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PubMedDate not supplied

Rebuilding morale after downsizing.

Motivating employees is one of a manager's most important roles, but it is a challenge in today's shifting health-care market. Decreasing funding and a changing patient population are forcing hospitals to either cut costs or go out of business. In such a tense environment, the possibility of layoffs continually looms over our heads. Whether your laboratory is contemplating job cuts or you already have been through them, you know there is no worse threat to employee morale. A March 1996 Strategic Management survey reported that poor morale is the worst human resource problem among 81% of 691 U.S. hospitals. Ronald Henkoff said it best in the January 1994 issue of Fortune Magazine: "A distressing 80% of downsizers admit that the morale of the remaining employees has been mugged. These sullen, dispirited, hunkered-down folks, lest we forget, are the very people who are supposed to revitalize our enterprise and delight our customers." Many times, when we focus on cost constraints and customer service, we overlook what we might do to improve trust among our staff. Rather than letting bad feelings run their course after 1999 job cuts, we decided to intervene. We developed new management tools and recovery interventions at Children's Medical Center to ward off discontent after the changes.

Humans↗
PubMed1997

[Moral elements in program of medical studies in Warsaw within the years of the annexation of Poland (1809-1915)].

In result of carried out observations it has been found out, that 1/ ethics as a separate subject has not been taught at the Warsaw Faculties of Medicine in period of the annexation of Poland, 2/ in outline of the history of medicine published in manuals of propedeutics by W Szczucki and H. Luczkiewicz have not included deontological texts, 3/ within the scope of propedeutics there were taught the physician's obligations and duties, what has been a way to create a moral stance, 4/ propedeutics has been taught nearly continuously starting from 1891, 5/ Luczkiewicz, a lecturer of propedeutics and history of medicine, translated into Polish the deontological texts of Hypocrites as the first one /Oath and Commandment/, making it available to physicians and students, 6/ some lecturers have been propagating moral principles with written and spoken words, and maybe with their own example. It has been found out that a continuation of research is recommended. It is encouraged a discussion to be held on the ways of educating ethically healthy society and moral physicians.

Education, Medical↗
PubMed2002

[Ethical dilemmas in early detection of dementia. An inventory of moral intuitions in practice].

In this article we present an inventory of the moral intuitions of the health care workers who work in the field of early detection of dementia. The effects of pharmacological treatment and professional care and support may improve when dementia is detected in an early stage. Furthermore, the patient (and his family) can prepare themselves for the period to come. Health care workers recognize moral problems and tensions concerning early detection that are related to the question whether persons will benefit from knowledge in an earlier stage of dementia, because this knowledge can be a heavy burden. We asked general practitioners, home care workers, employees of the so-called 'Memory clinic' and specialists, what ethical intuitions they recognize in practice. They mentioned the following questions: when are health care professionals allowed to take initiative, is causing worries and concerns problematic, and should a diagnosis always to be told? We conclude after a first analysis that many moral questions derive from the fact that many health care professionals lack knowledge of the wishes and interests of the elderly. At the same time they try to justify their actions on the (presupposed) consent of the elderly person. We suggest that the general norm 'only act when the patient wants to be helped' in health care should also apply to detection of dementia, although it should not be taken too strictly. Another justification for early detection can be found in the benefits for the elderly people, when their wishes are no longer expressed.

Aged↗
PubMed1975

Children's use of motives and intentionality in person perception and moral judgement.

Preschool, second-, and fifth-grade children watched films and heard stories which portrayed an actor who intentionally or accidentally injured another for either good or bad motives. After each film or story, children were interviewed to determine their understanding of the actor motives and the intentionality of his act and their moral judgements. The results suggest that children of all ages understood the concepts of motive and intentionality, but that the ability to make accurate inferences about motives and intentionality develops with age. Motives affected children's evaluations at all ages, but intentionality affected only grade school children's evaluations. The results for moral judgment were discussed in terms of a theory which included features of both cognitive-developmental and social learning explanations of moral development.

Age Factors↗
PubMed2002

Navigating towards a moral horizon: a multisite qualitative study of ethical practice in nursing.

This paper reports the results of a qualitative study of nurses' ethical decision-making. Focus groups of nurses in diverse practice contexts were used as a means to explore the meaning of ethics and the enactment of ethical practice. The findings centre on the metaphor of a moral horizon--the horizon representing "the good" towards which the nurses were navigating. The findings suggest that currents within the moral climate of nurses' work significantly influence nurses' progress towards their moral horizon. All too often, the nurses found themselves navigating against a current characterized by the privileging of biomedicine and a corporate ethos. Conversely, a current of supportive colleagues as well as professional guidelines and standards and ethics education helped them to move towards their horizon. The implications for nursing practice and for our understanding of ethical decision-making are discussed.

Decision Making↗
PubMed1976

Order of information presentation and children's moral judgments.

It was hypothesized that age differences in use of intent information in children's moral judgments might be due to a recency effect in the judgments of younger children. A study was conducted to examine the effect of order of stimulus presentation on children's moral judgments. The information was presented to children, ages 4-5 and 8-9 years old, through stories with either normal information order, intent-consequence, or reversed order, consequence-intent. It was found that order has a significant impact on children's moral judgments. In addition, memory data were gathered which indicated that the pattern of forgetting was parallel to the pattern of information preference for the younger subjects. The findings suggested that younger subjects' relative neglect of intent in the normal order of information was based, in part, on their failure to remember the material correctly rather than on differential weighting of the 2 cues.

Age Factors↗
PubMed1992

[Constraint and inclination for reducing complexity--social cognitive aspects of moral judgment in children].

When processing information about their reality human beings systematically reduce objective complexity. This is not only true in cognitive problem solving, but also in other every-day situations, e.g., when decisions in situations of moral relevance are required. From a developmental psychological point of view the adequate handling of such situations requires, on the one hand, an age-related differentiation of social cognitions, and, on the other hand, an increasingly effective structuring and integration of information. The latter developmental process, however, bears the danger that an adequate psychosocial development is substituted by a tendency toward complexity reduction in the sense of oversimplification due to the fact that such a tendency may suggest situation-specific alternative actions which are seemingly "easier to handle". In an empirical study with 176 students from Polytechnical High Schools in (East-)Berlin the hypothesis is tested if a tendency toward oversimplification in (fictitious) situations of moral relevance is systematically related to deviant behavior at school. Results show that indeed deviant students have a stronger tendency toward oversimplifying social cognitions than non-deviant students. Furthermore, it can be shown that this result is not moderated by possible sex, age or academic performance effects. As results with regard to moral judgement in the Kohlbergian sense differ substantially in their relation to academic performance and to behavioral deviance, it is assumed that the two judgement processes differ conceptually.

Adolescent↗
PubMed2004

Catholic moral teaching, medically assisted nutrition and hydration and the vegetative state.

A wide range of medical, legal and ethical opinion regarding withholding or withdrawing medically assisted nutrition and hydration (ANH) from vegetative state (VS) and persistent vegetative state patients (PVS) has been presented in professional journals over the past twenty years. This article concerns the moral aspects of this debate as it has developed within the Catholic Church, especially in the United States. It presents traditional Catholic teaching about the extent and limits of the moral obligation to employ medical means in the preservation of human life, and examines how this teaching applies to the specific question of supplying ANH to PVS patients. It provides a critique of two contradictory views on the morality of discontinuing ANH for PVS patients presented by Catholic theologians. It examines the teaching of Pope John Paul II, who identifies ANH as a natural means of preserving life that must be maintained as long as it preserves the patient's life or alleviates his suffering. Finally, it discusses the practical implications this papal teaching has for the treatment of PVS patients in all Catholic health care facilities.

Catholicism↗
PubMed2004

[The moral behaviour in human an non-human primates].

The well-known ethologist and Nobel Price Konrad Lorenz said that, according to the evolution, the human mental capacities, and therefore the morality, ought to have had forerunner in the animals which have preceded us: he call them < >, i.e. forerunners of our reason. Recently, the social life of non human primates has been intensely studied with the conclusions that there are rules which can be considered as rudiments of a moral behaviour. The so-called < >, for instance, can be an advantage for others, but at the expense of those who practise it and this can be interpreted as a moral behaviour.

Animals↗
PubMed2005

Can artificial techniques supply morally neutral human embryos for research?

Amidst controversy surrounding research on human embryos, biotechnology has conceived a substitute in the artificial human embryo. We examine the claim that novel embryos constructed artificially should be exempt from ethical restraints appropriate for research on embryos that come into being through natural processes. Morally relevant differences in intrinsic value depend on the sense in which the entity may be artificial, whether in regard to constituent matter, genetic or cellular form, generative means, or intended purpose. Considering each of these Aristotelian categories from a physicalist viewpoint, technology can achieve only limited degrees of artificiality because redesigned embryos still retain most of their natural features and relationships. From an essentialist viewpoint, the very limits of technology preclude the capability of manipulating the fundamental nature or essence of the individual who, even at the embryonic stage of life, cannot be made to be artificial through and through. A human may possess artificially contributed attributes but cannot be an artificial being. Classification of novel human organisms as artificial, therefore, is insufficient grounds by which to relinquish the principle that human moral status should be recognized for all living beings of human origin. In uncertain cases, at least the possibility of special human moral status should be considered present in organisms that are derived asexually, are developmentally defective, or are otherwise technologically altered.

Chromosome Aberrations↗
PubMed2005

Discussing the theological grounds of moral principles.

Discussing the theological beliefs that ground Catholic moral principles can make some people uncomfortable, even while others will appreciate it. But these reactions will sometimes be revealed not as the emotions they are, but as objections to the relative independence or dependence of morality on foundational beliefs. In the end, context should dictate whether one displays the theological beliefs that ground Catholic moral principles.

Bioethics↗
PubMed2005

Honoring experience in moral discourse.

This essay seeks to address the role of human experience in moral discourse. The authors propose that it is precisely through incorporating a collective experience of what it means to be human in moral discourse that we come to understand the relevance of moral norms in ethical decision-making. We conclude by offering a number of recommendations for ethics committees and hospital administrators.

Bioethical Issues↗
PubMed1992

Development of moral judgment and its relationship to the education and training of dietitians.

The purpose of this study was to compare the development of moral judgment in 171 dietetics students before and after training from internships (n = 96), coordinated undergraduate programs (n = 61), and preprofessional practice programs (n = 14). The results of the study supported the research hypothesis that greater moral development growth would occur in supervised practices that allow students more experiences promoting moral growth, such as clinical rotations with patients, peer discussions on ethical issues, and access to instructors trained in ethics. Analysis of covariance indicated differences in the posttest scores of the three groups. Student scores for the internship and the coordinated undergraduate program were significantly different. Scores of preprofessional practice program students did not differ from those of the other groups. Internship programs offered more time in clinical rotations, used trained ethicists more, and used more methods to introduce ethics into the curriculum than did the other programs.

Adult↗
PubMedDate not supplied

Moral competence as a positive youth development construct: conceptual bases and implications for curriculum development.

Moral competence refers to the orientation to perform altruistic behavior and the ability to judge moral issues logically, consistently and at an advanced level of development. A brief review of the concepts of altruism and justice is presented. The gender and cultural issues are also discussed. The contents of moral competence program units include four major topics: (1) Fairness, (2) Proper conduct (mainly altruistic and prosocial orientation), (3) Responsibility and altruistic orientation, and (4) Integrity and fairness. The general goal is to help students to develop an altruistic orientation and a judgment structure of a high level of justice. This paper is part of the development of the positive youth development program in Hong Kong.

Adolescent↗
PubMed2006

Toward a safer moral climate.

The authors define moral climate in the context of health care as the implicit and explicit values that drive health-care delivery and shape the workplaces in which care is delivered. Over the past six years, their research has focused on describing the moral climates of nurses' workplaces and improving them. In this article, the authors argue that nurses in direct care delivery roles have the insights, expertise and interpersonal skills required to create a much safer moral climate for practice. To make this happen, nurses require opportunities for self-reflection and for true collaboration with their colleagues in management and administration and other health-care disciplines.

Attitude of Health Personnel↗
PubMed2006

Moral communities.

This article explores the twin issues of whether organizations can act as ethical agents and what it means to exert moral influence over others. A discursive perspective is advanced that characterizes ethics as the action of communities based on promises. The received view of ethics as either the universal principles or individual responsibility is criticized as inadequate. Moral influence within community is considered under the various headings of democracy, office, brotherhood, agency, witness, and promise making. Moral influence among communities can include the damaging methods of "the superior position," coercion and misrepresentation, and appeal to third parties and the sound methods of rhetoric and promise making.

Community-Institutional Relations↗
PubMed2006

Building moral communities? First, do no harm.

As concern for the oral health of vulnerable populations grows, dentistry continues to seek effective ways to respond. In August 2005, Dr. Donald Patthoff and Dr. Frank Catalanotto convened a national workshop at the American Dental Association headquarters on the ethics of access to oral health care. A series of papers were produced for the workshop and subsequently revised for publication. This one responds to the paper by Dr. David Chambers on moral communities and the discursive imperative for building community and consensus around issues affecting equitable access to oral health care. I explore three interrelated issues that ought to be considered when endeavoring to build moral communities: 1) the problem of power relations-a fundamental constituent within discourse that can impede constructive efforts; 2) the discursive disconnect between theoretical ethics and social constructs affecting dentistry; and 3) the bioethical principle of nonmaleficence as a priority in the desire for building moral communities. In essence, this article responds also to the call from ethicists who see a significant need for substantive interdisciplinary contributions to inform how people at different social levels react in ethically problematic situations in its broad social context.

Community-Institutional Relations↗
PubMed1990

Dissocial behaviour and the formation of moral judgement in adolescence.

The examination of moral judgement under the aspects of judgement competence and of judgement performance has achieved an important result in connection with an analysis of the biographical context of dissocial adolescents above all in the area of the décalage of the moral judgement. Whilst the global level demonstrates no relationship to dissocial behaviour, the connection between dissocial behaviour and décalage, the difference between global and the highest reached level, between global stage and competence stage is significant. The thus characterized imperilment of the coherence of the ego corresponds with the result found in psychotic adolescents of a distinct décalage as sign of a distinct disactualisations weakness (Reinhard 1990a) and presents proof of Rauchfleisch's (1981) thesis, which moves dissocial adolescents to the proximity of borderline disturbances and just as with psychoses diagnoses an imperilment of the ego coherence at the sight of massive splitting tendencies. The peculiarities of existential mastering found over and above--liability of mood and evasion--correspond with the results found previously in a larger random test of dissocial adolescents (Reinhard 1988b). Further connections between moral judgement and forms of existential mastering should be gone into elsewhere (Reinhard 1991).

Adolescent↗