This chapter describes a study undertaken as part of the UCL Evidence programme to explore how policymakers talk about and reason with evidence. Specifically, researchers were interested in the micro-processes of deliberation and meaning-making practices of a group of people charged with prioritising health care in an NHS Primary Care Trust in the UK. The chapter describes how the research study brought together ideas from rhetorical theory and methods of discourse analysis to develop an innovative approach to exploring how evidence (...) is constituted at the micro-level of social interaction and communication. It presents empirical data to illuminate the representation and meaning of evidence within one particular policymaking forum, and to highlight contrasting constructions of the policymaking process. (shrink)

Evidence-based medicine has always required integration of patient values with ‘best’ clinical evidence. It is widely recognized that scientific practices and discoveries, including those of EBM, are value-laden. But to date, the science of EBM has focused primarily on methods for reducing bias in the evidence, while the role of values in the different aspects of the EBM process has been almost completely ignored.

The evidence-based practice and evidence-based medicine movements have promoted standardization through guideline development methodologies based on systematic reviews and meta-analyses of best available research. EBM has challenged clinicians to question their reliance on practical reasoning and clinical judgement. In this paper, we argue that the protagonists of EBM position their mission as reducing uncertainty through the use of standardized methods for knowledge evaluation and use. With this drive towards uniformity, standardization and control comes a suspicion towards intuition, creativity and uncertainty (...) as integral parts of medical practice. We question the appropriateness of attempts to standardize professional practice through a discussion of the importance of uncertainty. Greenhalgh’s taxonomy of uncertainty is used to inform an analysis of the clinical reasoning occurring in a potentially life threatening emergency situation with a young patient. The case analysis is further developed by the use of the Canadian philosopher Bernard Lonergan’s theory about understanding and objective knowing. According to Lonergan it is not by getting rid of or even by reducing uncertainty, but by attending systematically to it and by relating to it in a self-conscious way, that objective knowledge can be obtained. The paper concludes that uncertainty is not a regrettable and unavoidable aspect of decision making but a productive component of clinical reasoning. (shrink)

BackgroundImplementation science research, especially when using participatory and co-design approaches, raises unique challenges for research ethics committees. Such challenges may be poorly addressed by approval and governance mechanisms that were developed for more traditional research approaches such as randomised controlled trials.DiscussionImplementation science commonly involves the partnership of researchers and stakeholders, attempting to understand and encourage uptake of completed or piloted research. A co-creation approach involves collaboration between researchers and end users from the onset, in question framing, research design and delivery, (...) and influencing strategy, with implementation and broader dissemination strategies part of its design from gestation. A defining feature of co-creation is its emergent and adaptive nature, making detailed pre-specification of interventions and outcome measures impossible. This methodology sits oddly with ethics committee protocols that require precise pre-definition of interventions, mode of delivery, outcome measurements, and the role of study participants. But the strict requirements of ethics committees were developed for a purpose – to protect participants from harm and help ensure the rigour and transparency of studies. We propose some guiding principles to help square this circle. First, ethics committees should acknowledge and celebrate the diversity of research approaches, both formally and informally ; without active support, their members may not understand or value participatory designs. Second, ground rules should be established for co-design applications and communicated to committee members and stakeholders. Third, the benefits of power-sharing should be recognised and credit given to measures likely to support this important goal, especially in research with vulnerable communities. Co-design is considered best practice, for example, in research involving indigenous peoples in New Zealand, Australia and Canada. (shrink)

Professional identity and competent ethical behaviors of nursing students are commonly developed through curricular inclusion of professional nursing values education. Despite the enactment of this approach, nursing students continue to express difficulty in managing ethical conflicts encountered in their practice. This descriptive correlational study explores the relationships between professional nursing values, self-esteem, and ethical decision making among senior baccalaureate nursing students. A convenience sample of 47 senior nursing students from the United States were surveyed for their level of internalized professional (...) nursing values (Revised Professional Nursing Values Scale), level of self-esteem (Rosenberg’s Self-Esteem Scale), and perceived level of confidence in ethical decision making. A significant positive relationship (p < 0.05) was found between nursing students’ professional nursing values and levels of self-esteem. The results of this study can be useful to nursing educators whose efforts are focused on promoting professional identity development and competent ethical behaviors of future nurses. (shrink)

For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re-clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for (...) use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care. (shrink)

When healthcare professionals feel constrained from acting in a patient’s best interests, moral distress ensues. The resulting negative sequelae of burnout, poor retention rates, and ultimately poor patient care are well recognized across healthcare providers. Yet an appreciation of how particular disciplines, including physicians, come to be “constrained” in their actions is still lacking. This paper will examine how the application of shared decision-making may contribute to the experience of moral distress for physicians and why such distress may go under-recognized. (...) Appreciation of these dynamics may assist in cross-discipline sensitivity, enabling more constructive dialogue and collaboration. (shrink)

This chapter discusses Guattari's ecosophy, placing his work within the extant literature on environmental education and science and technology studies; defining key terms and examining ecosophy as a philosophy radical and encompassing enough to make intelligible the dynamic connections between various fields of existence. It then offers a ‘reading’ of two different pedagogical strategies that have achieved a wide following in the last few decades: direct instruction, and critical pedagogy. Reading these pedagogies through ecosophy allows us to name more fully (...) the troubling assumptions and lacunae of these pedagogical strategies. The chapter also explores connections between individuals, communities, practices, and the nonhuman (material) world. Finally, the chapter argues not only that education is a matter of connection to people and communities, but also that education involves an exploration and reimagining of our connections to things, processes, and living systems. (shrink)

This project evaluates the impact of the National Science Foundation's policy to promote education in the responsible conduct of research. To determine whether this policy resulted in meaningful RCR educational experiences, our study examined the instructional plans developed by individual universities in response to the mandate. Using a sample of 108 U.S. institutions classified as Carnegie “very high research activity”, we analyzed all publicly available NSF RCR training plans in light of the consensus best practices in RCR education that were (...) known at the time the policy was implemented. We found that fewer than half of universities developed plans that incorporated at least some of the best practices. More specifically, only 31% of universities had content and requirements that differed by career stage, only 1% of universities had content and requirements that differed by discipline; and only 18% of universities required some face-to-face engagement from all classes of trainees. Indeed, some schools simply provided hand-outs to their undergraduate students. Most universities had plans that could be satisfied with online programs such as the Collaborative Institutional Training Initiative's RCR modules. The NSF policy requires universities to develop RCR training plans, but provides no guidelines or requirements for the format, scope, content, duration, or frequency of the training, and does not hold universities accountable for their training plans. Our study shows that this vaguely worded policy, and lack of accountability, has not produced meaningful educational experiences for most of the undergraduate students, graduate students, and post-doctoral trainees funded by the NSF. (shrink)

Researchers working on children's moral understanding maintain that the child's capacity to distinguish morality from convention shows that children regard moral violations as objectively wrong. Education in the moral domain. Cambridge: Cambridge University Press). However, one traditional way to cast the issue of objectivism is to focus not on conventionality, but on whether moral properties depend on our responses, as with properties like icky and fun. This paper argues that the moral/conventional task is inadequate for assessing whether children regard moral (...) properties as response-dependent. Unfortunately, children's understanding of response-dependent properties has been neglected in recent research. Two experiments are reported showing that children are more likely to treat properties like fun and icky as response-dependent than moral properties like good and bad. Hence, this helps support the claim that children are moral objectivists. (shrink)

That which constitutes a ‘good death’, or dying well, has long been of interest to philosophers and clinicians alike. While difficult to define due to its deeply personal nature and dependency on spiritual and cultural beliefs and past experiences, Wilkinson1 has drawn parallels from art and music to consider key ethical components. Few in clinical practice would dispute that a ‘good death’ is one that does not rob the person of a valuable life, is aligned with the preferences of the (...) patient and/or their family, where comfort and solace is provided, distress to family and caregivers is minimised or even that dying is not prolonged. However, what is more contentious is how tensions within the principles of a ‘good death’ should be managed or prioritised. In the context of caring for critically ill babies and children, the tension often takes the form of prolonging the dying process through providing life-sustaining interventions to meet the needs of, and to lessen the longer term distress of, the bereaved family, who must live with the decisions that are made. Though often justifiable, such interventions may result in considerable moral distress within caregivers—particularly, as often the case, when interventions are perceived by some clinicians to be of greater benefit to the family than the patient. Some clinicians may have difficulty …. (shrink)

Offering cash payments to research subjects is a common recruiting method but there is significant debate about whether and in what amount such payments are appropriate. This paper is concerned with exploitation and whether there should be a lower limit on the amount researchers can pay their subjects. When subjects participate in research as a way to make money, fairness requires that researchers pay them a fair wage. This call for the establishment of a lower limit meets resistance in two (...) places: (1) denial that the payments offered by researchers are wages for participation; and (2) concern about undue inducement. This paper critically examines these arguments for and against a lower limit. It shows that the need for a lower limit cannot be avoided by adopting a non-wage payment model and that concerns about undue inducement are unjustified in all trials except those that present greater than minimal risk. This analysis suggests the following compromise position: there should be an unconditional lower limit on payment amounts so that researchers cannot offer less than a fair wage, and when researchers cannot satisfy this limit because fairness requires a problematically large payment, then researchers should offer no payment at all. (shrink)

INTRODUCTION In her "Introduction" to Feeling_and Form Susanne K. Langer writes that nothing in this book is exhaustively treated. ...

The debate around vaccine passports has been polarising and controversial. Although the measure allows businesses to resume in-person operations and enables transitioning out of lockdown due to the COVID-19 pandemic, some have expressed concerns about liberty violations and discrimination. Understanding the splintered viewpoints can aid businesses in communicating such measures to employees and consumers. We conceptualise the business implementation of vaccine passports as a moral decision rooted in individual values that influence reasoning and emotional reaction. We surveyed support for vaccine (...) passports on a nationally representative sample in the United Kingdom in 2021: April (n = 349), May (n = 328), and July (n = 311). Drawing on the Moral Foundations Theory—binding (loyalty, authority, and sanctity), individualising (fairness and harm), and liberty values—we find that individualising values are a positive predictor and liberty values a negative predictor of support for passports, suggesting adoption hinges on addressing liberty concerns. Longitudinal analysis examining the trajectory of change in support over time finds that individualising foundations positively predict changes in utilitarian and deontological reasoning over time. In contrast, a fall in anger over time predicts increased support towards vaccine passports. Our study can inform business and policy communication strategies of existing vaccine passports, general vaccine mandates, and similar measures in future pandemics. (shrink)

Offering cash payments to research subjects is a common recruiting method, but this practice continues to be controversial because of its potential to compromise the protection of human subjects. Some critics question whether researchers should be allowed to offer money at all, citing concerns about commodification of the research subject, invalidation of study results, and increased risks to subjects. Other critics are comfortable with the idea of monetary payments but question how much researchers can pay their subjects, citing concerns about (...) undue inducement, crowding out, and monetary exploitation. Focusing only on the amount researchers can pay their subjects, this paper argues that the federal regulations and guidelines should implement a standard payment formula. It argues for a wage payment model, and critically examines three candidates for a base wage: the nonfarm production wage, the FLSA minimum wage, and a living wage. (shrink)

A common and driving assumption in agricultural research is that the introduction of research trials, new practices and innovative technologies will result in technology adoption, and will subsequently generate benefits for farmers and other stakeholders. In Lao PDR, the potential benefits of introduced technologies have not been fully realised by beneficiaries. We report on an analysis of a survey of 735 smallholder farmers in Southern Lao PDR who were questioned about factors that influenced their decisions to adopt new technologies. In (...) this study, we have constructed measures or states of adoption which identify key elements of an adoption decision-making nexus. Analysis was conducted to statistically group explanatory factors of adoption. The key explanatory factors represented attributes of the farmer, the factors considered when undertaking production decisions and elements of the agricultural value chain that present as opportunities or constraints. We describe the combination of farmer’s personal attributes, perceptions of the value chain, and the introduction of new technologies by external actors as an “agricultural research value chain”, where agricultural research activities intervene to derive greater benefits for local farmers. A generalised linear model, via Poisson regression analysis on the identified explanatory factors, was applied to explore how they influence adoption measures and we found several significant relationships. (shrink)

Moral distress is prevalent within the neonatal intensive care unit (NICU) and can negatively affect clinicians. Studies have evaluated the causes of moral distress and interventions to mitigate it...

All research tools have limitations. Not all tools will be suited to every purpose. Understanding the limitations and accurately interpreting the output from any tool is essential to conducting mea...

This paper challenges the fitness of Angela Ballantyne's proposed theory of exploitation by situating her ‘fair risk account’ in an ongoing dialogue about the adequacy conditions for benchmarks of fairness. It identifies four adequacy conditions: (1) the ability to focus on level rather than type of benefit; (2) the ability to focus on micro-level rather than macro-level fairness; (3) the ability to prevent discrimination based on need; and (4) the ability to prescribe a certain distribution as superior to all others. (...) While the fair risk account satisfies the first condition, this paper argues that it has difficulty satisfying the last three conditions. Ballantyne's proposal includes several new and promising features, but in order for the fair risk account to be useful in identifying and preventing exploitation, Ballantyne must either clarify and augment her theory or challenge the relevance of the adequacy conditions it fails to meet. (shrink)