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)

Although respect and human presence are frequently reported in nursing literature, these are poorly defined within a nursing context. The aim of this study was to examine the differences, if any, in the perceived frequency of respect and human presence in the clinical care, between nurses and patients. A convenience sample of 1537 patients and 1148 nurses from six European countries (Cyprus, Czech Republic, Finland, Greece, Hungary and Italy) participated in this study during autumn 2009. The six-point Likert-type Caring (...) Behaviours Inventory-24 questionnaire was used for gathering appropriate data. The findings showed statistically significant differences of nurses’ and patients’ perception of frequency on respect and human presence. These findings provide a better understanding of caring behaviours that convey respect and assurance of human presence to persons behind the patients and may contribute to close gaps in knowledge regarding patients’ expectations. (shrink)

A descriptive, cross-sectional study aimed to determine the inclination of nursing students towards ethical values and the effects of these values on care behaviours. The data for this study were collected from 466 students studying from May 13–24, 2019. The data were collected using a questionnaire on the sociodemographic characteristics of the students, Inclination to Ethical Values Scale (IEVS), and Caring Behaviors Inventory-24 (CBI-24). In this study, 43.1 per cent of them belonged to families who had a protective (...) attitude. The total mean (SD) IEVS and CBI-24 scores were 63.99 (12.68) and 117.19 (17.95), respectively. The mean item score was 4.88 (0.74). A moderate positive correlation was observed between the inclination of the students towards ethical values and their care behaviours. The general family structure of the nursing students and their participation in an ethics class affected the inclination of the nursing students to ethical values and their care behaviours. This study showed that the ethical values of the students positively affected their care behaviours. (shrink)

Background Care is the basis of the nursing profession and nurse’s caring behavior is one of the important factors in patient satisfaction. On the other hand, psychological empowerment can improve the provision of care services, and leaders have a significant impact on the behavior of followers. This study determined the correlation between ethical leadership, psychological empowerment, and caring behavior from nurses’ perspective. Methods This cross-sectional descriptive study was conducted in 2019. A total of 200 nurses were selected by (...) stratified random sampling. Data were collected with ethical leadership, caring behavior and psychological empowerment questionnaires and analyzed with descriptive statistics and inferential statistics using SPSS20. Results The findings showed a significant correlation between ethical leadership, psychological empowerment and caring behavior of nurses. Also, there was a significant correlation between psychological empowerment and nurses’ caring behavior. The regression analysis showed that ethical leadership and psychological empowerment are a predictor of caring behavior of nurses. Conclusion Applying an ethical leadership style by nursing managers can lead to nurses’ improved psychological empowerment and caring behaviors and ultimately, patient care quality. Thus, considering guidelines at the team and organizational levels and programs such as providing workshops and periodic counseling to cultivate ethical nurse leadership can lead to better caring behavior. (shrink)

Developing caring competences is considered to be one of the most important aims of undergraduate nursing education and the role of clinical placement is recognised as special in this regard. Students' reflection on caring, their experience and obstacles in being caring is recommended as a key strategy in the process of teaching and studying the nursing discipline. Therefore, the aim of this study was to describe the concept of caring, its manifestations and possible obstacles while (...) class='Hi'>caring, as perceived by first‐year nursing students before and after their first clinical placement. Qualitative content analysis of 15 Polish students' narratives written before and after their clinical experience in the form of text‐diaries was undertaken. The findings revealed that students entered their nursing education with a deep humanistic vision of caring both on theoretical and practical levels and the first clinical placement has enriched this vision. Expressive caring was more appreciated by students than the instrumental one and their concept of caring was coherent with the caring behaviours as described in their narratives. Several internal and external obstacles for caring have been reported by students, indicating a specific tension between their ideal of caring and their practical experience of caring in the clinical reality. (shrink)

Hrvatski odgojno-obrazovni sustav se, kao i sustavi u drugim zemljama, u današnjem vremenu suočava s različitim izazovima – od porasta rizika u mentalnom zdravlju i vršnjačkog nasilja do nezadovoljstva učenika školom. U odgovaranju na te izazove potrebno je krenuti od kontekstualnih faktora, poput odnosa učenika i nastavnika. Budući da je brižan odnos nastavnika i učenika ključan preduvjet za cjeloviti razvoj učenika te njihov školski uspjeh, nužno je utvrditi prepreke koje mogu ugroziti razvoj takvog odnosa. U dosadašnjim istraživanjima uočeno je kako (...) učenici i nastavnici u određenim uvjetima različito percipiraju i doživljavaju brižnost nastavnika, što može onemogućiti razvoj njihove bliskosti i povezanosti. Stoga, cilj ovoga rada je prikazati, analizirati i interpretirati razlike u viđenjima brižnog ponašanja nastavnika iz perspektive učenika i nastavnika. Dok nastavnici svoju brižnost najčešće shvaćaju u kontekstu podrške koju pružaju učenicima u procesu učenja, učenici ju pak shvaćaju u osobnijem kontekstu i osjećaju bliskosti s nastavnikom. The Croatian educational system, like the systems in other countries, nowadays faces various challenges, from the increase of mental health risks and peer violence to students’ dissatisfaction with school. In responding to these challenges, it is necessary to start from the contextual factors, such as the teacher–student relationship. Since a caring teacher–student relationship is a necessary prerequisite for the holistic development of students and their school success, it is important to identify obstacles that may jeopardize the development of such a relationship. Previous researches show that students and teachers in certain conditions perceive and experience caring differently, which may prevent the development of their closeness and connectedness. Therefore, the aim of this paper is to present, analyse and interpret differences in perceptions of the caring behavior of teachers from the perspective of students and teachers. While teachers most often perceive their care in the professional context, students understand it in a more personal way. (shrink)

The aim of this study was to investigate significant differences in the mean scores for the Caring Behaviors Inventory between first-year and third-year nursing students. There were two sample groups: group A comprised 117 first-year nursing students and group B included 49 third-year nursing students (n = 166). All participants were from one Slovenian university. Data were collected by questionnaire and ana- lysed using SPSS v. 17.0. Independent sample t-tests were used for the comparison of means for each item (...) in both groups. The results showed that the students in group B (third year) often agreed more significantly with Caring Behaviors Inventory items than the students in group A (first year). Principles of right action indicate how nurses must behave in order to provide good nursing care. Nursing educators can prepare students through demonstrations of their own behaviour in practice. (shrink)

Aims: The aim of this study is to determine the levels of nurses’ fear of compassion for others, fear of compassion from others, and fear of self-compassion and to examine the effect of fear of compassion on caring behaviors. Design: A cross-sectional, quantitative design was used. Participants and research context: The study was conducted between October 2022 and April 2023 with 304 nurses working in two public hospitals. Data collection tools were the “Fears of Compassion Scales” and the “ (...) class='Hi'>Caring Behaviors Inventory.” Data were analyzed using a t test, one-way ANOVA, Pearson correlation analysis, and stepwise multiple regression model. Ethical considerations: Ethics committee approval of the research was obtained from the non-invasive ethics committee of Kütahya Health Sciences University (Reference No: 25.05.2022/2022/06-19). The principles of the Declaration of Helsinki were followed in the study. The purpose of the research was explained to all participants, and their verbal/written informed consent was obtained. Results: The mean scores of nurses on fear of compassion for others and from others were at a moderate level, and their scores on fear of self-compassion were close to a moderate level. It was found that the level of nurses’ fear of compassion was related to their sociodemographic and professional variables. Fear of self-compassion, fear of compassion for others, and fear of compassion from others explained 33.5% of the total variance in caring behaviors. Conclusions: Nurses’ caring behaviors were shown to be more associated with fear of self-compassion than fear of compassion for others. Fear of compassion may be one of the barriers to compassionate care. Interventions that will reduce nurses’ fear of compassion may be one way to provide compassionate care. It is recommended to conduct awareness studies on self-compassion and accepting compassion from others in nurses. (shrink)

In this paper we argue that greater attention must be given to peoples’ expression of “care” in relation to consumption. We suggest that “caring about” does not necessarily lead to “care-giving,” as conceptualising an attitude–behaviour gap might imply, but that a closer examination of the intensity, morality, and articulation of care can lead to a greater understanding of consumer narratives and, thus, behaviour. To examine this proposition, a purposive sample of self-identified ethical consumers was interviewed. Care is expressed by (...) the study’s participants in a variety of ways and linked to behaviour through diverse patterns that includes consumption and abstention. We find significant correspondence between the academic literature on the ‘ethics of care’ and our participants’ articulation of their ethical consumption behaviours. We suggest, therefore, that a close understanding of an ethics of care among consumers is important both in providing insight into the attitude–behaviour gap challenge evident in the literature and to the continued development of an ethical consumption discourse. (shrink)

This integrative review aims to provide a synthesis of research findings of health-care professionals’ knowledge, attitudes and behaviours relating to patient capacity to consent to or refuse treatment within the general hospital setting. Search strategies included relevant health databases, hand searching of key journals, ‘snowballing’ and expert recommendations. The review identified various knowledge gaps and attitudinal dispositions of health-care professionals, which influence their behaviours and decision-making in relation to capacity to consent processes. The findings suggest that there is (...) tension between legal, ethical and professional standards relating to the assessment of capacity and consent within health care. Legislation and policy guidance concerning capacity assessment processes are lacking, and this may contribute to inconsistencies in practice. (shrink)

The objective of this study was to describe the cultural domain of ethical behaviours in clinical practice as defined by health care providers in Mexico. Structured interviews were carried out with 500 health professionals employed at the Mexican Institute of Social Security in Mexico City. The Smith Salience Index was used to evaluate the relevance of concepts gathered from the free listings of the interviewees. Cluster analysis and factor analysis facilitated construction of the conceptual categories, which the authors refer (...) to as `dimensions of ethical practice'. Six dimensions emerged from the analysis to define the qualities that comprise ethical clinical practice for Mexican health care providers: overall quality of clinical performance; working conditions that favour quality of care; use of ethical considerations as prerequisites for any health care intervention; values favouring teamwork in the health professional—patient relationship; patient satisfaction scores; and communication between health care providers and patients. The findings suggest that improved working conditions and management practices that promote the values identified by the study's participants would help to improve quality of care. (shrink)

A multifaceted, holistic approach to identifying potential predictors is needed to eradicate workplace bullying. The current study investigated the impact of an unfavourable organisational climate that plays a role in breeding workplace bullying. The present study also postulated that individual personality differences mediate between a caring climate and workplace bullying. Similarly, the interaction between workplace bullying and personality impacts PTSD. We also checked the role of workplace bullying as a mediator between a caring climate and PTSD. This research (...) tested all the proposed hypotheses, and the study was conducted in Pakistan. The data is analysed using the two-step partial least square structural equation modelling procedure. The first part assesses the measurement model, while in the second step, the structural model is evaluated. The results supported all the proposed hypotheses of this study. Type A behaviour moderated the caring climate—person-related bullying relationship, whereas it did not moderate the caring climate—work-related bullying in the suggested direction. Type A behaviour is moderated for both types of bullying and PTSD. Results also show significant indirect effects of a caring climate on PTSD through workplace bullying. This study will contribute theoretically to filling the literature gap on studies of climate-bullying and bullying-stress using contingency factors. (shrink)

The challenges presented by sustainable development are broadly accepted, yet resource use increases unabated. It is increasingly acknowledged that while technical solutions may play a part, a key issue is behaviour change. In response to this, there has been a plethora of studies into how behaviour change can be enabled, predominantly from psychological and sociological perspectives. This has resulted in a substantial body of knowledge into the factors that drive behaviour change and how they can be manipulated to achieve desired (...) social goals. In this paper, we describe a study that draws on this body of knowledge to design an intervention to drive behaviour change across the hairdressing sector, and by the process of diffusion, across the vast social networks of this occupational group to influence domestic hair-care practices. The intervention was successful: hairdressers indicated positive intentions to adopt more sustainable practices within their salons and pass them onto their customers. The customer survey confirms this: customers surveyed after their hairdresser attended the Green-Salon-Makeover intervention were significantly more likely to report that environmental issues had been considered in their salon visit and that they themselves would consider such issues in their hair-care practices at home than customers who were surveyed before the intervention. (shrink)

(2010). Approaches to behavior and classroom management: integrating discipline and care. Journal of Moral Education: Vol. 39, No. 4, pp. 524-526. doi: 10.1080/03057240.2010.521408.

Nurses facing impediments to what they perceive as moral practice may experience moral distress. The purpose of this descriptive, cross-sectional study was to determine similarities and differences in moral distress and avoidance behavior between critical care nurses and non-critical care nurses. Sixty-eight critical care and 28 non-critical care nurses completed the Moral Distress Scale and Impact of Event Scale. There were no differences in moral distress scores or impact of event scores between groups after adjusting for age. There was a (...) small positive correlation between moral distress and avoidance behaviors for both the groups. Moral distress is present in both critical care and noncritical care nurses. It is important that nurses are provided with opportunities to cope with this distress and that retention strategies include ways to reduce suffering and mitigate the effects on professional practice. (shrink)

This article investigates the effects of perceived supervisor support on ethical and unethical employee behavior using a multi-method approach. Specifically, we test the mediating mechanism and a boundary condition that moderate the relationship between support and ethical employee behaviors. We find that supervisor-based self-esteem fully mediates the relationship between supervisor support and ethical employee behavior and that employee task satisfaction intensifies the relationship between supervisor support and supervisor-based self-esteem.

Over recent years, a number of behavioural economic-informed policy frameworks have been developed, ranging from soft and hard forms of paternalism, to regulation against negative externalities, the so-called nudge, shove and budge approaches. This article considers these different frameworks as applied to some of the challenges posed by the social care needs of contemporary societies. It is argued that all of the frameworks are worthy of serious consideration in this policy domain, in that they offer food for thought on how (...) financial contributions to pay for social care might be increased, and how the quality of social care provision may be improved given available resources. (shrink)

BackgroundPublic health scholars have long called for preparedness to help better negotiate ethical issues that emerge during public health emergencies. In this paper we argue that the concept of ethical preparedness has much to offer other areas of health beyond pandemic emergencies, particularly in areas where rapid technological developments have the potential to transform aspects of health research and care, as well as the relationship between them. We do this by viewing the ethical decision-making process as a behaviour, and conceptualising (...) ethical preparedness as providing a health research/care setting that can facilitate the promotion of this behaviour. We draw on an implementation science and behaviour change model, COM-B, to demonstrate that to be ethically prepared requires having the capability, opportunity, and motivation to work in an ethically prepared way.MethodsWe use two case examples from our empirical research—one pandemic and one non-pandemic related—to illustrate how our conceptualisation of ethical preparedness can be applied in practice. The first case study was of the UK NHSX COVID-19 contact tracing application case study involved eight in-depth interviews with people involved with the development/governance of this application. The second case involved a complex case regarding familial communication discussed at the UK Genethics Forum. We used deductive qualitative analysis based on the COM-B model categories to analyse the transcripbed data from each case study.ResultsOur analysis highlighted that being ethically prepared needs to go beyond merely equipping health professionals with skills and knowledge, or providing research governance actors with ethical principles and/or frameworks. To allow or support these different actors to utilise their skills and knowledge, a focus on the physical and social opportunity is important, as is a better understanding the role of motivation.ConclusionsTo understand ethical preparedness, we need to view the process of ethical decision-making as a behaviour. We have provided insight into the specific factors that are needed to promote this behaviour—using examples from both in the pandemic context as well as in areas of health research and medicine where there have been rapid technological developments. This offers a useful starting point for further conceptual work around the notion of being ethically prepared. (shrink)

Background:Moral distress has various adverse effects on nurses working in critical care. Differences in personal values, and between values and self-perception of behaviour are factors that may cause moral distress.Research aims:The aims of this study were (1) to identify ethical values and self-perception of behaviour of critical care nurses in Japan and (2) to determine the items with a large difference between value and behaviour and the items with a large difference in value from others.Research design:A nationwide, cross-sectional study was (...) conducted.Participants and research context:We developed a self-administered questionnaire with 28 items, which was completed by 1014 critical care nurses in Japan. The difference between value and self-perception of behaviour was calculated from the score of each value item minus the score of each self-perception of behaviour item. The size of the difference in value from the others was judged by the standard deviation of each item.Ethical considerations:The study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214, M2019-045).Results:The items with a large difference between value and behaviour sources were related to the working environment and decision-making support. The items with a large difference in value from others were related to hospital management and disclosure of information to patients.Discussion:Improving the working environment for nurses is important for reducing moral distress. Nurses are faced with a variety of choices, including advocating for patients and protecting the fair distribution of medical resources, and each nurse’s priorities might diverge from those of other team members, which can lead to conflict within the team.Conclusion:This study revealed items with particularly high risks of moral distress for nurses. The results provide foundational information that can guide the development of strategies to mitigate moral distress. (shrink)

First published in 1994. Routledge is an imprint of Taylor & Francis, an informa company.

This paper analyses a situation where a patient's suffering provoked feelings of compassion in a student nurse, and distress at her patient's circumstances. The reported behaviour of qualified nurses within the situation suggests that they lacked compassion, had inadequate knowledge, and that they failed to understand their patient's plight. An account of the situation is followed by an exploration of the nature of moral agency, and understanding in nursing. Nurses' capacity for moral imagination is shown to be of crucial importance (...) to the care that patients receive. The extent of nurses' responsibility for their behaviour is considered, and in particular, the extent of nurses' responsibility during times when they experience strain. Argument leads to the conclusion that we are justified in holding nurses responsible for their behaviour in situations of patient care, although we must not judge a nurse's behaviour too hastily. Attention is drawn to the need for a moral climate to sustain those nurses who struggle to give good patient care, despite the strain that is ever present within today's world of health care. (shrink)

SummaryMalaria is a major cause of under-five mortality in Mali and many other developing countries. Malaria control programmes rely on households to identify sick children and either care for them in the home or seek treatment at a health facility in the case of severe illness. This study examines the involvement of mothers and other household members in identifying and treating severely ill children through case studies of 25 rural Malian households. A wide range of intra-household responses to severe illness (...) were observed among household members, both exemplifying and contravening stated social norms about household roles. Given their close contact with children, mothers were frequently the first to identify illness symptoms. However, decisions about care-seeking were often taken by fathers and senior members of the household. As stewards of the family resources, fathers usually paid for care and thus significantly determined when and where treatment was sought. Grandparents were frequently involved in diagnosing illnesses and directing care towards traditional healers or health facilities. Relationships between household members during the illness episode were found to vary from highly collaborative to highly conflictive, with critical effects on how quickly and from where treatment for sick children was sought. These findings have implications for the design and targeting of malaria and child survival programming in the greater West African region. (shrink)

What is at the basis of moral action? An altruism acquired by the application of rule and principle? Or, as Noddings asserts, caring and the memory of being cared for? With numerous examples to supplement her rich theoretical discussion, Noddings builds a compelling philosophical argument for an ethics based on natural caring, as in the care of a mother for her child. The ethical behavior that grows out of natural caring, and has as its core care-filled receptivity (...) to those involved in any moral situation, leaves behind the rigidity of rule and principle to focus on what is particular and unique in human relations. Noddings's discussion is wide-ranging, as she considers whether organizations, which operate at a remove from the caring relationship, can truly be called ethical. She discusses the extent to which we may truly care for plants, animals, or ideas. Finally, she proposes a realignment of education to encourage and reward not just rationality and trained intelligence, but also enhanced sensitivity in moral matters. (shrink)

Background:It is stated that high ethical sensitivity positively affects the quality of nursing care. However, the relationship between nursing care quality and ethical sensitivity has not been clearly demonstrated in researches.Aim:This study was carried out to determine the relationship between surgical nurses’ care behaviors and their ethical sensitivity.Method:The sample of this cross-sectional, descriptive-correlational study consists of 308 nurses who worked at the surgical departments in four Turkish hospitals. The data were collected using the “Nurse Description Form” developed by the researcher, (...) “Caring Behaviours Inventory-24” and “Ethical Sensitivity Questionnaire.” Data were evaluated by the Mann Whitney U test, Kruskal Wallis one-way analysis of variance and Spearman correlation analysis.Ethical considerations:The study was approved by the ethics committee. Verbal and written consent was received from the nurses.Results:It was found in the study that nurses’ Caring Behaviours Inventory-24 total score median was 5.25 (4.83–5.58), nurses’ perception level of caring quality was high, median of Ethical Sensitivity Questionnaire total score was 89.00 (75.00–101.00) and nurses’ ethical sensitivity was moderate. A negative significant relation was found between nurses’ Caring Behaviours Inventory-24 total score and Ethical Sensitivity Questionnaire total score (r = -0.162; p = 0.009). A negative relation was also detected between nurses’ working period at the current clinic and providing benefit (r = -0.147; p = 0.012), holistic approach (r = -0.139; p = 0.018) and orientation (r = -0.175; p = 0.003) scores of Ethical Sensitivity Questionnaire sub-scales.Conclusion:Nurses’ perception levels of caring quality were high and their ethical sensitivity levels were moderate. It was found out that nurses’ ethical sensitivity increased together with their perception of caring quality, and as their working period at the current clinic increased, the ethical sensitivity also increased in terms of the sub-scales of providing benefit, holistic approach, and orientation. The factors that adversely affect the quality of nursing care and ethical sensitivity should be examined and attempts should be made to improve the working environment. (shrink)

Self‐care, or self‐management, is presented in healthcare policy as a precursor to patient empowerment and improved patient outcomes. Alternatively, critiques of the self‐care agenda suggest that it represents an over‐reliance on individual autonomy and responsibility, without adequate support, whereby ‘self‐care’ is potentially unachievable and becomes ‘care left undone’. In this sense, self‐care contributes to a blame culture where ill‐health is attributed to personal behaviours or lack thereof. Furthermore, self‐care may represent a covert form of rationing, as the fiscal means (...) to enable effective self‐care and supplement, or replace, self‐care capacities, is not provided. This paper explores these arguments through a contemporary ethical analysis of the self‐care agenda. The terms self‐care and self‐management are used interchangeably throughout whereby self‐management is understood as a point in the wider self‐care continuum. (shrink)

Ethics has been discussed largely in the language of the father, Nel Noddings believes: in principles and propostions, in terms such as _justification,_ _fairness,_ and _equity._ The mother's voice has been silent. The view of ethics Noddings offers in this book is a feminine view. "This does not imply," she writes, "that all women will accept it or that most men will reject it; indeed there is no reason why men should not embrace it. It is feminine in the deep (...) classical sense—rooted in receptivity, relatedness, and responsiveness. It does not imply either that logic is to be discarded or that logic is alien to women. It represents an aternative to present views, one that begins with the moral attitude or longing for goodness and not with moral reasoning." What is at the basis of moral action? An altruism acquired by the application of rule and principle? Or, as Noddings asserts, caring and the memory of being cared for? With numerous examples to supplement her rich theoretical discussion, Noddings builds a compelling philosophical argument for an ethics based on natural caring, as in the care of a mother for her child. The ethical behavior that grows out of natural caring has at its core as care-filled receptivity to those involved in any moral situation, and leaves behind the rigidity of rule and principle to focus on what is particular and unique in human relations. "The hand that steadied us as we learned to ride our first bicycle did not provide propositional knowledge, but it guided and supported us all the same, and we finished up 'knowing how.'" Noddings's discussion is far-ranging, as she considers whether organizations, which operate at a remove from the caring relationship, can truly be called ethical. She discusses the extent to which we may truly care for plants, animals, or ideas. Finally, she proposes a realignment of education to encourage and reward not just rationality and trained intelligence, but also enhanced sensitivity in moral matters. (shrink)

The attitudes and behaviours that constitute caring affect both the quality of the patient's experience and the outcomes of medical care. They can be identified and can be nurtured or discouraged by the structures of organisation and financing within which health care is provided. They have costs, so their viability is threatened as pressures increase to make health care more economically efficient. Yet the value of caring behaviour may justify what is necessary to sustain it. This issue (...) deserves prompt and extensive debate as health care systems undergo revision throughout the world. (shrink)

BackgroundAssessing consciousness in other subjects, particularly in non-verbal and behaviourally disabled subjects (e.g., patients with disorders of consciousness), is notoriously challenging but increasingly urgent. The high rate of misdiagnosis among disorders of consciousness raises the need for new perspectives in order to inspire new technical and clinical approaches. Main bodyWe take as a starting point a recently introduced list of operational indicators of consciousness that facilitates its recognition in challenging cases like non-human animals and Artificial Intelligence to explore their relevance (...) to disorders of consciousness and their potential ethical impact on the diagnosis and healthcare of relevant patients. Indicators of consciousness mean particular capacities that can be deduced from observing the behaviour or cognitive performance of the subject in question (or from neural correlates of such performance) and that do not define a hard threshold in deciding about the presence of consciousness, but can be used to infer a graded measure based on the consistency amongst the different indicators. The indicators of consciousness under consideration offer a potential useful strategy for identifying and assessing residual consciousness in patients with disorders of consciousness, setting the theoretical stage for an operationalization and quantification of relevant brain activity.ConclusionsOur heuristic analysis supports the conclusion that the application of the identified indicators of consciousness to its disorders will likely inspire new strategies for assessing three very urgent issues: the misdiagnosis of disorders of consciousness; the need for a gold standard in detecting consciousness and diagnosing its disorders; and the need for a refined taxonomy of disorders of consciousness. (shrink)

Within the past few years, managed care health insurance programs have become commonplace. With managed care programs, however, physicians are facing increasing ethical pressures. This paper examines the relationship between physicians'' behavior intentions with respect to four managed care ethical scenarios and their responses to Forsyth''s (1980) Ethics Position Questionnaire (EPQ). This is one of the first papers to compare this scale to behavioral intentions in the workplace. We provide a literature review of the ethical dilemmas that doctors face under (...) a managed care system and conduct a national random sample of general practitioners and surgeons regarding the four managed care ethical dilemmas. The results show that the doctors surveyed are significantly more idealistic than relativistic. In relating the EPQ to the ethical scenarios, however, there was no support for the proposition that ethical ideology was related to the ethical behavioral intentions. This suggests more research is needed to establish the links between ethical positions, attitudes, and behavioral intentions. Finally, there were little differences in EPQ scores by practice or demographic variables, the only significant result being that general surgeons are significantly more idealistic than family practitioners. (shrink)

What can the art of living after Foucault contribute to ethics in relation to the mediation of human existence by technology? To develop the relation between technical mediation and ethics, firstly the theme of technical mediation is elaborated in line with Foucault’s notion of ethical problematization. Every view of what technology does to us at the same time expresses an ethical concern about technology. The contemporary conception of technical mediation tends towards the acknowledgement of ongoing hybridization, not ultimately good or (...) bad but ambivalent, which means for us the challenge of taking care of ourselves as hybrid beings. Secondly, the work of Foucault provides elements for imagining this care for our hybrid selves, notably his notions of freedom as a practice and of the care of the self. A conclusions about technical mediation and ethics is that whereas the approaches of the delegation of morality to technology by Latour and mediated morality by Verbeek see technical mediation of behavior and moral outlook as an answer in ethics, this should rather be considered the problem that ethics is about. (shrink)

The Autism Spectrum Disorder (ASD) represents a set of life-long disorders. In particular, subjects with ASD can display momentary behaviors of acute agitation and aggressiveness called crisis behaviors. These events are problematic for the subject and care providers but little is known about their occurrence, namely, possible relations among intensity, frequency, and duration. A group of ASD subjects (n=33) has been observed for 12 months reporting data on each crisis ( n = 1137 crises). Statistical analysis did not find significant (...) results, while the relation between crisis duration and frequency showed a good fit to a “power law” curve, suggesting the application of Self-Organized Criticality (SOC) model. The SOC is used to describe natural phenomena as earthquakes, bank failures of rivers, mass extinctions, and other systems where a type of “catastrophic events” is necessary to maintain a critical equilibrium. In a sense, subjects at risk of crisis behavior seem to fit the same model as seismic zones at risk of earthquakes. The employment of the same strategies, as those successfully developed for known SOC systems, could lead to important insights for ASD management. Moreover, the SOC model offers possible interpretations of crisis behavior dynamics suggesting that they are unpredictable and, in a sense, necessary. (shrink)

Behavior genetics is a controversial science. For decades, scholars have sought to understand the role of heredity in human behavior and life-course outcomes. Recently, technological advances and the rapid expansion of genomic databases have facilitated the discovery of genes associated with human phenotypes such as educational attainment and substance use disorders. To maximize the potential of this flourishing science, and to minimize potential harms, careful analysis of what it would mean for genes to be causes of human behavior is needed. (...) In this paper, we advance a framework for identifying instances of genetic causes, interpreting those causal relationships, and applying them to advance causal knowledge more generally in the social sciences. Central to thinking about genes as causes is counterfactual reasoning, the cornerstone of causal thinking in statistics, medicine, and philosophy. We argue that within-family genetic effects represent the product of a counterfactual comparison in the same way as average treatment effects (ATEs) from randomized controlled trials (RCTs). Both ATEs from RCTs and within-family genetic effects are shallow causes: They operate within intricate causal systems (non-unitary), produce heterogeneous effects across individuals (non-uniform), and are not mechanistically informative (non-explanatory). Despite these limitations, shallow causal knowledge can be used to improve understanding of the etiology of human behavior and to explore sources of heterogeneity and fade-out in treatment effects. (shrink)

Managed Care Organizations (MCOs) are frequently criticized for their marketing mistakes. Often that criticism is leveled against an implicit benchmark of an ideal competitive market or an ideal system of government provision. But any accurate assessment in the choice of health care organizations always requires a comparative measure of error rates. These are high in the provision of health care, given the inherent uncertainties in both the cost and effectiveness of treatment. But the continuous and rapid evolution of private health (...) care mechanisms is, in the absence of regulation, more likely to secure access and contain costs than any system of government regulation. State regulation is subject to the risk of capture and to the sluggish and acquisitive behavior of state run monopolies. The proposed fixes for the MCOs (rights to specialists, access to physicians outside the network, guaranteed emergency room access) are likely, when imposed from without, to cost more than they are worth. The long-term risk is that markets will fail under regulation, paving the way for greater losses from massive government control of the health care delivery system. (shrink)

Caring is at the core of what nurses and other health professionals do. But caring encompasses more than simply looking after people's physical health needs. People requiring any health service will have psychological needs that affect their feelings, thoughts, and behaviour. Good psychological care can even help improve physical health outcomes. An Introduction to Psychological Care in Nursing and the Health Professions explains and promotes the importance of psychological care for people when they become physically ill, giving a (...) sound theoretical basis to ensure care is evidence-based. It encourages the reader to think about the effects of illness and disability on patients, and to understand what can be done to identify and minimise any difficulties they might be experiencing in these areas. The chapters cover: the meaning and elements of care and holistic care; a model of psychological care in practice; the personal qualities and skills of carers that best underpin psychological care delivery, and how these might be enhanced; the knowledge needed for effective psychological caregiving; psychological care as it might be practised in a range of health care settings. This text contains key learning points, practical activities, reflective exercises and case illustrations. It is ideal for student and practising nurses, and health professionals who would like to improve their care for patients in this essential area. (shrink)

Studies have shown that using robot pets in dementia care contributes to a reduction in loneliness and anxiety, and other benefits. Studies also show that, even when people know they are dealing with robots, they often treat the robot as though it is a real pet with genuine emotions. This disconnect between beliefs and behavior occurs not just for people living with dementia, but with cognitively healthy adults, including those who are knowledgeable about how robots work. One possible explanation is (...) that robot pets prompt contradictory beliefs, and so the use of robot pets encourages self‐deception. Sparrow argues that this makes the use of robot pets in dementia care morally objectionable. We disagree. We argue that Gendler's concept of alief offers a better explanation of the belief‐behavior disconnect observed when people interact with robot pets. An alief is a mental state composed of an automatic, arational, emotional, and behavioral response to representational input. Aliefs are not beliefs and are not subject to truth norms. Thus, on our view, harms associated with the use of robot pets in dementia care are not likely to include the self‐deceptions that Sparrow suggests. It might seem like philosophical hair‐splitting to claim that deception has not occurred because discordant aliefs rather than false beliefs have been formed, but this distinction matters. We argue that aliefs carry their own risks. These risks are important to consider when using robot pets in dementia care. (shrink)

‘Have you ever taken sufficient care of yourselves?’ By asking the elite Athenian youth this question, Socrates implies that the liberation of self and the capacity to govern are inseparable. Drawing on the lectures given by Michel Foucault at the Collège de France in 1984 – only recently made available to the public – we show the consequences of the return to this ancient care‐of‐self ethic in the organizational context. After reviewing the contributions made to business ethics by these two (...) philosophers, we propose four phases necessary to the emergence and constitution of a moral subject in organizations: self‐awakening, self‐evaluation, self‐transformation and self‐presentation. We then suggest various managerial practices and behaviour inspired by this philosophical parrhesia embodied by the Greek philosopher wherein the manager should have a personal relationship with his or her own activity. Finally, we discuss implications of our study in the field of business ethics and propose an agenda for future research. (shrink)

One important ethical issue for health promotion and public health work is to determine what the goals for these practices should be. This paper will try to clarify what some of these goals are thought to be, and what they ought to be. It will specifically discuss two different approaches to health promotion, such as, behavior change and empowerment. The general aim of this paper is, thus, to compare the behavior-change approach and the empowerment approach, concerning their immediate goals or (...) aims, and to morally evaluate the strengths and weaknesses of these two goal models, in relation to the ultimate goal of health promotion. The investigation shows that the behavior-change approach has several moral problems. First of all, it is overly paternalistic and often disregards the individual’s or group’s own perception of what is important—something that also increases the risk of failed interventions. Furthermore, it risks leading to ‘victim blaming’ and stigmatization, and to increased inequalities in health, and it puts focus on the ‘wrong’ problems, i.e., behavior instead of the ‘causes of the causes’. It is thereafter shown that the empowerment approach does not have any of these problems. Finally, some specific problems for the empowerment approach are discussed and resolved, such as, the idea that empowering some groups might lead to power over others, the objection that the focus is not primarily on health, and the fact that empowered people might choose to live lives that risk reducing their health. (shrink)

‘Have you ever taken sufficient care of yourselves?’ By asking the elite Athenian youth this question, Socrates implies that the liberation of self and the capacity to govern are inseparable. Drawing on the lectures given by Michel Foucault at the Collège de France in 1984 – only recently made available to the public – we show the consequences of the return to this ancient care‐of‐self ethic in the organizational context. After reviewing the contributions made to business ethics by these two (...) philosophers, we propose four phases necessary to the emergence and constitution of a moral subject in organizations: self‐awakening, self‐evaluation, self‐transformation and self‐presentation. We then suggest various managerial practices and behaviour inspired by this philosophical parrhesia embodied by the Greek philosopher wherein the manager should have a personal relationship with his or her own activity. Finally, we discuss implications of our study in the field of business ethics and propose an agenda for future research. (shrink)

This paper proposes and showcases a methodology to develop an observational behavior assessment instrument to assess psychological competencies of police officers. We outline a step-by-step methodology for police organizations to measure and evaluate behavior in a meaningful way to assess these competencies. We illustrate the proposed methodology with a practical example. We posit that direct behavioral observation can be key in measuring the expression of psychological competence in practice, and that psychological competence in practice is what police organizations should care (...) about. We hope this paper offers police organizations a methodology to perform scientifically informed observational behavior assessment of their police officers’ psychological competencies and inspires additional research efforts into this important area. (shrink)

Joan Tronto defines care by three activities: maintaining, continuing, and repairing. These activities give care a maintenance quality, which is problematic given that caring often takes place within contexts of inequality and domination. Empirical research with paid support staff and people with intellectual and developmental disabilities (IDD) illustrate these problems: care practices tend to reinforce the social exclusion of people with IDD, particularly for people with challenging behavior. Yet, support workers’ care practices can facilitate a better quality of life (...) for people with IDD. This improved style of support maps onto Tronto’s fifth phase of care, caring with, which hinges practices of care on democratic principles of justice, equality, and freedom. As such, democratic care requires activities that Tronto excludes from care, including creativity, disruption, and pleasure. I use empirical research from the field of IDD to show how support workers and people with IDD practice creative, disruptive, and playful care to challenge persistent forms of exclusion, inequality, and stigma. (shrink)