Background: Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient’s body and self. Aim: To understand the meaning of traumatic injury for body and self for patients receiving intensive care. Research design: A qualitative descriptive study using Giorgi’s phenomenological approach. (...) Participants and research context: Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30–60 min. Audiotaped interviews were transcribed and analyzed. Ethical considerations: This study was approved by the Institutional Review Board of the medical center. Findings: The impact of the experience of traumatic injury on participants’ body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. Discussion and conclusion: The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient’s body and self that facilitates ethical care and recovery from injury. (shrink)

Background: Healthcare professionals follow codes of ethics, making them responsible for providing holistic care to all disaster victims. However, this often results in ethical dilemmas due to the need to provide rapid critical care while simultaneously attending to a complex spectrum of patient needs. These dilemmas can cause negative emotions to accumulate over time and impact physiological and psychological health, which can also threaten nurse–patient relationships. Aim: This study aimed to understand the experience of nurses who cared for burn victims (...) of the color-dust explosion and the meaning of ethical relationships between nurse and patient. Research design: A qualitative descriptive study using a phenomenological approach. Participants and research context: Clinical nurses who provided care to the patients of the Formosa color-dust explosion of 2015 were selected by purposive sampling (N = 12) from a medical center in Taiwan. Data were collected using individual in-depth semi-structured interviews. Audiotaped interviews were transcribed and analyzed using Colaizzi’s method. Ethical considerations: This study was approved by the institutional review board of the study hospital. All participants provided written informed consent. Findings Three main themes described the essence of the ethical dilemmas experienced by nurses who cared for the burn-injured patients: (1) the calling must be answered, (2) the calling provoked my feelings, and (3) the calling called out my strengths. Conclusions: Healthcare providers should recognize that nurses believed they had an ethical responsibility to care for color-dust explosion burn victims. Understanding the feelings of nurses during the care of patients and encouraging them to differentiate between the self and the other by fostering patient–nurse relationships based on intersubjectivity could help nurses increase self-care and improve patient caregiving. (shrink)

Background: As moral action could help nurses reduce moral distress, it is necessary to carry out qualitative research to present the experiences in which nurses apply moral action. Aim: To describe and analyze the phronesis applied by nurses in the face of moral distress. Research design: The research participants were invited to participate in in-depth interviews. The research materials were based on the stories described by the research participants and recorded by means of first-person narrative. Narrative analysis was applied to (...) interpret the nurses’ phronesis. Participants: Twenty-seven nurses from Taiwan. Ethical considerations: The Institutional Review Board of the Kaohsiung Medical University Hospital in Taiwan confirmed that this study passed the research ethical review. Findings: According to the narrative analysis results, the phenomenon of moral distress contains difficulty, action, and idea transformation. The difficulty is the source of moral distress, action is the practice of moral courage, and idea transformation is the nurse’s emotional movement. Action and idea transformation are collectively called phronesis in this study. Discussion: Moral distress refers to a state of suffering caused by situations in which nurses cannot carry out their ethical intentions. Phronesis is the process through which nurses take actions and relocate the subjects and is an ethical way to find relief from moral distress. Starting with empathy and respectful attitudes arising from self-reflection, nurses may be helped to get relief from the suffering of moral distress. Conclusion: Phronesis can help nurses positively face the emotional strain of moral distress. This article puts forward a narrative method to complete the four steps of phronesis: write about the care experience, identify the difficulties in the stories, seek the possibility of action, and form a new care attitude, which could help nurses learn to reduce their moral distress. (shrink)

Globalization has expanded its influence since the early 1980s hugely since Reagan and Thatcher were in power and devoted themselves to advocating its key ideas, such as deregulation and privatizat...

Research on the unrepresentability of death in Samuel Beckett’s oeuvre abound in Beckett scholarship, but little attention has been given to the artist’s representation of caregiving to the dying in his plays. With reference to Martin Heidegger’s concept of _care_ and Albert Camus’s idea of the _absurd_, this article analyzes _Endgame_ (1957) and _Footfalls_ (1976) by attending to Beckett’s dramatic representation of caregiving as undergirded by a sense of its absurdity. The almost 20-year gap between the writing of both plays (...) highlights the development of an understanding that this sense of absurdity is never about the caregiver’s questioning of one’s obligation to the dependent but about how one chooses to respond to caregiving as an absurd predicament. The pertinence of such a representation of caregiving by Beckett lies in its poignant articulation of a complex experience that is often left unexpressed by caregivers who prioritize their dependent loved ones over themselves. (shrink)

It has been argued that globalization assists the USA to gain a hegemonic position, allowing it to export its culture. Because this exportation leads to the domination by American culture of the local cultures of importing countries, which are the key element in sustaining their citizens’ national identity, citizens of these countries are unable to protect state sovereignty from this cultural invasion. In order to prevent a political crisis arising from such an invasion, these countries will adopt the strategy of (...) cultural localization. However, this top-down approach overestimates the influence of hegemonic cultures and, thus, overlooks the dynamic nature of cultural development that is generated by people’s agency. This essay rejects this top-down model by arguing that texts cannot dominate people, and that people influence their existence and value. (shrink)

Background Ethical dilemmas that arise in the clinical setting often require the collaboration of multiple disciplines to be resolved. However, medical and nursing curricula do not prioritize communication among disciplines regarding this issue. A common teaching strategy, problem-based learning, could be used to enhance communication among disciplines. Therefore, a university in southern Taiwan developed an interprofessional ethics education program based on problem-based learning strategies. This study described tutors’ experience teaching in this program. Aim To explore the phenomenon of teaching and (...) learning in interprofessional ethics education for medical and nursing students from the perspectives of tutors. Design Phenomenological qualitative research. Methods Medical and nursing students completed a 6-week interprofessional ethics education program moderated by either physician or nurse tutors. At the conclusion of the ethics education program, all 14 tutors were invited to participate in focus group interviews. Among them, six tutors (three nursing tutors and three physician tutors) participated in additional individual interviews. All of the contents from the focus group interviews and individual interviews were recorded and transcribed. Using the phenomenological approach, the phenomenon of teaching and learning in interprofessional ethics education were generated. Ethical consideration The study was approved by the Institutional Review Board. Findings Three themes emerged from the tutors' teaching perspectives, including the instructor’s motivation to teach, the use of narrative case scenarios, and the emphasis on improving interprofessional ethics communication. Discussion Problem-based learning creates an interprofessional communication platform in interprofessional ethics education. The phenomenon of value convergence between tutors and students, between different students’ professions, and between different students’ professional maturities is observed. Conclusion Problem-based learning is an effective teaching strategy for creating a communication platform for interprofessional ethics education. Ethic curriculum should emphasize motivating instructor, use narrative case scenarios, and focus on interprofessional communication. (shrink)

Background: Healthcare workers in the front line of diagnosis, treatment, and care of patients with coronavirus disease 2019 are at great risk of both infection and developing mental health symptoms. This study aimed to investigate the following: whether healthcare workers in general hospitals experience higher mental distress than those in psychiatric hospitals; the role played by religion and alexithymic trait in influencing the mental health condition and perceived level of happiness of healthcare workers amidst the stress of the COVID-19 pandemic; (...) and factors that influence the resilience of healthcare workers at 6 weeks' follow-up.Methods: Four-hundred and fifty-eight healthcare workers were recruited from general and psychiatric hospitals, and 419 were followed-up after 6 weeks. All participants filled out the 20-item Toronto Alexithymia Scale, five-item Brief-Symptom Rating Scale, and the Chinese Oxford Happiness Questionnaire.Results: Under the stress of the COVID-19 pandemic, 12.3% of frontline healthcare workers in general hospitals reported having mental distress and perceived lower social adaptation status compared with those working in psychiatric hospitals. Christians/Catholics perceived better psychological well-being, and Buddhists/Taoists were less likely to experience mental distress. The results at 6 weeks of follow-up showed that the perceived lower social adaptation status of general hospital healthcare workers was temporary and improved with time. Christian/Catholic religion and time had independent positive effects on psychological well-being; however, the interaction of Christian/Catholic religion and time had a negative effect.Conclusions: Collectivism and individualism in the cultural context are discussed with regard to alexithymic trait and Buddhist/Taoist and Christian/Catholic religious faiths. Early identification of mental distress and interventions should be implemented to ensure a healthy and robust clinical workforce for the treatment and control of the COVID-19 pandemic. (shrink)

Some of the authors of the essays on Chinese philosophers prefer the pin yin system of romanization for Chinese names and words, while others prefer the Wade‐Giles system. Given that both systems are in wide use today, important names and words are given in both their pin yin and Wade‐Giles formulations. The author's preference is printed first, followed by the alternative romanization within brackets.

Background: Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses’ values, the physician–nurse power hierarchy, and the influence of the culture. Research objective: To analyze the main causes for moral distress with interpretive interactionism. Research design: A qualitative study was adopted. Participants: Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples. Ethical considerations: Approval from the Institutional Review Board of the Kaohsiung (...) Medical University Hospital. Findings: Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician–nurse power hierarchy, and the Oriental culture affect nurses’ goodness-based intention for patients, which deteriorates moral distress. Discussion: The main cause for moral distress is the moral goodness of nurses. If nurses’ goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients’ right to know about their diseases, the choice of treatment, and patients’ autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care. Conclusion: The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses’ confidence and cultural sensitivity, so as to reduce the moral distress of nurses. (shrink)

Philosophy is presented in a wide range of forms, none of which can be convincingly claimed to be the “genuine” one. Historically speaking, there is not one “proper” way of doing philosophy, evidencing what may be called the social contingency of philosophy. This paper aims to provide a “critical” philosophy of today, in the Kantian sense of a philosophy that reflects on the conditions of its possibility, and thereby acknowledges the limitations they impose. Conceptually, our approach is grounded in Niklas (...) Luhmann’s social systems theory, in which “functional differentiation” and “second-order observation” are two crucial characteristics of modern society. The paper discusses how presentations of philosophy align themselves with the second-order observation mechanisms of the specific social systems in which they are “hosted.” This paper deals in particular with two such systems: academics and social media. These forms of presenting philosophy produce two different kinds of philosophy presenters: the expert and the influencer. (shrink)

This article examines the development of koro’s epistemic status as a paradigm for understanding culture-specific disorders in modern psychiatry. Koro entered the DSM-IV as a culture-bound syndrome in 1994, and it refers to a person’s overpowering belief that his (or her) genitalia is retracting and even disappearing. I focus in particular on mental health professionals’ competing views of koro in the 1960s—as an object of psychoanalysis, a Chinese disease, and a condition predisposed by culture. At that critical juncture, transcultural psychiatrists (...) based outside of continental China—namely, Taiwan, Hong Kong, and Singapore—appropriated ideas from traditional Chinese culture to consolidate the clinical diagnosis of koro as culture-bound. This new global meaning of koro was made possible by a cohort of medical experts who encountered the phenomenon and its sufferers in Sinophone (Chinese-speaking) communities, but placed their contributions within the broader contours of the global reach of Anglophone psychiatric science. (shrink)

Drawing on propositions from the signaling theory and expectancy theory, this study hypothesizes that the perceived corporate citizenship of job seekers positively affects a firm’s attractiveness and career success expectation. This study’s proposed research hypotheses are empirically tested using a survey of graduating MBA students seeking a job. The empirical findings show that a firm’s corporate citizenship provides a competitive advantage in attracting job seekers and fostering optimistic career success expectation. Such findings substantially complement the growing literature arguing that corporate (...) citizenship brings firms competitive advantages without solid evidence from the perspective of recruitment and human resources. Finally, managerial implications and limitations of this study are also discussed. (shrink)

This article aims to analyze the factors influencing the adoption of green practices in Chinese logistics industry. The determinant factors are composed of technological, organizational, and environmental dimensions. A questionnaire survey on the green practice adoption of Chinese logistics companies was conducted, and 322 samples were analyzed. Research results reveal that relative advantage and compatibility of green practices, organizational support, quality of human resources, regulatory pressure, and governmental support have significantly positive influences on the adoption of green practices for Chinese (...) logistics companies. Environmental uncertainty and green practice's complexity have significantly negative influences on green practice adoption. However, the influence of customer pressure is not significant for Chinese logistics companies. This article also suggests implications and opportunities for future research. (shrink)

The aim of this study was to analyze nurses' experiences of role strain when taking care of patients with severe acute respiratory syndrome (SARS). We adopted an interpretive/constructivist paradigm. Twenty-one nurses who had taken care of SARS patients were interviewed in focus groups. The data were analyzed using thematic analysis. The self-state of nurses during the SARS outbreak evolved into that of professional self as: (1) self-preservation; (2) self-mirroring; and (3) self-transcendence. The relationship between self-state and reflective practice is discussed.

Rips et al.'s analyses have boosted the plausibility of proposals that the human mind embodies some critical properties of natural numbers. I suggest that such proposals can be further evaluated by infant studies, neuropsychological data, and evolution-based considerations, and additionally, that Rips et al.'s model may need to be modified in order to more completely reflect infants' quantitative abilities.

Background: Truth-telling toward terminally ill patients is a challenging ethical issue in healthcare practice. However, there are no existing ethical guidelines or frameworks provided for Chinese nurses in relation to decision-making on truth-telling of terminal illness and the role of nurses thus is not explicit when encountering this issue. Objectives: The intention of this paper is to provide ethical guidelines or strategies with regards to decision-making on truth-telling of terminal illness for Chinese nurses. Methods: This paper initially present a case (...) scenario and then critically discuss the ethical issue in association with ethical principles and philosophical theories. Instead of focusing on attitudes toward truth disclosure, it aims to provide strategies regarding this issue for nurses. It highlights and discusses some of the relevant ethical assumptions around the perceived role of nurses in healthcare settings by focusing on nursing ethical virtues, nursing codes of ethics, and philosophical perspectives. And Confucian culture is discussed to explicate that deontology does not consider family-oriented care in China. Conclusion: Treating each family individually to explore the family’s beliefs and values on this issue is essential in healthcare practice and nurses should tailor their own approach to individual needs regarding truth-telling in different situations. Moreover, the Chinese Code of Ethics should be modified to be more specific and applicable. Finally, a narrative ethics approach should be applied and teamwork between nurses, physicians and families should be established to support cancer patients and to ensure their autonomy and hope. Ethical considerations: This paper was approved by the Ethics Committee of The Second Affiliated Hospital of Guangzhou Medical University. The authors have obtained consent to use the case study and it has been anonymised to preserve the patient's confidentiality. (shrink)

Based on the social identity theory, the relationship and influencing mechanism between high-performance human resource practices and employees’ voice behavior were explored by constructing a moderated mediation model, and the relationship between the field of human resources and the field of organizational behavior was also established. Through 1,178 paired samples of supervisor-employee survey and multilevel linear model analysis technology, it was found that HPHRPs had a positive impact on employees’ voice behavior; perceived insider status played a mediating role between HPHRPs (...) and voice behavior; voice efficacy played a moderating role between perceived insider status and voice behavior; and voice efficacy played a mediating role in the relationship between “HPHRPs-perceived insider status-voice behavior.”. (shrink)

Facing the possibility of a surge of COVID-19-infected patients requiring ventilatory support in Intensive Care Units, the Singapore Hospice Council and the Chapter of Palliative Medicine Physicians forward its position on the guiding principles that ought to drive the allocation of ICU beds and its role in care of these patients and their families.

Background Supporting physicians in Intensive Care Units s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support for (...) ICU physicians. Methods An SSR adopts the Systematic Evidenced Based Approach to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis is adopted. Results Eight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed. Conclusion This SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support. (shrink)

A great deal of progress has been made on information ethics. Which portion is not sufficient? That might be the comparison from countries to countries. The purpose of this study was closely examined using the cross-cultural method for comparison. To determine the ethics cognitions and behaviors of the students, a comprehensive survey was distributed. The questionnaire for the study used Mason’s four essential factors in information ethics that included Privacy, Accuracy, Property and Accessibility (PAPA). The samples were comprised of Kaohsiung (...) Taiwan and Nanjing China, junior high school students in 2006. The sample and the survey were obtained from two stages of random sampling that was conducted using an Internet website. Students could read the online questionnaire in the computer laboratory and then send immediate feedback to the website server. The result of the experiment showed the divergence of information ethics in cognition and behavior between Kaohsiung and Nanjing school children. The effects of background and correlation are from cognition and behavior between two regions. (shrink)

Followership is an important but understudied domain. This study adopted a follower-centric perspective to examine the internal process by which followership affects creative performance via work autonomy and creative self-efficacy. The study employed a 3-wave survey of 341 employees of a Taiwanese university to achieve the research purpose. This study showed that effective followership is positively associated with employees’ work autonomy and creative self-efficacy. Work autonomy and creative self-efficacy mediate the relationship between effective followership and creative performance. This study’s empirical (...) findings provide an improved way of measuring followership and broaden our understanding of how followership triggers intrinsic motivation to facilitate creative performance. (shrink)

This article discusses the intricate religio-linguistic links in multiethnic, multi-religion and multi-lingual Singapore, and looks at how language use in religious activities may affect language maintenance. As an ethnographic study, it examines heritage language use in both private and public domains of traditional religious events, in addition to discussing the implications that meaning-making processes involved in religious conversions in multi-faith families have for heritage language maintenance. The study also reveals the family institution as a stronghold where national language policy does (...) not fully penetrate, and argues that the vitality of heritage language may depend on how successfully cultural and religious practices continue to be performed in the heritage languages. (shrink)

Background Respect for patients’ autonomy is usually considered to be an important ethical principle in Western countries; privacy is one of the implications of such respect. Healthcare professionals frequently encounter ethical dilemmas during their practice. The past few decades have seen an increased use of courts to resolve intractable ethical dilemmas across both the developed and the developing world. However, Chinese and American bioethics differ largely due to the influence of Chinese Confucianism and Western religions, respectively, and there is a (...) dearth of comparative studies that explore cases of ethical dilemmas between China and the United States. Methods This paper discusses four typical cases with significant social impact. First, it compares two cases concerning patient privacy: the “Shihezi University Hospital Case”, in which a patient was used as a clinical teaching object without her permission, and the “New York-Presbyterian Hospital Case”, in which the hospital allowed the filming of a patient’s treatment without his consent. Second, it compares two cases regarding patient autonomy and potentially life-saving medical procedures: the “Case of Ms. L”, concerning a cohabitant’s refusal to sign a consent form for a pregnant woman’s caesarean, and the “Case of Mrs. V”, concerning a hospital’s insistence upon a blood transfusion for a dissenting patient. This paper introduces the supporting and opposing views for each case and discusses their social impact. It then compares and analyses the differences between China and the United States from cultural and legislative perspectives. Conclusions Ethical dilemmas have often occurred in China due to the late development of bioethics. However, the presence of bioethics earlier in the US than in China has not spared the US of ethical dilemmas. This paper highlights lessons and inspiration from the cases for healthcare professionals and introduces readers to the role and weight of privacy and autonomy in China and in the US from the perspectives of different cultures, religions and laws. (shrink)

Preparative and analytical methods developed by separation scientists have played an important role in the history of molecular biology. One such early method is gel electrophoresis, a technique that uses various types of gel as its supporting medium to separate charged molecules based on size and other properties. Historians of science, however, have only recently begun to pay closer attention to this material epistemological dimension of biomolecular science. This paper substantiates the historiographical thread that explores the relationship between modern laboratory (...) practice and the production of scientific knowledge. It traces the historical development of gel electrophoresis from the mid-1940s to the mid-1960s, with careful attention to the interplay between technical developments and disciplinary shifts, especially the rise of molecular biology in this time-frame. Claiming that the early 1950s marked a decisive shift in the evolution of electrophoretic methods from moving boundary to zone electrophoresis, I reconstruct various trajectories in which scientists such as Oliver Smithies sought out the most desirable solid supporting medium for electrophoretic instrumentation. Biomolecular knowledge, I argue, emerged in part from this process of seeking the most appropriate supporting medium that allowed for discrete molecular separation and visualization. The early 1950s, therefore, marked not only an important turning point in the history of separation science, but also a transformative moment in the history of the life sciences as the growth of molecular biology depended in part on the epistemological access to the molecular realm available through these evolving technologies. (shrink)

Against the scourge of the COVID-19 pandemic, college students’ learning engagement has become a key issue in universities and society. Guided by the theories of existential positive psychology and social perception, we explored the positive effect of a growth mindset on learning engagement during the COVID-19 pandemic. A total of 1,040 college students from universities in Henan Province of China effectively completed online questionnaires. The results showed that growth mindset was positively related to learning engagement and negatively associated with perceived (...) COVID-19 event strength and perceived stress; perceived COVID-19 event strength was positively related to perceived stress, while perceived COVID-19 event strength and perceived stress were negatively associated with learning engagement. Growth mindset affected learning engagement through three indirect paths: the mediating role of perceived COVID-19 event strength, the mediating role of perceived stress, and the serial mediating role of both perceived COVID-19 event strength and perceived stress. The results indicated that the growth mindset could contribute to college students’ learning engagement through the roles of perceived COVID-19 event strength and perceived stress during the COVID-19 pandemic. This study advances the understanding of the mechanism underlying the relationship between growth mindset and college students’ learning engagement during the COVID-19 pandemic. Furthermore, the findings of the study have important implications for promoting college students’ learning engagement during the pandemic. (shrink)

Studying the neural correlates of conscious awareness depends on a reliable comparison between activations associated with awareness and unawareness. One particularly difficult confound to remove is task performance capacity, i.e. the difference in performance between the conditions of interest. While ideally task performance capacity should be matched across different conditions, this is difficult to achieve experimentally. However, differences in performance could theoretically be corrected for mathematically. One such proposal is found in a recent paper by Lamy, Salti and Bar-Haim [Lamy (...) D, Salti M, Bar-Haim Y. Neural correlates of subjective awareness and unconscious processing: an ERP study. J Cognitive Neurosci 2009,21:1435-46], who put forward a corrective method for an electroencephalography experiment. We argue that their analysis is essentially grounded in a version of High Threshold Theory, which has been shown to be inferior in general to Signal Detection Theory. We show through a series of computer simulations that their correction method only partially removes the influence of perfor- mance capacity, which can yield misleading results. We present a mathematical correction method based on Signal Detection Theory that is theoretically capable of removing performance capacity confounds. We discuss the limitations of mathemati- cally correcting for performance capacity confounds in imaging studies and its impact for theories about consciousness. (shrink)

Background Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students’ caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy. Research objective This study aimed to examine the mediating effect of moral sensitivity and the (...) moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours. Research design A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro. Participants and research context This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China. Ethical considerations This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students. Results The clinical internship environment ( B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity ( B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students’ caring behaviours via moral sensitivity ( B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours ( B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity ( B = 0.006, 95% CI = [0.003, 0.010]). Conclusion Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students. (shrink)