Gender, ‘race’, poverty, health and discourses of health reform in the context of globalization: a postcolonial feminist perspective in policy researchIn this paper, I draw on extant literature and my empirical work to discuss the impact of globalization and healthcare reform on the lives of women — those from countries of the South as well as of the North. First, I review briefly the economic hardships identified in different sectors of the population that have been attributed to how globalization is (...) now working. Second, I examine what these global processes mean for health, with particular focus on poverty, gender, racialization and health. Third, I reflect on how nurse scientists might develop research agendas in the 21st century that would foster social transformation and social justice for all people. The position taken here is not an indictment of globalization. Rather, I argue that globalization is a fact in all of our lives. There are positive aspects of globalization. There are also negative aspects which we must collectively address, given that the issues identified can have deleterious consequences for the world’s poor, women in particular. I suggest that, to construct knowledge for practice and praxis, research agendas of the future should be inclusive of subaltern voices. I argue that drawing on a postcolonial feminist epistemology might help us to define such agendas, and express the multilayered sociopolitical contexts of health and illness in advocacy with policy‐makers. (shrink)

In 1991, Jones developed an issue-contingent model of ethical decision making in which moral intensity is posited to affect the four stages of Rest's 1986 model. Jones claimed that moral intensity, which is "the extent of issue-related moral imperative in a situation", consists of six characteristics: magnitude of consequences, social consensus, probability of effect, temporal immediacy, proximity, and concentration of effect. This article reports the findings of two studies that analyzed the factor structure of moral intensity, operationalized by a 12-item (...) Perceived Moral Intensity Scale adapted from the work of Sing-hapakdi et al. [1996, Journal of Business Research, 36, 245-255] and Frey [2000, Journal of Business Ethics, 26, 181-195]. The two items that were purported to measure CE were dropped due to their inability to effectively tap into the characteristic proposed by Jones. Factor analyses of the remaining 10 items supported a 3-factor structure, with the MC, PE, and TI items loading on the first factor, the PX items loading on the second factor, and the SC items loading on the third factor. These factors were labeled: Probable Magnitude of Consequences, Proximity, and Social Consensus. The authors conclude that moral intensity consists of three characteristics, rather than the six posited by Jones. (shrink)

Recent events around the globe reflect the tensions and ethical dilemmas of the postmodern, postcolonial and neocolonial world that have far reaching implications for health, well-being, and human suffering. As we consider what is at stake, and what this means for local lives and human relationships, we need to examine whether the theories we draw on are adequate to further our understanding of health, and the social and material conditions of human suffering. In this paper I begin to explore the (...) question, ‘Can postcolonial feminist theories provide an inclusive scholarship that would further our understanding of human suffering and open up a path to healing?’ At issue here is whether this scholarship adds another dimension to a praxis-oriented nursing science. (shrink)

Reconstructive allografts using Vascularized Composite Allotransplantation are providing individuals living with upper limb loss and facial disfigurement with new opportunities for a sensate, esthetically acceptable, and functional alternative to current treatment strategies. Important research attention is being paid to how best to assess and screen candidates for VCA, measure optimal patient outcomes, and support patient adherence to lifelong behaviors and medical regimens. Far less attention, however, has been dedicated to the team science required for these complex VCA teams to form, (...) prepare, and provide the highest quality clinical and psychosocial care to those receiving VCA. VCA teams are unique in that they require specialized team members whose scope of practice may not otherwise overlap. The team also needs to constantly negotiate balancing patient safety with multiple risks throughout the transplant process. This study aimed to elucidate the team science needed for this highly innovative and complex area of medicine. Using in-depth qualitative interviews with 14 VCA team members and observations at team meetings, we found that careful consideration of team composition, team structure, and organizational commitment influences team performance and patient outcomes, but that to be efficient and truly effective, teams need to commit to developing processes that foster collaboration. These processes are action-oriented, strategic and interpersonal. Dedication and commitment to team science allows teams to manage conflict under stress and exercise ways to leverage strengths to provide optimal performance or patient psychosocial and clinical outcomes. This study can provide insight into quality improvement efforts for VCA teams and guidance for other transplant programs that wish to consider expansion into VCA. (shrink)

As of December 1991, the Patient Self-Determination Act mandated that health care institutions which receive funding from Medicare or Medicaid provide written information about persons rights to participate in medical decision-making and formulate advance directives. The PSDA required each state…acting through a State agency, association, or other private nonprofit entity develop a written description of the law of the State concerning advance directives that would be distributed by providers or organizations under the requirements of [the Act].

Scholars have advocated for the inclusion of metacognition in our understanding of the ethical decision making process and in support of moral learning. An instrument to measure metacognition as a domain-specific capacity related to ethical decision making is not found in the current literature. This research describes the development and validation of the 20-item Moral Metacognition Scale. Psychometric properties of the scale were assessed by exploration and confirmation of the factor structure, and the demonstration of convergent, discriminant, and predictive validity. (...) Moral metacognition, as measured by the MMS, was significantly correlated with ethical awareness and ethical judgment. Limitations of our research, suggestions for future exploration, and practical implications are discussed. (shrink)

As of December 1991, the Patient Self-Determination Act mandated that health care institutions which receive funding from Medicare or Medicaid provide written information about persons rights to participate in medical decision-making and formulate advance directives. The PSDA required each state…acting through a State agency, association, or other private nonprofit entity develop a written description of the law of the State concerning advance directives that would be distributed by providers or organizations under the requirements of [the Act].

Examines Dante’s character of Beatrice and contends that, more than simply leading Dante to God, Beatrice allows him to see a feminine side in God, humanity, and himself.

A cutting-edge introduction to environmental ethics in a time of dramatic global environmental change, this collection contains forty-five newly commissioned articles, with contributions from well-established experts and emerging voices in the field.

Research is crucial to advancing knowledge about dementia, yet the burden of the disease currently outpaces research activity. Research often excludes people with dementia and other cognitive impairments because researchers and ethics committees are concerned about issues related to capacity, consent, and substitute decision-making. In Australia, participation in research by people with cognitive impairment is governed by a national ethics statement and a patchwork of state and territorial laws that have widely varying rules. We contend that this legislative variation precludes (...) a consistent approach to research governance and participation and hinders research that seeks to include people with impaired capacity. In this paper, we present key ethical principles, provide a comprehensive review of applicable legal rules in Australian states and territories, and highlight significant differences and ambiguities. Our analysis includes recommendations for reform to improve clarity and consistency in the law and reduce barriers that may exclude persons with dementia from participating in ethically approved research. Our recommendations seek to advance the national decision-making principles recommended by the Australian Law Reform Commission, which emphasize the rights of all adults to make their own decisions and for those with impaired capacity to have access to appropriate supports to help them make decisions that affect their lives. (shrink)