Background There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard “narrow” definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. Research aims To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. Research design (...) A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. Participants Registered nurses from four hospitals within one large healthcare system in Midwest United States. Ethical considerations IRB approval was obtained. Results 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by “other” distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. Conclusions Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed. (shrink)

Commentary on Aṣṭāvakragītā, work on Vedanta philosophy; includes some passages in Hindi and text in Gujarati.

A major philosophical mind in his day, William Paley wrote in a lucid style that made complex ideas more accessible to a wide readership. This work, first published in 1785, was based on the lectures he gave on moral philosophy at Christ's College, Cambridge. Cited in parliamentary debates and remaining on the syllabus at Cambridge into the twentieth century, it stands as one of the most influential texts to emerge from the Enlightenment period in Britain. An orthodox theologian, grounding his (...) utilitarian ethics in strong religious faith, Paley held notably progressive views on issues of toleration and the slave trade. His perspicuity prompted one contemporary to remark that the book 'presents a subject which has always been considered as harsh and difficult, in the most agreeable and intelligible form … we sit down to be informed of our duty, and are surprised to meet with amusement'. (shrink)