The purpose of this article is to describe the development of a model of moral distress in military nursing. The model evolved through an analysis of the moral distress and military nursing literature, and the analysis of interview data obtained from US Army Nurse Corps officers (n = 13). Stories of moral distress (n = 10) given by the interview participants identified the process of the moral distress experience among military nurses and the dimensions of the military nursing moral distress (...) phenomenon. Models of both the process of military nursing moral distress and the phenomenon itself are proposed. Recommendations are made for the use of the military nursing moral distress models in future research studies and in interventions to ameliorate the experience of moral distress in crisis military deployments. (shrink)

The development of nursing ethics as a field of inquiry has largely relied on theories of medical ethics that use autonomy, beneficence, and/or justice as foundational ethical principles. Such theories espouse a masculine approach to moral decision-making and ethical analysis. This paper challenges the presumption of medical ethics and its associated system of moral justification as an appropriate model for nursing ethics. It argues that the value foundations of nursing ethics are located within the existential phenomenon of human caring within (...) the nurse/patient relationship instead of in models of patient good or rights-based notions of autonomy as articulated in prominent theories of medical ethics. Models of caring are analyzed and a moral-point-of-view (MPV) theory with caring as a fundamental value is proposed for the development of a theory of nursing ethics. This type of theory is supportive to feminist medical ethics because it focuses on the subscription to, and not merely the acceptance of, a particular view of morality. (shrink)

The purpose of this article is to report what can be learned about nurses’ ethical conflicts by the systematic analysis of methodologically similar studies. Five studies were identified and analysed for: (1) the character of ethical conflicts experienced; (2) similarities and differences in how the conflicts were experienced and how they were resolved; and (3) ethical conflict themes underlying four specialty areas of nursing practice (diabetes education, paediatric nurse practitioner, rehabilitation and nephrology). The predominant character of the ethical conflicts was (...) disagreement with the quality of medical care given to patients. A significant number of ethical conflicts were experienced as ‘moral distress’, the resolution of which was variable, depending on the specialty area of practice. Ethical conflict themes underlying the specialty areas included: differences in the definition of adequacy of care among professionals, the institution and society; differences in the philosophical orientations of nurses, physicians and other health professionals involved in patient care; a lack of respect for the knowledge and expertise of nurses in specialty practice; and difficulty in carrying out the nurse’s advocacy role for patients. (shrink)

Every day nurses are required to make ethical decisions in the course of caring for their patients. Ethics in Nursing Practice provides the background necessary to understand ethical decision making and its implications for patient care. The authors focus on the individual nurse’s responsibilities, as well as considering the wider issues affecting patients, colleagues and society as a whole. This third edition is fully updated, and takes into account recent changes in ICN position statements, WHO documents, as well as addressing (...) current issues in healthcare, such as providing for the health and care needs of refugees and asylum seekers, bioethics and the enforcement of nursing codes. (shrink)

Book reviewed in this article: Case Studies in Nursing Ethics. By Robert M. Veatch and Sara T. Fry.

The origins of field guides and other plant identification manuals have been poorly understood until now because little attention has been paid to 18th century botanical identification guides. Identification manuals came to have the format we continue to use today when botanical instructors in post-Revolutionary France combined identification keys (step-wise analyses focusing on distinctions between plants) with the "natural method" (clustering of similar plants, allowing for identification by gestalt) and alphabetical indexes. Botanical works featuring multiple but linked techniques to enable (...) plant identification became very popular in France by the first decade of the 19th century. British botanists, however, continued to use Linnaeus's sexual system almost exclusively for another two decades. Their reluctance to use other methods or systems of classification Can be attributed to a culture suspicious of innovation, anti-French sentiment and the association of all things Linnaean with English national pride, fostered in particular by the President of the Linnean Society of London, Sir James Edward Smith. The British aversion to using multiple plant identification technologies in one text also helps explain why it took so long for English botanists to adopt the natural method, even after several Englishmen had tried to introduce it to their country. Historians of ornithology emphasize that the popularity of ornithological guides in the 19th and 20th centuries stems from their illustrations, illustrations made possible by printing technologies that improved illustration quality and reduced costs. Though illustrations are the most obvious features of late 19th century and 20th century guides, the organizational principles that make them functional as identification devices come from techniques developed in botanical works in the 18th century. (shrink)

The origins of field guides and other plant identification manuals have been poorly understood until now because little attention has been paid to 18th century botanical identification guides. Identification manuals came to have the format we continue to use today when botanical instructors in post-Revolutionary France combined identification keys with the "natural method" and alphabetical indexes. Botanical works featuring multiple but linked techniques to enable plant identification became very popular in France by the first decade of the 19th century. British (...) botanists, however, continued to use Linnaeus's sexual system almost exclusively for another two decades. Their reluctance to use other methods or systems of classification Can be attributed to a culture suspicious of innovation, anti-French sentiment and the association of all things Linnaean with English national pride, fostered in particular by the President of the Linnean Society of London, Sir James Edward Smith. The British aversion to using multiple plant identification technologies in one text also helps explain why it took so long for English botanists to adopt the natural method, even after several Englishmen had tried to introduce it to their country. Historians of ornithology emphasize that the popularity of ornithological guides in the 19th and 20th centuries stems from their illustrations, illustrations made possible by printing technologies that improved illustration quality and reduced costs. Though illustrations are the most obvious features of late 19th century and 20th century guides, the organizational principles that make them functional as identification devices come from techniques developed in botanical works in the 18th century. (shrink)

Categorical loudness scaling (CLS) measures provide useful information about an individual’s loudness perception across the dynamic range of hearing. A probability model of CLS categories has previously been described as a multi-category psychometric function (MCPF). In the study, a representative “catalog” of potential listener MCPFs was used in conjunction with maximum-likelihood estimation to derive CLS functions for participants with normal hearing and with hearing loss. The approach of estimating MCPFs for each listener has the potential to improve the accuracy of (...) the CLS measurements, particularly when a relatively low number of data points are available. The present study extends the MCPF approach by using Bayesian inference to select stimulus parameters that are predicted to yield maximum expected information (MEI) during data collection. The accuracy and reliability of the MCPF-MEI approach were compared to the standardized CLS measurement procedure (ISO16832:2006). A non-adaptive, fixed-level, paradigm served as a “gold-standard” for this comparison. The test time required to obtain measurements in the standard procedure is a major barrier to its clinical uptake. Test time was reduced from approximately 15 minutes to approximately 3 minutes with the MEI-adaptive procedure. Results indicated that the test-retest reliability and accuracy of the MCPF-MEI adaptive procedures were similar to the standardized CLS procedure. Computer simulations suggest that the reliability and accuracy of the MEI procedure were limited by intrinsic uncertainty of the listeners represented in the MCPF catalog. In other words, the MCPF provided insufficient predictive power to significantly improve adaptive-tracking efficiency under practical conditions. Concurrent optimization of both the MCPF catalog and the MEI-adaptive procedure have the potential to produce better results. Regardless of the adaptive-tracking method used in the CLS procedure, the MCPF catalog remains clinically useful for enabling maximum-likelihood determination of loudness categories. (shrink)

Mind &Language, Volume 34, Issue 5, Page 667-680, November 2019.

Researchers have argued that bilingual speakers experience less emotion in their second language. However, some studies have failed to find differences in emotionality between first and second lang...

Institutional ethics consultation services for biomedical scientists have begun to proliferate, especially for clinical researchers. We discuss several models of ethics consultation and describe a team-based approach used at Stanford University in the context of these models. As research ethics consultation services expand, there are many unresolved questions that need to be addressed, including what the scope, composition, and purpose of such services should be, whether core competencies for consultants can and should be defined, and how conflicts of interest should (...) be mitigated. We make preliminary recommendations for the structure and process of research ethics consultation, based on our initial experiences in a pilot program. (shrink)

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

Institutional ethics consultation services for biomedical scientists have begun to proliferate, especially for clinical researchers. We discuss several models of ethics consultation and describe a team-based approach used at Stanford University in the context of these models. As research ethics consultation services expand, there are many unresolved questions that need to be addressed, including what the scope, composition, and purpose of such services should be, whether core competencies for consultants can and should be defined, and how conflicts of interest should (...) be mitigated. We make preliminary recommendations for the structure and process of research ethics consultation, based on our initial experiences in a pilot program. (shrink)

Background Research is crucial to improve treatment, survival and quality of life for children with cancer. However, recruitment of children for research raises ethical challenges. The aim of this study was to explore and describe ethical values and challenges related to the recruitment of children with cancer for research, from the perspectives and experiences of healthcare professionals in the Swedish context. Another aim was to explore their perceptions of research ethics competence in recruiting children for research. Methods An explorative qualitative (...) study using semi-structured interviews with key informants. Seven physicians and ten nurses were interviewed. Interviews were analysed using inductive qualitative content analysis. Results The respondents’ ethical challenges and values in recruitment mainly concerned establishing relationships and trust, meeting informational needs, acknowledging vulnerability, and balancing roles and interests. Ensuring ethical competence was raised as important, and interpersonal and communicative skills were highlighted. Conclusion This study provides empirical insight into recruitment of children with cancer, from the perspectives of healthcare professionals. It also contributes to the understanding of recruitment as a relational process, where aspects of vulnerability, trust and relationship building are important, alongside meeting informational needs. The results provide knowledge on the complexities raised by paediatric research and underpin the importance of building research ethics competence to ensure that the rights and interests of children with cancer are protected in research. (shrink)

Perspective taking has been proposed to be impaired in persons with autism spectrum disorder, especially when implicit processing is required. In narrative texts, language perception and interpretation is fundamentally guided by taking the perspective of a narrator. We studied perspective taking in the linguistic domain of so-called Free Indirect Discourse, during which certain text segments have to be interpreted as the thoughts or utterances of a protagonist without explicitly being marked as thought or speech representations of that protagonist. Crucially, the (...) correct interpretation of text segments as FID depends on the ability to detect which of the protagonists “stands out” against the others and is therefore identifiable as implicit thinker or speaker. This so-called “prominence” status of a protagonist is based on linguistic properties, in other words, the perspective is “hidden” and has to be inferred from the text material. In order to test whether this implicit perspective taking ability that is required for the interpretation of FID is preserved in persons with ASD, we presented short texts with three sentences to adults with and without ASD. In the last sentence, the perspective was switched either to the more or the less prominent of two protagonists. Participants were asked to rate the texts regarding their naturalness. Both diagnostic groups rated sentences with FID anchored to the less prominent protagonist as less natural than sentences with FID anchored to the more prominent protagonist. Our results that the high-level perspective taking ability in written language that is required for the interpretation of FID is well preserved in persons with ASD supports the conclusion that language skills are highly elaborated in ASD so that even the challenging attribution of utterances to protagonists is possible if they are only implicitly given. We discuss the implications in the context of claims of impaired perspective taking in ASD as well as with regard to the underlying processing of FID. (shrink)

In a crisis, societal needs take precedence over a patient’s best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. (...) But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When “triaging” or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies. (shrink)

I argue that fitting envy plays a special role in safeguarding our happiness and flourishing. After presenting my theory of envy and its fittingness conditions, I contrast Kant’s view that envy is always unfitting with D’Arms and Jacobson’s defense of fitting envy as an evolutionarily-shaped response to a deep and wide human concern, that is, relative positioning. However, D’Arms and Jacobson don’t go far enough. First, I expand on their analysis of positional goodness, distinguishing between an epistemic claim, according to (...) which we use implicit or explicit comparison to know what position we occupy in a continuum of goodness, and thus to form judgments of goodness, and a metaphysical one, according to which much human goodness depends on implicit or explicit rankings and positionality. Second, I argue that fitting envy is not only intrinsically valuable qua fitting response to authentic goodness, but can be epistemically, morally and prudentially valuable. (shrink)

The debate on love's reasons ignores unrequited love, which—I argue—can be as genuine and as valuable as reciprocated love. I start by showing that the relationship view of love cannot account for either the reasons or the value of unrequited love. I then present the simple property view, an alternative to the relationship view that is beset with its own problems. In order to solve these problems, I present a more sophisticated version of the property view that integrates ideas from (...) different property theorists in the love literature. However, even this more sophisticated property view falls short in accounting for unrequited love's reasons. In response, I develop a new version of the property view that I call the experiential view. On this view, we love a person not only in virtue of properties shaped by and experienced in a reciprocal loving relationship, but also in virtue of perspectival properties, whose value can be properly assessed also outside of a reciprocal loving relationship. The experiential view is the only view that can account not only for reciprocated love's reasons, but also for unrequited love's reasons. (shrink)

There is no topic that attracts more attention, more energy and time and devotion, than love. As long as there's been recorded history, love has taken center seat as the inspiration for countless paintings, instigator of wars, muse of untold poets and musicians. And just as poetry, art and music have the ability to communicate something about love that is difficult to articulate with words, the same is true of mathematics. Of course, mathematics can't easily help us translate the emotional (...) side of love, emotions rarely behave in a neatly ordered, rational and easily predictable way. It is difficult to quantify the rollercoaster of romance or to define how lovers might feel via a set of simple equations. But that doesn't mean that mathematics isn't crucial to understanding love. Love, like most things in life, is full of patterns. And mathematics is ultimately the study of patterns, from predicting the weather to the fluctuations of the stock market, the movement of planets or the growth of cities. These patterns twist and turn and warp and evolve just as the rituals of love do. In [this book, the author] takes the listener on a fascinating journey through the patterns that define our love lives, tackling some of the most common yet complex questions pertaining to love: What's the chance of us finding love? What's the chance that it will last? How does online dating work, exactly? When should you settle down? How can you avoid divorce? When is it right to compromise? Can game theory help us decide whether or not to call? From evaluating the best strategies for online dating to defining the nebulous concept of beauty, Dr. Fry proves, with great insight, wit and fun, that math is a surprisingly useful tool to negotiate the complicated, often baffling, sometimes infuriating, always interesting, patterns of love. (shrink)

There is a growing resurgence in the study of psychedelic medicines for the treatment of mental health and substance use disorders. However, certain early investigations are marred by questionable research methods, abuses against research participants, and covert Central Intelligence Agency financial involvement. The purpose of this study was to understand how and to what extent people of colour and other vulnerable populations, specifically, individuals who were incarcerated or incapacitated due to mental health issues, were exploited during the first wave of (...) psychedelic research in the USA. To do so, we reviewed available empirical publications according to current ethical standards. Variables of interest included race and ethnicity of participants, population vulnerability, drug administration conditions, informed consent and undue influence. Our findings draw attention to the history of research abuses against people of colour in Western psychedelic research. In light of these findings, we urge a call-to-action to current psychedelic researchers to prioritise culturally inclusive and socially responsible research methods in current and future studies. All data relevant to the study are included in the article. (shrink)

Biological evolution provides a creative fount of complex and subtle adaptations, often surprising the scientists who discover them. However, because evolution is an algorithmic process that transcends the substrate in which it occurs, evolution’s creativity is not limited to nature. Indeed, many researchers in the field of digital evolution have observed their evolving algorithms and organisms subverting their intentions, exposing unrecognized bugs in their code, producing unexpected adaptations, or exhibiting outcomes uncannily convergent with ones in nature. Such stories routinely reveal (...) creativity by evolution in these digital worlds, but they rarely fit into the standard scientific narrative. Instead they are often treated as mere obstacles to be overcome, rather than results that warrant study in their own right. The stories themselves are traded among researchers through oral tradition, but that mode of information transmission is inefficient and prone to error and outright loss. Moreover, the fact that these stories tend to be shared only among practitioners means that many natural scientists do not realize how interesting and lifelike digital organisms are and how natural their evolution can be. To our knowledge, no collection of such anecdotes has been published before. This paper is the crowd-sourced product of researchers in the fields of artificial life and evolutionary computation who have provided first-hand accounts of such cases. It thus serves as a written, fact-checked collection of scientifically important and even entertaining stories. In doing so we also present here substantial evidence that the existence and importance of evolutionary surprises extends beyond the natural world, and may indeed be a universal property of all complex evolving systems. (shrink)

Sara Confalonieri presents an overview of Cardano's mathematical treatises and, in particular, discusses the writings that deal with cubic equations. The author gives an insight into the latest of Cardano's algebraic works, the De Regula Aliza (1570), which displays the attempts to overcome the difficulties entailed by the casus irreducibilis. Notably some of Cardano's strategies in this treatise are thoroughly analyzed. Far from offering an ultimate account of De Regula Aliza, by one of the most outstanding scholars of the (...) 16th century, the present work is a first step towards a better understanding. Contents Inter-Dependencies Between the Families of Cubic Equations in the Ars Magna Ars Magna, Chapters XI-XXIII and the Casus Irreducibilis Getting Acquainted with the De Regula Aliza The Method of the Splittings in Aliza, Chapter I Target Groups Academics, researcher and students in the fields of mathematics, the history of mathematics, and epistemology. The Author Sara Confalonieri graduated in Philosophy at the Università degli Studi di Milano, in Mathematics at the Université Paris 6, and in Epistemology at the Université Paris 7, where she also obtained the PhD degree in history of mathematics on cubic equations during the Renaissance. At present, she takes part in a project on history of the didactic of mathematics in the 18th century at the Bergische Universität in Wuppertal as a post-doctoral researcher. (shrink)

Building on critical approaches that understand algorithms in terms of communication, culture and organization, this paper offers the supplementary conceptualization of algorithms as organizational figuration, defined as material and meaningful sociotechnical arrangements that develop in spatiotemporal processes and are shaped by multiple enactments of affordance–agency relations. We develop this conceptualization through a case study of a Danish fintech start-up that uses machine learning to create opportunities for sustainable pensions investments. By way of ethnographic and literary methodology, we provide an in-depth (...) analysis of the dynamic trajectory in and through which the organization gives shape to and takes shape from its key algorithmic tool, mapping the shifting sociotechnical arrangements of the start-up, from its initial search for a viable business model through the development of the algorithm to the public launch of its product. On this basis, we argue that conceptualizing algorithms as organizational figuration enables us to detail not only what algorithms do but also what they are. (shrink)

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube (...) feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care. (shrink)

The essays in this volume apply philosophical analysis to address three kinds of questions: What are the implications of genetic science for our understanding of nature? What might it influence in our conception of human nature? What challenges does genetic science pose for specific issues of private conduct or public policy?

Our fast-paced society does not approve of solitude; being alone is antisocial and some even find it sinister. Why is this so when autonomy, personal freedom and individualism are more highly prized than ever before? Sara Maitland answers this question by exploring changing attitudes throughout history. Offering experiments and strategies for overturning our fear of solitude, she to helps us to practice it without anxiety and encourages us to see the benefits of spending time by ourselves. By indulging in (...) the experience of being alone, we can be inspired to find our own rewards and ultimately lead more enriched, fuller live. - The School of Life is dedicated to exploring life's big questions: How can we fulfill our potential? Can work be inspiring? Why does community matter? Can relationships last a lifetime? We don't have all the answers, but we will direct you toward a variety of useful ideas--from philosophy to literature, from psychology to the visual arts--that are guaranteed to stimulate, provoke, nourish, and console. (shrink)