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PubMed2002

The impact of political conflict on moral maturity: a cross-national perspective.

This cross-national study of moral reasoning among adolescents in Northern Ireland, Scotland and the Republic of Ireland, addresses the problem of possible moral truncation in Northern Ireland due to the political conflict. The Sociomoral Reflection Measure-Short Form (SRM-SF; Gibbs et al. (1992) Moral Maturity: Measuring the Development of Sociomoral Reflection. Englewood Cliffs, NJ: Erlbaum. was presented to a proportionate stratified sample of 14-15 year olds (n = 613) from three locations including a small town, large town and city in each country to control for urbanization. This adolescent sample consisted of participants from both of Northern Ireland's religious communities and was matched for age and sex. Analysis of the results suggested that despite the violent atmosphere over the last 30 years, the Northern Irish adolescents were not developmentally delayed in moral terms as previously feared (Fraser (1972) Special Education,61, 6-8; Fields (1973). A Society on the Run: A Psychology of Northern Ireland. Harmondsworth, Middlesex: Penguin; (1976) Northern Ireland: Society Under Siege. New Brunswick and London: Transaction Books; Lyons (1973) The Northern Teacher, 19-30)

Adolescent↗
PubMedDate not supplied

Building a professional ethical culture in case management.

Professional ethical development is a moral obligation, a responsibility of both professional associations as entities and individual members. Herein is a blueprint for professional ethical development in case management, including guidelines for a program to foster the development of a professional ethical culture. The most important goal of this culture is to encourage dialogue about the fundamental value commitments of case management.

Case Management↗
PubMed1998

An adjusted version of Kohlberg's moral theory: discussion of its validity for research in nursing ethics.

Critics of Kohlberg's moral theory today focus on the content of his theory and more specifically on its justice-orientated moral concept. This has led to the well-known 'justice-care debate'. The purpose of this article is to critically examine the validity of Kohlberg's moral theory for research in nursing ethics from a caring perspective (referring to the content) as well as from a cognitive-structural perspective (referring to the basic assumptions of the model). The analysis points to the usefulness and value of the cognitive-structural model to empirically study nurses' ethical behaviour; the content of Kohlberg's model, however, needs to be adapted by adding a caring perspective as well as some personal and situational variables. An adjusted version of Kohlberg's model is proposed and discussed.

Cognition↗
PubMed2003

[Improving job morale of nurses despite insurance cost control. 1: Organization assessment].

Faced with declining resources for health care and greater pressures to improve productivity of nursing staff, nursing administrators must act now to develop organizational responses to morale problems among nursing staff. As part of a two-part series for JONA, the authors describe low-cost organizational approaches that address nursing morale. Presented in Part 1 is a low-cost diagnostic process for assessing needs of staff and appraising organizational dimensions contributing to morale. Assessment findings provide clear direction for developing organizational approaches for improving morale.

Cost Control↗
PubMed2001

Is there a unique moral status of human DNA that prevents patenting?

The gene patenting debate, which proved to be a focal point for divergent moral concerns about recent developments in genome research and biotechnology, has revealed that the moral status of DNA is not clear. One of the arguments used to stop undesirable developments was that DNA possesses a unique status, which renders it unfit for patenting. This paper investigates the allegedly unique (moral) status of genetic material and the information it holds from different perspectives. Several properties of DNA prove to be unique. We examine the relevance of these for patentability of genes and conclude that only the unique symbolic meaning of DNA is a relevant factor, which should be taken into account but weighed against other interests involved.

DNA↗
PubMed1984

Improving nursing morale in a climate of cost containment. Part 1. Organizational assessment.

Faced with declining resources for health care and greater pressures to improve productivity of nursing staff, nursing administrators must act now to develop organizational responses to morale problems among nursing staff. As part of a two-part series for JONA, the authors describe low-cost organizational approaches that address nursing morale. Presented in Part 1 is a low-cost diagnostic process for assessing needs of staff and appraising organizational dimensions contributing to morale. Assessment findings provide clear direction for developing organizational approaches for improving morale.

Cost Control↗
PubMed1994

The do-not-resuscitate order. Moral responsibilities of the perioperative nurse.

To provide care that is consistent with a patient's view of his or her best interests, the perioperative nurse must be a knowledgeable, informed member of the OR team. This knowledge must include familiarity with and understanding of all policies that relate to the care of the surgical patient--including DNR policies. The nurse must be willing to assert his or her moral agency in developing DNR policies that will eliminate potential conflict among the OR team members regarding patients with DNR designations. Only by being a knowledgeable moral agent can the perioperative nurse function as an effective advocate of the patient as a person.

Conflict, Psychological↗
PubMed1995

The hospital: battleground or meeting place? Ethical considerations regarding a fair distribution of new medical technologies.

Here, the notion of distributive justice is explored in relation to the introduction and the application of new medical technologies within the clinical setting. The point of departure is that, in the decision making process on what is necessary and fair in patient care, participants will mobilize different ethical models to justify their outlooks and interests. The history of the introduction of Taxol (paclitaxel) is used as an illustration. In the hospital, it is important to make a clear distinction between the moral obligations of the physician and those of the chief executive officer (medical director). Finally, a model is proposed that could help to develop a better moral understanding on the meso-level about what is necessary and fair in distributing the results of medical innovations, without turning the clinic into a battleground of moral interests.

Antineoplastic Agents, Phytogenic↗
PubMed1990

Moral education for nursing decisions.

This paper attacks the Kantian conception of mortality that predominates in our society and the rationalist educational strategies that flow from it. In its place it offers an Aristotelian conception of ethics in which sensitivity and feeling are important components of practical reason. It argues that a nurse's ethical concerns extend further than the several moral dilemmas discussed in the daily press and that those concerns should be responded to in moral education by a process called 'empowerment'. Empowerment seeks to develop confidence and sensitivity in the making of difficult decisions and does so by training habits, developing attitudes, and encouraging reflection on actions performed.

Attitude↗
PubMed1990

National survey of ethical issues presented to drug information centers.

Whether and how drug information centers respond to calls from the public that involve ethical issues was studied. A survey describing six ethical dilemmas typical of those presented by calls from the public was mailed to pharmacists in 154 drug information centers to see how the questions would be handled. Centers that had written policies governing responses to questions with ethical implications were asked to submit those policies. One hundred twenty-six centers (82%) responded to the survey; of these, 81 (64.3%) answered questions from the public. There were no significant differences in characteristics between centers that did and did not respond to public calls. The case analyses, completed only by pharmacists in centers that responded to public calls, covered such issues as invasion of privacy, social responsibility, personal liability, and interference with the patient-physician relationship. Respondents exercised a wide degree of discretion in determining if they would answer a question; for example, while only 4% would not answer a question concerning the efficacy of a weight-loss diet patch, 77% reported they would not respond to a caller asking for information on drugs that could interfere with the results of a polygraph test. Although respondents often cited institutional policy as the reason for failing to respond to a question, none submitted a copy of such a policy. The pharmacists' responses indicated a high degree of moral and social sensitivity; nonetheless, written policies should be developed to assist drug information center staff members in handling questions that have ethical implications.

Adrenergic beta-Antagonists↗
PubMed1988

Families as caregivers: the limits of morality.

There is a developing trend to look to families to provide care and support of those in need of rehabilitation. A widespread assumption is that family care is superior care and, with modest degrees of support, families can provide that care. Yet we may question the ethical limits of the obligation of a family or family member to provide care when the demands are severe. Psychologic and moral problems that confront caregivers are examined. In some cases caregivers must sacrifice their present and future welfare. That the moral claim made upon them may seem a justifiable one in many respects does not mean that it will be endurable; that it is endurable does not mean that it is justifiable. The problem is exacerbated by lack of a supportive culture, one that rewards and honors those who take on heroic duties. Caregivers may be socially isolated. If heroic demands are to be made on family members, a richer moral culture is required, not just the provision of improved social services.

Persons with Disabilities↗
PubMed2005

[Between science and moral injury--dead human bodies' treatment in anatomy and pathology during early modern times].

In this essay the history of anatomy and pathology between the 16th and the 19th century is focused under the two aspects of scientific development and of moral injury. In anatomy, which came along as a special field of theoretical medicine in 16th century, the human corpse was used as a suitable and to an increasing degree legitimate model of the healthy living body. About two hundred years later, even pathology started to be transformed into pathological anatomy. While anatomists were dealing with the structure of the healthy body pathological anatomists were interested in the morbid changes of the human corpse; the pathologist perceived the dead body as a static model of the dynamic pathological process in the living patient. Anatomy came along in the era of Renaissance and Humanism not least because of a close connection between science and the fine arts, whereas its practical relevance during the 16th and the 17th century resulted from a preparatory function for army surgery. The corpses of executed criminals, infanticides, and of unmarried mothers who had died from natural causes were often used for anatomical purposes including public autopsy. Pathological anatomy, however, unfolded its power not until the end of the 18th and the beginning of the 19th century when a new medical institution had been established: the clinic. The physical methods of examination such as percussion and auscultation of the patient's body could now be reviewed by the results of a post-mortem autopsy. The growing influence of pathological anatomy during 19th century medicine was reflected by a modified perception and evaluation of disease: The spatial dimensions of the visible findings received priority to the chronological development of the process of disease with the consequence of a heightened risk of separating the pathological structures from the suffering patient's biographical context. For the gain to scientism pathological anatomy had to tolerate a loss of reality, replacing the complexity of "heart and soul" by a reductionist model of the dead body.

Anatomy↗
PubMed1996

Family processes as predictors of adolescents' preferences for ascribed sources of moral authority: a proposed model.

This paper develops a model of the family's role in the moralization of the adolescent. To achieve this aim, the Circumplex Model of Marital and Family Systems (Olson, Sprenkle, & Russell, 1979; Olson, 1983) provides the theoretical framework needed to identify levels of adaptability, cohesion, and communication within each family system. Once identified, these family processes are treated as possible predictors of certain moral preferences, in particular, the number and type of sources of moral authority held by the adolescent. The notion "source of moral authority" is based on Henry's (1983) reconceptualization of Kohlberg's stage theory of moral judgments. In light of this, a new measure, the Moral Authority Scale (MAS) has been developed to assess such adolescent preferences for different sources of moral authority. Overall, this unique approach identifies salient family processes as influencing adolescent moral reasoning by drawing together systems theory, cognitive developmental, and psychosocial approaches and generating testable predictions. In so doing, research needs and inadequacies of the current literature are highlighted and possible strategies to overcome such problems are explicated.

Adolescent↗
PubMed1987

Adolescent sexuality: values, morality and decision making.

The first section of this paper presents a theoretical basis of morality and value formation which provides the background for an examination of adolescent sexual and cognitive development. Data from a study of influences on the sexual decisions of five hundred 13- to 19-year-olds are analyzed in the remainder of the article. Relationships between individual characteristics and the importance of various influences are interpreted in light of the structure of values and moral development.

Adolescent↗
PubMed2000

Enzymes: the most important markers of pregnancy development.

From ethical and moral reasons, the progress in neonatology and anesthesiology must not obscure the iatrogenic labors, which begin at the time improper for individual child, especially after induction and - because of that - very often instrumental. Enzymatic monitoring has enabled reduction of the number of preterm and instrumental deliveries, and--more importantly--the elimination of statistical (so-called post-datism) indications for terminating pregnancies instead of natural their individual occurrence in the entire range of physiological norm of human labors from 37 0/7 to 43 2/7 weeks. During pregnancy the mothers organism has to secure a proper environment for the growth and development of the child, which is accompanied by the constant increase in oxytocinase and isoxytocinase. These enzymes are closely connected even with the regulation of ovulation as well as with the embryo nidation and development of early pregnancy. Both enzymes are very important indicator of the threatened life and health of the fetus. It is important since these changes precede clinical symptoms by several weeks. On the other hand, they enable monitoring of the efficiency of ACTH depot therapy as well as pregnancy complicated by diabetes, hypertension and endocrinopathies. The values of prenatal oxytocinasaemia make possible prediction the date and course of delivery. Also, they are highly positively correlated with the weight, length and maturity of the newborn, as well as the size of the placenta. In multifetal pregnancies, levels of both enzymes are higher than in single ones.

Adaptor Proteins, Signal Transducing↗
PubMed2002

Democratic deficit and communication hyper-inflation in health care systems.

There is a widespread perception of poor performance and reduced trust in relation to health care systems. The roots of this problem are interpreted in terms of the democratic deficit and communication hyper-inflation. The democratic deficit is characterized as a persistent but chronically unsatisfied demand for complete public authority over all significant societal institutions--including the health care system. However, such professional institution systems necessarily perform their functions using specialized internal languages, which are not transparent to external scrutiny. Furthermore, professional institution systems tend to eliminate all subjective and imprecise criteria, such as individual moral values. This situation encourages communication inflation, which describes the large and unpredictable divergence between the real and nominal informational content of communications. Hyper-inflation is generated by the development of morality-free information management subsystems (specifically public relations and advertising) to the extent that 'official' communications convey almost zero reliable information. Reduction of the democratic deficit and control of communication inflation depends upon successful penetration of the health care system by representative public values, including individual morality.

Attitude to Health↗
PubMed1988

In search of the moral foundation of nursing.

This article is offered as an extension of the work of Yarling and McElmurry, who ostensibly discussed the moral foundations of nursing. They did not actually broach their intended topic, but they did offer important clues for further analysis. This presentation attempts to show how the moral foundation of nursing might be discerned by indicating both its linkage to the great moral ideas and certain confusions in current nursing ideology. It is claimed that the moral foundation of nursing--indeed, the moral inspiration at the heart of nursing practice--must come from a clearly developed understanding of the idea of nursing.

Ethics, Nursing↗