'Moral distress'-time to abandon a flawed nursing construct?

Moral distress has been characterised in the nursing literature as a major problem affecting nurses in all healthcare systems. It has been portrayed as threatening the integrity of nurses and ultimately the quality of patient care. However, nursing discourse on moral distress is not without controversy. The notion itself is conceptually flawed and suffers from both theoretical and practical difficulties. Nursing research investigating moral distress is also problematic on account of being methodologically weak and disparate. Moreover, the ultimate purpose and significance of the research is unclear. In light of these considerations, it is contended that the notion of moral distress ought to be abandoned and that concerted attention be given to advancing inquiries that are more conducive to improving the quality and safety of moral decision-making, moral conduct and moral outcomes in nursing and healthcare domains.

Being dialysis-dependant: a qualitative perspective

The technology of renal dialysis offers a way in which life can be sustained, so it is not surprising that the complex, diverse and evolving iatrogenic aspects of dialysis-dependency continue to be researched. However, there has been a tendency to take for granted the human process of making sense of the intrusiveness of dialysis. This study was designed to explore the meanings of dialysis-dependency. The study sample was 10 participants: five female, five male; five on peritoneal dialysis, five on haemodialysis; whose ages ranged from 22 to 68 years. Using a narrative methodology the following methods were used: in-depth interviews, narrative and thematic analysis, fieldwork/notes from five renal units, participant validation, and journal reflections. A thematic analysis revealed the continuum themes of Freedom-Restrictions, Being Normal-Being Visible, Control-Acquiesce, Hope-Despair and Support-Abandon. The themes portrayed as continuums serve to remind health care professionals that those with chronic illnesses strive to make sense of what is happening to them. Variations within each of these themes can occur daily, weekly or monthly. Acceptance may never be reached or may be tentative. Some clients will strive for control and freedom to choose for themselves, others will acquiesce to the overwhelming changes wrought in their lives. Thus, health care professionals might consider placing the personal meanings of those who are dialysis-dependent to the fore, being sensitive to the sufferings wrought by the regime, which treats but does not cure, which sustains life but does not heal.

The Australian Government`s abandoned infrastructure outsourcing program: "fiasco" or relatively typical?

Early in 2001, after a damning public report by the Auditor-General, the Australian Federal Government was forced to abandon its highly promoted “whole of government” infrastructure outsourcing initiative. This about-face was greeted in the press with reports that the initiative was a “fiasco”. Yet a four-year case study of the initiative suggests a more complex picture. The initiative can be viewed in a quite different light on the basis of comparisons with a contemporary survey of 240 Australian organisations engaged in IT outsourcing. This reveals that many of the negative outcomes associated with this “fiasco” are typical of those experienced by large Australian organisations. This has important implications for decision makers confronted with choices about sourcing IT service delivery.

Production decisions and lot sizing for automotive stamping

A discrete event model was used to examine the effect of machine downtime and operating policy on the long-run average cost of an automotive stamping line. Operating policy refers to the selection of a target batch size and the circumstances under which a line stoppage will lead to the current batch being abandoned. It is assumed that the abandon/resume decision is based solely on the severity of the problem (i.e., repair cost) and the fraction of the batch completed. A method of identifying low-cost operating policies is presented using data obtained from a real stamping plant. It is found that, within a single part framework, this approach results in significantly lower average costs than are currently achieved. It is also demonstrated that by varying the model parameters it is possible to measure the potential benefits arising from process modifications (e.g., decreased die-set times). This can be used to identify the areas where improvements will have the greatest impact on cost and is particularly useful when assessing the expected return on a potential investment. A multiple-part extension to the model is suggested and the potential benefits discussed.

Enough energy to get half way to the moon

A proposal to abandon Melbourne's Supreme Court for a new high-tech facility prompted quite an outcry of dismay when it was reported in the Melbourne press earlier this year, and has highlighted sustainability issues in relation to heritage buildings in Victoria.

Journal impact factors: implications for the nursing profession

Background: The journal impact factor (IF) has become widely used as an absolute measure of the quality of professional journals. It is also increasingly used as a tool for measuring the academic performance of researchers and to inform decisions concerning the appointment and tenure of academic staff as well as the viability of their departments/schools. In keeping with these IF-related trends, nurse researchers and faculty the world over are being increasingly expected to publish only in journals that have a high IF and to abandon all other forms of publishing (including books and book chapters) that do not attract IF rankings.

Issues: The IF obsession is placing in jeopardy the sustainability and hence viability of nursing journals and academic nursing publication lists (academic texts). If nurse authors abandon their publishing agenda and publish only in 'elite' journals (many of which may be outside nursing), the capacity of the nursing profession to develop and control the cutting edge of its disciplinary knowledge could be placed at risk.

Actions: Other means for assessing the quality and impact of nursing journals need to be devised. In addition, other works (such as books and book chapters) need also to be included in quality metrics. Nurse authors and journal editors must work together and devise ways to ensure the sustainability and viability of nursing publications.

People's war under modern conditions : an investigation into Chinese defence strategy, 1977-2049

This thesis is an investigation of the relevance of ‘people's war’ to contemporary Chinese defence policy. This loose concept has been eroded by 'modernity’, but a guerilla-based defence remains the essential theme. Prior to China's acquisition of nuclear weapons, people's war was the sole element of the state's deterrent policy, aiming to swamp an invader with China's numerical strength. In the 1980s and beyond people's war finds effectiveness through a combination of materiel of middle range technology and the traditional usage of massive manpower. People's war under modern conditions remains essentially defensive, but now incorporates 'active defence’ with accent on greater mobility. However, the central thesis of this work relates to how the traditional strategy may influence nuclear doctrine. This thesis proposes that China could abandon long-range ballistic missiles and adopt a new concept in nuclear strategy: that of, Guerilla Nuclear Warfare. Trained in guerilla tactics and equipped with battlefield nuclear weapons, this would represent the logical extension of China's people's war strategy to the new nuclear conditions associated with superpower research into space-based ballistic missile defences and which, in full deployment, could nullify a Chinese nuclear deterrent based only on 'mid-tech' delivery systems. Guerilla Nuclear Warfare, as a strategy, would involve the irregular use of locally held and controlled tactical nuclear weapons, but it would also be a method of circumventing the proposed Soviet missile defence shield by not challenging it. Guerilla Nuclear Warfare does not exist in the late 1980s, but evidence exists to suggest its development. It cannot yet be proven as the new direction but China's strategic circumstances add weight to available indications: unless the Strategic Defence programs of the established superpowers are arrested then it appears the sole option available to the Chinese for the maintenance of a nuclear deterrent in the early part of the 21st Century.

Case studies in human rights education and critical educational science

This thesis offers an account of the history and effects of three curriculum projects sponsored by the Australian Human Rights Commission between 1983 and 1986. Each project attempted to improve observance of human rights in and through Australian schools through participatory research (or critical educational science). That is, the research included, as a conscious feature, the effort to develop new forms of curriculum work which more adequately respect the personal and professional rights of teachers, especially their entitlement as persons and professionals to participate in planning, conducting and controlling the curriculum development, evaluation and implementation that constitutes their work. In more specific terms, the Australian Human Rights Commission's three curriculum projects represented an attempt to improve the practice and theory of human rights education by engaging teachers in the practical work of evaluating, researching, and developing a human rights curriculum. While the account of the Australian Human Rights Commission curriculum project is substantially an account of teachers1 work, it is a story which ranges well beyond the boundaries of schools and classrooms. It encompasses a history of episodes and events which illustrate how educational initiatives and their fate will often have to set within the broad framework of political, social, and cultural contestation if they are to be understood. More exactly, although the Human Rights Commission's work with schools was instrumental in showing how teachers might contribute to the challenging task of improving human rights education, the project was brought to a premature halt during the debate in the Australian Senate on the Bill of Rights in late 1985 and early 1986. At this point in time, the Government was confronted with such opposition from the Liberal/National Party Coalition that it was obliged to withdraw its Bill of Rights Legislation, close down the original Human Rights Commission, and abandon the attempt to develop a nationwide program in human rights education. The research presents an explanation of why it has been difficult for the Australian Government to live up to its international obligations to improve respect for human rights through education. More positively, however, it shows how human rights education, human rights related areas of education, and social education might be transformed if teachers (and other members of schools communities) were given opportunities to contribute to that task. Such opportunities, moreover, also represent what might be called the practice of democracy in everyday life. They thus exemplify, as well as prefigure, what it might mean to live in a more authentically democratic society.

A stage model of intranet technology implementation and management

In the seventies, Nolan was the first to address the need for a descriptive stage theory concerning the planning, organizing, and controlling activities associated with managing the organizational computer resource. The arrival of newer technologies such as those based on the Internet calls for fresh approaches in terms of their implementation and management. Intranet technology – which is based on Internet technology – differs from other types of IT in terms of its use and implementation. We propose a four-stage model for intranet implementation and management. Each stage is portrayed by seven general characteristics. We propose that in order to ensure intranet institutionalization, three existential crises must be overcome. Firstly, if the intranet is not nurtured by a sponsor it cannot evolve beyond its experimental beginnings. Secondly, if a critical mass of both users and content cannot be reached simultaneously, the intranet will not progress. Finally, if the intranet remains uncontrolled, it will be perceived to be useless and therefore users will abandon it.

Managing the crises in intranet implementation : a stage model

In the seventies, Nolan was the first to address the need for a descriptive stage theory concerning the planning, organizing and controlling activities associated with managing the organizational computer resource. The arrival of newer technologies, such as those based on the Internet, calls for fresh approaches in terms of their implementation and management. Intranet technology, which is based on Internet technology, differs from other types of IT in terms of its characteristics, use and implementation. We propose a four-stage model for intranet implementation and management. Each stage is portrayed by seven general characteristics. We propose that, in order to ensure intranet institutionalization, three existential crises must be overcome. First, if a sponsor does not nurture the intranet, it cannot evolve beyond its experimental beginnings. Second, if a critical mass of both users and content cannot be reached simultaneously, the intranet will not progress. Finally, if the intranet remains uncontrolled, it will be perceived to be useless, and therefore users will abandon it.

Is narrative identity four-dimensionalist?

The claim that selves are narratively constituted has attained considerable currency in both analytic and continental philosophy. However, a set of increasingly standard objections to narrative identity are also emerging. In this paper, I focus on metaphysically realist versions of narrative identity theory, showing how they both build on and differ from their neo-Lockean counterparts. But I also argue that narrative realism is implicitly committed to a four-dimensionalist, temporal-parts ontology of persons. That exposes narrative realism to the charge that the narratively constituted self, on the one hand, and the self that is the object of much of our everyday self-reference and self-experience, on the other, can’t be the same thing. This conclusion may well force narrativists to abandon metaphysical realism about narrative selves — which, in turn, may leave the invocation of ‘narrativity’ as identity-constituting somewhat under-motivated.

What’s missing in episodic selfhood? A Kierkegaardian response to Galen Strawson

Galen Strawson has articulated a spectrum of 'temporal temperaments' populated at one end by 'Diachronics,' who experience their selves (understood as a 'present mental entity') as persisting across time, and at the other end by 'Episodics', who lack this sense of temporal extension. Strawson provides lucid descriptions of Episodic self-experience, and further argues that nothing normatively significant depends upon Diachronicity. Thus, neither temperament is inherently preferable. However, this last claim requires a non-reductive phenomenology of Diachronicity that Strawson does not supply. I offer Kierkegaard's account of 'contemporaneity' as a candidate for this missing phenomenology of Diachronic self-experience. Kierkegaard offers a compelling description of Diachronic self-experience that offers more parsimonious explanations for certain puzzling features of Episodicity than Strawson's account does. Yet Kierkegaard's account is irreducibly normative in character; if Strawsonians reject this account of Diachronicity, they must either provide another, normatively-neutral one, or abandon neutrality between Episodicity and Diachronicity.

Direct perception, inter-subjectivity and social cognition: why phenomenology is a necessary but not sufficient condition

In this paper I argue that many of the core phenomenological insights, including the emphasis on direct perception, are a necessary but not sufficient condition for an adequate account of inter-subjectivity today. I take it that an adequate account of inter-subjectivity must involve substantial interaction with empirical studies, notwithstanding the putative methodological differences between phenomenological description and scientific explanation. As such, I will need to explicate what kind of phenomenology survives, and indeed, thrives, in a milieu that necessitates engagement with the relevant sciences, albeit not necessarily deference to them. There will be two central aims to this paper: 1. to defend the centrality and vitality of phenomenological treatments of inter-subjectivity via a consideration of some remarks in Sartre - which I do think possess a non-trivial unity amongst the various interlocutors - and the manner in which they in fact serve to provide the basis for a better explanation of an array of empirical data than existing inferentialist or mindreading accounts of social cognition (notably Theory Theory, Simulation Theory, and hybrid versions); 2. to offer the methodological resources for renewing phenomenology in a manner that acknowledges ostensibly non-phenomenological moments in theory production - which involve explanation, inference to the best explanation, etc. - but does not abandon phenomenology for all that, allowing it to be simply absorbed into empirical explanation or other forms of philosophical analysis without remainder.

The in‐between: exposing everyday learning at work

Much has been written about how space and time are integral to understanding social relations, in particular about associations between space and understanding learning in workplaces. Drawing from a research study exploring everyday learning at work, this paper looks beyond what is generally understood as work situations by turning to those spaces and times where ‘social’ and ‘work’ overlap, such as breaks in tearooms. These spaces are not so work orientated that they can be described as ‘workspaces’, nor are they entirely social. The nexus between work and the social, of being a worker and a social being, of engaging in legitimate work and socializing are put forward as rich expanses for everyday learning. The paper draws on interviews and observational data from four work sites within one organization. It undertakes an exploration of the intersection of space, time and informal learning with regard to the social/work spaces located at work. It argues that a key location for everyday learning at work is at the points of intersection between work and social spaces and that it is necessary to abandon simplistic dichotomies between work, social and learning space.

Power, effects, confidence, and significance: an investigation of statistical practices in nursing research

Objectives: To (a) assess the statistical power of nursing research to detect small, medium, and large effect sizes; (b) estimate the experiment-wise Type I error rate in these studies; and (c) assess the extent to which (i) a priori power analyses, (ii) effect sizes (and interpretations thereof), and (iii) confidence intervals were reported. Design: Statistical review. Data sources: Papers published in the 2011 volumes of the 10 highest ranked nursing journals, based on their 5-year impact factors. Review methods: Papers were assessed for statistical power, control of experiment-wise Type I error, reporting of a priori power analyses, reporting and interpretation of effect sizes, and reporting of confidence intervals. The analyses were based on 333 papers, from which 10,337 inferential statistics were identified. Results: The median power to detect small, medium, and large effect sizes was .40 (interquartile range [. IQR]. = .24-.71), .98 (IQR= .85-1.00), and 1.00 (IQR= 1.00-1.00), respectively. The median experiment-wise Type I error rate was .54 (IQR= .26-.80). A priori power analyses were reported in 28% of papers. Effect sizes were routinely reported for Spearman's rank correlations (100% of papers in which this test was used), Poisson regressions (100%), odds ratios (100%), Kendall's tau correlations (100%), Pearson's correlations (99%), logistic regressions (98%), structural equation modelling/confirmatory factor analyses/path analyses (97%), and linear regressions (83%), but were reported less often for two-proportion z tests (50%), analyses of variance/analyses of covariance/multivariate analyses of variance (18%), t tests (8%), Wilcoxon's tests (8%), Chi-squared tests (8%), and Fisher's exact tests (7%), and not reported for sign tests, Friedman's tests, McNemar's tests, multi-level models, and Kruskal-Wallis tests. Effect sizes were infrequently interpreted. Confidence intervals were reported in 28% of papers. Conclusion: The use, reporting, and interpretation of inferential statistics in nursing research need substantial improvement. Most importantly, researchers should abandon the misleading practice of interpreting the results from inferential tests based solely on whether they are statistically significant (or not) and, instead, focus on reporting and interpreting effect sizes, confidence intervals, and significance levels. Nursing researchers also need to conduct and report a priori power analyses, and to address the issue of Type I experiment-wise error inflation in their studies. © 2013 .