenges that need to be considered when research is reviewed by ethics committees, relating for instance to broad consent, the feedback of individual genetic findings, and regulation of secondary sample access and use. Yet existing ethics guidelines and regulations in Africa do not successfully regulate (...) research based on sharing, causing confusion about what is allowed, where and when. In order to understand better the ethics regulatory landscape around genomic research and biobanking, we conducted a comprehensive analysis of existing ethics guidelines, policies and other similar sources. We sourced 30 ethics regulatory documents from 22 African countries. We used software that assists with qualitative data analysis to conduct a thematic analysis of these documents. Surprisingly considering how contentious broad consent is in Africa, we found that most countries allow the use of this consent model, with its use banned in only three of the countries we investigated. In a likely response to fears about exploitation, the export of samples outside of the continent is strictly regulated, sometimes in conjunction with regulations around international collaboration. We also found that whilst an essential and critical component of ensuring ethical best practice in genomics research relates to the governance framework that accompanies sample and data sharing, this was most sparingly covered in the guidelines. There is a need for ethics guidelines in African countries to be adapted to the changing science policy landscape, which increasingly supports principles of openness, storage, sharing and secondary use. Current guidelines are not pertinent to the ethical challenges that such a new orientation raises, and therefore fail to provide accurate guidance to ethics committees and researchers. (shrink)

This manuscript offers a qualitative exploration aimed at proposing effective strategies for enhancing compliance with and enforcement of labor laws in Bangladesh by diminishing the incentives for non-compliance. The study relies on primary data obtained from statutes, legal decisions, and secondary data sourced from scholarly articles, books, and book chapters, among others. Employing a cost-benefit analysis approach from the employers’ perspective, the study contends that showcasing the superior costs associated with violating labor laws, in comparison to the (...) benefits gained, will incentivize employers to prioritize compliance to safeguard their interests. To this end, the research puts forth eight distinct techniques or mechanisms to curtail the benefits derived from disregarding labor laws. These strategies are thoughtfully organized into two categories, namely “increasing the likelihood of self-enforcement” and “supporting by other actors.” The proposed techniques for enhancing compliance with and enforcement of labor laws in Bangladesh hold significant potential in benefiting key stakeholders, policymakers, and practitioners in the field. Furthermore, the study’s findings carry valuable implications for other developing countries in the South Asian region, given their similar socio-economic and cultural contexts. (shrink)

This article sets out to provide a conceptual contribution to theoretical and empirical work on the level of media repertoires. We will first discuss theoretical approaches which allow for an explanation of media repertoires and relate them to the most prominent approaches to selective audience behavior. Secondly, in order to empirically analyze media repertoires we propose a combination of secondary analyses of existing surveys on media use and qualitative studies on the internal ‘architecture’ of these repertoires and their (...) practical meaning in the user's everyday life. These proposals for secondary analyses are illustrated by two examples based on different data sets and referring to different levels of analysis. (shrink)

Systematics, along with the other comparative biological sciences and certain astronomical disciplines, is much more concerned with form and organization than other biological and physical sciences, in which dynamics plays the central role. Within the biological sciences, Nelson (1970) characterizes disciplines that study diversity and patterns “comparative” and those that search for process and dynamics “general.” The goal of “general” science is to uncover the mechanisms that unify observed phenomena. Whether the physicist sees herself, like Newton (1953: 3-5), to be (...) discovering fundamental causal explanations, or like Duhem (1962: 19-30), to be uncovering a natural classification, dynamical concepts referring to essentially hidden processes are indispensable. Much of comparative biology, in contrast, is primarily descriptive, with explanations taking a secondary role, at least until the diversity is described and comparisons made. Unlike the general sciences, in which elegance and quantitative analysis have long been major indicators of truth, the comparative sciences stress complexity, happenstance and qualitative analysis. In systematics in particular, theory and explanation are often thought to play a minimal role, if any at all1. (shrink)

Background: Compassion fatigue is recognized as impacting the health and effectiveness of healthcare providers, and consequently, patient care. Compassion fatigue is distinct from “burnout.” Reliable measurement tools, such as the Professional Quality of Life scale, have been developed to measure the prevalence, and predict risk of compassion fatigue. This study reviews the prevalence of compassion fatigue among healthcare practitioners, and relationships to demographic variables. Methods: A systematic review was conducted using key words in MEDLINE, PubMed, and Ovid databases. Data were (...) extracted from a total of 71 articles meeting inclusion criteria, from studies measuring compassion fatigue in healthcare providers using a validated instrument. Quantitative and qualitative data were extracted and compiled by three independent reviewers into an evidence table that included basic study characteristics, study strength and quality determination, measurements of compassion fatigue, and general findings. Meta-analysis, where data allowed, was stratified by Professional Quality of Life version, heterogeneity was quantified, and pooled means were reported with 95% confidence interval. A table of major study characteristics and results was created. Ethical consideration: This paper contains no primary data obtained directly from research participants. Data obtained from previously published resources have been acknowledged within references. Psychological distress, particularly compassion fatigue, can be insidious, no health profession is immune, and may significantly impact the ability to provide care. Results: A total of 71 studies were included. Compassion fatigue was reported across all practitioner groups studied. Relationships to most demographic variables such as years of experience and specialty were either not statistically significant or unclear. Variability in reporting of Professional Quality of Life results was found. Interpretation: Compassion fatigue exists across diverse practitioner groups. Prevalence is highly variable, and its relationship with demographic, personal, and/or professional variables is inconsistent. Questions are raised about how to mitigate compassion fatigue. (shrink)

Background: Doping has been a prominent issue for the sport of athletics in recent years. The endurance disciplines, which currently account for 56% of the global anti-doping rule violations in athletics, appear to be particularly high risk for doping.Objective: Using this high-risk, high-pressure context, the main purpose of this study was to investigate the human impact of doping and anti-doping on “clean” athletes. The secondary aim of the study was to better understand the reasons for, and barriers to, competing (...) “clean” among this group of athletes.Method: Semi-structured interviews were conducted with 11 elite distance runners from the UK to explore: the reasons and motivations for competing clean. Perceptions of the anti-doping system, and experiences of being part of that system. Views on the prevalence and causes of doping and the impact of doping on the lives of clean athletes. The interviews were audio-recorded, transcribed verbatim, and analysed using Reflexive Thematic Analysis.Results: Four major themes were identified: The participants in this study have not been tempted to use prohibited substances or methods; they compete in their sport for the personal satisfaction of seeing how good they can be, rather than in pursuit of winning at all costs. Anti-doping does not currently prevent doping effectively and is not implemented evenly across the globe. Doping was perceived as a major issue and was felt to be borne out of certain sporting cultures in which doping is enabled. Doping has impacted the careers of clean athletes in irreversible ways and presents a continuing challenge to the psychological preparation for competition.Conclusions: Clean athletes suffer negative consequences from both doping and anti-doping. ADOs must collaborate across borders to ensure a more even implementation of anti-doping activities, to facilitate a more level playing field on the global stage. ADOs must also acknowledge the existence of a large group of athletes who would never consider deliberately doping and make anti-doping work for these athletes too. (shrink)

Purpose: The purpose of this article is to present the stylistic and thematic analysis of Geez poetry, in a way that examines the profound and complex meaning that it carries.Research Methodology: The article methodology consisted of qualitative research methodology and a purposive sampling was used in field work. Secondary data was also obtained from books and scholarly journals and duly acknowledged. Idiomatic and literal translation methods were used, with special emphasis on meaning rather than form. The translation (...) from Geez to English was conducted by the researcher and content analysis was used to analyze the data.Findings: The poems revealed a rich, valuable aesthetics and dynamic changes taking place in the cultural mold of the Geez speaking society. It has also revealed that a huge amount of Geez oral poetry still remains unrecorded. It has also shown that Geez oral poetry is not being learned by the young generation and this could lead to a loss in cultural practices embodied in it.Unique Contribution to Theory, Policy and Practice: The article will contribute to the preservation, documentation and research endeavors being undertaken by researches, educators as well as policy makers involved in areas related to the study of the classical language of Geez. This is because none of Geez poetry has been composed, written or recorded in any parchments or books by the churches at all. Hence, it is only too obvious that a massive amount of poetic wisdom has been lost that future generations could have benefited from. (shrink)

This research project analyzes a strategy for teaching philosophy in secondary school inspired by Socratic dialogue, which aims at the creation and effective management of cognitive dissonance as a tool for promoting critical thinking, called Socratic Challenge (SC). The research originates from workshops held in the years 2016/2019 in a technical and vocational institute in the province of Varese, in which I participated as the creator and conductor, involving the voluntary participation of about 150 students. The research questions are: (...) What are the characteristics of the Socratic Challenge? Can it constitute a teaching methodology to be proposed? Under what conditions? Within what project framework? The empirical research is qualitative, naturalistic, and exploratory (Lumbelli, 1984), specifically a self-study (Hamilton & Pinnegar 2009), divided into two phases. In the first phase, data regarding motivation and perceptions of training impact were collected through in-depth interviews of students (16) and analyzed using the criteria of reflective thematic analysis (Braun & Clarke 2019). In the second phase, the workshops were repeated remotely in technical and vocational institutes in Milan and the province, involving 113 students who were surveyed with a qualitative questionnaire. The workshops were recorded and the discussion interactions were analyzed according to a qualitative inductive approach that refers to Constructivist Grounded Theory (Charmaz, 2006). Results show how this dialogical instructional strategy in philosophy teaching can be considered an effective alternative to the historical-philosophical approach predominant in the Italian tradition (Illetterati 2007). (shrink)

This article analyzes Toole’s novel from a causal perspective, focusing on the cause-effect dynamics that make the plot advance, from the initial event at D.H. Holmes until the outcome in the Night of Joy. A combination of qualitative and quantitative methodologies has been applied to identify a series of 47 causal events that summarize all actions with an impact on plot development. Our research shows that the causal study of the novel is a useful approach that can reinforce or (...) modify qualitative assessments of previous studies. The relevance of “Night of Joy” plot within the whole narrative and its key role in the rest of the subplots are verified in numerical terms. Besides, we have expanded and quantified the causal chains operating in the novel; and we have made sure, as well, that every subplot is essential in order to reach the final outcome (with the only exception of Dr. Talc’s story). Finally, we have formulated an alternative outline of secondary plots than the ones supported by preceding research by using numeric metrics, demonstrating that “Paradise Vendors” and “Dorian Greene”, previously considered secondary storylines, exert a high impact on Confederacy’s finale, and are, perhaps, not so secondary plots after all. (shrink)

The results show that the Religious Courts play an important role in harmonising Islamic law with national development policies and international legal standards, particularly in the context of protecting the rights of women and children. However, challenges exist in harmonising interpretations of Islamic law with the principles of human rights and gender equality guaranteed by international conventions such as CEDAW. This research uses a qualitative approach with a case study method to analyse the relevance of Religious Court decisions related (...) to marriage to national development policies as well as their relationship to international law. Primary data was obtained through analysis of Religious Court decisions in several regions of Indonesia in the last five years covering marital issues such as divorce, polygamy, child custody, and division of joint property. Secondary data included national policy documents, such as the RPJMN, as well as international legal instruments such as CEDAW. This research identifies the need for progressive reforms in the Religious Courts system, including capacity building of judges in understanding international law, revision of the Compilation of Islamic Law, and strengthening co-operation between relevant institutions. The innovative contribution of this research lies in its in-depth analysis of how the Religious Courts can serve as a bridge between religious law, national development policy, and Indonesia's international obligations. (shrink)

Background Some have hypothesized that talk about suffering can be used by clinicians to motivate difficult decisions, especially to argue for reducing treatment at the end of life. We examined how talk about suffering is related to decision-making for critically ill patients, by evaluating transcripts of conversations between clinicians and patients’ families.Methods We conducted a secondary qualitative content analysis of audio-recorded family meetings from a multicenter trial conducted in the adult intensive care units of five hospitals from (...) 2012–2017 to look at how the term “suffering” and its variants were used. A coding guide was developed by consensus-oriented discussion by four members of the research team. Two coders independently evaluated each transcript. We followed an inductive approach to data analysis in reviewing transcripts; findings were iteratively discussed among study authors until consensus on key themes was reached.Results Of 146 available transcripts, 34 (23%) contained the word “suffer” or “suffering” at least once, with 58 distinct uses. Clinicians contributed 62% of first uses. Among uses describing the suffering of persons, 57% (n = 24) were related to a decision, but only 42% (n = 10) of decision-relevant uses accompanied a proposal to limit treatment, and only half of treatment-limiting uses (n = 5) were initiated by clinicians. The target terms had a variety of implicit meanings, including poor prognosis, reduced functioning, pain, discomfort, low quality of life, and emotional distress. Suffering was frequently attributed to persons who were unconscious.Conclusions Our results did not support the claim that the term “suffering” and its variants are used primarily by clinicians to justify limiting treatment, and the terms were not commonly used in our sample when decisions were requested. Still, when these terms were used, they were often used in a decision-relevant fashion. (shrink)

Recently, consumer boycott has been used as an economic weapon and a tool of passive resistance. There are several dimensions to consumer boycott, which serves as a means for Muslim communities to assert their will and to make their voices heard. This study primarily examines the legal (fiqhi) justifications for consumer boycott. The main objective of the study is to identify the reasons (causes) that lead Muslims to engage in consumer boycott. In addition, a secondary objective of our study (...) is to present the problems that may arise in issuing fatwas in relation to the identified causes and abiding by the consequences of these causes. The qualitative analysis method was used to achieve the objective of the study. This analysis was largely carried out using literature and content analysis techniques. Classical jurisprudential principles (uṣūl al-fiqh), principles of issuing fatwas (uṣūl al-iftā), consideration of consequences (i‛tibār al-ma’ālāt) and principles of Islamic governance (al-siyāsah al-shar‛iyyah) were also highlighted in the research methodology. According to our findings, the concept of boycott is not commonly found in classical jurisprudential sources. The rulings on boycott are more implicitly addressed in issues regulating commercial relations with non-Muslims. As far as contemporary literature is concerned, there are numerous studies on Muslim consumer boycott from different perspectives. However, there is a gap in the literature regarding the identification of the cause of boycott. As a result, four causes of boycott have been identified: “disrespect for Muslim dignity”, “insulting religious values”, “supporting the enemy in a state of war with Muslims”, and “political interests and general welfare of Muslims”. Some issues related to the practical application of these grounds are also discussed. In addition, the author raises the question of whether threatening the ḥalâl and healthy nutrition of Muslim communities is a reason for boycott and suggests it as a topic for further research. (shrink)