Right Course Of Action Research Articles

Organizational Virtue Ethics and Moral Distress among Healthcare Workers.

AbstractMoral distress is traditionally defined as situations where one knows the right thing to do but external constraints make it nearly impossible to pursue the right course of action. Many interventions to mitigate moral distress focus on making healthcare workers more resilient or courageous in the face of adverse circumstances. While these "virtue cultivation" responses might be valuable traits for individuals, I want to argue that cultivating virtue is at best an incomplete strategy for dealing with moral distress in an organizational setting. The individualistic character of these approaches ignores how an organization's policies may be contributing to many morally distressing situations. I will argue that resources from the virtue tradition can still play a valuable theoretical role in addressing moral distress in healthcare settings if we transpose them to the organizational level. The policies of a hospital or healthcare institution can be seen as virtuous to the degree that they further the organization's goals of medicine. Organizational virtue ethics can then illuminate the issue of moral distress in healthcare organizations. If an organization's policies contribute to its members suffering from moral distress, then that policy may well inhibit the organization from carrying out its mission of providing excellent healthcare. Organizations should respond to moral distress and seek ways to mitigate if not eliminate it.

Caregiving During COVID and Beyond: The Experience of Workplace Stress and Chaplain Care Among Healthcare Workers.

Healthcare workers (HCWs) experience occupational stressors that negatively impact emotional well-being and exacerbate turnover intentions. In the wake of the COVID-19 pandemic, the resultant acute care turnover rates have reached an all-time high. In addition, occupational stressors lead to psychological stress, including moral distress, defined as the dissonance between perceiving what the right course of action is and encountering an obstacle to acting accordingly. This qualitative descriptive study explored the perceptions of patient-facing HCWs in acute care hospital settings regarding the workplace stressors they encountered and the role of hospital-based chaplains in addressing emotional well-being and stress with 33 interviews. Findings suggest that HCW frequently experience work-related moral distress and seek relief by interacting with hospital chaplains. Chaplain care, common in American healthcare facilities for the spiritual care of patients, is an easily accessible resource to HCWs. Facilitating chaplain-HCW interactions may be an effective strategy for responding to moral distress and improving healthcare workers' well-being.

A Phenomenological Exploration of Physicians' Moral Distress: Situating Emotion Within Lived Experiences.

Physicians often experience moral distress from being prevented from taking what they believe to be the right course of action. Although causes and consequences of moral distress have been studied, little research offers insight into the significance of feeling morally challenged, especially in medicine. This study was undertaken to advance understanding of what physicians experience when encountering morally challenging situations and to examine how those experiences influence their interactions with the world of health care. Guided by hermeneutic phenomenology, the authors conducted semistructured interviews with purposefully sampled Canadian physicians from September 2022 to January 2023. Analysis used Van Manen's 6 activities of hermeneutic research and included "story crafting" to sharpen insights. Late in that process, Van Manen's "lived existentials" was determined to provide a strong framework for physicians' experiences of moral distress. Of the 12 physicians interviewed, all experienced varied and long-lasting emotional reactions to morally challenging experiences. The emotions associated with moral distress, reported as inevitable, were experienced in ways that aligned with the lived existentials of body, space, time, and relations. A richer understanding of physicians' lived experiences with moral distress can help mentors and educators more thoughtfully engage in conversations about it with colleagues and learners. This study highlights the core dimensions of moral distress through body, space, time, and relations, thereby providing a means to enrich discussion about emotions and their transformational power. Through such nuanced consideration, calls for emotional candor may be strengthened to enhance practice by acknowledging the scope of impact that efforts to deliver care are likely to provoke.

The role of the purposeful shared decision making model in vascularized composite allotransplantation.

For some patients who have lost the lower part of an arm, hand transplant offers the possibility of receiving a new limb with varying degrees of sensation and function. This procedure, Vascularized Composite Allotransplantation (VCA), is demanding for patients and their care community and comes with significant risks. As a high-stakes decision, patients interested in VCA are subject to extensive clinical evaluation and eligibility decision making. Patients and their care community must also decide if hand transplant (versus other approaches including rehabilitative therapies with or without prosthesis) is right for them. This decision making is often confusing and practically and emotionally fraught. It is complicated in four ways: by the numerous beneficial and harmful potential effects of hand transplant or other options, the number of people affected by VCA and the diverse or conflicting positions that they may hold, the practical demands and limitations of the patient's life situation, and the existential significance of limb loss and transplant for the patient's being. Patients need support in working through these treatment determining issues. Evaluation does not provide this support. Shared decision making (SDM) is a method of care that helps patients think, talk, and feel their way through to the right course of action for them. However, traditional models of SDM that focus on weighing possible beneficial and harmful effects of treatments are ill-equipped to tackle the heterogeneous issues of VCA. A recent model, Purposeful SDM extends the range of troubling issues that SDM can help support beyond opposing effects, to include conflicting positions, life situations, and existential being. In this paper we explore the pertinence of these issues in VCA, methods of SDM that each require of clinicians, the benefits of supporting patients with the breadth of issues in their unique problematic situations, implications for outcomes and practice, and extend the theory of the Purposeful SDM model itself based on the issues present in hand transplant decision making.

Beyond Trolleyology: The CNI Model of Moral-Dilemma Responses.

How do people make judgments about actions that violate moral norms yet maximize the greater good (e.g., sacrificing the well-being of a small number of people for the well-being of a larger number of people)? Research on this question has been criticized for relying on highly artificial scenarios and for conflating multiple distinct factors underlying responses in moral dilemmas. The current article reviews research that used a computational modeling approach to disentangle the roles of multiple distinct factors in responses to plausible moral dilemmas based on real-world events. By disentangling sensitivity to consequences, sensitivity to moral norms, and general preference for inaction versus action in responses to realistic dilemmas, the reviewed work provides a more nuanced understanding of how people make judgments about the right course of action in moral dilemmas.

Knowledge, attitude, and practices of parents regarding the red flags of developmental milestones in children aged 0–5 years in Karachi, Pakistan: a cross-sectional study

BackgroundDevelopmental delays in children are assessed in four basic domains: gross motor, fine motor, social, and language. Early years of life are crucial in a child’s development, so it is imperative that parents be aware of developmental milestones to facilitate early diagnosis and treatment in case of a developmental delay. This study assessed parental knowledge, attitude, and practices regarding children’s developmental milestones and associated “red flags”.MethodsA cross-sectional study was conducted at the Department of Pediatrics at Liaquat National Hospital, Karachi. 390 parents, who had at least one child under 5 years of age, with no diagnosed developmental delay, were interviewed during outpatient clinic visits. The questionnaire consisted of three components to assess parental knowledge, attitude, and practices.Results59% and 54% of parents had poor knowledge of gross and fine motor milestones respectively; In the social domain, 56% of the respondents had inadequate knowledge. 42% had inadequate knowledge of language milestones; 29% of parents strongly agreed that their pediatricians provide satisfactory information regarding red flags of developmental milestones. 60% of parents strongly agreed that their child’s developmental delay would be a cause of concern for them. In the case of developmental delay, 55% of parents said they would consult a general pediatrician, 11% preferred a pediatric neurologist, 21% opted for a developmental pediatrician and 13% opted for a family physician. Residence and family systems were found to be associated with language-related milestones with significantly higher odds of knowledge among urban residents than rural ones and a significantly lower likelihood of language milestones knowledge among joint families than nuclear families. Female gender was found to be significantly associated with positive attitude.ConclusionThe majority of our respondents showed considerably poor knowledge regarding developmental milestones. This highlights the need to devise ways to educate parents on this subject to enable them to vigilantly monitor their child’s developmental status and any associated abnormalities and ultimately facilitate the right course of action.

What Role Do Boards Play in Companies with Visionary CEOs?

ABSTRACTVisionary CEOs have strong beliefs about the right course of action for their firms. How should a board of directors that does not necessarily share the visionary CEO's confidence advise and monitor the CEO? We consider a model in which the board can acquire costly information about the firm's optimal strategic direction. The board not only advises the CEO on strategy, but also must approve it, and the CEO exerts effort to implement the strategy. We find that the board gathers less information when the CEO believes more strongly in his vision. Further, depending on the strength of the CEO's belief bias, the board either plays an advisory role, a monitoring role, or a rubberstamping role. The model predicts that in firms that are led by highly visionary CEOs, boards are passive in that they acquire little information and rubberstamp the visionary's proposal. Nevertheless, shareholders prefer the visionary over an unbiased manager in industries in which obtaining information about the correct course of action is difficult and costly.

Internet of Things (IoT)-Based Smart Healthcare System for Efficient Diagnostics of Health Parameters of Patients in Emergency Care

The Internet of Things has been instrumental in bringing about several advancements and innovations in the domain of healthcare. Healthcare professionals are essentially life savers when it comes to handling emergency cases such as accidents, heart attacks, etc. Only the patient’s vital parameters generally characterize emergency cases, and the doctors must wait for additional details for a wholesome diagnosis. As a result, the treatment processes and procedures sometimes get hastened and, in turn, put the patients’ lives at risk. It would always be helpful for doctors to be equipped with the medical requirements in advance for deciding the right course of action, thereby increasing the scope and chances of recovery. In this work, Multi-Model IoT (MMIoT) devices are deployed to monitor and collect health data from different body parts simultaneously. The healthcare data comprises signals and imagery captured from the MMIoT devices. Both the U-Net model and LSTM model are used to analyze the data automatically. The data processing is carried out by the server connected to the MMIoT network. All the medical IoT devices experimented with in this work are interconnected using a potential 5G network for optimal data transmission. The output obtained from the U-Net and the LSTM are channelized through a dense layer to classify the health anomalies accurately. It would not only facilitate but also educate medical professionals to handle unseen and typical cases in the future confidently. It can improve the overall quality of treatment and save lives with the best available resources.

End-of-Life Discussions With Patients and Caregivers Affected By Neurogenetic Diseases.

No effective cure is available for neurogenetic diseases such as Huntington disease, spinocerebellar ataxias, and Friedreich ataxia, all of which cause progressive motor, cognitive, and psychiatric symptoms leading, in the long term, to severe communication (among other) impairments. In end-of-life situations, advanced directives (indications formulated by the patient about end-of-life choices) are one decision-making resource for relatives, caregivers, and health care professionals. Given the slowly progressive nature of these diseases, the related disabilities, and their hereditary component, patients, caregivers, and neurologists are often at a loss concerning the right course of action to take. Our study's aim was to explore patients' and caregivers' perceptions, needs, and expectations around anticipated end-of-life discussions and advanced directives. DIRAGENE is an observational, cross-sectional, mixed-methods study with a patient-centered component and a primary caregiver-centered component. Observations include disease severity, psychosocial, and emotional scales; in-house questionnaires; and semidirected interviews. We included 124 participants, of which 81 were patients and 43 primary caregivers. Only 16% of the participants knew specifically about advanced directives and 7% had written documents vs 30% and 18% in the general French population, respectively, adjusted for age. Qualitative analysis of the interviews with 15 couples showed notable dissimilarities in ideas about advanced directives between patients and caregivers and that the underlying pathology, severity, and inheritability are less relevant factors regarding end-of-life discussions than age, environment, prior experiences with death, and history of family illness. Most patients (95%) and caregivers (98%) found that participating in the study was helpful in bringing awareness to end-of-life issues, wished to prioritize discussing them with loved ones, and requested assistance in managing them throughout the course of the disease. Being affected by severe neurogenetic diseases does not seem to prompt individuals to give much thought to end-of-life planning. However, patients and caregivers welcome comprehensive information and expect progressive support from trained health care professionals in having such discussions. Routine integration of these conversations into medical management through a holistic and adapted approach will benefit patients with illnesses with unfavorable long-term prognoses.

Biomimethics: a critical perspective on the ethical implications of biomimetics in technological innovation

Biomimetics, bioinspiration, biomimicry, and related nature-inspired activities—collectively known as biom*—are witnessing an unprecedented surge in popularity, as they offer unparalleled opportunities for technological advancement, innovation, and sustainable development. The growing prevalence of biom*, however, has sparked moral debates regarding their approaches, emphasizing the need for universally applicable ethical guidelines that can effectively guide practitioners in their work. In this perspective, we outline some of the moral, ethical, and legal challenges associated with biom*, particularly the scientific discipline of biomimetics, focusing on various issues surrounding our motivations for pursuing these approaches, the valuation of nature within them, and regulations in the commercialization of biological knowledge. By highlighting the challenges inherent in biom*, this perspective aims to empower practitioners in the field to make informed decisions and take purposeful action. Specific recommendations are provided to guide them in choosing the right course of action for the right reasons.

HR Analytics – Importance and Challenges

Businesses are growing rapidly in this gig economy. Businesses produce a tonne of data about their clients, rivals, suppliers, employees, etc. This data aids businesses in reaching new heights when handled appropriately and judiciously to get business insights. In recent decades, human resources have grown to be a significant asset and are now treated as a crucial corporate partner. Analytics may help HR professionals connect expertise to data and direct the company towards the right course of action. This conceptual research paper examines the benefits of the developing field of HR analytics and the challenges of the HR decision-making process that is driven by data.

Moral Distress in Radiology: Frequency, Root Causes, and Countermeasures-Results of a National Survey.

BACKGROUND. A major cause of burnout is moral distress: when one knows the right course of action but institutional constraints make the right course impossible to pursue. OBJECTIVE. The purpose of this study was to assess the frequency and severity with which radiologists experience moral distress and to explore moral distress's root causes and countermeasures. METHODS. This study entailed a national survey that evaluated moral distress in radiology. The survey incorporated the validated Moral Distress Scale for Health Care Professionals, along with additional questions. After the scale was modified for applicability to radiology, respondents were asked to assess 16 clinical scenarios in terms of frequency and severity of moral distress. On May 10, 2022, the survey was sent by e-mail to 425 members of radiology practices included on a national radiology society's quality-and-safety LISTSERV. The Measure of Moral Distress for Health Care Professionals (MMD-HP) score was calculated for each respondent as a summary measure of distress across scenarios (maximum possible score, 256). RESULTS. After 12 surveys with incomplete data were excluded, the final analysis included 93 of 425 respondents (22%). A total of 91 of 93 respondents (98%) experienced at least some moral distress for at least one scenario. A total of 17 of 93 respondents (18%) had left a clinical position due to moral distress; 26 of 93 (28%) had considered leaving a clinical position due to moral distress but did not leave. The mean MMD-HP score was 73 ± 51 (SD) for those who had left, 89 ± 47 for those who had considered leaving but did not leave, and 39 ± 35 for those who had never considered leaving (p < .001). A total of 41 of 85 respondents (48%) thought that the COVID-19 pandemic had influenced their moral distress level. Across respondents, the three scenarios with highest moral distress were related to systemic causes (higher case volume than could be read safely, high case volume preventing teaching residents, and lack of administrative action or support). The countermeasure most commonly selected to alleviate moral distress was educating leadership about sources of moral distress (71%). CONCLUSION. Moral distress is prevalent in radiology, typically relates to systemic causes, and is a reported contributor to radiologists changing jobs. CLINICAL IMPACT. Urgent action by radiology practice leadership is required to address moral distress, as radiologists commonly practice in environments contradictory to their core values as physicians.

Leveraging text mining approach to explore research roadmap and future direction of wrong-way driving crash studies

This study delves into the wrong-way driving (WWD) research performed in the United States over the past five decades. The study employs a text network to summarize and synthesize major themes, data sources, and collaboration efforts from 123 previously published WWD articles collected from various online databases. The analysis shows that the majority of WWD studies were conducted between 2014 and 2020. Throughout the entire period, the primary focuses have been on WWD countermeasures, freeways, exit ramps, contributing factors, driver behavior, and detection systems. Over time, there has been a noticeable shift in the key themes, whereby earlier studies focused on freeways and driver behaviors, while the latter delved into exit ramps, limited access, and contributing factors among others. Most studies were from Florida, Texas, Illinois, and Alabama, with little collaboration of researchers across the States, except for Alabama and Illinois. Further, across the four States, there observed variations in the interests. Studies from Texas and Florida were centered on WWD countermeasures, detection systems, and the use of connected vehicles, while Illinois and Alabama investigated WWD crashes on exit ramps and interchanges. Despite the development and deployment of various countermeasures, there is still a need to develop crash modification factors to examine the effectiveness of the countermeasures. Furthermore, as technology continues to advance, connected and autonomous technology is expected to play a significant role in mitigating the WWD problem. The findings are essential for transportation agencies to evaluate the mitigation efforts and direct resources toward the right course of action.

A novel artificial intelligence-based predictive analytics technique to detect skin cancer.

One of the leading causes of death among people around the world is skin cancer. It is critical to identify and classify skin cancer early to assist patients in taking the right course of action. Additionally, melanoma, one of the main skin cancer illnesses, is curable when detected and treated at an early stage. More than 75% of fatalities worldwide are related to skin cancer. A novel Artificial Golden Eagle-based Random Forest (AGEbRF) is created in this study to predict skin cancer cells at an early stage. Dermoscopic images are used in this instance as the dataset for the system's training. Additionally, the dermoscopic image information is processed using the established AGEbRF function to identify and segment the skin cancer-affected area. Additionally, this approach is simulated using a Python program, and the current research's parameters are assessed against those of earlier studies. The results demonstrate that, compared to other models, the new research model produces better accuracy for predicting skin cancer by segmentation.

All the King’s Horses and All the King’s Men: Falling Into Moral Injury, During the COVID-19 Pandemic

Health care providers who experienced giving care or abbreviating those services, during the COVID-19 pandemic, risked experiencing a sense of moral injury. Moral injury is a term to describe incidents where a health care provider knows the right thing to do, but constraints make it exceedingly difficult or impossible to execute the right course of action. These incidents likely also were present for sonographers and vascular technologists, and it is vital that these compromises for patients are recognized, and healing strategies offered to those suffering from moral injury. Some suggestions for treatment of moral injury are to recognize these experiences, seek solutions, provide empathy for patients and resources for health care providers. It may also be beneficial to allow employees and employers to forgive the mistakes made during the pandemic and focus on solutions to prevent future incidents of moral injury.

On a tendency in health economics to dwell on income inequality and underestimate social stress

Social stress can cause physical and mental harm. It is therefore not surprising that public health policy makers have sought to identify and implement policies aimed at tackling this social ill. A frequently prescribed remedy is to reduce social stress by reducing income inequality, which is typically measured by the Gini coefficient. Decomposing the coefficient into a measure of a population’s social stress and a population’s income makes it possible to show that steps taken to lower the coefficient can actually exacerbate social stress. We formulate conditions under which lowering the Gini coefficient coincides with increasing social stress. If the aim of public policy is to improve public health and increase social welfare, and if social welfare is reduced by social stress, then lowering the Gini coefficient may not be the right course of action.

“I can't be the nurse I want to be”: Counter-stories of moral distress in nurses' narratives of pediatric oncology caregiving

As a term used in nursing and other health professions to describe when one is prevented by institutional constraints from pursuing the right course of action, moral distress has gained traction to examine the effects of restructuring on health and social care providers. Using a critical narrative methodology, this paper presents the counter-stories of nine pediatric oncology nurses in Ontario, Canada, whose stories illustrate the embeddedness of their caregiving and moral distress within institutional contexts that leave them stretched thin amongst multiple caregiving and administrative demands, and that limit their capacities to be the nurses they want to be. Informed by feminist philosophical theorizations of moral distress, we elucidate how the nurses' counter-stories: (i) re-locate the sources of their moral distress within institutional constraints that fracture their moral identities and moral relationships, and (ii) dis-locate dominant narratives of technological cure by ascribing value and meaning to the relational care through which they sustain moral responsibilities with patients and their families. By making visible the relational care that they find meaningful and that brings them in proximity to patients and families, these counter-stories assist nurses in restoring their damaged moral identities. This study demonstrates the power of identifying and mobilizing counter-stories in tracing and critically examining the conditions that structure nurses’ experiences of moral distress. The findings add theoretical and empirical depth to contemporary understandings of moral distress and complement ongoing public discussion of burnout among nurses and other health care workers during the COVID-19 pandemic. These counter-narratives may act as resources for resistance among nurses, help to reduce the distance between management and health care workers, and catalyze changes in policy and practice so that nurses, and the full scope of their caregiving, are valued.

Social bonds are related to health behaviors and positive well-being globally.

At times of turmoil, such as during disasters, social crises, or pandemics, our social bonds can be key to receiving support and gaining certainty about the right course of action. In an analysis combining two global datasets (N=13,264) collected during the first wave of the COVID-19 pandemic, this study examined how social bonds with close social circles (i.e., family and friends) and extended groups (i.e., country, government, and humanity) relate to engagement in health behaviors and psychological well-being. Results revealed that only family bonding was associated with self-reported engagement in health behaviors. Being strongly bonded with both close circles and extended groups predicted less anxiety and depression and better well-being, particularly for those who were bonded with more groups. These findings highlight that close and extended social bonds offer different sources of support and direction during the most challenging of circumstances and that continuous investment is needed to forge and maintain both.

The presence of moral distress among critical care nurses in Saudi Arabia

Background: Moral distress (MD) was first defined as a situation in which one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. This can be even more challenging within the critical care context as critical the care context imposes physical, emotional, and cognitive stressors on critical care nurses. Methodology: A descriptive quantitative approach was followed, and the critical care units of two tertiary hospitals in two provinces in Saudi Arabia were included in the study, yielding a cluster sample size of 361 critical care nurses. Data were collected using the MD Scale-Revised, for which reliability and validity have been established. Results: The mean total MD experienced by respondents was 77.15 ± 58.32, representing a low level of MD. The statement that nurses indicated as causing the most distress was “follow the family's wishes to continue life support even though I believe it is not in the best interest of the patient” with 5.98 ± 5.04. Furthermore, 17.5% (n = 63) of nurses had considered leaving their positions because of MD. MD was the highest in the Emergency department with 102.12 ± 70.59; as experience increased by 1 year, the MD score increased by 11.56. Conclusion: When dealing with issues related to futile care, critical care nurses experience MD. Therefore, future research is required to develop appropriate interventions with which to address critical care-related MD.

Trustees cannot ask Argentine Courts for guidance (Macri, Mauricio c/Inspección General de Justicia)

Abstract One of the questions most commonly asked to practitioners by trustees is if it is possible to request advice, or a binding order from a Judge, on the right course of action. Obviously, such possibility would preclude any further discussion of the responsibility of the trustee (that followed the judicial advice or instruction). This request is possible in most jurisdictions on tax issues, but is not possible on business or other issues. Argentina is no exception, and this case explains the applicable law.