Conserving the vitality of suffering: addressing family constraints to illness conversationsWhen persons are confronted with life‐threatening or chronic illness, there is always a possibility that family members other than the person experiencing the illness also suffer as they attempt to manage their own distress. This paper describes exemplars from a hermeneutic study that explored therapeutic conversations between nurses and families who were living with a member experiencing ischaemic heart disease. These conversations uncovered the complexity of both individual and family suffering (...) following acute cardiac illness events, and called attention to nursing practices that addressed some of the ways that family members were constrained from having conversations about the illness. When spaces were created for these conversations to occur, possibilities for making sense of illness and suffering were revealed as vital. These understandings support the efforts of family members to sustain and conserve family relationships in the face of illness and suffering, and inform both the professional and personal lives of nurses. (shrink)

Self-protection can have psychological and behavioral implications. We contrast them with the implications of a self-enhancement strategy. Both self-enhancement and self-protection have costs and benefits as survival strategies, and we identify some of the emotional, cognitive, and behavioral tradeoffs associated with the differential preferences for each strategy. New analyses on a large existing data set confirm the target article's hypothesis that women are more attuned than men to potential negative consequences of innovations.

Jeffery Aubin,Dianne Cole,Julio Cesar Dias Chaves,Jonathan von Kodar,Anne-France Morand,Timothy Pettipiece,Paul-Hubert Poirier,Martin Voyer,Eric Crégheur.

The complexity of registered nurses’ work in the intensive care unit places them at risk of experiencing critical incident stress. Gadamer's philosophical hermeneutics (1960/2013) was used to expand the meanings of work‐related critical incident stress for registered nurses working with adults in the intensive care unit. Nine intensive care unit registered nurses participated in unstructured interviews. The interpretations emphasized that morally distressing experiences may lead to critical incident stress. Critical incident stress was influenced by the perception of judgment from co‐workers (...) and the organizational culture. Nurses in this study attempted to cope with critical incident stress by functioning in ‘autopilot’, temporarily altering their ability to critically think and to conceal emotions. Participants emphasized the importance of timely crisis interventions tailored to support their needs. This study highlighted that critical incident stress was transformative in how intensive care unit nurses practiced, potentially altering their professional self‐identity. Work‐related critical incident stress has implications for nurses, the discipline, and the health care system. (shrink)

The output from motor neuron pools is influenced by the integration of synaptic inputs originating from descending corticomotor and spinal reflex pathways. In this study, using paired non-invasive brain and peripheral nerve stimulation, we investigated how descending corticomotor pathways influence the physiologic recruitment order of the soleus Hoffmann reflex. Eleven neurologically unimpaired adults completed an assessment of transcranial magnetic stimulation -conditioning of the soleus H-reflex over a range of peripheral nerve stimulation intensities. Unconditioned H-reflex recruitment curves were obtained by delivering (...) PNS pulses to the posterior tibial nerve. Subsequently, TMS-conditioned H-reflex recruitment curves were obtained by pairing PNS with subthreshold TMS at short and long intervals. We evaluated unconditioned and TMS-conditioned H-reflex amplitudes along the ascending limb, peak, and descending limb of the H-reflex recruitment curve. Our results revealed that, for long-interval facilitation, TMS-conditioned H-reflex amplitudes were significantly larger than unconditioned H-reflex amplitudes along the ascending limb and peak of the H-reflex recruitment curve. Additionally, significantly lower PNS intensities were needed to elicit peak H-reflex amplitude for long-interval facilitation compared to unconditioned. These findings suggest that the influence of descending corticomotor pathways, particularly those mediating long-interval facilitation, contribute to changing the recruitment gain of the motor neuron pool, and can inform future methodological protocols for TMS-conditioning of H-reflexes. By characterizing and inducing short-term plasticity in circuitry mediating short- and long-interval TMS-conditioning of H-reflex amplitudes, future studies can investigate supraspinal and spinal circuit contributions to abnormal motor control, as well as develop novel therapeutic targets for neuromodulation. (shrink)

Jeffery Aubin ,Marie Chantal ,Dianne Cole ,Julio Chaves ,Cathelyne Duchesne ,Christel Freu ,Steve Johnston ,Brice Jones ,Amaury Levillayer ,Stéphanie Machabée ,Paul-Hubert Poirier ,Philippe Therrien ,Jonathan von Kodar ,Martin Voyer ,Jennifer Wees ,Eric Crégheur.

_BMC Medical Ethics_ is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies. _BMC __Medical Ethics _is part of the _BMC_ series which publishes subject-specific journals focused on the needs of individual research communities across all areas of biology and medicine. We do not make editorial decisions on the basis of the interest of a study or (...) its likely impact. Studies must be scientifically valid; for research articles this includes a scientifically sound research question, the use of suitable methods and analysis, and following community-agreed standards relevant to the research field. Specific criteria for other article types can be found in the submission guidelines. _BMC series - open, inclusive and trusted_. (shrink)

DUREY A, WYNADEN D, THOMPSON SC, DAVIDSON PM, BESSARAB D and KATZENELLENBOGEN JM. Nursing Inquiry 2012; 19: 144–152 [Epub ahead of print]Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal AustraliansWell‐documented health disparities between Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) and non‐Aboriginal Australians are underpinned by complex historical and social factors. The effects of colonisation including racism continue to impact negatively on Aboriginal health outcomes, despite being under‐recognised and under‐reported. Many Aboriginal people (...) find hospitals unwelcoming and are reluctant to attend for diagnosis and treatment, particularly with few Aboriginal health professionals employed on these facilities. In this paper, scientific literature and reports on Aboriginal health‐care, methodology and cross‐cultural education are reviewed to inform a collaborative model of hospital‐based organisational change. The paper proposes a collaborative model of care to improve health service delivery by building capacity in Aboriginal and non‐Aboriginal personnel by recruiting more Aboriginal health professionals, increasing knowledge and skills to establish good relationships between non‐Aboriginal care providers and Aboriginal patients and their families, delivering quality care that is respectful of culture and improving Aboriginal health outcomes. A key element of model design, implementation and evaluation is critical reflection on barriers and facilitators to providing respectful and culturally safe quality care at systemic, interpersonal and patient/family‐centred levels. Nurses are central to addressing the current state of inequity and are pivotal change agents within the proposed model. (shrink)

This article focuses on the ways that sexual risk behaviors are related to race, class, and gender among low-income, culturally diverse women in South Florida. Data concerning sexual risk and gender are presented in terms of race and class variations. Results indicate that, in general, these women have a high degree of knowledge about acquired immune deficiency syndrome, a quite contemporary awareness of women's gendered subordination, and a lack of trust in heterosexual relationships. Attitudes, beliefs, and knowledge, however, are not (...) translated into sexual behaviors with men partners that would reduce their vulnerability to infection with the human immunodeficiency virus. The data indicate that race is a major factor that places women into an underclass position. Consequently, without socioeconomic resources, gendered behaviors have a direct influence on sexual risk. Multivariate analyses indicate that those women who are sex workers are significantly more likely to negotiate safe sex with clients than with main partners. The research not only challenges mainstream thinking about race, class, and gender but also provides overdue information on the vulnerability of women to HIV infection. (shrink)

This conversation between two scholars of international law focuses on the contemporary realities of feminist analysis of international law and on current and future spaces of resistance. It notes that feminism has moved from the margin towards the centre, but that this has also come at a cost. As the language of women’s rights and gender equality has travelled into the international policy worlds of crisis management and peace and security, feminist scholars need to become more careful in their analysis (...) and find new ways of resistance. While noting that we live in dangerous times, this is also a hopeful discussion. (shrink)

Women face extraordinary difficulty in seeking sterilization as physicians routinely deny them the procedure. Physicians defend such denials by citing the possibility of future regret, a well‐studied phenomenon in women’s sterilization literature. Regret is, however, a problematic emotion upon which to deny reproductive freedom as regret is neither satisfactorily defined and measured, nor is it centered in analogous cases regarding men’s decision to undergo sterilization or the decision of women to undergo fertility treatment. Why then is regret such a concern (...) in the voluntary sterilization of women? I argue that regret is centered in women’s voluntary sterilization due to pronatalism or expectations that womanhood means motherhood. Women seeking voluntary sterilization are regarded as a deviant identity that rejects what is taken to be their essential role of motherhood and they are thus seen as vulnerable to regret. (shrink)

This book presents an overview of these studies and attempts to clarify apparently disparate results by placing them in a coherent theoretical framework.

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were (...) higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

This essay uses the phenomenal advent of women's climbing as a paradigm case for integrating feminism and phenomenology, and for analyzing how women experience and evolve free movement and existence. In contrast to the paradigm set by Iris Marion Young's “Throwing like a Girl,” it stresses the category of the lived body over the category of gender, and it reveals how women, by employing and cultivating the body's motility and spatiality, engage and transcend the limits of crux situations.

It is clear now that open education is much more than a binary consideration of open versus closed but also includes "opening." This book maps a range of different theoretical and practice-oriented approaches and proposals to (re)considering open education.

: This essay uses the phenomenal advent of women's climbing as a paradigm case for integrating feminism and phenomenology, and for analyzing how women experience and evolve free movement and existence. In contrast to the paradigm set by Iris Marion Young's "Throwing like a Girl," it stresses the category of the lived body over the category of gender, and it reveals how women, by employing and cultivating the body's motility and spatiality, engage and transcend the (gender) limits of crux situations.

The figure of Donna Haraway’s cyborg continues to loom large over contemporary feminist engagements with questions of technology. Across a range of analytical projects ranging from cosmetic surgery to employment practices it has come to be one of the defining figurations through which the social and discursive construction of bodies in a technological age are theorized. Indeed, it has become a widely accepted and largely unquestioned orthodoxy of postmodern feminist thinking. Not only has the cyborg offered a theoretical framework for (...) exploring the feminist possibilities of technologies, it has provided a focus for situating questions of technology and bodies into broader feminist theoretical considerations of the structures of knowledge, particularly those of binary oppositions and the logic of identity. While a productive and influential intervention into feminist theorizing, the cyborg is not without limitations. One of these is pointed out by Kirby (1997) as a failure to break convincingly with the logic ofidentity in the way Haraway theorizes the intersection of bodies and technologies in the fabrication of the cyborg. This article examines that criticism and then explores the possibilities which Deleuze and Guattari’s concept of assemblageoffers as a mean of thinking the meetings of bodies and technologies beyond binary oppositions. (shrink)

This study aims to address how and when retailers’ sustainability efforts translate into positive consumer responses. Hypotheses are developed and tested through a scenario-based experiment among 672 consumers. Retailers’ assortment sustainability and distribution sustainability are manipulated. Retailers’ sustainability efforts lead to positive consumer responses via two underlying mechanisms: consumers’ identification with the store and store legitimacy. The effects of sustainability efforts are strengthened if consumers have personal norms favoring shopping at environmentally friendly stores. Remarkably, when controlling for moderation by personal (...) norms, social norms weaken the effects. The findings show that traditional marketing mix elements provide opportunities for retailers to improve their organizations’ bottom line and positively affect consumer well-being. This study helps retailers decide whether or not to invest in and communicate about sustainability. Past research has shown the clear potential for positive consumer responses to firms’ sustainability efforts, but little is known about the underlying mechanisms and the conditions under which such responses take place. This study advances theory by examining personal and social factors as mediators and moderators of the retailers’ sustainability efforts–consumer responses relationship. (shrink)

Many opponents of BIG programs believe that receiving guaranteed subsistence income would act as a strong disincentive to work. In contrast, various areas of empirical research in psychology suggest that a BIG would not lead to meaningful reductions in work. To test these competing predictions, a comprehensive review of BIG outcome studies reporting data on adult labor responses was conducted. The results indicate that 93 % of reported outcomes support the prediction of no meaningful work reductions when the criterion for (...) support is set at less than a 5 % decrease in either average hours worked per week or the rate of labor participation. Overall, these results indicate that adult labor responses would show no substantial impact following a BIG intervention. (shrink)

We suggest edits to Part Four of the Ethical and Religious Directives (ERDs) to help the US bishops address and clarify essential Church teachings on specific beginning-of-life issues facing Catholic health care today. As a teaching tool, Part Four must be updated so that Catholic health care professionals and the lay faithful can understand and apply Church teachings to new ethical challenges. Further, more direction and clarity from the ERDs is needed in applying general principles to assisted procreative technologies, pre- (...) and post-viability induction of labor, ectopic pregnancies, genetic screening and diagnosis, and contraception. Catholic health care clinicians and administrators also need to receive ongoing instruction on the ERDs’ teachings as well as the theological and philosophical rationales that undergird them. (shrink)

Implicit learning is said to occur when a person learns about a complex stimulus without necessarily intending to do so, and in such a way that the resulting knowledge is difficult to express. Over the last 30 years, a number of studies have claimed to show evidence of implicit learning. In more recent years, however, considerable debate has arisen over the extent to which cognitive tasks can in fact be learned implicitly. Much of the debate has centred on the questions (...) of how unconscious, and how abstract, is implicitly acquired knowledge? The aim of this book is to provide students and researchers with a self-contained and balanced summary of the various theoretical and empirical positions that are currently shaping this exciting area of research. (shrink)

The micro-regional focus of bioregionalism is a small unit of physical space, typically a watershed region. In bioregional discourse, natural systems become metaphors for cultural coherence. However, when we look for laws embedded in the natural world, those that are found do not then reveal themselves as principles which apply to systems of culture. Further, within most individuals, the sense of regional identity spans several scales because our past narratives and present affiliations span several localities. Humans are not immersed in (...) singular niches, nor is the bioregionalist an existential, primordial localist, for his or her choice has been crafted. (shrink)

BackgroundWith the enactment of Bill C-7 in Canada in March 2021, people who are eligible for medical assistance in dying (MAiD), whose death is reasonably foreseeable and are at risk of losing decision-making capacity, may enter into a written agreement with their healthcare provider to waive the final consent requirement at the time of provision. This study explored healthcare providers’ perspectives on honouring eligible patients’ request for MAiD in the absence of a contemporaneous consent following their loss of decision-making capacity. (...) MethodA critical qualitative methodology, using a feminist ethics theoretical lens with its focus on power and relationality, was used to examine how socio-political and environmental contexts influenced healthcare providers' moral agency and perspectives. Semi-structured interviews were conducted with 30 healthcare providers (13 physicians, six nurse practitioners, nine nurses and two social workers) from across Canada who provide MAiD-related care.ResultsThemes identified include; (1) balancing personal values and professional responsibilities, (2) anticipating strengths and limitations of the proposed waiver of final consent amendment, (3) experiencing ethical influences on decisions to enter into written agreements with eligible patients, (4) recognizing barriers to the enactment of MAiD in the absence of a contemporaneous consent and (5) navigating the potential for increased risks and burden.DiscussionTo our knowledge, this is the first study in Canada to explore healthcare providers’ perspectives on waiving the final consent for MAiD using a written agreement. Most participants supported expanding eligible people’s access to MAiD following loss of capacity, as they believed it would improve the patients’ comfort and minimize suffering. However, the lack of patients’ input at the time of provision and related ethical and legal challenges may impact healthcare providers’ moral agency and reduce some patients’ access to MAiD. Providers indicated they would enter into written agreements to waive final consent for MAiD on a case-by-case basis. This study highlights the importance of organizational, legal and professional support, adequate resources, clear policies and guidelines for the safety and wellbeing of healthcare providers and to ensure equitable access to MAiD. (shrink)

When consumers choose to abstain from purchasing meat, they face some uncertainty about whether their decisions will have an impact on the number of animals raised and killed. Consequentialists have argued that this uncertainty should not dissuade consumers from a vegetarian diet because the “expected” impact, or average impact, will be predictable. Recently, however, critics have argued that the expected marginal impact of a consumer change is likely to be much smaller or more radically unpredictable than previously thought. This objection (...) to the consequentialist case for vegetarianism is known as the “causal inefficacy” (or “causal impotence”) objection. In this paper, we argue that the inefficacy objection fails. First, we summarize the contours of the objection and the standard “expected impact” response to it. Second, we examine and rebut two contemporary attempts (by Mark Budolfson and Ted Warfield) to defeat the expected impact reply through alleged demonstrations of the inefficacy of abstaining from meat consumption. Third, we argue that there are good reasons to believe that single individual consumers—not just consumers in aggregate—really do make a positive difference when they choose to abstain from meat consumption. Our case rests on three economic observations: (i) animal producers operate in a highly competitive environment, (ii) complex supply chains efficiently communicate some information about product demand, and (iii) consumers of plant-based meat alternatives have positive consumption spillover effects on other consumers. (shrink)

The diagnosis was Turn-to-Stone disease. None of us had heard of it and rushed to Google. Her body calcified itself, painfully turning tissue to bone. She planned her funeral; turning stone to ashes.Meanwhile Viagra four times a day took blood to her hands and feet. “Viagra!” she’d joke, “you’d think I was hard..

Research ethics principles and regulations typically have been applied to the protection of individual human subjects. Yet, new paradigms of research that include the place-based community and cultural groups as partners or participants of environmental research interventions, in particular, require attention to place-based identities and geographical contexts. This paper argues the importance of respecting “place” within human subjects protections applied to communities and cultural groups as part of a critical need for research ethics and cultural competence training for graduate research (...) students. These protections and benefits are extensions of the Belmont Principles and have been included in recent recommendations from research regulatory committees. (shrink)

The 'business judgement rule ' requires corporate directors only to act with honesty and reasonable care in the interest of shareholders. A stronger ' fiduciary ' duty is required where one party requires protection from another. This paper argues that where corporations take risks with the environment, directors are fiduciaries. Stakeholders are in that case the general public, future generations and other species, which have not voluntarily accepted risk and cannot limit liability. Recognition of fiduciary duty in such cases is (...) consistent with recent trends in the law of equity. It would require all economic activities to move from open to closed systems. (shrink)

Set within the socio-political context of standards-based education reform, this article explores the constitutive role of teaching standards in the production of the practice and identity of the ‘accomplished’ teacher. It contrasts two idioms for thinking about and studying these standards, the representational and the performative. Utilising the material-semiotic approach of actor-network theory, it addresses the issue of how the representational idiom of teaching standards has become so authoritative that it readily eclipses other ways to think and ‘do’ them. In (...) tracing the development of a specific set of teaching standards as part of a national research project, the argument is made that standards should be understood as performative knowledge and identity practices. And, accounting them should also be performative. Accordingly, attention is given to key locales in which this development is taking place. Teaching standards emerge as ontologically variable and it is struggles around this variability that can create conditions for a renewed practice and politics of education reform. (shrink)

How to live at multiple scales? Immersed in infrastructure, economics and politics functioning at a scale beyond our immediate experience, our capacities for reason and abstraction have led to the geological era of the Anthropocene. Yet it is also these capacities that mean we are the singular planetary species with any chance of developing systems that can assure less rather than more devastation as a result of these planetary shifts. This essay explores the ways in which we can use our (...) capacity for reason, abstraction, to design what a future ought to be: open to regular revision in response to our practical behaviours given the persistent contingency of the conditions in which we are immersed. (shrink)