Background and significance of research: Nurses’ awareness of professional values and how those values affect their behaviors is an integral part of nursing care. There is a large body of research on nursing professional values, however, a careful survey of the available literature did not yield any studies investigating the status of professional values in operating rooms. Objective: This study aims to investigate the perception of operating room nurses of university hospitals toward professional values. Research plan: In (...) this cross-sectional study, data were collected using Schank and Weis’s Nurses Professional Values Scale–Revised. The collected data were analyzed in SPSS version 16. Participants and settings: The 513 participants of the study consisted of operating room nurses and nurse anesthetists from six university hospitals. Ethical considerations: This study has been approved by the ethics committee of the university. Findings: The mean total professional values score of the operating room staff was found to be 100.84 ± 15.685, which indicates that the participants had a positive perception toward observance of nursing professional values in practice. The results showed that the participants considered the domains of justice and activism as, respectively, the most and the least important. The operating room staff’s overall professional values scores were not found to correlate significantly with their ages, professional experience, university majors, or attendance at ethics workshops. However, a significant difference was found between the professional values scores of the female and male staff. The professional values scores of the operating room nurses and the nurse anesthetists were not significantly different. Conclusion: Operating room staff’s awareness of professional values is essential to providing care to patients based on professional principles. Accordingly, there is need for programs to raise operating room nurses’ awareness of their professional duties and improve their professional performance. (shrink)

Scheduling surgical procedures among operating rooms is mistakenly regarded as merely a tedious administrative task. However, the growing demand for surgical care and finite hours in a day qualify OR time as a limited resource. Accordingly, the objective of this manuscript is to reframe the process of OR scheduling as an ethical dilemma of allocating scarce medical resources. Recommendations for ethical allocation of OR time—based on both familiar and novel ethical values—are provided for healthcare institutions and individual surgeons.

BackgroundFor the patients receiving care in the operating room, it emphasizes that the ethical behavior and attitude of health professionals should be aligned with patients’ basic human rights. Surgical ethics may provide an ethical alternative in a specific operating room context. However, it is unclear how actively research is being conducted in this regard.AimThis study determines the direction of future research by identifying ethical issues experienced in the operating room.MethodThis scoping review is based on (...) the methodological framework suggested by Arksey and O’Malley in 2005. PubMed, CINAHL, EMBASE, WOS, Cochrane, KISS, and KMbase databases were searched from January 2012 to May 2022. Two researchers independently screened the searched articles by reviewing the titles, abstracts, and full texts. Consequently, 19 studies were selected.FindingsFive categories were identified: Professional ethics, Organizational ethics, Patients’ rights, Patient safety, and Allocating resources. The derived categories covered all the same content as the International Council of Nurses’ (ICN) code of ethics, with the exception of one element, that is, global health.ConclusionsThis study highlights ethical issues in the operating theatre and emphasizes the need for individual and organizational strategies aligned with the ICN code of ethics. Future research should cover a wider range of issues, employ diverse perspectives and methodologies, and enhance ethical practices to improve understanding and ethical practices in the field. (shrink)

BackgroundNon-technical skills are cognitive and interpersonal skills underpinning technical proficiency. Ethical values and respect for human dignity make operating room nurses responsible for nursing decisions that are clinically and technically sound and morally appropriate.AimTo learn what ethical issues operating room nurses perceive as important regarding non-technical skills.Research designQualitative individual in-depth interviews were conducted. The interviews were analysed using Braun and Clarke’s six phases for thematic analysis.Participants and research contextEleven experienced perioperative/operating room nurses working in (...) an operating unit at a Norwegian university hospital.Ethical considerationsApproval was given by The Norwegian Social Science Data Service in care of the hospital’s Data Protection Officer.FindingsThree main themes were found: respect and care for the patient, making the patient feel safe, and respect within the perioperative team. These features or themes, which incorporate collaboration and communication, are closely connected to patient safety.DiscussionDefending the patient’s dignity is part of caring for and respecting the patient. The manner in which the operating room team collaborates is important for the patient to feel safe and secure. Poor teamwork may have dire consequences. Reciprocal respect within the team includes respect for each other’s tasks and responsibilities and to talk to one another in a friendly manner.ConclusionBeing respectful and contributing to a caring atmosphere are central ethical skills in the operating room. To patients, harmonious teamwork translates into a feeling of safety and being cared for. The nurses see respect and patient safety, and respect and reciprocal politeness among the members of the perioperative team as central ethical non-technical skills. Lack of respect influences the team negatively and is detrimental for patient safety. Good communication is an important safety measure during surgery and creates a feeling of good ‘flow’ within the operating room team. (shrink)

BackgroundOccupational burnout is a mental health problem that among nurses may lead not only to physical and psychological complications, but also to a decrease in the quality of patient care. Considering the stressful nature of surgery, operating room nurses may be at a greater risk. Therefore, the present study aimed to identifying factors associated with the occupational burnout from the perspective of operating room nurses.Materials and methodsThis qualitative study was conducted in Iran in 2021 using conventional (...) content analysis. Sampling was performed using purposeful sampling method with maximum variation. In order to collect data, individual, semi-structured interviews were performed with 18 operating room nurses. Interviews continued until data saturation. Data were recorded, transcribed and analyzed using steps proposed by Graneheim and Lundman. Data management was performed using MAXQDA-2020 software. Four criteria provided by Guba and Lincoln were used to improve the study’s trustworthiness and rigor.ResultsA main theme, 4 categories and 15 subcategories were extracted from the data. The main theme is “gradual burnout due to job tension” and categories and subcategories include organizational factors, interpersonal factors, Occupational nature factors as well as individual factors.ConclusionNumerous factors associated with burnout in operating room nurses, which may put the personnel under more pressure. According to these factors, nursing managers and operating room nurses can consider effective strategies to prevent or coping with burnout. (shrink)

This article deals with surgical practice as it is locally organized within the course of the operation; it focuses on the way in which surgical action shaping the body for the local purposes of the operation is organized in a timely, situated, interactive manner. In order to do that, I offer a systematic analysis of the instructions addressed by a chief surgeon to his assistant in the form of directives during a surgical operation, as well as of instructed actions of (...) the assistant following the directives of the surgeon. In this way, I aim to show how surgery is a methodic collaborative achievement, relying on finely tuned coordination between staff members. More generally, the article sketches a systematic and detailed analysis of instructions as situated accomplishments in time, and of instructed action as resulting from an embodied and indexical understanding of directives and requests as they are produced in time and in context. (shrink)

Snap‐shots of live theatre: the use of photography to research governance in operating room nursing The use of photography is an underreported method of research in the nursing literature. This paper explores its use in an ethnographic research project, the fieldwork of which was undertaken by the first author. The aim was to examine the governance of operating room nursing in the clinical setting and the theoretical orientation was the work of Michel Foucault. The focus of (...) this paper is on how photography was used as a means of data generation. To establish some context we begin by drawing on writers from sociology and anthropology to provide an overview of the status of vision and visual research methods in contemporary social research. We then move to a brief discussion of the uses of photography in social research and the limitations imposed by ethical considerations of its use in clinical nursing settings. As well, the process and approach involved in this research project, and issues of analysis are discussed. Three ‘snap‐shots’ of operating room nursing, taken by participants, are presented. Each is analysed in terms of its contributions to the research process as well as its substantive contribution to the theoretical framework and the research aims. (shrink)

Background The organizational climate in the operating room is special due to the specific conditions of the patient, and the ethical climate may affect moral distress of the operating room staff. Objective This study determined the relationship between ethical climate and moral distress from staff working in operating rooms of hospitals affiliated to Mashhad University of Medical Sciences. Method This analytical study was performed on 169 operating room staff in Mashhad, Iran. The (...) class='Hi'>operating room staff was selected using stratified random sampling. The data were collected via Olson's Hospital Ethical Climate Survey and the Corley Moral Distress Scale and analyzed with IBM Statistical Package for the Social Sciences (SPSS) software version 21. Results The results showed no relationship between the ethical climate, the frequency, and intensity of moral distress of the operating room staff ( p > 0.05). In addition, the mean score of the ethical climate was 3.32 ± 0.48, indicating the average ethical climate in the operating room. The mean frequency and intensity of moral distress were 36.36 ± 11.68 and 48.8 ± 15.92, showing a moderate rate. There was a significant inverse relationship between the dimensions of ethical climate, the relationship with physicians, and the intensity of moral distress ( p <0.05). A significant relationship was found between the intensity of moral distress, the level of education, and field of study ( p <0.05). Conclusion The results of the current study showed that interventional programs should be implemented to reduce moral distress and improve the ethical climate in the operating room. (shrink)

IntroductionThe idea of video recording in the operating room with panoramic cameras and microphones is a new concept that is changing the approach to medical activities in the OR. However, VR in the OR has brought up many concerns regarding patient privacy and has highlighted legal and ethical issues that were never previously exposed.AimTo review the literature concerning these aspects and provide a better ethical and legal understanding of the new challenges concerning VR in the OR.ConclusionsThere is a (...) disparity between the two main legal models concerning VR in the OR, namely the European legal system ) and the American legal framework ). This difference mainly deals with two distinct bioethical paradigms: GDPR places a strong emphasis on protecting patients’ privacy to improve the public health system, whereas HIPAA indicates the need to generate protocols to safeguard the risks connected to medical activity and patient privacy. Following from this point, we may argue that, at the ethical and bioethical level, GDPR and HIPAA depend mainly on two different ethical models: a perspective based on moral acquaintances and weak proceduralism, respectively. It is worth noting the importance of developing additional guidelines concerning different world regions to avoid the ethical problems that may emerge when simply applying a foreign paradigm to a very different culture. (shrink)

The 2008 ‘credit crisis’ brought to attention that business and finance operate in open-complex systems. In contrast, the period leading up to the crisis was dominated by narrower thinking developed from the idea that business was about economics and that management concerned agency. This paper revisits ideas first developed in the late 1990s that arose from the observation that business was confronting interacting ‘systems.’ The main systems were around (sustainable) development, the internationalization of business and a set of social and (...) cultural concerns resulting from globalization.The paper anticipated the collapse of parts of the economic system as a result of hyper-competition. It points to the growing significance of ‘identity’ and its potential to create a ‘clash of values.’ It concludes by suggesting that as we enter this ‘systems age’ our models and assumptions around the boundaries of companies and the idea of companies and stakeholders would be severely challenged. (shrink)

Background The ethical climate is an essential component of organizational climate or culture. The ethical climate is necessary for clinical practice in operating rooms. Objective This study aimed to compare the ethical climate from the perspective of operating room nursing students and operating room staff of hospitals affiliated with Mashhad University of Medical Sciences, Iran. Method This analytical study was performed on 95 operating room nursing students and 169 operating room staff (...) of hospitals in Mashhad, Iran. The students were selected through the census method and the staff were selected by using stratified random sampling. The data were collected via Olson’s Hospital Ethical Climate Survey and analyzed by using BMI SPSS version 21. Results The total mean scores of the ethical climate were 3.44 ± 0.45 and 3.32 ± 0.48 from students and staff’s perspectives, and the independent t-test showed no significant difference between them. Furthermore, the results of the study indicated a significant difference in communication with physicians’ score between operating room staff and students’ views. Conclusion Although it is difficult to create a right ethical climate in operating rooms, but hospital managers should implement practical programs to improve the ethical climate of operating rooms and inter-professional teamwork. Besides, deans of faculties can provide ethical-based education for students, who can effectively create an ethical climate. (shrink)

In this article, I investigate the process of coordination between three ‘bodies’ of surgery: the patient-ensemble(s) constructed in pre-operative activities; the surgeon-body constructed with these ensembles in the operating room; and the body-world inhabited by the surgeon. This investigation is done through an ethnography of a neurosurgical clinic, with an analytical focus on the relationship between the spatial configuration of the body of the surgeon and the embodied practices of operating that this configuration demands. My argument is (...) that coordination between those three bodies is organized in the layered space into which the multiple ensembles of surgery are assembled. This relationship, I suggest, lies at the core of the power and technical expertise held by surgeons, and constitutes a challenge for explorations of other forms of articulation between subject body-worlds and the embodiment of power in subject-bodies. (shrink)

This article explores stories related by perioperative nurses when asked to describe ethical judgements and subsequent actions that affected patient outcomes. A total of 214 patient care situations were analysed for moral actions taken and moral outcomes achieved in the perioperative arena. Content analysis of the patient care situations revealed a wide variety of ethical issues. Concerns about informed consent and quality of care were the most frequently identified issues. Respondents reported that 7% of patients underwent unwanted procedures and that (...) positive moral outcomes were achieved in 65% of situations. It is of concern that, despite the fact that more than two-thirds (69%) of the respondents reported undergoing ethics education, only 27% could relate a story of an ethical situation. (shrink)

Pediatric dentists rely on access to hospital operating rooms for safe, effective, and humane delivery of dental care. The children who benefit most from dental treatment in a hospital operating room are those who are very young, have dental anxieties or phobias, are precommunicative or noncommunicative, need extensive or invasive dental treatments, or have special healthcare needs. Diminishing access to hospital operating rooms for pediatric dental treatment has become an escalating problem in contemporary times. Financial barriers, (...) hospital costs, reimbursement rates, health insurance policies and deductibles, out-of-network hospitals, socioeconomic factors, and the COVID-19 pandemic are prominent contributing factors. This problem in access to care has resulted in long waiting times for hospital operating rooms, deferral of medically necessary dental care, and pain and infection among this vulnerable patient population. Pediatric dentists have responded to the problem by utilizing alternative methods of care delivery, such as in-office deep sedation or in-office general anesthesia, and by implementing aggressive medical management of dental caries. However, the youngest of pediatric patients and children with special healthcare needs still remain at a disadvantage in receiving definitive dental treatment. This article aims to highlight the ethical challenges faced by pediatric dentists in contemporary practice in the face of limitations in hospital operating room access through four case scenarios. (shrink)

The question of whether Do Not Resuscitate orders should be sustained in the operating room was brought to our ethics committee by a pulmonologist and involved one of his patients for whom he serves as a primary care physician. His patient, a woman with chronic obstructive lung disease was electing, for comfort purposes, to have a hip pinning following a fracture. At the same time, she wished to have a DNR order covering her entire hospital stay. The anesthesiologist (...) described her direction as “improper” and refused to participate in surgical procedures if DNR orders extended to the operating room. The patient refused to rescind the order during surgery. As a result, the surgery was canceled to the great chagrin of the patient. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Operating in a Contemporary Safety NetJason D. KeuneIt is summer, and I have just started my fourth year of general surgery residency, having just returned from two years in the lab. My “lab years” were spent as a Scholar–in–Residence of the American College of Surgeons. The scholarship that I engaged in included obtaining an MBA and a Graduate Certificate in Professional Ethics. The ethics component was self–designed with (...) help from an advisor, and was made up of graduate courses in political theory, healthcare financing law and bioethics. To say that I was reflective as I returned to the clinical rotations of the fourth year of residency would be understated.During this two–year period, I did not operate. I did do some clinical work during this time, but there wasn’t anyone in town willing to hire a partially–trained surgeon to do anything operative. I ended my third year of residency very happy with my technical skills, and was not sure just how these skills would survive a two–year hiatus. The challenge, as I thought of it then, would be to return to clinical rotations with this insecurity in mind and try to gain insight into just how rusty my skills were in a short period of time, and rectify them. I was in for a surprise.I felt a chill of trepidation when I discovered that the rotation that had been selected for me to return to was one in which I would be assigned to operate on and care for a low–income population of uninsured or underinsured patients with surgical problems—with minimal attending supervision. The patients were referred from the Federally Qualified Health Centers in town. The rotation had arisen from altruistic roots. The surgical service, provided at a large, academic urban hospital, was established when the city’s last remaining public hospital closed its doors for surgical patients. The service was an upright attempt to provide surgical continuity for this population. As I started the rotation and performed my first surgeries in two years with very minimal supervision, I realized that I would be participatory in what sums to a thoroughly unjust healthcare system. I would be caught in a swirl of humanitarian justice celebrated and a focus on a justice that seemed to fall short of a mark.The indigent hospital itself managed the clinic with a full complement of staff befitting a contemporary surgical clinic, albeit with a rather rudimentary computer system. The recordkeeping mechanism in our surgical office, however, was done without administrative assistance. We occupied a small room amongst the academic surgical offices at our home institution. The chief resident sat at a large [End Page 12] desk, the intern at a smaller desk, and the medical student had a chair and a laptop. The recordkeeping mechanism tracking who needed surgery, who had had surgery, and who needed follow–up on pathology was maintained by all members of the team. It involved one labyrinthine Excel spreadsheet, with multiple tabs, and a complex color–coordinated scheme of organization. The team would scan the entire thing on a daily basis to make sure nothing would be missed.When it came time to schedule a patient for the operating room, it was my responsibility as a chief resident to get an attending to “cover the case”, which amounted to finding an attending who agreed, at the bare minimum, to be present for the “critical portion” of the case. If the case was complex or very difficult, an attending surgeon would have to be sought who would scrub in and help perform the procedure. Not every attending would cover a charity case—the reasons why were not forthcoming. One surgeon would scrub every case he was asked to cover, stating that he felt every patient should have the same chance at the best treatment. Another would come to the room, but sit along the wall and review manuscripts as we operated, there to grant reassurance, and answer questions, but not, presumably, to direct the overall decision–making. All patients with breast cancer were seen, and operated on by one very dedicated breast surgeon with a humanitarian bent.I... (shrink)

In a world of glossy corporate social responsibility reports, the shallowness of the actual CSR results may well be its counterpart. We claim that the possible gaps between aspirations and implementations are due to the company's overrating abilities to deal with the irrational and complex moral world of business. Many academic approaches aim to lift business ethics up to a higher level by enhancing competences but will fail because they are too rationalistic and generalistic to match the pluralistic and situational (...) practice constituted by the mosaic of values and set of constraints. This is demonstrated by describing and analyzing the CSR development of the multinational caterer Sodexo and in particular its Dutch branch. We explain what they do and why they are not successful. We present a new tool named Ethical Room for Maneuver that centers experiences and concrete situations in a playground of inquiry and experiment to enhance abilities to operate in themoral world and to meliorate business and society with more effectiveness. (shrink)

Against the medical and social models of disability are two newer proposals. Elizabeth Barnes’ Minority Body proposes that it is the bodies which are advocated for and included in the disability rights movement which are rightfully called “disabled.” Savulescu and Kahane’s Welfarist approach proposes that disability is intrinsically tied to the effects of bodily states on welfare. They put the need for a consistent and relatively simple normative theory above accounting for standard case judgements about who is and is not (...) disabled or looking at all to membership of the disabled community. I argue that Barnes’ theory offers the best response to issues with the dominant models of disability. Further, I argue that the Welfarist theory operates in a space removed from the wishes and lived experiences of disabled people – separating ‘disability’ from activism entirely – to its detriment. Doing so compromises its explanatory power, over-generalizes the concept and prevents the insertion of meaningful boundaries. Barnes’ ‘solidarity thesis’ soundly conceptualizes disability whilst making room for activist voices. The centering of activist projects makes it stronger. (shrink)

Viewed in the light of the remarkable performance of ‘Watson’ - IBMs proprietary artificial intelligence computer system capable of answering questions posed in natural language - on the US general knowledge quiz show ‘Jeopardy’, we review two experiments on formal systems - one in the domain of quantum physics, the other involving a pictographic languaging game - whereby behaviour seemingly characteristic of domain understanding is generated by the mere mechanical application of simple rules. By re-examining both experiments in the context (...) of Searle’s Chinese Room Argument, we suggest their results merely endorse Searle’s core intuition: that ‘syntactical manipulation of symbols is not sufficient for semantics’. Although, pace Watson, some artificial intelligence practitioners have suggested that more complex, higher-level operations on formal symbols are required to instantiate understanding in computational systems, we show that even high-level calls to Google translate would not enable a computer qua ‘formal symbol processor’ to understand the language it processes. We thus conclude that even the most recent developments in ‘quantum linguistics’ will not enable computational systems to genuinely understand natural language. (shrink)

Surgeons are in a unique position, serving as gatekeepers to the operating room. They determine if operations are possible, are indicated, and have a reasonable risk–to–benefit profile. When an operation is indicated and the patient is amenable to it, the conversation between surgeon and patient is usually straightforward. On the other hand, when a patient’s co–morbidities substantially increase the risk of operative intervention, surgeons often question the utility of offering their services. These situations become immensely more difficult when (...) patients have the expectation of being offered surgical treatment. This case describes the clinical encounter between an endocrine surgeon and an 83–year–old woman who has been incidentally found to have adrenal metastasis from melanoma. The patient wants an operation that the surgeon is reluctant to offer because of her frailty and high operative risk. The case focuses on the ethical dilemma that arises when a patient wants an operation that a surgeon does not want to perform. I was the resident in the endocrine surgery clinic the day that Ms. M came in. Given my background in bioethics, the attending physician told me about the patient’s history beforehand and asked for advice on how to approach the clinical encounter. I then accompanied him into her room to talk with her and her husband. (shrink)

Viewed in the light of the remarkable performance of ‘Watson’ - IBMs proprietary artificial intelligence computer system capable of answering questions posed in natural language - on the US general knowledge quiz show ‘Jeopardy’, we review two experiments on formal systems - one in the domain of quantum physics, the other involving a pictographic languaging game - whereby behaviour seemingly characteristic of domain understanding is generated by the mere mechanical application of simple rules. By re-examining both experiments in the context (...) of Searle’s Chinese Room Argument, we suggest their results merely endorse Searle’s core intuition: that ‘syntactical manipulation of symbols is not sufficient for semantics’. Although, pace Watson, some artificial intelligence practitioners have suggested that more complex, higher-level operations on formal symbols are required to instantiate understanding in computational systems, we show that even high-level calls to Google translate would not enable a computer qua ‘formal symbol processor’ to understand the language it processes. We thus conclude that even the most recent developments in ‘quantum linguistics’ will not enable computational systems to genuinely understand natural language. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Operating Through HatredAndrew G. Shuman“You’re not cutting my ***ing neck. The cancer is in my ***ing mouth.”While many patient encounters are memorable, Mr. K’s introduction to the head and [End Page 20] neck surgical oncology clinic is indelibly imprinted into the minds of all of the clinicians present on that certain autumn morning. This was, quite simply, a man who resonated hate. He was rude and disruptive. He (...) insisted on an expedited workup “without any waiting.” He questioned the ethnicity and nationality of his care providers. He told me, in no uncertain terms, that he did not appreciate my Jewish heritage—the swastika tattooed on his bicep underscored the point. He bragged about his recent incarceration for armed robbery. While my colleagues and I were tempted to simply refuse to assume his care, Mr. K had a bad problem—his recurrent tongue cancer required a major operation in order to offer him any hope for cure.Mr. K initially received an abbreviated course of radiation at an outside institution, which was limited by his non–compliance. While one might debate the wisdom of this decision in retrospect—in general, surgery is preferred for his type of tumor—the die was already cast. A heroic attempt at surgical salvage was now his only curative option. He previously sought care elsewhere... only to be fired by this original surgeon when Mr. K physically threatened him in the outpatient office during preoperative consultation. [It was the doctor’s fault for insulting him in the first place, Mr. K maintained... and no charges were filed.] We were, indeed, his last resort. Other than his recurrent cancer, Mr. K was robust; he was in his sixth decade, physically fit, and on the whole, fairly healthy. In the classic surgical lexicon, he was a reasonable surgical candidate. But was it reasonable to operate on such a person?I remember thinking, at the time, about our obligation to care for such an individual. Of course, being a medical professional carries with it many obligations, including a judicious assumption of personal risk. And, working in a tertiary care center begets the responsibility to assist referring clinicians in the management of difficult cases. Although professional obligations certainly have their limits, defining their bounds is decidedly more difficult. Paramount is creating an atmosphere of mutual trust and acceptance. Naturally, this was easier said than done in regard to Mr. K.Perhaps against our better judgment, we agreed to operate under the condition that he abide by strict behavioral ground rules, on our terms. We agreed upon the extent of the necessary operation (which indeed involved cutting his ***ing neck, much to his chagrin and reluctant acceptance). Mr. K promised to follow instructions for postoperative care. He assured us that he would not swear or yell (again). And, in the presence of hospital security, who reinforced our institutional policies regarding patient behavior, he guaranteed that he would not be verbally or physically violent or inappropriate, and would not make disparaging comments to other patients or staff. It seemed, at least, that we had an understanding.Needless to say, these rules were broken shortly after he awoke from surgery. I vividly remember being summoned from the OR when he threatened to murder his impressionable and terrified nurse a few days later, who would not acquiesce to his unreasonable demands. From that point onward, hospital security was deployed to his room regularly, and anything resembling a potential weapon was safeguarded. Any semblance of a mutual doctor–patient bond was shattered. At this point, everyone’s goal was simply to get Mr. K home.My visceral reactions to his behavior, while intense, were not unexpected, and fell in line with those of the entire team of clinicians caring for him. His antics brought his healthcare team together in collective unity (and condemnation). However, my surgical colleagues and I also felt somewhat guilty and responsible. While surgeons can choose to assume some degree of inherent personal danger in caring for a violent and angry patient, we also put the safety and soundness of the entire perioperative team in jeopardy, without necessarily seeking their input. But once we had decided to... (shrink)

The concerns regarding patient autonomy presented in August A. Culbert et al.’s “Navigating Informed Consent and Patient Safety in Surgery: Lessons for Medical Students and Junior Trainees” fall just short of addressing the main issue. Patient autonomy is not something that just one member of a team should consider, and it should not be something that any protocol should have the power to subvert, particularly in an environment as tenuous as the operating room. This article will take the (...) concerns regarding the ethics of removing a patient’s hearing aid prior to entering the operating room presented in the aforementioned article and show the necessity for a new standard operating procedure. (shrink)

This study looks at the interactions between health workers, physical space, surgical tools, and the “patient-body” in an operating theater. My aim is to explore the approaches of Katz, Rawlings, and Collins and to show that when rituals, restrictive entrance procedures, and clothing requirements are not in place, when rules are not observed for reasons that this article addresses, the boundary between the operating theater and its surroundings blurs. It becomes a trivialized space. Data were collected in the (...) regional hospital of one major town of the Extrême Nord of Cameroon. I describe a context of crisis and a lack of equipment and personnel that narrow the boundaries of the operating room but do not erase them. Restrictive entrance procedures, clothing requirements, rituals, and rules that are supposed to separate the operating theater from its surroundings, as Katz has shown, are not observed. Instead, the theater is connected to its surroundings through an “intriguing combination of practices” consistent with the analyses of Rawling and Collins. Thus, the operating theater is not a closed and limited area inside the hospital that can be completely isolated from its surroundings. There is continuity between the interior and the exterior. (shrink)

We argue that a command and control system can undermine a commander’s moral agency if it causes him/her to process information in a purely syntactic manner, or if it precludes him/her from ascertaining the truth of that information. Our case is based on the resemblance between a commander’s circumstances and the protagonist in Searle’s Chinese Room, together with a careful reading of Aristotle’s notions of ‘compulsory’ and ‘ignorance’. We further substantiate our case by considering the Vincennes Incident, when the (...) crew of a warship mistakenly shot down a civilian airliner. To support a combat commander’s moral agency, designers should strive for systems that help commanders and command teams to think and manipulate information at the level of meaning. ‘Down conversions’ of information from meaning to symbols must be adequately recovered by ‘up conversions’, and commanders must be able to check that their sensors are working and are being used correctly. Meanwhile ethicists should establish a mechanism that tracks the potential moral implications of choices in a system’s design and intended operation. Finally we highlight a gap in normative ethics, in that we have ways to deny moral agency, but not to affirm it. (shrink)

Nanotechnologies are enabling technologies which rely on the manipulation of matter on the scale of billionths of a metre. It has been argued that scientific uncertainties surrounding nanotechnologies and the inability of regulatory agencies to keep up with industry developments mean that voluntary regulation will play a part in the development of nanotechnologies. The development of technological applications based on nanoscale science is now increasingly seen as a potential test case for new models of regulation based on future-oriented responsibility, lifecycle (...) risk management, and upstream public engagement. This article outlines findings from a project undertaken in 2008–2009 for the UK Government’s Department of Environment, Food and Rural Affairs (DEFRA) by BRASS at Cardiff University, involving an in-depth survey both of current corporate social responsibility (CSR) reporting in the UK nanotechnologies industry, and of attitudes to particular stakeholder issues within the industry. The article analyses the results to give an account of the nature of corporate social performance (CSP) within the industry, together with the particular model of CSR operating therein (‘do no harm’ versus ‘positive social force’). It is argued that the nature of emerging technologies requires businesses to adopt particular visions of CSR in order to address stakeholder issues, and that the nanotechnologies industry presents specific obstacles and opportunities in this regard. (shrink)

This study analyzed and explored the cognitive load of Australian energy market operators managing one of the longest inter-connected electrical networks in the world. Each operator uses a workstation with seven screens in an active control room environment, with a large coordination screen to show information and enable collaboration between different control centers. Cognitive load was assessed during both training scenarios and regular control room operations via the integration of subjective and physiological measures. Eye-tracking glasses were also used (...) to analyze the operators gaze behavior. Our results indicate that different events, different participants for the same session, and different periods of one session all have varying degrees of cognitive load. The system design was observed to be inefficient in some situations and to have an adverse affect on cognitive load. In critical situations for instance, operator collaboration was high and the coordination screen was used heavily when collaborating between two control centers, yet integration with the system could be improved. Eye tracking data analysis showed that the layout of applications across the seven screens was not optimal for many tasks. Improved layout strategies, potential combination of applications, redesigning of certain applications, and linked views are all recommended for further exploration in addition to improved integration of procedures and linking alarms to visual cues. (shrink)

I propose that the intensification of meat production ironically makes meat concepts available to be populated by plants. I argue that what I call “technologies of effacement” facilitate the intensification of animal farming and slaughter by blocking face-to-face encounters between animals and people (Levinas 1969; Efstathiou 2018, 2019). My previous ethnographic work on animal research identifies technologies of effacement as including (a) architectures and the built environment, (b) entry and exit rules, (c) special garments, (d) naming and labeling procedures, and (...) (e) protocols for handling animals (Efstathiou 2018, 2019). Building on ethnographic research by Dawn Coppin (2003) and Nöellie Vialles (1994), in the United States and France respectively, I propose that (a) Concentrated Animal Feeding Operation (CAFO) buildings, gestation, and farrowing crates; (b) rules for entering and exiting the slaughterhouse; (c) white slaughterhouse garments; (d) unique identification systems; and (e) “trapping” animals before stunning can all operate as technologies of effacement. Though developed to serve other manifest aims, like hygiene, expediency, or safety, these technologies operate to sustain routine, inviting one to look at animals as tokens of a known type while blocking encounters between humans and animals (and also among animals) as radically different, morally significant Others (Efstathiou 2018, 2019). (shrink)

The processing of metaphors and idioms has been the subject of neuroscientific research for several decades. However, results are often contradictory, which can be traced back to inconsistent terminology and stimulus control. In this systematic review of research methods, we analyse linguistic aspects of 116 research papers which used EEG, fMRI, PET, MEG, or NIRS to investigate the neural processing of the two figurative subtypes metaphor and idiom. We critically examine the theoretical foundations as well as stimulus control by performing (...) a systematic literature synthesis according to the PRISMA guidelines. We explicitly do not analyse the findings of the studies but instead focus on four primary aspects: definitions of figurative language and its subtypes, linguistic theory behind the studies, control for factors influencing figurative language processing, and the relationship between theoretical and operational definitions. We found both a lack and a broad variety in existing definitions and operationalisation, especially in regard to familiarity and conventionality. We identify severe obstacles in the comparability and validation potential of the results of the papers in our review corpus. We propose the development of a consensus in fundamental terminology and more transparency in the reporting of stimulus design in the research on figurative language processing. (shrink)