Smartphone app-use patterns will predict professional golfers’ athletic performance, and the use time of serious apps would be associated with improved performance. This longitudinal 4-week observation of 79 professional golfers assessed golf handicaps and smartphone app-use patterns at the start of the Korean professional golf season and 2 and 4 weeks later. We classified use as social networking, entertainment, serious apps, and others. Use time of entertainment apps increased for non-improved golfers but did not change for improved golfers. Use time (...) of serious apps increased for improved golfers and decreased for non-improved ones. Changes in golf handicaps were positively correlated with changes in entertainment app use time and negatively correlated with changes in serious app use time. Professional golfers’ sports performance was not associated with smartphone use time but was with the smartphone app type. The management of smartphone app-use patterns is important for professional golfers’ performance. (shrink)

To arrive at their final evaluation of a manuscript or grant proposal, reviewers must convert a submission’s strengths and weaknesses for heterogeneous peer review criteria into a single metric of quality or merit. I identify this process of commensuration as the locus for a new kind of peer review bias. Commensuration bias illuminates how the systematic prioritization of some peer review criteria over others permits and facilitates problematic patterns of publication and funding in science. Commensuration bias also foregrounds a range (...) of structural strategies for realigning peer review practices and institutions with the aims of science. (shrink)

Andrew McGonigal presents some interesting data concerning truth in serial fictions.1 Such data has been taken by McGonigal, Cameron and Caplan to motivate some form of contextualism or relativism. I argue, however, that many of these approaches are problematic, and that all are under-motivated as the data can be explained in a standard invariantist semantic framework given some independently plausible principles.

Rae Langton and Caroline West famously argued that pornography operates like a language game, in that it introduces certain views about women into the common ground via presupposition accommodation. While this pragmatic model explains how pornography has the potential to change its viewers’ beliefs, it leaves open how pornography changes people’s desires. Our aim in this paper is to show how Langton and West’s discourse theoretic account of pornography can be refined to close this lacuna. Using tools from recent developments (...) in discourse theory, we propose that pornography issues implicit directives, and thereby introduces bouletic components into the discourse. (shrink)

Ludwig Wittgenstein and Martin Heidegger are two of the most important--and two of the most difficult--philosophers of the twentieth century, indelibly influencing the course of continental and analytic philosophy, respectively. In _ Groundless Grounds_, Lee Braver argues that the views of both thinkers emerge from a fundamental attempt to create a philosophy that has dispensed with everything transcendent so that we may be satisfied with the human. Examining the central topics of their thought in detail, Braver finds that Wittgenstein and (...) Heidegger construct a philosophy based on _original_ _finitude_--finitude without the contrast of the infinite. In Braver's elegant analysis, these two difficult bodies of work offer mutual illumination rather than compounded obscurity. Moreover, bringing the most influential thinkers in continental and analytic philosophy into dialogue with each other may enable broader conversations between these two divergent branches of philosophy. Braver's meticulously researched and strongly argued account shows that both Wittgenstein and Heidegger strive to construct a new conception of reason, free of the illusions of the past and appropriate to the kind of beings that we are. Readers interested in either philosopher, or concerned more generally with the history of twentieth-century philosophy as well as questions of the nature of reason, will find _Groundless Grounds _of interest. (shrink)

In this paper, I defend fictional creationism, the view that fictional objects are abstract artifacts, from the objection that the apparent truth of fictional negative existentials, such as “Sherlock Holmes does not exist,” poses a serious problem for creationism. I develop a sophisticated version of the pragmatic approach by focusing on the inconsistent referential intentions of ordinary speakers: the upshot would be that creationism is no worse —perhaps even in a better position— than anti-realism, even if we restrict our linguistic (...) data to fictional negative existentials. (shrink)

A famous mathematical theorem says that the sum of an infinite series of numbers can depend on the order in which those numbers occur. Suppose we interpret the numbers in such a series as representing instances of some physical quantity, such as the weights of a collection of items. The mathematics seems to lead to the result that the weight of a collection of items can depend on the order in which those items are weighed. But that is very hard (...) to believe. A puzzle then arises: How do we interpret the metaphysical significance of this mathematical theorem? I first argue that prior solutions to the puzzle lead to implausible consequences. Then I develop my own solution, where the basic idea is that the weight of a collection of items is equal to the limit of the weights of its finite subcollections contained within ever-expanding regions of space. I show how my solution is intuitively plausible and philosophically motivated, how it reveals an underexplored line of metaphysical inquiry about quantities and locations, and how it elucidates some classic puzzles concerning supertasks. (shrink)

Let a smooth experience be an experience with perfectly gradual changes in phenomenal character. Consider, as examples, your visual experience of a blue sky or your auditory experience of a rising pitch. Do the phenomenal characters of smooth experiences have continuous or discrete structures? If we appeal merely to introspection, then it may seem that we should think that smooth experiences are continuous. This paper (1) uses formal tools to clarify what it means to say that an experience is continuous (...) or discrete, and (2) develops a discrete model of the phenomenal characters of smooth experiences. As a result, I'll argue that introspection leaves open whether smooth experiences are continuous or discrete. Yet I’ll also argue—perhaps surprisingly—that the discrete theory may better fit our introspective evidence. (shrink)

To be conscious—according to a common metaphor—is for the “lights to be on inside.” Is this a good metaphor? I argue that the metaphor elicits useful intuitions while staying neutral on controversial philosophical questions. But I also argue that there are two ways of interpreting the metaphor. Is consciousness the inner light itself? Or is consciousness the illuminated room? Call the first sense subjectivity (where ‘consciousness’ =def what makes an entity feel some way at all), and the second sense phenomenal (...) character (where ‘consciousness’ =def what it feels like to be an entity). I use this distinction—as well as the metaphor of the inner light—to clarify some philosophical questions about whether consciousness comes in degrees, whether consciousness is multidimensional, and whether there are borderline cases of consciousness. (shrink)

Is A & C sufficient for the truth of ‘if A were the case, C would be the case’? Jonathan Bennett thinks not, although the counterexample he gives is inconsistent with his own account of counterfactuals. In any case, I argue that anyone who accepts the case of Morgenbesser's coin, as Bennett does, should reject Bennett’s counterexample. Moreover, I show that the principle underlying his counterexample is unmotivated and indeed false. More generally, I argue that Morgenbesser’s coin commits us to (...) the sufficiency of A & C for the truth of the corresponding counterfactual. (shrink)

In recent years, the science and the philosophy of consciousness has seen growing interest in structural questions about consciousness. This is the Editorial Introduction for a special volume for Philosophy and the Mind Sciences on “Structuralism in Consciousness Studies.”.

I develop and defend "metaethical experientialism," the thesis that phenomenal facts explain certain kinds of value facts. I argue, for example, that anyone who knows what it’s like to feel extreme pain is in a position to know that that kind of experience is bad. I argue that metaethical experientialism yields genuine counterexamples to the principle that no ethical conclusion can be derived from purely descriptive premises. I also discuss the prospects for a pluralistic metaethics, whereby different metaethical theories hold (...) for different classes of ethical facts. (shrink)

We address the question of why particular laws were selected for the universe, by proposing a mechanism for laws to evolve. Normally in physical theories, timeless laws act on time-evolving states. We propose that this is an approximation, good on time scales shorter than cosmological scales, beyond which laws and states are merged into a single entity that evolves in time. Furthermore the approximate distinction between laws and states, when it does emerge, is dependent on the initial conditions. These ideas (...) are illustrated in a simple matrix model. (shrink)

In this thesis, I present an account of the development of early Greek epistemology, according to which Protagoras' measure doctrine, and his argument from conflicting appearances, was the starting point for work on perception and knowledge by Plato in the Theaetetus, Aristotle in Metaphysics IV and Democritus. In Chapter One, I argue against the assumption that Protagoras' Aletheia contained a philosophical theory. It was probably not a treatise, but a virtuoso show-piece, with the aim of "knocking down" views according to (...) which truth is only known by gods, and, with difficulty, by privileged humans--namely, philosophers. For this, it need not have contained more than some well-chosen examples of perceptual and value beliefs, and arguments that one cannot decide which are true. In Chapter Two, I argue that Democritus should be seen as Protagoras' heir. Democritus argued Protagoras' general claim is self-refuting, but thought he was right about perceptual appearances. In Confirmations, he defended the senses, attributing to them knowledge and "power of proof." However, his theory led to an ancestor of the primary/secondary quality distinction, and this threatened to undermine the theory itself because of implications--that one can only know how things appear and not how things are by nature--which were later taken up in Pyrrhonist skepticism. In Chapter Three, I present a reading of the Secret Doctrine in Plato's Theaetetus as a defense and diagnosis of Protagoras' claim, in particular, an explanation of the global relativization which Protagoras' claim seems to recommend. This reading is meant to avoid the well-known difficulties concerning the prevailing interpretation of Protagoras' "Secret Doctrine" as a flux doctrine. I also argue that Plato developed the Secret Doctrine with Democritus in mind. In Chapter Four, I argue that Plato's "self-refutation argument" is aimed at relativism, but not relativism about truth. The latter, which Aristotle dismisses as eristical, is a position Protagoras can take, but Plato's argument works against it as well. In Chapter Five, I examine why Aristotle seems to treat Protagoras in Metaphysics IV as being committed to a denial of the principle of non-contradiction. (shrink)

The connection between Chinese sexism and Confucianism has been a subject of study on the condition of Chinese women in the West since the rise of feminist consciousness in the 1970s. However Confucianism in feminist scholarship is inescapably construed as a misogynous ideology that is incapable of self-rectification in regards to the issue of gender parity. Hence, conceptually the eradication of Confucianism becomes the necessary condition for the liberation of Chinese women, and the adoption of Western ideology let it be (...) Marxist-socialism, Liberalism, or Existentialism is then a logical next step for Chinese women. Yet, such a dichotomization of the West as a superior moral subject and the East as a passive object victimized by their "sexist" tradition is nevertheless an oversimplification of the condition and the liberation of women in the developing world. In the end, it is essentially a neo-colonial discourse in a feminist disguise. This dissertation sets itself up to accomplish two tasks: first, it is to obtain a conceptual clarity of what constitutes Confucianism and its connection with dominant sexist, social practices; second, it is to go beyond a mere critique of Confucianism and feminism as an ally of Chinese patriarchal family structure and Western imperialism respectively, and to lay a foundation for a future construction of a gender theory based on Confucianism as a theoretical ground to explain the cultural construct of Chinese women and to conceive an alternative ethical ground for women's liberation. Eventually, the whole project can be seen as an act of self-affirmation of my ethnic identity as a Chinese and an act of reconciliation with my feminist identity in the modern world. (shrink)

In his 2004 paper ‘Tensed Quantifiers’, David Lewis presented an apparently powerful case for eternalism by arguing that we cannot account for the truth-conditions of sentences like ‘There have been forty-four presidents of the United States’ and ‘There will be five more presidents of the United states’ and maintain a non-revisionary attitude towards their truth-values, without committing to the existence of ‘past’ and ‘future’ things. Related arguments can be found in works by Ted Sider, and by Zoltan Gendler Szabó. We (...) can call the fully developed form of this argument the Argument from Semantics. In this paper, I counter the AfS by showing that these truth-conditions can be captured without commitment to the existence of things—such as Socrates and Abraham Lincoln—which we take to have existed but not to exist, or things—like the par.. (shrink)

In the literature of environmental philosophy, the single most potent argument that has been made against the claim that nature may possess intrinsic value in any objective sense is the Humean thesis of projectivism and its associated view that human consciousness is the source of all values. Theorists, in one way or another, have to face up to this challenge. For instance, J. Baird Callicott upholds this Humean foundation to modern Western philosophy. However, by distinguishing between the source and locus (...) of value, he makes it possible to argue that nature is the locus of intrinsic value without at the same time compromising the thesis that human consciousness is the source of all values. On the other hand, Holmses Rolston, III, another eminent environmental philosopher, criticizes the distinction as well as challenges the Humean foundation itself. In this article, I attempt to resolve the disagreement between Callicott and Rolston over this particular distinction, thereby doing justice to the insights which each theorist, undoubtedly, has brought to bear on the issue of intrinsic value, at least as far as individual organisms is concerned. However, I am also critical of both for having failed to draw out the full implications behind certain crucial distinctions that should be made about the notion of intrinsic value itself. (shrink)

This essay analyzes two types of patient‐experience data to broaden and deepen understanding of trust in health care. Analysis of patients’ open‐ended comments shows a close connection between patients’ feelings of trust and their intent to recommend providers and provider organizations—a global measure to evaluate patients’ perceptions of care experiences. Patients’ comments also reveal the bidirectional building of trust between the patient and the caregiver. Trust gets built when patients perceive their caregivers to trust their knowledge of their bodies as (...) well as when caregivers demonstrate caring behaviors that earn the patients’ trust. Patients’ ratings of a closed‐ended survey item on “confidence in provider” create the greatest differentiation for the global measure of patient experience—whether patients did or did not recommend a practice or provider. The essay also discusses related findings on pre‐visit friction and the use of humor by the caregiver to expand understanding of trust. (shrink)

For many, Thomas Beauchamp and James Childress have elaborated moral reasoning by using the four principles whereby all substantive problems of medical ethics (and of ethics more generally) can be properly analysed and cogent philosophical solutions for the problems can be found. It seems that their ‘principlism’ gets updated, with better features being added during the course of the six editions of Principles of Biomedical Ethics. Nonetheless, Beauchamp and Childress seem to have been losing their way when it comes to (...) the common-morality justification, which is the epistemological (and perhaps metaphysical) backbone of their method, and this is shown more vividly in their most recent (2009) edition of Principles of Biomedical Ethics. The author points out what he calls the problem of ‘thick in status, thin in content’ in principlism. The problem exists because principlism cannot adequately explain how the prescriptive sense of common morality it supports is consistent with the existence of what Beauchamp and Childress call the ‘legitimate moral diversity in the world’. Because of this problem, first, the practical end that principlism allegedly accomplishes (ie, providing practical moral guidelines in a relatively ‘thick’ content, based on common morality) is frustrated, and, second, principlism makes itself the method of common morality de jure and of moral pluralism de facto. (shrink)

Bio-heteronormative conceptions of the family have long reinforced a nuclear ideal of the family as a heterosexual marriage, with children who are the genetic progeny of that union. This ideal, however, has also long been resisted in light of recent social developments, exhibited through the increased incidence and acceptance of step-families, donor-conceived families, and so forth. Although to this end some might claim that the bio-heteronormative ideal is not necessary for a social unit to count as a family, a more (...) systematic conceptualization of the family—the kind of family that matters morally—is relatively underexplored in the philosophical literature. This paper makes a start at developing and defending an account of the family that is normatively attractive and in line with the growing prevalence of non-conventional families and methods of family-formation. Our account, which we call a constitutive-affirmative model of the family, takes the family to be constituted by an ongoing process of relevant affective and affirmative relations between the putative family members. (shrink)

Religion inspires honesty. The love of money incites dishonesty. Religious and monetary values apply to all religions. We develop a formative theoretical model of monetary wisdom, treat religiosity (God) and the love of money (mammon), as two yoked antecedents—competing moral issues (Time 1), and frame the latent construct in good barrels (performance or humane contexts, Time 2), which leads to (dis)honesty (Time 3). We explore the direct and indirect paths and the model across genders. Our three-wave panel data (411 participants) (...) show that religious and monetary values are negatively correlated. Directly, religiosity consistently curbs dishonesty; surprisingly, the love of money has no impact on dishonesty. In the performance context, the two mediation effects reduce dishonesty. Across genders, this mediation effect is nonsignificant for males but significantly excites females' honesty. In the humane context, the two mediation effects are nonsignificant. Across genders, for the love of money, males passively curb dishonesty by omission, and females actively engage in honesty by commission. Decision-makers must challenge people's moral issues, frame them in good barrels, and help people become good apples, choice architects, and moral and ethical decision-makers, promoting the Matthew effect in religion. We offer practical implications to individuals and organizations. (shrink)

In a society marked by liberal gun ownership laws, and an increasingly militarized police force, how should we think about cases where a homeowner shoots a person who has mistakenly knocked on the wrong door, or where a police officer shoots someone who is unarmed? The general tendency – by shooters, courts, and many observers – is to use the framework of self-defense. However, as I will argue, relying on the framework of self-defense is inappropriate in these cases, because theories (...) of self-defensive killing are built up around a very specific type of case, namely, a random, sudden, one-off encounter between roughly equally matched strangers. When a person who acts in self-defense has undertaken certain preparations to kill in self-defense – such as buying a gun, or undergoing certain kinds of training – they transform what would have been defensive violence into offensive violence. But because the self-defense framework distinguishes only between defensive and aggressive violence, it cannot easily register the unique moral features of offensive violence. Relying on the self-defense framework, then, produces judgments that are overly permissive of killings by gun owners and police, masking them as self-defensive when in fact they are much more morally fraught. (shrink)

There are a wide variety of potential applications of artificial intelligence (AI) in Defence settings, ranging from the use of autonomous drones to logistical support. However, limited research exists exploring how the public view these, especially in view of the value of public attitudes for influencing policy-making. An accurate understanding of the public’s perceptions is essential for crafting informed policy, developing responsible governance, and building responsive assurance relating to the development and use of AI in military settings. This study is (...) the first to explore public perceptions of and attitudes towards AI in Defence. A series of four focus groups were conducted with 20 members of the UK public, aged between 18 and 70, to explore their perceptions and attitudes towards AI use in general contexts and, more specifically, applications of AI in Defence settings. Thematic analysis revealed four themes and eleven sub-themes, spanning the role of humans in the system, the ethics of AI use in Defence, trust in AI versus trust in the organisation, and gathering information about AI in Defence. Participants demonstrated a variety of misconceptions about the applications of AI in Defence, with many assuming that a variety of different technologies involving AI are already being used. This highlighted a confluence between information from reputable sources combined with narratives from the mass media and conspiracy theories. The study demonstrates gaps in knowledge and misunderstandings that need to be addressed, and offers practical insights for keeping the public reliably, accurately, and adequately informed about the capabilities, limitations, benefits, and risks of AI in Defence. (shrink)

Research now provides participants greater indications of genetic risk for disease, even for conditions incidental to the research study. Given this development, should such information also be disclosed to the family of research participants? There has been some indication at the national level that genetic risk information can be disclosed to participants' families; however, limited attention has been given to returning research results to family. Thus, we have also incorporated the discussion surrounding the disclosure of genetic risk discovered in the (...) clinic (e.g., genetic testing). A number of important questions are examined: Should genetic research results be provided to family? Are there differences between clinical and research findings that would prevent research results from being disclosed to family? Who should make the disclosure, if in fact it is done at all? We conclude by noting that the return of results is increasingly accepted as technology permits the discovery of more and more medically useful data. However, debates of whether results should be returned to participants must first be settled before moving to familial disclosure. (shrink)

For the first time, the revised Common Rule specifies that public health surveillance activities are not research. This article reviews the historical development of the public health surveillance exclusion and implications for other foundational public health practices.

In this article, I argue that various epistemic challenges associated with eating disorders (EDs) can negatively affect the care of already marginalized patient groups with various EDs. I will first outline deficiencies in our understanding of EDs—in research, healthcare settings, and beyond. I will then illustrate with examples cases where discriminatory misconceptions about what EDs are, the presentation and treatment of EDs, and who gets EDs, instantiate obstacles for the treatment of various ED patient groups.

The study of the relationship between religion and health has grown substantially in the past decade. There is little doubt that religion plays an important role in many people's lives and that this has an impact on their health. The question is how researchers and clinicians can best evaluate the available information and how we can improve upon the current findings. In this essay we review the current knowledge regarding religion and health and also critically review issues pertaining to methodology, (...) findings, and interpretation of these studies. It is important to maintain a rigorous perspective with regard to such studies and also to recognize inherent limitations and suggest constructive ways in which to advance this field of study. In the end, such an approach can provide new information that will improve our understanding of the overall relationship between religion and health. (shrink)

The Organization of Economic Co-operation and Development’s (OECD) global governance of education has been gradually increasing. Its field of interest is currently expanding from educational evaluation through the Program for International Student Assessment (PISA) to curriculum reform through the Education 2030 project. Here, it is interesting to note that the nature of the terms the OECD has been creating reveals a ‘humanistic turn’. This shows up well in the frequent occurrence of terms such as ‘well-being’, ‘attitudes and values’, ‘inclusiveness’, ‘responsibility’, (...) and ‘sustainability’ in the ongoing Education 2030 project. Perhaps this new humanistic discourse increases the likelihood of the smooth adoption of the OECD’s proposed curriculum redesign in more countries. If the OECD’s new discourse captures and transforms contemporary people’s ways of thought and practice about education, then this is related to the problem of colonialism in our era. It is also worth noting that language plays a vital role in colonization. In particular, the need for translation between different languages serves as a useful means for colonization. Conversely, it is also seen as having a potential decolonizing power. In this context, I would like to examine the new language the OECD has adopted, specifically regarding student experience and the nature of knowing. Next, I shall attempt to criticize the underlying educational assumptions in the OECD’s pronouncements. Following this, I shall explore how the OECD’s new discourse has been translated in South Korea, taking this as an example of wider experience in the East Asian context and possibly elsewhere. Finally, I shall conclude by considering the direction of curriculum decolonization in terms of translation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Casting a Vote for Subordination Using a SlurDuckkyun Lee1. IntroductionIn this paper, I develop an account of slurs focusing on their two underappreciated features. The first underappreciated feature is what I call their "communal nature." Slurs are communal. The meaning of a slur depends on the existence of a significant number of people who are bigoted against the target. When this condition is not satisfied, a slur loses its (...) power to offend. This can be seen when we consider how philosophers choose examples of slurs to avoid offending people. For example, Williamson, in his essay "Reference, Inference and the Semantics of Pejoratives," uses a slur for Germans as his main example. What makes the slur for Germans a safe example to use is the fact that there is no widespread bigotry against Germans in any Anglophone country. Had there been strong enmity between Germans and the people in the Anglophone countries, even if Williamson had chosen an outdated slur, his example would not have been such a safe choice. Slurs are words that bigots use to offend and harm the people they are bigoted against. When there are no bigots, neither are there slurs.The focus on the communal nature of slurs leads to the second underappreciated feature of slurs. A bigot does not use a slur just to express his beliefs or feelings, but to subordinate his target. To subordinate others, a bigot needs to cooperate and coordinate with other bigots. In this paper, I will propose a mechanism for how slurs work as a tool for coordinating subordination. To account for the communal and subordinating nature of slurs, I turn to speech act theory and explain what kind of illocutionary act is performed when one uses a slur.1My proposal is to understand utterances made using a slur, or slurring,2 as an act of casting a vote for ranking the target as socially inferior. On this [End Page 37] view, a slur is a conventional tool used to cast a vote demanding the subordination of its target. The considerations that motivate this view are as follows: First, the uses of a slur are the results of consciously choosing it over its neutral counterpart. By explicitly avoiding a neutral counterpart term, one can show their support for fellow bigots and the willingness to participate in whatever activity they do. Second, the point of using a slur does not seem to be exhausted by its role of expressing the bigot's negative beliefs about the target. We can see this when we consider that the way to fight a slur is to impose strict prohibitions against its use, not by objecting to the content of the slurring utterance. This can be better explained when we understand the slur as a conventional tool for the performance of a certain type of action, rather than a word that has distinctive descriptive content different from the descriptive content of its neutral counterpart. Finally, the point of some speech acts is not just expressing the state of the mind of the speaker. The point of some speech acts is to change what is the case in society. To make an utterance using a slur seems to fall into this latter category of speech acts. What would bigots be up to if they were not engaged in the project of creating a society where their target was inferior to them? This consideration suggests that making an utterance using a slur might fall into the kind of speech act Searle calls declaration (Taxonomy 361–68). As a declaration, slurring is an attempt to change society such that the target is subordinated.Insofar as an election is understood as a process within which people collectively decide on what should be the case in society by indicating their stance for or against a proposal, slurring can be understood as a casting of a vote in the election bigots' proposal to subordinate their target. I argue that this account can better explain why a slur cannot function as a slur without there being a significant number of bigots, and how it is used to coordinate the bigots' effort of subordinating their target.The paper... (shrink)

The mechanism underlying action potentials is routinely used to explicate the mechanistic model of explanation in the philosophy of science. However, characterisations of action potentials often fixate on neurons, mentioning plant cells in passing or ignoring them entirely. The plant sciences are also prone to neglecting non-neuronal action potentials and their role in plant biology. This oversight is significant because plant action potentials bear instructive similarities to those generated by neurons. This paper helps correct the imbalance in representations of action (...) potentials by offering an overview of the mechanism for plant action potentials and highlighting their similarity to those in neurons. Furthermore, it affirms the role of plant action potentials in discovering the evolution and function of mechanisms of action potentials more broadly. We stress the potential of plants for producing generalisations about action potentials and the possible role of plants as experimental organisms. (shrink)

Background Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding (...) end-of-life care and its consequential impacts. Research objectives To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design A qualitative descriptive approach was employed. Participants and research context Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. (shrink)