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At least 145 records · Page 8Linked to original sources
PubMed2005

Riding the emotional roller-coaster: a framework for improving nursing morale.

PURPOSE: To examine the literature on employee morale and to construct a model of this area pertaining to nurses. This framework seeks to present morale in a holistic manner, illustrating the causal factors that influence nursing morale, the changes that occur in morale when these input variables are altered, and the consequences to patient care and individual and group nursing practices. DESIGN/METHODOLOGY/APPROACH: A number of published works on morale, its causal factors and resulting consequences are critiqued. The findings from this literature review are used to develop a framework for nursing morale. FINDINGS: The paper presents a definition of morale and, from the literature review, concludes that previous models on morale are fragmented; only tending to explore the variables that influence the employees' emotional state. Consequently, a framework of nursing morale is constructed in order to illustrate this topic from a holistic point-of-view. PRACTICAL IMPLICATIONS: The paper concludes with a number of management and research implications. The management implications consist of a number of useful suggestions for senior nurses to enhance the morale within their units. ORIGINALITY/VALUE: This paper fulfils an identified gap in the literature, namely the lack of a holistic model of nursing morale, and offers practical help to senior nurses so that they can initiate processes within their wards that can improve their subordinates' morale.

Emotions↗
PubMed2005

Nurse moral distress and ethical work environment.

This study examined the relationship between moral distress intensity, moral distress frequency and the ethical work environment, and explored the relationship of demographic characteristics to moral distress intensity and frequency. A group of 106 nurses from two large medical centers reported moderate levels of moral distress intensity, low levels of moral distress frequency, and a moderately positive ethical work environment. Moral distress intensity and ethical work environment were correlated with moral distress frequency. Age was negatively correlated with moral distress intensity, whereas being African American was related to higher levels of moral distress intensity. The ethical work environment predicted moral distress intensity. These results reveal a difference between moral distress intensity and frequency and the importance of the environment to moral distress intensity.

Adult↗
PubMed2005

The lived experience of moral distress: nurses who assisted with elective abortions.

The concept of moral distress has been studied mainly as an occupational issue and has not been developed for use in clinical practice. This study was designed to bridge prior studies of occupational moral distress with future clinical investigations of moral distress. Study aims were to discover the essence, properties, and full content domain of the concept of moral distress in order to develop a universal definition of the concept. A modified phenomenological study of nurses' experience of a particular moral issue was conducted. A maximum variation sampling strategy was used to recruit a final sample of registered nurses (N = 10). Interior aversion is the essential act of moral distress. Five properties of the lived experience of moral distress were identified: perception, pain, valuing, altered participation, and perspective. Three types of moral distress identified in this study were: shocked, muted, and suppressed (persistent). Type of moral distress was related to situational conditions, recognition of moral ends, quality of coping processes, and temporal breadth. Negative outcomes of moral distress, which probably exist, were undetectable with this study design. The definition has been composed in universal terms, but remains tentative, since the full content domain of moral distress was largely but not definitively identified.

Abortion, Legal↗
PubMed1998

Preserving moral integrity: a follow-up study with new graduate nurses.

The purpose of this follow-up study was to describe, explain and interpret how new graduate nurses perceived their adaptation to the 'real world' of hospital nursing and what they perceived as major influences on their moral values and ethical roles in the 2 years following graduation. The method was qualitative, specifically grounded theory. The earlier study took place when informants were senior nursing students. The follow-up study began after the informants had been practising for 1 year. Research questions guiding the study were: How do new graduate nurses describe their adaptation to the 'real world' of hospital nursing? What do they describe as factors influencing their moral values and ethical roles in hospital nursing? Preserving moral integrity was the basic psycho-social process that explained how these new graduate nurses adapted to the real world of hospital nursing. Six stages of this process were identified: vulnerability; getting through the day; coping with moral distress; alienation from self; coping with lost ideals; and integration of new professional self-concept. Moral distress was a consequence of the effort to preserve moral integrity. It is the result of believing that one is not living up to one's moral convictions. Data supported that the most pervasive attributes of moral distress were self-criticism and self-blame, as informants judged their actions against their moral convictions and their standards of what a good nurse would do. Moral distress was an acute form of psychological disorientation in which informants questioned their professional knowledge, what kind of nurses they were and what kind of nurses they were becoming. Theoretical explanations of these findings are grounded in social interaction and moral psychology theories.

Adult↗
PubMed1982

The moral responsibility of the hospital.

The hospital has legal liability. Does it also have moral responsibility? Is it a moral agent, and if so in what sense? There are two issues involved, one conceptual and the other normative. The conceptual issue is whether a hospital can be morally responsible. If seen not only as a physical facility but as a formal organization, it can be said to act rationally, choose between alternatives, and affect human beings. It thus satisfies the criteria for moral responsibility, even though it is not a person. Though moral responsibility can be attributed intelligibly to a hospital, such responsibility can be assumed only by those within it who act for it. Such responsibility is agent responsibility and may be shared in a number of ways. Hospital responsibilities can be separated from the professional moral responsibility and the personal moral responsibility held by doctors, nurses, and others within a hospital. Assuming these three types of responsibility makes possible conflicts of responsibility for those who hold them. Normatively, the moral responsibility of the hospital is appropriately limited by its purpose and is primarily administrative. It has designatable moral responsibilities to its patients, doctors and nurses, and the public. These can be distinguished from the responsibilities of doctors and nurses to the public. The responsibility of a doctor on the hospital staff is different from the responsibility of a doctor who simply practices in the hospital; that of a staff nurse from that of a private nurse. The difference is in large part a function of the one sharing the responsibility of the hospital and the other not. An analysis of a hospital's moral responsibilities suggests structures appropriate to a hospital that wishes to meet its moral responsibilities.

Ethics↗
PubMed1990

Solomon--the ultimate moral expert?

When faced with difficult moral decisions, many people would prefer to shift the burden of moral responsibility to a moral expert. I imagine what appears to be the perfect moral expert: a computer program called SOLOMON designed to fit in a computer on one's wrist. After noting some advantages of using SOLOMON, I claim that moral agents would find individualizing the program as difficult as making moral decisions in the past. A revised version of the ultimate moral expert is also considered: one hires the wisest, kindest person on earth--Solomé--to accompany one as a moral guide. However, turning over our moral problems to an expert, even to the noble Solomé, still falls short. For the process of coming to moral decisions is itself import. One's values and personality may change as a result of moral deliberation.

Ethics, Institutional↗
PubMed1986

Moral growth among athletes and nonathletes: a comparative analysis.

Sport may be described as a unique moral context encouraging adaptations in participants' moral reasoning. The relation between sport participation and maturity of moral reasoning regarding general social problems and sport-specific dilemmas was investigated in two related studies. Study 1 involved 100 high school and college basketball players and nonathletes, with an equal distribution of females and males. Moral protocols were administered and scored according to Haan's (1978, 1983) interactional model of moral development. Multivariate analyses of variance revealed no moral reasoning differences between high school basketball players and nonathletes, but high school females' moral reasoning was more mature than was males'. Within the college sample, nonathletes' moral reasoning was significantly more mature than was athletes'. Also, females' moral reasoning about sport was more mature than that of their male counterparts, though no sex differences were found in general life moral reasoning. In Study 2, 20 swimmers were added to the college sample. Basketball players employed less mature moral reasoning about sport than both swimmers and nonathletes (who did not differ from each other). Results were discussed in terms of sport-specific experiences.

Adolescent↗
PubMed1993

Personhood, moral strangers, and the evil of abortion: the painful experience of post-modernity.

The epistemological and sociological consequences of post-modernity include the inability to show moral strangers, in terms they can see as binding, the moral wrongness of activities such as abortion. Such activities can be perceived as morally disordered within a content-full moral narrative, but not outside of the context it brings. Though one can salvage something of the Enlightenment project of justifying a morality that can bind moral strangers, one is left with moral and metaphysical views that can be recognized as impoverished and incomplete by those who live their lives within the embrace of a content-full moral narrative. The cardinal dualism of post-modernity is not that which separates mind from body, but the gulf between the morality binding moral strangers and that binding moral friends.

Abortion, Legal↗
PubMed1993

Moral philosophy and public policy: the case of NRTs.

In this paper, I will express some reservations about the usefulness of moral philosophy for the analysis of public policy issues.... My question is whether taking morality seriously requires taking moral philosophy seriously. This paper focuses on one particular public policy context -- namely, government commissions into new reproductive technologies, such as Britain's Warnock Committee, Australia's Waller and Michael Committees, Canada's Baird Commission, and many others.... Moral philosophers are sometimes asked to participate in these commissions, either as Commissioners, staff, or expert advisers. How can moral philosophers contribute to the analysis of public policy recommendations on NRTs? A survey of the literature suggests that there are two main views on this question, one of which is ambitious, the other more modest. The ambitious view says that moral philosophers should attempt to persuade Commissioners to adopt the right comprehensive moral theory (e.g. adopt a deontological theory, rather than utilitarianism or contractarianism), and then apply this theory to particular policy questions. The more modest view shies away from promoting a particular moral theory, given that the relative merits of different moral theories are a subject of dispute even amongst moral philosophers. Instead, it says that moral philosophers should attempt to ensure that the Commission's arguments are clear and consistent. On this view, philosophers should focus on identifying conceptual confusions or logical inconsistencies within the Commission's arguments without seeking to influence its choice of the underlying theory.

Advisory Committees↗
PubMed1995

Moral reasoning about sexually transmitted diseases.

The purpose of this research was to investigate moral reasoning related to sexual behavior that could lead to the transmission of sexually transmitted diseases (STDs). Using hypothetical dilemmas about situations in which STDs can be transmitted, respondents were asked to explain why they believed the characters should or should not engage in risky behaviors. 40 college freshmen (M = 18.3 years) and 32 college seniors (M = 22.3 years) participated. Using Kohlberg's moral stage theory and Gilligan's moral orientation model, the interviews were scored for moral stage and moral orientation. Results indicated that the older age group had a significantly higher stage of moral reasoning than the younger age group when responding to dilemmas about STDs. There was a significant difference in moral stage between dilemmas, reflecting the possible effect of dilemma content on moral reasoning. The overall pattern of results shows nonsignificant gender differences in stage of moral reasoning and moral orientation. Clinical and theoretical implications of these findings for understanding the role of moral reasoning in sexual risky behavior are discussed.

Adolescent↗
PubMed1999

[Is brain surgery on primates in basic research morally acceptable?]

In the contemporary controversy about the legitimacy of vivisection a few basic assumptions are shared by nearly all participants of the discussion. (I) Pure Research in the service of medicine is of great value for humankind. It contributes to prolonging human life and the alleviation and prevention of human suffering. (II) Brain surgery for the sole purpose of pure research is morally unacceptable in the case of any human being. (III) Primates are sensitive beings which lead a rich social life and are endowed with remarkable intellectual capacities. (IV) Primates have a moral standing, possibly to a lesser degree compared with human beings, certain acts are therefore an injustice toward them. The controversy then is about the question whether premise (I) outweighs (IV), i.e. whether the benefit of the pure research is from a moral point of view more important than the suffering of innocent primates. I shall present four arguments against such a conclusion. 1) According to premise (I) brain surgery on human beings for the sole purpose of pure research is morally unacceptable. Since this prohibition is meant to include all human beings it cannot rest on the exclusive human possession of reason because e.g. some mentally handicapped human beings lack this faculty. All other properties which may be named as basis for the ascription of a moral status which forbids brain surgery for pure research, are possessed also by some animals, especially primates; therefore it is impossible to deny them the same moral status. 2) Brain surgery on primates is confronted with an insoluble dilemma: If the characteristics of the primate brain are very similar to that of human beings, the scientific benefit is obvious, but the procedure appears to be morally unacceptable exactly because of this similarity. If, on the other hand, the characteristics differ significantly, brain surgery may seem legitimate but the scientific benefit becomes doubtful at best. 3) We could quite easily save hundreds of human lives if e.g. speed limits would be reduced (say) by half. Most of us, however, are unwilling to accept such a loss of quality of life in order to save a certain number of human lives. Since we are no prepared to pay this comparatively modest price, we have, in my eyes, no moral right to impose considerable pain and suffering on a primate to save human lives. 4) Pure research in the service of human medicine is from a moral point of view of great importance. Since most of the work in this area is done or financed by private corporations and not by state institutions, from a economical point of view the aim consists in making profit. Since the latter aspect has gained more and more weight in the last years the moral worth of pure research cannot rule out any other moral concern.

Journal Article↗
PubMed2005

Some things ought never be done: moral absolutes in clinical ethics.

Moral absolutes have little or no moral standing in our morally diverse modern society. Moral relativism is far more palatable for most ethicists and to the public at large. Yet, when pressed, every moral relativist will finally admit that there are some things which ought never be done. It is the rarest of moral relativists that will take rape, murder, theft, child sacrifice as morally neutral choices. In general ethics, the list of those things that must never be done will vary from person to person. In clinical ethics, however, the nature of the physician-patient relationship is such that certain moral absolutes are essential to the attainment of the good of the patient - the end of the relationship itself. These are all derivatives of the first moral absolute of all morality: Do good and avoid evil. In the clinical encounter, this absolute entails several subsidiary absolutes - act for the good of the patient, do not kill, keep promises, protect the dignity of the patient, do not lie, avoid complicity with evil. Each absolute is intrinsic to the healing and helping ends of the clinical encounter.

Bioethics↗
PubMed1998

There is no moral authority in medicine: response to Cowdin and Tuohey.

Central to the Cowdin-Tuohey paper is the concept of a moral authority proper to medical practitioners. Much as I agree with the authors in refusing to degrade doctors to the status of mere technicians, I argue that one does not succeed in retrieving the moral dimension of medical practice by investing doctors with moral authority. I show that none of the cases brought forth by Cowdin-Tuohey really amounts to a case of moral authority. Then I try to explain why no such cases can be found. Developing an insight that is common to all the major moral thinkers in the philosophia perennis, I show that doctors are professionally competent with respect only to a part of the human good; morally wise persons are competent with respect to that which makes man good as man. I try to show why it follows that a) professional expertise has no natural tendency to pass over into moral understanding, and that b) doctor and non-doctor alike start from the same point in developing their understanding of medical morality. It follows that the authors fail in their attempt to de-center the moral magisterium of the Church by setting up centers of moral authority outside of the Church.

Abortion, Induced↗
PubMed1998

The internal morality of medicine: explication and application to managed care.

Some ethical issues facing contemporary medicine cannot be fully understood without addressing medicine's internal morality. Medicine as a profession is characterized by certain moral goals and morally acceptable means for achieving those goals. The list of appropriate goals and means allows some medical actions to be classified as clear violations of the internal morality, and others as borderline or controversial cases. Replies are available for common objections, including the superfluity of internal morality for ethical analysis, the argument that internal morality is merely an apology for medicine's traditional power and authority, and the claim that there is no single, "core" internal morality. The value of addressing the internal morality of medicine may be illustrated by a detailed investigation of ethical issues posed by managed care. Managed care poses some fundamental challenges for medicine's internal morality, but also calls for thoughtful reflection and reconsideration of some traditionally held moral views on patient fidelity in particular.

Contracts↗
PubMed2003

A defense of the common morality.

Phenomena of moral conflict and disagreement have led writers in ethics to two antithetical conclusions: Either valid moral distinctions hold universally or they hold relative to a particular and contingent moral framework, and so cannot be applied with universal validly. Responding to three articles in this issue of the Journal that criticize his previously published views on the common morality, the author maintains that one can consistently deny universality to some justified moral norms and claim universality for others. Universality is located on the common morality and nonuniversality in other parts of the moral life, called "particular moralities." The existence of universal moral standards is defended in terms of: (1) a theory of the objectives of morality, (2) an account of the norms that achieve those objectives, and (3) an account of normative justification (both pragmatic and coherentist).

Bioethics↗
PubMed2005

Moral heuristics.

With respect to questions of fact, people use heuristics--mental short-cuts, or rules of thumb, that generally work well, but that also lead to systematic errors. People use moral heuristics too--moral short-cuts, or rules of thumb, that lead to mistaken and even absurd moral judgments. These judgments are highly relevant not only to morality, but to law and politics as well. examples are given from a number of domains, including risk regulation, punishment, reproduction and sexuality, and the act/omission distinction. in all of these contexts, rapid, intuitive judgments make a great deal of sense, but sometimes produce moral mistakes that are replicated in law and policy. One implication is that moral assessments ought not to be made by appealing to intuitions about exotic cases and problems; those intuitions are particularly unlikely to be reliable. Another implication is that some deeply held moral judgments are unsound if they are products of moral heuristics. The idea of error-prone heuristics is especially controversial in the moral domain, where agreement on the correct answer may be hard to elicit; but in many contexts, heuristics are at work and they do real damage. Moral framing effects, including those in the context of obligations to future generations, are also discussed.

Decision Making↗
PubMed1991

Describing and testing a moderator of the moral judgment and action relationship.

The relationship between moral judgment development and action for Ss who differ in the degree to which justice-based moral judgments influence moral decision making was investigated. First, a method for quantifying Ss' use of justice-based moral judgments in moral decision making (the utilizer variable) is described. Second, 5 moral judgment and action studies are reanalyzed to assess the moderating effect of the utilizer variable information. Results indicate that the relationship between moral judgment scores and action intensifies as utilization increases. Moreover, the utilizer effect appears uniform across different age and educational levels and behavioral domains. These findings support the validity of the utilizer variable and are consistent with recent multiprocess models of moral action that suggest that moral judgements are a necessary, but insufficient, factor in the production of moral action.

Decision Making↗
PubMed2002

The relevance of moral theory to pediatric neurology.

Although you should never abandon your well-considered moral judgments because of their conflict with a moral theory, you should also usually not hold that your well-considered moral judgments are the only correct moral judgments. Common morality does not provide unique correct answers to every moral question, it only sets limits to the range of morally acceptable answers. In serious discussions of controversial cases or policies, almost all of the answers will be morally acceptable. The recognition that there are sometimes several conflicting morally acceptable answers allows for a friendly and fruitful discussion with no one sacrificing their moral integrity.

Child↗