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PubMed1984

Improving nursing morale in a climate of cost containment. Part 2. Program planning.

Declining resources in health care frequently translate into work overload and declining opportunities for nursing staff. Faced with increases in absenteeism and lower morale among staff, nursing administrators must develop low-cost approaches to these problems. Building on the assessment process in Part 1 (October 1984 JONA), the authors present elements of program planning, illustrating the process with a low-cost model program to improve morale that addresses workload, learning opportunities, and organizational rewards for staff nurses.

Administrative Personnel↗
PubMed1984

The insanity defense: effects of abolition unsupported by a moral consensus.

The insanity defense reflects the moral judgment that some criminal defendants do not deserve criminal sanctions because of mental incapacity. This Note examines the alternative formulations, such as guilty but mentally ill and diminished responsibility, that some states have enacted in the face of growing controversy over the insanity defense. It observes that the alternatives, if used in lieu of the insanity defense, distort the criminal law and do not comport with the legal doctrine of responsibility, which eschews punishing mentally ill defendants. The Note concludes that the insanity defense should not be abolished unless the moral consensus changes regarding the criminal responsibility of mentally ill defendants.

Criminal Law↗
PubMed1978

Medical economics and morality: the conflict of canons.

The more the economics of cost containment becomes an ideology, taking on a moral tone, the more it conflicts with the traditional medical morality. Looking at the canons of "good" economics in health care and at the canons of "good" medicine and examining the potential conflicts may point to methods of equilibrating their opposing tendencies.

Costs and Cost Analysis↗
PubMed1995

Modes of moral judgment among early adolescents.

Early adolescence is an important definitional stage during which a value system and behavior code are largely shaped (Levy, 1988). Since one's value system and behavior code govern moral reasoning and resultant behavior, how early adolescents reason about moral/value issues has implications for schools, parents, and society as a whole. This study found that early adolescents use a variety of modes to make moral decisions. These include care--where they wish others not to suffer; justice--where decisions are made according to principles (golden rule), and narrowly concerned or selfish. All three modes were used by males and females; however, males were much more likely to choose the narrowly concerned mode than were females.

Adolescent↗
PubMed1995

Quality management: the influence of staff morale on customer focus.

Staff morale can be an indicator of an organization's progress towards developing a customer-focused culture, which is necessary for delivering quality services. While not a new concept, customer focus is the force that drives Quality Management. It is, however, only one of the essential components of quality management. The methodology for assessing staff morale and relating it to customer satisfaction in a large rural hospital is outlined and discussed. Results suggest that staff are willing to respond to the present external customer focus initiative demanded by the New South Wales Health Department, provided management plays its role in creating a work environment conducive to the delivery of satisfying services.

Attitude of Health Personnel↗
PubMed1994

Emergency nurses' moral evaluation of patients.

Introduction Judgments by nurses concerning patients' moral fitness and the appropriateness of their visits to the emergency department are made constantly. The treatment rendered to patients is affected by these judgments. This study explored which patient characteristics emergency nurses used to morally evaluate patients, determined reasons the nurses gave for this behavior, and identified some factors that contributed to the evaluative behavior. Methods An exploratory, descriptive study with a mailed questionnaire was conducted on nurses working in emergency departments in hospitals throughout Alberta. Results Eighty-three questionnaires were completed and returned, representing a response rate of 55%. A hierarchy emerged from the data, validating previous research. Nature of the illness and diagnosis, in addition to certain patient characteristics, were critical in determining emergency nurses' attitudes. Nurses appeared to be unaware that they were acting prejudicially. Discussion When patients are aware of being disliked by the nurses caring for them, nurse-patient communication and relationship are jeopardized. This may affect care and, ultimately, recovery. Recommendations included encouraging nurses to recognize the dynamics, consequences, and inherent dangers of labeling patients and to improve their understanding of patients identified as unfavorable.

Alberta↗
PubMed1993

The anencephalic organ donor: a challenge to existing moral and statutory laws.

OBJECTIVES: To inform physicians of the critical shortage of neonatal heart donors and to provide arguments for and against selecting brain-absent anencephalics as heart donors for brain-normal infants who are dying of hypoplastic left heart syndrome. DATA SOURCES: International scientific journals of medicine, genetics, epidemiology, bioethics, and public health; adjudicated U.S. civil court cases; and state regulations and statutes. STUDY SELECTION: Worldwide experience with anencephalics as homologous organ donors. DATA EXTRACTION: Demographic and epidemiologic data on anencephalic births and natural histories; U.S. civil, district, and appellate court case decisions directing or prohibiting organ donation; state determination-of-death acts; state uniform-anatomical-gift acts. DATA SYNTHESIS: Organization of all data into either moral challenges or legal challenges to anencephalic organ donation. CONCLUSIONS: Statutory laws pose a greater challenge to anencephalic organ donation than moral laws. Case law reviews eliminate substituted judgment rulings in directing anencephalic organ donation. A redefinition of brain death applying only to human beings born without a brain would make more donor hearts available to brain-normal infants dying of hypoplastic left heart syndrome.

Anencephaly↗
PubMed1993

Caring in the health care professions--a moral or a professional stand: perceptions of caring of female occupational therapists.

This article presents research that explores how female occupational therapists define and experience their professional caring role. The research analyses the relation between female occupational therapists' self-perception, their moral stand and their professional behaviour as patients' advocates. Caring for others, helping people in need, being responsible for the good of others; these and other calls of duty have been a major theme in defining the roles of occupational therapists as well as of other health care professionals. In the present study, seven female occupational therapists from the New York metropolitan area participated. For the collection of the data the researcher interviewed each of the participant, using in-depth ethnographic interviews. From the research main theme named 'self-perception as a caring person', four sub-themes were identified: (a) the perception of being a caring person; (b) being a caring person leads to becoming an occupational therapist; (c) being available to patients; and (d) protecting and helping patients. In this article the first three sub-themes are briefly described. The focus is on the fourth one. It analyses how the interviewees' self-perceptions as caring individuals are central to their moral decision-making process and to their involvement in patients' advocacy as part of their role and functions in occupational therapy.

Adult↗
PubMedDate not supplied

The moral context of oncology nursing.

Current work environments in health care are hierarchical social systems built around disease-oriented medical goals and procedures. Expansion of biomedical technologies and cost-containment policies have increased the ethical concerns and problems of nurses and other providers. Yet, nurses often are not included as major contributors in deliberations about solutions to these ethical problems. A patriarchal pattern of decision making reflects the paternalistic organization of patient care settings and discounts the reality that multiple providers from many disciplines and specialties provide patient care. To foster ethical practice as a shared activity, ways are needed to build work environments that foster interdependent practice and facilitate moral discourse among all participants. Actions to promote the development of work environments as moral contexts require systematic attention to conceptual, structural, process, and leadership issues that foster collaboration, open communication, and person-centered care.

Cost Control↗
PubMed1994

The bioethics of human fetal tissue research and therapy: moral decision making of professionals.

OBJECTIVE: We investigated the decision making of professionals regarding the ethical acceptability of using human fetal tissue from elective abortion for research or therapy. STUDY DESIGN: We surveyed 390 professionals from 20 European countries on their ethical beliefs regarding the scientific and medical use of human fetal tissue from elective abortion. We assessed the importance of basic medical ethics and beliefs regarding the morality of abortion and fetal rights to their decision making. RESULTS: Sixty-six percent of 198 responding professionals believed that use of fetal tissue from elective abortion was ethically acceptable. Beliefs regarding the morality of elective abortion and fetal exploitation overwhelmingly influenced individual ethics regarding fetal tissue research or therapy. CONCLUSION: Ethical decision making is a dynamic process and individuals are not altogether consistent in their beliefs. The important public policy issues raised in this study concern the rights of the dead fetus, whether these rights are exploited through fetal tissue therapy, and whether women's right of authority over the disposition of aborted fetal tissue is abdicated.

Aborted Fetus↗
PubMed1993

[The moral problem of suicide].

There are 2 important philosophical traditions discussing the moral problem of suicide. One tradition rejects suicide as an immoral act that is against either an absolute or transcendent order, or against socio-political responsibilities, or against the duties one has to obey with respect to your own individual life. The other tradition argues that a specifically "qualified" suicide is a morally good privilege of human freedom and self-determination. Weighting the pros and cons the debate seems to end in a drawn game, perhaps with little advantages for the position against suicide. In any case, in the end it comes down to the very question whether a human being is still able to experience that it is good that he exists and that it is good to be engaged in this existence or not.

Ethics, Medical↗
PubMed1996

[A scientific discourse on theories of morals and ethics].

An academic discourse on ethical and moral theory The papers in this issue of Pflege were delivered by the authors at a conference on Moral Action, held in Osnabrück on Nov. 11th 1994. In the argument which follows, Marianne Arndt's critique points to the fact that Bondolfi's paper is based mainly on Kohlberg's theory and offers, in contrast, research by Gilligan. Bondolfi stresses that men and women are equally capable of rational and emotionally motivated action. Being "human" is a characteristic of members of both genders.

Ethics↗
PubMed1996

Children's narratives about hypothetical moral dilemmas and objective measures of their conscience: mutual relations and socialization antecedents.

We explored children's conscience using narrative measures that utilized responses to hypothetical moral dilemmas and objective measures (observed moral conduct and mothers' reports). Children and mothers were studied at Time 1 (N = 103, 26-41 months) and at Time 2 (N = 99, 43-56 months). The first goal was to examine correspondence between both sets of measures. There were meaningful links between the narratives, administered at Time 2, and children's observed and mother-reported conscience at Times 1 and 2. Children who produced many antisocial narrative themes were less internalized, whereas children who produced many themes of commitment to and concern about good behavior were more internalized on the objective measures. The second goal was to test the prediction that maternal power assertion is detrimental to conscience. Children who experienced more power-assertive maternal discipline produced fewer themes of commitment to and concern about good behavior in their narratives and were more poorly internalized on observed and mother-reported measures at Time 1 and Time 2. Girls were more internalized on the narrative and objective conscience measures.

Age Factors↗
PubMedDate not supplied

Troubles in Smurftown: youth gangs and moral visions on Guam.

An explosive youth gang problem in U.S. Guam may derive from the changes in island traditionalism wrought by modern society. Island youths sense the erosion of the traditional culture's moral visions, but find modern Western individualism unpalatable as an alternative. Gang membership offers a third option, bestowing on youths a sense of honor, bravery, and solidarity lost from traditional society. Gang members must be viewed not as social deviants but as members of a culture that proposes moral visions and prescribes group behaviors for its membership.

Child↗
PubMed1996

Ethnicity and morality in a multicultural world.

The choice of moral acts is governed by the unique ethnic and/or cultural meaning and values ascribed to by the individual. In pursuing an "acceptable" moral choice, the process of analysis is further directed by the ethical theories which are molded by time and tempered by the current context to which the action is undertaken. An OPTIMIN MODEL OF ETHICAL-DECISION MAKING PARADIGM is proposed, and health care policy on cultural diversity is adduced.

Adolescent↗
PubMed1997

Consciousness and the moral ideal: a transcultural analysis of Watson's theory of transpersonal caring.

The global society in which advanced practice nurses work calls for an appreciation of cultural diversity and transcultural care. Theories to guide education, research, and practice must therefore incorporate understanding of cultural concepts. Watson's transpersonal caring theory, which is shaped by the tenets of consciousness and the moral ideal, does not address cultural care per se but does bring into focus the forces of the moral and the spiritual in the event of caring. Thus, it has the potential to be valuable in culturally diverse transcultural nursing situations.

Cultural Diversity↗
PubMed1998

A moral analysis of military medicine.

This paper offers a brief examination of the moral status of military medicine. Military physicians assume one set of obligations as physicians, including obligations of beneficence, nonmaleficence, and respect for autonomy. They assume another set of obligations as members of an armed service, such as maintaining combat readiness and maximizing the fighting strength of the force. These different obligations may come into conflict, but so may the obligations of civilian physicians in a variety of practice settings. In military service, however, both patients and physicians give up a greater measure of autonomy over their choices and actions than they do in most other settings. Because of both their increased risks and their decreased ability to make choices, military personnel can be viewed as a vulnerable population. Military physicians' ability to act on their behalf, however, is limited by the physicians' obligations to pursue military goals and to obey the lawful orders of superior officers. A physician's decision to enter military service is thus a morally weighty one that bears reflection on the practices of the military service to which one is pledging obedience.

Delivery of Health Care↗
PubMed1976

Is a moral consensus in medical ethics possible?

At the moment in Britain and elsewhere the debate inside and outside of Parliament on various medical issues which are essentially moral never ends. Everybody has his own point of view--or principles. But what emerges for society to adopt can often be called in lay terminology 'compromise'. Professor Mitchell argues in this paper that a moral consensus is possible and indeed ought to be achieved, as today the medical practitioner can no longer make his decision only in accordance with the strict code of ethics of the medical profession. The task of the philosopher, says Professor Mitchell, is to interpret the actions and attitudes demanded by modern medical practice.

Abortion, Legal↗