bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypertrophic Cardiomyopathy Is Predominantly a Disease of Left Ventricular Outflow Tract Obstruction
Authors: Maron Martin S. , Olivotto Iacopo , Zenovich Andrey G. , Link Mark S. , Pandian Natesa G. , Kuvin Jeffery T. , Nistri Stefano , Cecchi Franco , Udelson James E. , Maron Barry J.
Published: November 2006

Background—

Nonobstructive hypertrophic cardiomyopathy (HCM) has been regarded as the predominant hemodynamic form of the disease on the basis of assessment of outflow gradient under resting conditions. We sought to prospectively define the prevalence, clinical profile, and significance of left ventricular (LV) outflow tract obstruction under resting conditions and with physiological exercise in a large HCM cohort.

Methods and Results—

We prospectively analyzed 320 consecutive HCM patients (age, 47±17 years), measuring LV outflow gradient at rest, with Valsalva maneuver, and with exercise echocardiography. LV outflow obstruction was present at rest and/or with exercise in 225 patients (70%); 119 had rest gradients ≥50 mm Hg and were not exercised. Of the other 201 patients with gradients <50 mm Hg at rest (average, 4±9 mm Hg), 106 developed mechanical obstruction to LV outflow resulting from mitral valve–septal contact after exercise (80±43 mm Hg), including 76 with marked gradients ≥50 mm Hg and 46 with heart failure symptoms. The remaining 95 patients (30%) had no or small gradients (<30 mm Hg) both at rest and with exercise. Valsalva maneuver underestimated the presence and magnitude of exercise-induced obstruction.

Conclusions—

Among those patients who come to clinical evaluation, HCM is a predominantly obstructive disease in which LV outflow gradients, frequently associated with heart failure symptoms and often identified only with exercise, are evident in most patients (ie, 70%). Identification of LV outflow obstruction with exercise echocardiography may broaden management options in HCM by identifying symptomatic patients not otherwise regarded as potential candidates for septal reduction therapy. Assessment of subaortic gradients with exercise should be a routine component of the evaluation of HCM patients without outflow obstruction under resting conditions.
Multimodal Virtual Environments: Response Times, Attention, and Presence
Authors: Hecht David , Reiner Miriam , Halevy Gad
Published: November 2006

Multimodal virtual environments (VE) succeed better than single-sensory technologies in creating a sense of presence. We hypothesize that the underlying cognitive mechanism is related to a faster mental processing of multimodal events. Comparing simple detection times of unimodal (auditory, visual, and haptic) events, with bimodal and trimodal combinations, we show that mental processing times are in the following order: unimodal > bimodal > trimodal. Given this processing-speed advantage, multimodal VE users start their cognitive process faster, thus, in a similar exposure time they can pay attention to more informative cues and subtle details in the environment and integrate them creatively. This richer, more complete and coherent experience may contribute to an enhanced sense of presence.
Super Wide Field of View Head Mounted Display Using Catadioptrical Optics
Authors: Nagahara Hajime , Yagi Yasushi , Yachida Masahiko
Published: November 2006

Many virtual reality, mixed reality, and telepresence applications use head mounted displays (HMD). HMD systems are portable and can display stereoscopic images. However, the field of view (FOV) of commercial HMD systems is too narrow for conveying the feeling of immersion. The horizontal FOV is typically around 60°, significantly narrower than that of the human eye. In this paper, we propose new display optics for a super wide FOV head mounted display. The proposed optics consists of an ellipsoidal and a hyperboloidal mirror that will display distortionless images by using the characteristics of the mirrors, even if the image has a large FOV. We constructed a prototype HMD system with a 180° horizontal × 60° vertical FOV that includes the peripheral vision of the human eye. The FOV has a 60° × 60° overlap area that can display stereoscopic images. We estimated the resolution, focus, and aberration of the prototype in an optical simulation and experimentally confirmed that the prototype displays distortionless wide FOV images.
Strategies for Economic Reforms and Development of Western China
Authors: Jia Ren
Published: November 2006

Western China, known for its diverse ethnic cultures and abundant natural resources, is a vast territory with a great potential for development owing to its unique geographic location in proximity to China's neighbouring countries. Still, it remains underdeveloped and lags far behind the rest of the country in social-economic development, and the growing disparity between the western and eastern parts of the country threatens to undermine the overall social-economic development of China. A strong case can be made for easing government control over state-owned enterprises, encouraging private entrepreneurship with appropriate incentives, and forging economic links with both the Eastern region of the country and the countries sharing borders with Western China.
Methodological Individualism, Explanation, and Invariance
Authors: Steel Daniel
Published: November 2006

This article examines methodological individualism in terms of the theory that invariance under intervention is the signal feature of generalizations that serve as a basis for causal explanation. This theory supports the holist contention that macro-level generalizations can explain, but it also suggests a defense of methodological individualism on the grounds that greater range of invariance under intervention entails deeper explanation. Although this individualist position is not threatened by multiple-realizability, an argument for it based on rational choice theory is called into question by experimental results concerning preference reversals.
How Not to Structure a Social Theory
Authors: King Anthony
Published: November 2006

In his recent review of my book, The Structure of Social Theory, Karsten Stueber rejected my criticisms of contemporary social theory. Against my “hermeneutic” sociology which prioritizes human social relations, he advocates a return to a dualistic ontology of structure and agency. This reply addresses Stueber’s criticisms to re-affirm the ontology of social relations against ontological dualism.
On ReviewingMachine Dreams
Authors: Boland Lawrence A.
Published: November 2006

Philip Mirowski’s recent book Machine Dreams: Economics Becomes a Cyborg Science continues to receive many reviews. Judging by recent reviews, this is a very controversial book. The question considered here is, how can one fairly review a controversial book—particularly when the book is widely popular and, for a history of economic thought book, a best seller? This essay uses Mirowski’s book as a case study to propose one answer for this question. In the process, it will examine how others seem to have answered this question.
Assessing thermal performance of an atrium integrated with photovoltaics
Authors: Gan G , Riffat S B
Published: November 2006

The thermal performance of an atrium integrated with photovoltaic (PV) modules at the Jubilee Campus, University of Nottingham, has been evaluated by measurement and computational fluid dynamic (CFD) modelling. The internal and external environments of the atrium were monitored and CFD was applied to the prediction of the thermal performance of the atrium. The effect of ventilation strategies on the performance of PV arrays was investigated. CFD modelling indicated that for effective cooling of roof PV arrays, the air inlet should be placed close to the roof.
A climatic variable for constructing thermal performance lines for air-conditioned commercial buildings in Hong Kong
Authors: Yik F WH , Sat P SK
Published: November 2006

The feasibility of using thermal performance lines to assess the efficiency of using energy in air-conditioned commercial buildings in Hong Kong is being explored. The paper describes a regression study aimed at identifying a suitable climatic variable that would yield linear thermal performance lines for commercial buildings in Hong Kong. The study was based on the monthly electricity consumption of 26 existing office/commercial buildings obtained from a recent survey. Candidate weather parameters considered include monthly mean outdoor temperature, outdoor air moisture content and global solar radiation, and their square and product terms. The regression analysis shows that the square of monthly mean outdoor temperature would be the most appropriate climatic variable. Explanations are also given as to why moisture content and global solar radiation were considered less appropriate, notwithstanding that in Hong Kong, the humidity is high for most of the time in the year and the cooling load due to solar heat gain is a significant component of the design cooling load of airconditioned buildings.
The use of the pre-heat margin in heating system design: a review based upon published literature
Authors: Hudson G
Published: November 2006

The size of a pre-heat margin for heating system design has been an engineering design decision for the past 35 years. This paper examines this issue through published literature. It is seen that although design techniques exist to ascertain the margin size and its consequent pre-heat time engineers do not appear to have used them or the full economic analysis called for in the 1970 IHVE guide. Engineers are reported as using empirical margins in most cases. The 1999 CIBSE guide is seen as an improvement, but it is seen that for over 20 years it has been suggested that empirical methods for sizing heating systems are no longer sufficient and that simulations may be the correct method to ascertain heating system size.
Likeable versus popular: Distinct implications for adolescent adjustment
Authors: Sandstrom Marlene J. , Cillessen Antonius H.N.
Published: November 2006

In the current study, 466 children completed a peer nomination survey assessing both perceived and sociometric popularity at the end of the 5th grade. Measures of behavior problems were assessed through a composite of peer-, teacher- and self-reports at the end of the 8th grade. Examination of the unique concurrent associations of each popularity type with peer nominated social characteristics in 5th grade demonstrated that sociometric popularity was positively associated with prosocial behavior and inclusive behavior, while perceived popularity was positively associated with overt and relational aggression. In addition to emerging as distinct conceptual constructs, these two dimensions of popularity also demonstrated unique associations with adjustment over time. Sociometric popularity in the 5th grade was associated with lower levels of externalizing behavior problems 3 years later, while perceived popularity was associated with higher levels of these problems over time. Interestingly, high levels of perceived popularity in the 5th grade were associated with less internalizing symptoms over time for boys, while high levels of sociometric popularity were associated with less internalizing symptoms over time for girls.
Personality development from childhood to adolescence: A longitudinal study of ego-control and ego-resiliency in Sweden
Authors: Chuang Susan S. , Lamb Michael E. , Hwang C. Philip
Published: November 2006

We investigated the development of ego-control (EC) and ego-resiliency (ER) over a 13-year period in a cohort of Swedish children first assessed at 2 years of age. Children became more ego-controlled over time although individual differences in EC remained stable. Children’s levels of resiliency increased from 2 to 3 years of age and then declined when they were 7 and 8 years of age. Boys continued to become less resilient in adolescence whereas girls became more resilient. Individual differences in boys’ resiliency levels were more stable over the 13-year span than girls’. The inter-correlations between EC and ER were only significant for boys at 2 and 15 years of age. The external validity of EC and ER was demonstrated by significant associations with ratings of the children’s adaptation to school as well as with their measures of their internalizing and externalizing behavior problems.
Does the child’s actual participation make a difference? Positive and negative emotion states mentioned by mothers of young children during narrative construction
Authors: Landau Rivka , Yanay Niza , Eshel Yohanan , Ben-Aaron Miriam
Published: November 2006

The study examined the rate that mothers mentioned positive and negative emotion states and emotion calls during narrative construction from a text-free children’s picture book illustrating happy and emotionally charged situations. Ninety-three mothers of 3- to 4-year-old kibbutz children were divided into three groups: (1) the child was not present and not mentioned; (2) the child was not present, but was mentioned by the experimenter; and (3) the child co-constructed the narrative with his/her mother. Mothers mentioned significantly more negative emotion states in the co-construction group than in the two other groups; no difference was found for positive emotion states. Findings for emotion calls differed: mothers used more positive emotion calls in the second group than in the other groups, and they used more negative emotion calls in the second and third group than in the first group.
Making Sense of Theory Construction: Metaphor and Disciplined Imagination
Authors: Cornelissen Joep P.
Published: November 2006

This article draws upon Karl Weick’s insights into the nature of theorizing, and extends and refines his conception of theory construction as ‘disciplined imagination’. An essential ingredient in Weick’s ‘disciplined imagination’involves his assertion that thought trials and theoretical representations typically involve a transfer from one epistemic sphere to another through the creative use of metaphor. The article follows up on this point and draws out how metaphor works, how processes of metaphorical imagination partake in theory construction, and how insightful metaphors and the theoretical representations that result from them can be selected. The paper also includes a discussion of metaphors-in-use (organizational improvisation as jazz and organizational behaviour as collective mind) which Weick proposed in his own writings. The whole purpose of this exercise is to theoretically augment and ground the concept of ‘disciplined imagination’, and in particular to refine the nature of thought trials and selection within it. In doing so, I also aim to provide pointers for the use of metaphorical imagination in the process of theory construction.
Organizing is Both a Verb and a Noun: Weick Meets Whitehead
Authors: Bakken Tore , Hernes Tor
Published: November 2006

Weick’s work on organizing and sensemaking has contributed significantly towards efforts in organization theory to explore organization as process. His discussion of the relationship between verbs and nouns in particular has served to highlight central dynamic features of processes. Weick’s conception of the verb-noun relationship is one of tension between levels of analysis. We propose, drawing upon the work of Alfred North Whitehead, to draw attention to the formation of nouns and how verbs shape nouns and vice versa. We argue that Weick’s work may be extended by looking more closely at the selection of verbs and nouns, i.e. by looking at how selection may be made on the basis of their relationality, thus allowing for their mutual transformation. We illustrate our point using the imagery provided by the ‘pseudopod’.
How Can We Know What We Think Until We See What We Said?: A Citation and Citation Context Analysis of Karl Weick’s The Social Psychology of Organizing
Authors: Anderson Marc H.
Published: November 2006

A substantial portion of Karl Weick’s influence on organization studies is based upon his classic book The Social Psychology of Organizing (abbreviated as Organizing). A citation analysis shows the magnitude of this influence compared to five other organization studies classics, and reveals that Organizing continues to be highly cited. A citation context analysis (i.e. content analysis) of all citations to Weick (1979) in three top organization studies journals ( Academy of Management Review, Administrative Science Quarterly, and Organization Studies) shows that 12 concepts account for 67.6% of citations to Organizing, but that the book is cited for a remarkable diversity of additional content as well. Furthermore, a consideration of differences between the concepts cited in the US journals versus Organization Studies reveals several regional differences. Finally, very few citations are critical of Organizing or involve empirical tests. These results hold a variety of implications for future research.
Supporting Student Teachers
Authors: Conderman Greg , Pedersen Theresa
Published: November 2006

This article provides practical suggestions for principals for enhancing the success of student teaching experiences in their building. Specifically, principals can develop procedures for welcoming the student teacher, communicate with university officials early and frequently, monitor the quality and variety of the student teaching experience, and provide specific feedback to the student teacher. These actions send powerful positive messages to the student teacher while supporting their successful transition into the teaching profession.
Instructional Leadership and Monitoring: Increasing Teacher Intent to Stay Through Socialization
Authors: Angelle Pamela S.
Published: November 2006

This study examines principal monitoring and beginning teachers' experiences through interviews. Findings indicate socializing into an ineffective school will either promulgate ineffective practices or will produce an internal conflict. At schools where principals were “all about the kids,” teachers demonstrated loyalty and voiced intentions to remain in teaching due to the culture where first teaching experiences took place. The quality of the instructional leader's monitoring not only socializes the beginner into the school organization but influences the teacher's intent to stay.
Technology Standards for School Administrators: An Analysis of Practicing and Aspiring Administrators' Perceived Ability to Perform the Standards
Authors: Yu Chien , Durrington Vance A.
Published: November 2006

This study investigated practicing and aspiring school administrators' perceived level of proficiency related to the Technology Standards for School Administrators adopted by the International Society for Technology in Education. Based on the mentor-mentee relationship, the study found there were no significant differences between mentors and mentees in their perceived ability to meet any of the Technology Standards for School Administrators. However, there was a significant difference between mentors and mentees on the social, legal, and ethical issues standard, with mentees showing a greater desire to pursue professional development in this standard area.
Three Principles of Explanation
Authors: Rudolph Udo , von Hecker Ulrich
Published: November 2006

Two studies demonstrated that explanations of interpersonal events are governed by the principles of implicit verb causality and balance. In addition, the data indicate that subjectively imbalanced interpersonal events (e.g., John admires Jack because he is so arrogant) elicit processes designed to achieve imbalance repair. In contrast to previous studies, we analyzed subjective (rather than objective) balance and imbalance as well as the cognitive processes mediating the repair of subjectively imbalanced situations. The results suggest that repair mechanisms implied by perceived imbalance vary consistently for different kinds of verbs. Moreover, imbalance repair results in highly systematic attributions to different persons or specific interactions between the persons involved, in line with predictions derived from Kelley's covariation principle. Additional analyses of perceived covariation information provided evidence that these repair mechanisms are mediated by reevaluations of covariation information implicit in the meaning of the verbs used to describe the interpersonal event.
When parents lay their children to rest: Between anger and forgiveness
Authors: Ronel Natti , Lebel Udi
Published: November 2006

A hermeneutic-phenomenological study of 13 bereaved parents of fallen soldiers or victims of terrorism describes their grief, anger, and forgiveness in relation to their struggle with personal loss. The findings indicate anger as a major variable among participants, aroused by three sources: (i) the circumstances of the loss; (ii) the institutionalized response to the loss; and (iii) a certain policy and its makers. A salient finding is that the ‘enemy,’ the target of the most anger, was never the one who actually killed their son, but a political leader who participants perceived to be responsible for the loss. Forgiveness was scarcely relevant to participants. A proposed explanation focuses on the meaning of the respective representations of the dead child in the participants’ inner and social worlds, and their lack of readiness for the necessary transformation of that representation. Recommendations include the institutionalized responses that may benefit the parents personally and assist them in reaching forgiveness and reconciliation with their defined enemy.
Models of relating - not relationship models: Cognitive representations of relating across interpersonal relationship domains
Authors: Koerner Ascan F.
Published: November 2006

Two studies apply Fiske’s Relational Model Theory (RMT) to interpersonal relationships and indicate that rather than being models of relationships, relational models are models of relating that are used differently across interpersonal relationship domains. Study 1 (n = 145) investigated the use of relational models in three relationship types (mother, friend, and acquaintance). Results showed that even though relationship type predicted relational model use, model use varied significantly across relationship domains. Study 2 (n = 282) provides a cross-cultural replication of these findings (US and Singapore). Results of both studies suggest that Relational Model Theory is a particularly fruitful approach to relationship research when individual relationship domains are considered in addition to relationship types.
Charitable Giving: Factors Influencing Giving in U.S. States
Authors: Gittell Ross , Tebaldi Edinaldo
Published: November 2006

Charitable giving by households in the United States is significant. More than two thirds of households self-report giving. Private giving represents more than 2% of total gross domestic product (GDP) and is a significant factor in funding the nonprofit sector. This research note documents giving across U.S. states. It adds detailed data and analysis supporting and supplementing research that identifies personal income, capital gains, religious group affiliation, age, volunteerism, and educational attainment as the main factors affecting household giving.
Comparative Performance and Quality Among Nonprofit Nursing Facilities in Texas
Authors: Knox Kris Joseph , Blankmeyer Eric C. , Stutzman J. R.
Published: November 2006

Researchers have given little attention to relative economic efficiency among nonprofit nursing facilities. Presumably, religious-affiliated, government, and private secular nonprofit facilities pursue similar objectives, perform similarly, and receive tax exemptions accordingly. Using modified, translog cost-and profit-function regression analyses, this article rejects the hypothesis of homogeneous performance. In Texas, private secular nonprofit nursing homes are the most cost-efficient, followed by religious-affiliated and then government nursing facilities. When allocation efficiency is also considered, government and private secular facilities have similar overall economic efficiency; religious-affiliated and government facilities are similar as well; however, private secular facilities are significantly more efficient than religious-affiliated homes. Quality appears to be homogeneous among facility classifications. Given these significant differences, policy makers may want to consider the role of relative economic performance when granting nonprofit status to nursing facilities because nonprofit governance boards may allow their organizations to pursue the “socially superior” goal somewhat divergently.
The mid-Holocene Tsuga canadensis (hemlock) decline, eastern North America–age versus causes: a reply to Payette
Authors: Bennett K. D. , Fuller J. L.
Published: November 2006

A reply is made to comments by Payette (2004) concerning the paper that attempted to determine the age of the Tsuga canadensis decline in eastern North America (Bennett and Fuller, 2002). It is pointed out that his criticisms of the methods used are all aspects covered in the original paper, and which make little, if any, difference to the result obtained. However, ecological aspects of the decline were outside the scope of the paper.
Researching the Bereaved: an investigator’s experience
Authors: Sque Magi
Published: November 2006

The issues discussed in this article concern the process of interviewing the bereaved relatives of organ donors, the personal impact, and the potentially painful nature of such research. Narrative interviews were carried out with 24 donor relatives. The relatively small number of donating families and their anonymity mean that little is understood about the experience of having a relative in a critical care situation that ends in donation. The purpose of this study was to develop a theory that explained the organ donation process for relatives of ‘major organ’ donors. A central concern of implementing the investigation was the possible threat it posed to the participants and myself. The sensitive nature of the research made access to relatives difficult. Undoubtedly, my nursing background and personal attributes had an impact on interactions with participants and the pursuance of the research agenda.
An Analysis and Evaluation of Student Nurses’ Participation in Ethical Decision Making
Authors: Han Sung-Suk , Ahn Sung-Hee
Published: November 2006

This study analyses the types and frequencies of ethical dilemmas and the rationale of ethical decision making in student nurses; it also evaluates their decision making. One hundred senior student nurses who were enrolled in a two-credit course in nursing ethics were asked to provide an informal description of a dilemma that they had experienced during their clinical practice. The results were as follows. The ethical dilemmas identified fell into four categories and were of 27 types. Those most frequently experienced were ‘family giving up on a patient because he or she could not be cured’, and ‘not telling the truth to the patient’. The Korean Nurses’ Code of Ethics was applied, in particular the preamble, and the third, fourth, seventh and tenth clauses. The most common rule of ethics and principle applied in these nurses’ ethical decision making were veracity and nonmaleficence. With regard to the moral reasoning process, the primary concern was the welfare of the patients. These students were equipped with the ability to exercise critical and reflective thought when they experienced ethical dilemmas.
Relational Narratives: Solving an Ethical Dilemma Concerning an Individual’s Insurance Policy
Authors: Lindsay Robin , Graham Helen
Published: November 2006

Decisions based on ethics confront nurses daily. In this account, a cardiac nurse struggles with the challenge of securing health care benefits for Justin, a patient within the American system of health care. An exercise therapy that is important for his well-being is denied. The patient’s nurse and an interested insurance agent develop a working relationship, resulting in a relational narrative based on Justin’s care. Gadow’s concept of a relational narrative and Keller’s concept of a relational autonomy guide this particular case. As an ethics framework influenced by feminist ethical theory, Gadow’s, Keller’s and Tisdale’s ideas demonstrate the fluidity with which the nurse and others can work while maintaining both autonomy and engagement without being self-sacrificing.
Confidentiality and HIV/AIDS in South Africa
Authors: Uys Leana R
Published: November 2006

Keeping the diagnosis of a client confidential is one of the cornerstones of professional practice. In the case of a diagnosis such as HIV/AIDS, however, the ethics of this action may be challenged. Such a decision has a range of negative effects, for example, the blaming of others, supporting the denial of the client, and complicating the health education and care of the patient. It is suggested that the four ethical principles should be used to explore the ethics of such decisions, and that professional regulatory bodies and organizations should support professionals in situations where the client’s sexual partner is informed against the wishes of the client.
Nursing and Genetics: a feminist critique moves us towards transdisciplinary teams
Authors: Anderson Gwen W , Monsen Rita Black , Rorty Mary Varney
Published: November 2006

Genetic information and technologies are increasingly important in health care, not only in technologically advanced countries, but world-wide. Several global factors promise to increase future demand for morally conscious genetic health services and research. Although they are the largest professional group delivering health care world-wide, nurses have not taken the lead in meeting this challenge. Insights from feminist analysis help to illuminate some of the social institutions and cultural obstacles that have impeded the integration of genetics technology into the discipline of nursing. An alternative model is suggested - the transdisciplinary model - which was developed initially by a nurse and introduced in the 1970s into the delivery of health care and social services for children with developmental disabilities. This holistic model enables all health care professionals to have an equal voice in determining how genetic health care will be globalized.
Genetics, Ethics and Education: considering the issues for nurses and midwives
Authors: Kirk Maggie
Published: November 2006

The rapid advances and scope of the Human Genome Project bring into sharp focus the relevance of genetics and ethics for nursing and midwifery practice in the new millennium. This article offers a UK perspective on how education plays a crucial part in preparing practitioners to integrate clinical advances effectively and ethically, yet may be failing in this role. Provision for teaching genetics in the UK has been found to be largely inadequate and the ethical implications of this are reviewed. The context of genetics teaching is a further issue. Genetics is classified in the bioscience component of training courses in nearly 70% of UK nursing colleges; this may be of significance in its perceived relevance to practice. Finally, the ethical issues around the teaching of genetics will be discussed. Educators who are involved in delivering the genetics component of the curriculum are under an obligation to consider how learning is best achieved and how the delivery itself should be ‘ethical’.
A Professional Code of Ethics Provides Guidance for Genetic Nursing Practice
Authors: Scanlon Colleen
Published: November 2006

While ethical quandaries and dilemmas are commonplace for nurses, recent advances in human genetics have and will continue to create new challenges and controversies. Throughout time, nursing has been an ethical endeavour, with nurses viewing the ethical mandates of their responsibilities on a par with other core dimensions of their professional life. The (American) profession’s code of ethics, Code for nurses with interpretive statements, provides direction for practice and for the fulfilment of ethical obligations. The explication of these ethical norms and values that shape professional practice is necessary as nurses confront the integration of genetic services into health care. The goal of preserving professional integrity and ethical soundness in the context of genetic health care mandates that nurses rely on and act upon the profession’s national and international codes of ethics.
An Ethical Insight into Nursing Research in Turkey
Authors: Ulusoy M Filiz , Uçar Hülya
Published: November 2006

Scientific and technological improvements are accomplished only because of much research. The increase in the number of research studies causes a rise in ethical problems. Nursing research is no exception to this. The aim of this study is to identify and analyse ethical problems in nursing studies. This research is descriptive and partly analytical. It is retrospective in the sense that 169 Master of Science and 66 doctoral theses written between 1972 and 1998 in the Department of Nursing, Institute of Health Sciences, Hacettepe University, Ankara, Turkey, were examined. The following ethical rules were used as criteria: that no harm should be caused to the subject; the subject was informed about the research topic; permission was obtained from the subject; and the privacy of the subject was maintained. The evaluation was carried out by distributing the theses among background variables and by employing nonparametric tests. The research associated with the theses was not harmful to the participants in 93.2%, while 6.8% were considered to have caused harm. In 72.7% of the theses the subjects were not informed of the research; in 73.6%, the researchers did not obtain permission from the subjects; and in 8.5% their privacy was not kept. An ethical score was assigned to each thesis, which varyed between 0 and 15. The mean score was 5.02.
Users’ Views of Palliative Care Services: ethical implications
Authors: Woods Simon , Beaver Kinta , Luker Karen
Published: November 2006

This article is based on the findings of a study that elicited the views of terminally ill patients ( n = 15), their carers ( n = 10) and bereaved carers ( n = 19) on the palliative care services they received. It explores the range of ethical issues revealed by the data. Although the focus of the original study was on community services, the participants frequently commented on all aspects of their experience. They described some of its positive and negative aspects. Of concern was the reported lack of sensitivity to the role of the family among health professionals. The family, as carers, service users and advocates, represent a challenge to professional boundaries and the ethical norms of confidentiality and best interest. The accounts reveal the complexity of the ethical issues that characterize terminal care, issuing specific ethical challenges to nurses and other health professionals involved in this field.
Development of an Instrument to Investigate Parents’ Perceptions of Research with Newborn Babies
Authors: Oberle Kathleen , Singhal Nalini , Huber Joelene , Burgess Ellen
Published: November 2006

Neonatal intensive care nurses are often involved in research protocols as investigators, research assistants or staff nurses implementing the protocol and providing support and explanations to families. It is important, therefore, that nurses have information about parents’ understanding of and attitudes towards the research process. The purpose of this study was to begin an exploration of parents’ perceptions about research with newborn babies through the development and validation of a survey instrument. The questionnaire included: demographic questions; scaled items about research with newborn babies; scenarios describing research studies that varied in degree of risk and benefit to the newborn baby; questions about parents’ willingness to enrol their newborn baby in the studies described; and questions regarding circumstances under which consent should be sought. Content and face validity were established by an expert panel and a pilot test conducted with a small group of health care professionals and lay persons. A convenience sample of 231 parents of newborn babies completed the final version of the questionnaire. Factor analysis revealed seven factors corresponding to issues identified in the literature, providing evidence of construct validity. Parents appeared to have no difficulty in completing the instrument and all questions were answered by the majority of participants. It was concluded that the questionnaire had adequate psychometric properties and that a mixed method approach can be fruitful in exploring sensitive issues.
Comprehensive STD/HIV Prevention Education Targeting US Adolescents: review of an ethical dilemma and proposed ethical framework
Authors: Brown Emma J , Simpson Edith M
Published: November 2006

Adolescents are increasingly at risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection. The prolonged latency period, sometimes in excess of five years, and the incubation period of up to 10 years before the manifestation of symptoms, may foster adolescents’ false sense of invincibility and denial as they often do not see the devastating effects of the disease in their peers until they are older. In turn, their practice of safer sex may be hindered and thereby contribute to the escalation of this public health crisis among sexually active adolescents. Prevention-focused recommendations were made in the USA as a result of this crisis. Recommendations were made to: (1) include STD/HIV education in the curricula of grades kindergarten to 12; (2) increase to at least 75% the proportion of primary care and mental health professionals who provide age-appropriate STD/HIV prevention counselling to adolescents; and (3) expand HIV prevention services to include age-appropriate HIV education curricula for students in grades 4-12 in 95% of schools. Yet, in the USA, the provision of school-based comprehensive STD/HIV education has been difficult to achieve owing to certain limitations and, in some instances, legal action. These limitations include: limited student access; restricted content; and the implementation of sporadic and/or brief educational programmes. Given these recommendations and the fact that adolescents are acquiring STDs and HIV infections at increasing rates, and despite the limitations and legal actions, do health care professionals not have an ethical obligation to provide adolescents with comprehensive STD/HIV prevention education? This ethical dilemma will be discussed using the ethical decision-making principles of ‘autonomy’ and ‘beneficence’, and a decision-making model proposed by Thompson and Thompson, and by Chally and Loric.
Ethical Implications of Pain Management in a Nursing Home: a discussion
Authors: Hicks Tom J
Published: November 2006

Pain is the most frequently communicated complaint among elderly people. Discussion of the ethics of pain management in nursing home residents has not appeared in the literature. The purpose of this article is to present an ethically-based pain management action plan for elderly nursing home residents. Nurses empowered with the latest information and cognizant and comfortable with their own views about pain are likely to effectuate a positive patient outcome. Further research will add to the current knowledge base while laying the groundwork for new interventions.
The Attitude of Canadian Nurses Towards Advance Directives
Authors: Blondeau Danielle , Lavoie Mireille , Valois Pierre , Keyserlingk Edward W , Hébert Martin , Martineau Isabelle
Published: November 2006

This article seeks to shed light on the beliefs that influence nurses’ intention of respecting or not respecting an advance directive document, namely a living will or a durable power of attorney. Nurses’ beliefs were measured using a 44-statement questionnaire. The sample was made up of 306 nurses working either in a long-term care centre or in a hospital centre offering general and specialized care in the province of Québec. The results indicate that nurses have a strong intention of complying with advance directives written by patients. The analysis also shows that four variables determine the strength of this intention: respect for autonomy; the location of the workplace; justice; and the dimension of relationships and emotions. Although these documents favour the expression of patients’ wishes, nurses should be aware that they do not systematically guarantee respect of a patient’s autonomy, nor do they replace a relationship based on trust between patients and health care professionals.
Policy Implications of the Biological Model of Mental Disorder
Authors: Olsen Douglas P
Published: November 2006

The current dominant paradigm of mental disorder is that psychopathology is a deviation from normal physiological functioning of the brain. This paradigm is closely allied to the identity theory of mind in philosophy, which holds that mental phenomena are identical with the physical state of the brain. The assumptions of the biological model have policy implications, regardless of the utility or ‘truth’ of the paradigm, which should be made explicit for the assessment of ethics in mental health policy formulation. The nature of mental phenomena has been debated throughout history, without consensus. Several critiques of the biological model are offered to encourage enquiring scepticism. The policy implications discussed are political conservatism, broadened rationales for forced treatment, utility in managed care, and the use of medical necessity criteria to allocate treatment.
The Helsinki Declaration: why all the fuss?
Authors: Tadd Win
Published: November 2006

Since 1964, the Declaration of Helsinki has been accepted internationally as the cornerstone for research ethics. As such it has been incorporated into a number of guidance documents for research undertaken on human subjects. In 1999, the American Medical Association put forward a proposal for wide-ranging revision of the document, which would significantly weaken the rights of research subjects and lower the standards for research on human subjects. This article discusses the probable effects of the most significant proposals for change and argues against them. It also urges nurses, especially those involved in research, to become involved in the international consultation currently being undertaken by the World Medical Association.
Ethics and Education
Authors: Birkelund Regner
Published: November 2006

In the debate concerning the education of nurses that is currently taking place in Denmark, two widely differing views are apparent regarding the best way of training nurses such that the ethical aspect of their work is adequately considered. The first of these is based on the premise that practical care is fundamental to and justified by theories on nursing, care and ethics, which is why the theoretical part of nurse education deserves a higher priority. The second view is based on the premise that social care cannot be taught by means of theories, but can be learnt only through practice. The master-apprentice principle of ancient Greece is stressed in connection with this as being a viable alternative to the theoretical model of education. These two very different views can be traced back to Plato’s and Aristotle’s ideas on ethics and teaching respectively; indeed, those engaged in the debate make specific reference to these philosophers.

In Denmark, a third fundamental viewpoint exists, known as ‘ontological ethics’. Phenomenologist KE Løgstrup is one of the best-known representatives of this view. Basing the line of argument on Løgstrup’s ethics and the view of education associated with this, this article questions the relevance of ancient Greek thought to today’s world by illustrating a number of problems that are connected with the theoretical model of nurse education and with the master-apprentice principle.

Løgstrup associates ethics with the aesthetic principle that ‘the useless is the most useful’ in human life and with the view we also see in Kierkegaard’s and NFS Grundtvig’s writings that ethics can be imparted only by indirect means. Løgstrup bases his understanding of ethics on the Judaeo-Christian concept of Genesis and the view that human beings were created with an ethical potential that is best nourished by aesthetic impressions.
A Socratic Dialogue on the Question ‘What is Love in Nursing?
Authors: Fitzgerald Les , van Hooft Stan
Published: November 2006

It is the thesis of the authors that the caring ethic and moral state of being of nurses ideally suffuses their professional caring and is thus implicit in their ethical decision making. Socratic dialogue is a technique that allows such moral attitudes to be made explicit. This article describes a Socratic dialogue conducted with nurses on the topic: ‘What is love in nursing?’ The conclusions drawn were based on the belief that the current western-style health care system restricts the practice of nursing in such a way as to limit professional caring and loving possibilities. Nurses who love in the practice of caring go beyond the role definition of the duty of care; they are people who are prepared to think differently about their practice as professionals, and are identified as competent risk takers committed to the betterment of the other. From this dialogue, ‘love in nursing’ was understood as the willingness and commitment of the nurse to want the good of the other before the self, without reciprocity.
The Experiences of Elderly People in Geriatric Care with Special Reference to Integrity
Authors: Randers Ingrid , Mattiasson Anne-Cathrine
Published: November 2006

The aim of this study was to obtain an increased understanding of the experiences of elderly people in geriatric care, with special reference to integrity. Data were collected through qualitative interviews with elderly people and, in order to obtain a description of caregivers’ integrity-promoting or non-promoting behaviours, participant observations and qualitative interviews with nursing students were undertaken.

Earlier studies on the integrity of elderly people mainly concentrated on their personal and territorial space, so Kihlgren and Thorsén opened up the possibility of considering the concept of integrity from a broader view by recognizing its relationship to the larger framework of the self-concept. Based on this, findings in the present study indicate that elderly people’s integrity relating to their corporal self were the least violated. On the other hand, their psycological, information and cultural selves were the most exposed. The study also identified a further dimension (i.e. one relating to social self), which should be included in the concept of integrity because respecting elderly people’s social self reduces their feelings of loneliness, isolation and seclusion. In summary, the results indicate that the concept of integrity is complex and has several dimensions.
Moral Sensitivity: some differences between nurses and physicians
Authors: Lützén Kim , Johansson Agneta , Nordström Gun
Published: November 2006

We report the results of an investigation of nurses’ and physicians’ sensitivity to ethical dimensions of clinical practice. The sample consisted of 113 physicians working in general medical settings, 665 psychiatrists, 150 nurses working in general medical settings, and 145 nurses working in psychiatry. The instrument used was the Moral Sensitivity Questionnaire (MSQ), a self-reporting Likert-type questionnaire consisting of 30 assumptions related to moral sensitivity in health care practice. Each of these assumptions was categorized into a theoretical dimension of moral sensitivity: relational orientation, structuring moral meaning, expressing benevolence, modifying autonomy, experiencing moral conflict, and following the rules. Significant differences in responses were found between health care professionals from general medical settings and those working in psychiatry. The former agreed to a greater extent with the assumptions in the categories ‘meaning’ and ‘autonomy’ and to a lesser degree with the categories ‘benevolence’ and ‘conflict’. Moreover, those from the psychiatric sector agreed to a greater extent to the use of coercion if necessary. Significant differences were also found for some of the MSQ categories, between physicians and nurses, and between males and females.