Moral shielding: A grounded theory of integrity maintenance in multidisciplinary teams

Using a classic grounded theory methodology (CGT), this study explores the phenomenon of moral shielding within mental health multidisciplinary teams (MDTS). The study was located within three catchment areas engaged in acute mental health service practice. The main concern identified was the maintenance of a sense of personal integrity during situational binds. Through theoretical sampling thirty two practitioners, including; doctors, nurses, social workers, occupational therapists, counsellors and psychologists, where interviewed face to face. In addition, emergent concepts were identified through observation of MDTs in clinical and research practice. Following a classic grounded theory methodology, data collection and analysis occurred simultaneously. A constant comparative approach was adopted and resulted in the immergence of three sub- core categories; moral abdication, moral hinting and pseudo-compliance. Moral abdication seeks to re-position within an event in order to avoid or deflect the initial obligation to act, it is a strategy used to remove or reduce moral ownership. Moral gauging represents the monitoring of an event with the goal of judging the congruence of personal principles and commitments with that of other practitioners. This strategy is enacted in a bid to seek allies for the support of a given moral position. Pseudo-compliance represents behaviour that hides desired principles and commitments in order to shield them from challenge. This strategy portrays agreement with the dominant position within the MDT, whilst holding a contrary position. It seeks to preserve a reservoir of emotional energy required to maintain a sense of personal integrity. Practitioners who were successful in enacting moral shielding were found to not experience significant emotional distress associated with the phenomenon of moral distress; suggesting that these practitioners had found mechanisms to manage situational binds that threatened their sense of personal integrity.

A study of the situations, features, and coping mechanisms experienced by Irish psychiatric nurses experiencing moral distress

Purpose: The purpose of this study was toinvestigate moral distress in Irish psychiatric nurses. Design: A qualitative descriptive methodology was used. Findings: The study confirmed the presence of moral distress and the situations that gave rise to moral distress within psychiatric nurses working in acute care settings. Practice Implications: The findings indicate that while multidisciplinary teams appear to function well on the surface, situations that give rise to moral distress are not always acknowledged or dealt with effectively. Furthermore, unresolved moral conflict impacts upon the quality of clinical decision-making by not allowing open and transparent discussions that allow clinicians the opportunity to address their concerns adequately.

Nurses’ perceptions of nursing presence and the relationship between nursing presence and moral sensitivity in nurses working with people with dementia in residential care

Aim: The aim of this study was to measure nursing presence among nurses caring for people with dementia in residential care settings, and to investigate the relationship between nursing presence and moral sensitivity. Background: Nursing presence is a core relational skill in nursing and holds many benefits for nurses and their patients. Moral sensitivity is defined as how one recognises the moral elements of a situation, and how one’s moral or ethical decision making may impact on an individual. Methods: A descriptive, cross sectional quantitative methodology was used with a sample of 150 registered nurses. The Presence of Nursing Scale for Registered Nurses was used to investigate nursing presence, and the Moral Sensitivity Questionnaire for moral sensitivity. Results: Findings from the study demonstrated that participants agreed with the majority of elements of nursing presence, (mean 76.97, SD= 7.51). A mean score of 36.22 was evidence of a well developed level of moral sensitivity in participants. Nurses who perceived themselves to be highly present to their patients also scored highest on certain elements of moral sensitivity such as moral strength. Nursing presence was also found to be more developed in those participants that rated themselves as having higher levels of expertise based on Benner’s (1984) definitions. Older nurses also scored higher on nursing presence. There was a high level of agreement that factors such as lack of time (n=133), and heavy workload influenced nursing presence. Nurses, who were older and had longer clinical experience, were shown to have greater moral strength. There were differences in elements of moral sensitivity between groups of nurses who ranked themselves according to Benner’s (1984) competence framework with higher scores evident in the more expert groups. Conclusion: Overall, this study showed that participants had a well developed level of nursing presence, and certain elements of moral sensitivity are positively related to nursing presence. Nursing presence appears to be linked to the level of expertise of the nurse but factors such as time and workload do influence nursing presence.

An energy efficient power controller switching methodology for an ambient healthcare network

A methodology for improved power controller switching in mobile Body Area Networks operating within the ambient healthcare environment is proposed. The work extends Anti-windup and Bumpless transfer results to provide a solution to the ambulatory networking problem that ensures sufficient biometric data can always be regenerated at the base station. The solution thereby guarantees satisfactory quality of service for healthcare providers. Compensation is provided for the nonlinear hardware constraints that are a typical feature of the type of network under consideration and graceful performance degradation in the face of hardware output power saturation is demonstrated, thus conserving network energy in an optimal fashion.

Building effectiveness communication ratios (BECs): an integrated ‘life-cycle’ methodology for mitigating energy-use in buildings

Current building regulations are generally prescriptive in nature. It is widely accepted in Europe that this form of building regulation is stifling technological innovation and leading to inadequate energy efficiency in the building stock. This has increased the motivation to move design practices towards a more ‘performance-based’ model in order to mitigate inflated levels of energy-use consumed by the building stock. A performance based model assesses the interaction of all building elements and the resulting impact on holistic building energy-use. However, this is a nebulous task due to building energy-use being affected by a myriad of heterogeneous agents. Accordingly, it is imperative that appropriate methods, tools and technologies are employed for energy prediction, measurement and evaluation throughout the project’s life cycle. This research also considers that it is imperative that the data is universally accessible by all stakeholders. The use of a centrally based product model for exchange of building information is explored. This research describes the development and implementation of a new building energy-use performance assessment methodology. Termed the Building Effectiveness Communications ratios (BECs) methodology, this performance-based framework is capable of translating complex definitions of sustainability for energy efficiency and depicting universally understandable views at all stage of the Building Life Cycle (BLC) to the project’s stakeholders. The enabling yardsticks of building energy-use performance, termed Ir and Pr, provide continuous design and operations feedback in order to aid the building’s decision makers. Utilised effectively, the methodology is capable of delivering quality assurance throughout the BLC by providing project teams with quantitative measurement of energy efficiency. Armed with these superior enabling tools for project stakeholder communication, it is envisaged that project teams will be better placed to augment a knowledge base and generate more efficient additions to the building stock.

Scientism and instrumentalism After the Bomb: Dr Strangelove, End Zone, Crash and The Wire

This thesis argues that through the prism of America’s Cold War, scientism has emerged as the metanarrative of the postnuclear age. The advent of the bomb brought about a new primacy for mechanical and hyperrational thinking in the corridors of power not just in terms of managing the bomb itself but diffusing this ideology throughout the culture in social sciences, economics and other such institutional systems. The human need to mitigate or ameliorate against the chaos of the universe lies at the heart of not just religious faith but in the desire for perfect control. Thus there has been a transference of power from religious faith to the apparent material power of science and technology and the terra firma these supposedly objective means supply. The Cold War, however was a highly ideologically charged opposition between the two superpowers, and the scientific methodology that sprang forth to manage the Cold War and the bomb, in the United States, was not an objective scientific system divorced from the paranoia and dogma but a system that assumed a radically fundamentalist idea of capitalism. This is apparent in the widespread diffusion of game theory throughout Western postindustrial institutions. The inquiry of the thesis thus examines the texts that engage and criticise American Cold War methodology, beginning with the nuclear moment, so to speak, and Dr Strangelove’s incisive satire of moral abdication to machine processes. Moving on chronologically, the thesis examines the diffusion of particular kinds of masculinity and sexuality in postnuclear culture in Crash and End Zone and finishing up its analysis with the ethnographic portrayal of a modern American city in The Wire. More than anything else, the thesis wishes to reveal to what extent this technocratic consciousness puts pressure on language and on binding narratives.

The application of computer modelling to develop a methodology for ‘existing building’ upgrades to move towards carbon-neutral buildings

The retrofitting of existing buildings for decreased energy usage, through increased energy efficiency and for minimum carbon dioxide emissions throughout their remaining lifetime is a major area of research. This research area requires development to provide building professionals with more efficient building retrofit solution determination tools. The overarching objective of this research is to develop a tool for this purpose through the implementation of a prescribed methodology. This has been achieved in three distinct steps. Firstly, the concept of using the degree-days modelling method as an adequate means of basing retrofit decision upon was analysed and the results illustrated that the concept had merit. Secondly, the concept of combining the degree-days modelling method and the Genetic Algorithms optimisation method is investigated as a method of determining optimal thermal energy retrofit solutions. Thirdly, the combination of the degree-days modelling method and the Genetic Algorithms optimisation method were packaged into a building retrofit decision-support tool and named BRaSS (Building Retrofit Support Software). The results demonstrate clearly that, fundamental building information, simplified occupancy profiles and weather data used in a static simulation modelling method is a sufficient and adequate means to base retrofitting decisions upon. The results also show that basing retrofit decisions upon energy analysis results are the best means to guide a retrofit project and also to achieve results which are optimum for a particular building. The results also indicate that the building retrofit decision-support tool, BRaSS, is an effective method to determine optimum thermal energy retrofit solutions.