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Results for “Moral Development”

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PubMed2002

The influence of a move to program management on physical therapist practice.

BACKGROUND AND PURPOSE: The purpose of this qualitative study was to examine how a move to program management (PM) from a traditional department structure affected the professional practice of physical therapists in a large Canadian teaching hospital. SUBJECTS: Twenty-five physical therapists participated in 1 of 5 focus groups, and 4 physical therapists participated in individual interviews. METHODS: Focus groups and structured interviews were conducted by an experienced facilitator who was not a physical therapist. All focus groups and interviews were audiotaped and transcribed. Using an open-coding technique, 2 investigators undertook line-by-line analysis of each transcript to identify and code specific events related to the physical therapists' experiences. The investigators reached a consensus on all coding categories and then identified themes. RESULTS: Seven themes that addressed issues of affect (a sense of loss, low morale, and positive coping), professional practice (loss of professional development activities, professional advantages, the assuming of multiple roles), and patient care were identified. DISCUSSION AND CONCLUSION: Physical therapists who were deployed from a department to a program described both positive and negative effects of the move to PM on their practice. There were reported influences on their personal affect, professional practice, and patient care. Staff and physical therapy administrators need to be aware of potential implications of an organization's move to PM on the professional practice of frontline staff.

Adaptation, Psychological↗
PubMed1991

[The quality of demographic development in Czechoslovakia from the European viewpoint].

Forty years of a totalitarian regime imply economic, cultural and moral devastation. Statistical analyses reveal, however, also demographic devastation in particular in the sphere of health and social aspects. This means that the basic indicators of the quality of demographic development in Czechoslovakia during the last 25 years are remarkably close to the indicators of the former socialist system and that they deteriorate and lag behind when compared with other countries, in particular developed industrial countries. This trend can be also called "balkanization" because Czechoslovakia which belonged before the war among the eight most highly developed industrial countries dropped at the end of the eighties to the level of demographic indicators of Bulgaria, Jugoslavia, Hungary, Roumania etc. In the submitted investigation the authors demonstrate these facts based on the analysis of selected coefficients of quality of the demographic development such as infant mortality, specific mortality of the male and female population aged 55-59 years and the mean life expectancy of men and women at birth, on the background of the general European demographic situation. For analyses only the latest data published by UNO were used.

Adult↗
PubMed2006

The moral difference between intragenic and transgenic modification of plants.

Public policy on the development and use of genetically modified organisms (GMOs) has mainly been concerned with defining proper strategies of risk management. However, surveys and focus group interviews show that although lay people are concerned with risks, they also emphasize that genetic modification is ethically questionable in itself. Many people feel that this technology "tampers with nature" in an unacceptable manner. This is often identified as an objection to the crossing of species borders in producing transgenic organisms. Most scientists reject these opinions as based on insufficient knowledge about biotechnology, the concept of species, and nature in general. Some recent projects of genetic modification aim to accommodate the above mentioned concerns by altering the expression of endogenous genes rather than introducing genes from other species. There can be good scientific reasons for this approach, in addition to strategic reasons related to greater public acceptability. But are there also moral reasons for choosing intragenic rather than transgenic modification? I suggest three interrelated moral reasons for giving priority to intragenic modification. First, we should respect the opinions of lay people even when their view is contrary to scientific consensus; they express an alternative world-view, not scientific ignorance. Second, staying within species borders by strengthening endogenous traits reduces the risks and scientific uncertainty. Third, we should show respect for nature as a complex system of laws and interconnections that we cannot fully control. The main moral reason for intragenic modification, in our view, is the need to respect the "otherness" of nature.

Community Participation↗
PubMedDate not supplied

Exaggerated pain behavior: by what standard?

This paper provides a philosophical, historical, and clinical analysis of exaggerated pain behavior, focusing on the nature of the standards used to judge behavior as exaggerated. Malingering is understood as a special case of exaggerated pain behavior. Drawing upon the work of philosopher Ludwig Wittgenstein and psychiatrist-anthropologist Horacio Fabrega, I argue that these standards are primarily moral rather than scientific in nature. Pain behavior is not validated by matching public pain behavior with private pain experience. If this pain experience is truly private, it is not available to scientific investigation. Rather, pain behavior is judged as appropriate or exaggerated through complex assessments of the function of this behavior in its social context. As human social contexts have become more complex through history, so have the accommodations made for sick and disabled members of the group. Criteria for legitimate entry to the sick role have evolved with society, with only modern industrial society placing heavy emphasis on tissue damage demonstrated on medical tests. The highly variable relation between clinical pain and tissue damage, as well as the common problem of medically unexplained physical symptoms in primary care, pose serious challenges to this strategy of illness behavior validation. It will remain necessary to triage suffering presented to health care providers into that which should be addressed in the medical setting and that which is better addressed elsewhere. But we need to discard pseudoscientific reliance on medical tests and develop new standards that are openly acknowledged to be moral and social in nature.

Activities of Daily Living↗
PubMed2001

Serious misapplications of military research: dysfunction between conception and implementation.

Researchers and technologists involved in the development of weapon systems can take their work to such extremes as to cause unplanned injury or death to others and lasting damage to the environment, reviewed here. In some cases innocent human casualties and ecological harm may actually be programmed and achieved. An analysis is proffered, attributing blame, and indicating efforts to correct the situation. The ethics involved are "complexified",a moral boundaries are exceeded, and humanity is transgressed as it develops solutions to the problem.

Biological Warfare↗
PubMed1989

Moral treatment in asylums and general hospitals in 19th-century America.

Moral treatment, a therapeutic approach that emphasized character and spiritual development, and called for kindness on the part of all who came in contact with the patient, flourished in American mental hospitals during the first half of the 19th century. Many of its essential features also existed then in the treatment of physical illness in American general hospitals. Changing social and welfare services and advances in scientific medicine contributed to a subsequent decline in moral treatment and to a divergence between the therapeutic approaches of the two kinds of hospitals. In recent years, there has been a gradual convergence in their treatment modes. Contemporary social and welfare services are contrasted with traditional moral treatment.

Deinstitutionalization↗
PubMed1991

Non-animal alternative toxicity tests for detergents: genuine replacements or mere prescreens?

Non-animal toxicity tests and testing strategies for use in identifying the potential toxic hazard of chemicals and products, and in providing information for use in risk and safety assessment, are in the course of development, validation and evaluation. Possible replacement alternatives to the rabbit Draize eye irritancy test are discussed, and results obtained for two in-vitro tests developed by FRAME (the kenacid blue test and the neutral red release test), applied to 19 surfactants and 32 formulations, are discussed. It is concluded that there are now legal and moral requirements that relevant and reliable non-animal tests should be developed and accepted for use whenever possible.

Animal Testing Alternatives↗
PubMed2001

From the urban to the civic: the moral possibilities of the city.

Relating bioethics to the philosophy of the city creates the possibility for developing the field along paths not yet explored. In the Western tradition, the city has been understood as the venue for two quite different forms of activity and two different types of moral possibility. In one guise, the city is an urbs, a center of commerce, market exchange, and social individualism. In another guise, the city is a civitas or polis, the space of active democratic citizenship, equality under law, and civic virtue. As civitas, classical philosophers regarded the city as the place of moral growth and full human self-realization. These two possibilities of human moral and political experience in the city have given rise to distinct traditions of political theory--liberalism and civic republican and democratic theory. This article traces these conceptual configurations into the domain of contemporary bioethics, arguing that most work in the field has drawn on the liberal tradition and hence has been insufficiently critical of the moral paradigm of market individualism and unduly inattentive to the values of civitas and the civic tradition. It argues for the creation of a form of civic bioethics and explores some of the theoretical foundations that type of bioethics would require.

Bioethics↗
PubMed2001

Identifying and assessing the conceptions of teaching of secondary school physics teachers in China.

BACKGROUND: Recent research indicates that how lecturers think about the nature of teaching influences both the way they teach and the way their students learn and ultimately the learning outcomes they achieve. Such research has primarily been conducted at the tertiary level in Western countries and its relevance for school teaching and in non-Western contexts has yet to be demonstrated. AIMS: Study 1 aimed to develop a model of the conceptions of teaching of Chinese secondary school teachers of physics and an instrument to assess these conceptions. Study 2 then tested the reliability and within-construct validity of responses to the latter and the relationships between teaching experience and gender and teaching conceptions were investigated. SAMPLE: The interview sample in Study 1 comprised 18 teachers of physics in Guangdong, China. The instrument was administrated to 450 physics teachers from the province in Study 2. METHOD: An in-depth emic approach involving both interviews and classroom observations was utilised to develop the model. Confirmatory factor analysis was used to test the fit of responses to the instrument to the proposed model. RESULTS: Five lower order conceptions (Knowledge Delivery, Exam Preparation, Ability Development, Attitude Promotion, and Conduct Guidance) and two higher order orientations (Moulding and Cultivating) were identified. Responses to the instrument were found to be of satisfactory internal consistency reliability and to fit the expected underlying factor model. Neither teaching experience nor gender was found to be related to conceptions of teaching. CONCLUSIONS: The model developed differed in some respects from those found in the Western tertiary literature due probably to cultural factors which emphasise more an affective, moral view of teaching and to a school contextual emphasis on exams. The instrument developed had very adequate psychometric properties and seems promising as a tool for assessing teaching conceptions in future research within China and across cultures.

Adolescent↗
PubMed2007

Practical strategies for providing culturally sensitive, ethical care in developing nations.

Providing health care in developing nations results in cultural and ethical challenges for health care professionals. The authors' intent is to raise readers' awareness of how to maintain an ethical and culturally sensitive approach to practice in developing nations. Four practical approaches to ethical decision-making, developed from the literature and praxis, in conjunction with traditional moral theory and guidelines from professional and international organizations are discussed. Ethical multiculturalism, a view that combines universalism and multiculturalism undergirds culturally appropriate and ethically responsive decisions.

American Nurses' Association↗
PubMed2004

Is physician-assisted death only for developed countries? Latin America as a case study.

The achievements of modern medicine are manifold and impressive. However, there is a broad recognition of the fact that continuing medical treatment is not always beneficial to the patient, nor is it always what the patient wants. This has led to a debate about the way physicians may or may not be involved in the end of life of patients. Could there be a justification for the active ending of a patient's life? This debate has a global character. In this article we will explore this debate for developing countries; we will focus on physician-assisted death (PAD) in Latin American countries. At stake is the moral relevance of differences, not the moral justification of PAD per se. We argue that arguments for PAD apply equally in affluent and in developing countries. Some of the counterarguments, however, would seem to hold more in developing countries than in affluent countries. Yet, under certain conditions, a policy tolerating PAD would be as acceptable in developing countries as in developed countries.

Attitude of Health Personnel↗
PubMedDate not supplied

Ethical dilemma and moral distress: proposed new NANDA diagnoses.

PURPOSE: To propose two NANDA diagnoses--ethical dilemma and moral distress--and to distinguish between the NANDA diagnosis decisional conflict and the proposed nursing diagnosis of ethical dilemma. SOURCES USED: Journal articles, books, and focus group research findings. DATA SYNTHESIS: Moral/ethical situations exist in health care. Nurses' experiences of ethical dilemmas and moral distress are extrapolated to the types and categories of ethical dilemmas and moral distress that patients experience and are used as the basis for development of two new nursing diagnoses. CONCLUSION: The two proposed NANDA diagnoses fill a void in current standardized terminology. PRACTICE IMPLICATIONS: It is important that nurses have the ability to diagnose ethical or moral situations in health care. Currently, NANDA does not offer a means to document this important phenomenon. The creation of two sets of nursing diagnoses, ethical dilemma and moral distress, will enable nurses to recognize and track nursing care related to ethical or moral situations.

Conflict, Psychological↗
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↗
PubMed2001

Developing standards for institutional ethics committees: lessons from The Netherlands.

This article presents standards for setting up and educating institutional ethics committees (IECs). These standards are based on experiences in the Netherlands, where IECs have been established in a large number of health care institutions. Though the IEC has become a generally accepted institution within Dutch health care, there are concerns over its effectiveness regarding the improving of the moral quality of clinical decision making. Health care practitioners and members of IECs too, experience a gap between the IEC and the reality of the clinical environment. At this moment, there is interest in developing programmes which educate practitioners in moral issues and how to deal with them, using the method of a structured debate on the ward. The IEC will not be made obsolete by this development, but can play a guiding role in the implementation of such programmes. Current concerns are the lack of patient representation in the Dutch IEC, and the loss of contact with the local community of health care practitioners because of the merger of hospitals into bodies similar to UK National Health Service (NHS) trusts.

Ethics Committees, Clinical↗
PubMed2003

Structural estimation of a principal-agent model: moral hazard in medical insurance.

Despite the importance of principal-agent models in the development of modern economic theory, there are few estimations of these models. I recover the estimates of a principal-agent model and obtain an approximation to the optimal contract. The results show that out-of-pocket payments follow a concave profile with respect to costs of treatment. I estimate the welfare loss due to moral hazard, taking into account income effects. I also propose a new measure of moral hazard based on the conditional correlation between contractible and noncontractible variables.

Contracts↗
PubMed2000

Shared governance--nurses making a difference.

AIM: This paper aims to describe how shared governance can be successfully integrated into existing management structures in a large medical directorate. It will show how the shared governance philosophy can lead to the creation of a culture where nurses feel important and valued and also consider its use as a foundation for the implementation of the nursing strategy. BACKGROUND: The hospital adopted shared governance in 1995 with the setting up of councils led by staff nurses. Shared governance advocates claim it broadens involvement of clinically-based nurses in the process of change through devolved decision-making thereby enhancing clinical practice and increasing staff moral and self-esteem. Key issues Shared governance is a cultural change that will develop the leadership and management skills of all grades of staff. Shared governance is not a quick fix for the profession; involvement of all staff needs time, persistence, determination and a strong commitment to training and development. CONCLUSION: The national nursing strategy puts nurses in a position to positively influence health care for the advantage of patients, however, for nurses to grasp this opportunity cultural change is required. This practical example of shared governance demonstrates how it can be used to create a proactive culture, focused on improving patient care. The nurturing and developing of clinically-based nurses provides them with the knowledge and skills to challenge the status quo and lead change. Thus, shared governance is an excellent foundation from which to develop the nursing strategy.

Decision Making, Organizational↗
PubMed2003

Are children moral objectivists? Children's judgments about moral and response-dependent properties.

Researchers working on children's moral understanding maintain that the child's capacity to distinguish morality from convention shows that children regard moral violations as objectively wrong (e.g. Nucci, L. (2001). Education in the moral domain. Cambridge: Cambridge University Press). However, one traditional way to cast the issue of objectivism is to focus not on conventionality, but on whether moral properties depend on our responses, as with properties like icky and fun. This paper argues that the moral/conventional task is inadequate for assessing whether children regard moral properties as response-dependent. Unfortunately, children's understanding of response-dependent properties has been neglected in recent research. Two experiments are reported showing that children are more likely to treat properties like fun and icky as response-dependent than moral properties like good and bad. Hence, this helps support the claim that children are moral objectivists.

Child↗