Nursing Leaders’ Ethical Decision-Making About Professional Boundaries and Nurse-Patient Relationships: A Mixed Methods Explanatory Sequential Design

The purpose of this mixed methods explanatory sequential design study was to ascertain nursing leaders’ knowledge and skill in ethical decision-making when evaluating and managing professional nurse-patient relationship boundaries. It was also the purpose of this study to better understand nursing leaders’ perception of moral, cognitive, and organizational factors influencing their ethical decision-making in evaluating and managing professional nurse-patient relationships, with the intent of generating a theory grounded in the views of the participants as a final outcome of the study. The two theories, virtue ethics and self-efficacy comprise the ethicality construct of the conceptual framework explaining the nurse leaders’ beliefs about themselves and their ability to conduct ethical decision-making. The professional boundaries construct of the conceptual framework delineates the attributes and expectations of nursing as a profession, thus further explaining the nurse leaders’ role in ascertaining ethical professional boundaries among nurses and patients. Participants in the quantitative phase of this study included 28 female and 13 male nurse leaders selected by a convenience sampling approach from San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas. The participants were asked to complete a researcher designed Ethical Decision-Making Survey Instrument consisting of two scenario based vignettes with six Likert questions per vignette and a demographic questionnaire. The Ethical Decision-Making Survey Instrument was designed to assess nurse leader’s ethical decision-making about nurse-patient relationships and professional boundaries. Data analysis revealed by 48 bivariate Pearson product-moment correlation coefficients that the greater the number of years of work experience as an RN and the greater the number of years of work experience as a nurse manager, the more comfortable a nurse manager felt speaking with a nurse about his/her behavior regarding nurse-patient professional boundary transgressions. Additionally, the greater number of years of work experience as a nurse manager, the more knowledge she/he believed she/he had to appropriately manage nurse-patient professional boundary transgressions. Calculating six paired-samples t-tests revealed significantly greater mean scores for a nurse leader’s belief that nurses violate boundaries and exhibit unethical behavior in the scenario depicting a nurse involved in a personal relationship with a patient than a flirtatious relationship. Calculating 48 mixed between-within subjects ANOVAs revealed substantial main effects for nurse manager’s ethical decision-making in determining violations of nurse-patient professional boundary breaches and the unethicality of the behavior revealing higher scores on the scenario depicting a nurse involved in a personal relationship with a patient than a nurse involved in a flirtatious relationship with a patient. The qualitative phase was designed to further explain the results of the quantitative analysis. Participants in the qualitative phase of this study included seven female and zero male nurse leaders initially selected through purposeful sampling followed by a snowball sampling approach from San Antonio Military Medical Center, Brooke Army Medical Center, Fort Sam Houston, Texas. The participants were interviewed utilizing 12 guided open-ended questions with the aim of assessing moral, cognitive, and organizational factors influencing ethical decision-making about nurse-patient relationships and professional boundaries. Thematic analysis revealed the following themes: (a) ascribing conscience, (b) codifying knowledge repertoire, (c) summoning support systems, and (d) weighing elements affecting judgment. Each theme is discussed in depth and supported by exact participant quotations. The study culminates in a grounded theory. The study concludes with implications for nursing leadership, health care organizations, and nursing academia. As a result of the study findings, recommendations are highlighted that may promote a skill set conducive to improving nursing leader’s ethical decision-making about nurse-patient relationships and professional boundaries

The end of stigma? Understanding the dynamics of legitimisation in the context of TV series consumption

This research contributes to prior work on stigmatisation by looking at stigmatisation and legitimisation as social processes in the context of TV series consumption. Using in-depth interviews, we show that the dynamics of legitimisation are complex and accompanied by the reproduction of existing stigmas and creation of new stigmas

Preempting Online Review Helpfulness-An Elaboration Likelihood Perspective

The Information Systems literature has substantially advanced understanding of online review helpfulness in both its antecedents and consequences. Despite the rich understanding, existing studies predominately focused on the impact of coarser-grained characteristics on consumer’s helpfulness perception. The possibility of evaluating review’s helpfulness based on both fine-grained textual information along with multiple general factors of reviewer and products challenged existing understanding. While textual features such as latent topics and semantic traits of a review have been considered as effective predictors for identifying helpful reviews, the causal effects of these predictors on review’s perceived helpfulness still remain largely unclear. Drawing on the Elaboration Likelihood Model (ELM), this proposal focuses on understanding how coarse-grained general characteristics and finegrained textual characteristics jointly affect the perceived helpfulness of online review. In particular, following the spirit of ELM, we propose a model to disentangle the types of online review characteristics through a dual information processing perspective, and investigate how consumer’s motivation moderates effect of the two information processing routes. The proposed research model shall be operationalized by employing a panel data analysis

Adapting to the new normal: The process of relational change after stroke within romantic dyads

Brain injury can introduce serious life changes for the survivor and those responsible for care. Stroke, a specific form of brain injury, has been shown to impact communication (e.g., Fridriksson, Fillmore, Guo, & Rorden, 2015) and alter behavior (e.g., Fann, Uomoto, & Katon, 2000), both of which have individual and relational consequences (see Anderson & Keating, 2017). The current study extends the literature on life after stroke by highlighting the shared experiences of relational partners post-stroke. For this study, I gathered sensitizing concepts from the uncertainty in illness theory (Mishel, 1988), the uncertainty management theory (Brashers, 2001), and relational turbulence theory (Solomon, Knobloch, Theiss, & McLaren, 2016) to investigate how couples navigated the illness trajectory after a stroke. I focused specifically on the experience of uncertainty and relational changes that individuals associated with the stroke. I utilized the pragmatic iterative approach (Tracy, 2013) to analyze the interviews I collected from 22 stroke survivors and 22 caregiving partners (complete couples N = 20). My results led to a model of relational changes after stroke within romantic dyads that showed couples often experienced a shift in how they saw themselves, their partner, and the relationship after the stroke. Survivors and caregiving partners also reported an ongoing sense of uncertainty that they associated with the stroke. For couples in this study, managing life after stroke involved a process of acceptance and adaptation. These findings challenge existing theory by highlighting the dyadic experience of illness and the similarities between how survivors and their partners navigate life after a stroke. The current study also suggests that more education about stroke in general, and the influence on couples specifically, is needed at the professional and community levels

The language of family therapy : what we say we do and what we actually do in therapy

Systemic family therapy, as a variant of the "talking cure", has developed its conceptual base during the second half of the twentieth century. Its founding fathers and mothers made a conceptual break with psychoanalysis, and this theoretical distinction has until recently been well established. Contemporary theorists have shown an interest in narrative metaphors and sought to situate systemic therapy within the terms of postmodernist and specifically social constructionist discourses. By this fact a challenge is presented to the researcher who wishes to subject to scrutiny the theoretical claims made for this form of human activity: how to rigorously evaluate theoretical propositions whilst employing a methodology that is congruent with the assumptive base of family therapy. The present study represents an attempt at taking up this challenge. Family therapy sessions are videotaped, transcribed and subjected to a discursive anlalysis. The method is in tune with social constructionist premises and allows for a meaningful analysis of such contemporary theoretical preoccupations as the therapeutic relationship, power, gender, culture and the injunction to place the self of the therapist within the system. The actual enactment of these theoretical premises is examined and the conditions for the successful accomplishment of discursive, and hence therapeutic, goals is explored. A finding emerges that cannot be adequately accounted for within a post-foundationalist epistemology of socially and culturally-situated talk: consistent individual differences in the positions taken by interactants. In order to explain this finding it has been found necessary to insert an ontology of subjectivity within social constructionist explanatory frameworks. A nonrational, non-unitary version of the individual is constructed that bears more than a passing resemblance to the psychoanalytic subject. Consideration is given to the implications of these findings for future research

Study Habits Of College Students And Their Perceptions Of The Impact Of Brain-Based Attention Strategies On Their Independent Study Time

The purpose of this research was twofold. The first part explored the study habits of lower-division undergraduate college students during independent study time, with special inquiry into sustained attention and mental effort. A questionnaire and focus groups answered research questions that explored students\u27 general study practices, their study habits, factors influencing study, the length of sustained attention and mental effort, the strategies used to maintain attention, perceptions about productivity, and the metacognitive strategies used (i.e., self-monitoring, self-regulating, planning, and self-evaluating). The study showed that 1) students do not spend enough time studying, 2) the more time students spent on the job, the less they studied; 3) different factors impeding study were identified by the different age groups; 4) only 67% of study time was characterized by productive, sustained mental effort; 5) of the variability on productivity, 15.5 % could be accounted for by the use of metacognitive strategies; and 6) students reported using strategies most related to knowledge and comprehension goals rather than higher order thinking goals. The purpose of the second part was to investigate the perceived impact of the use of a brain-based study strategy. Participants used a 20 to 25 minute study segment, followed by a two to five minute break, in which cross-midline body movement was employed. The research focused on questions about the benefits of the study strategy, its effectives in increasing sustained attention, its effect on the length of time studied, its influence on better learning and productivity, and its continued use. After a two-week trial, 15 students completed an individual interview about their results using the strategy. Students reported increasing their attention and productivity and positively impacting their grades and learning. They attributed their successes to use of the strategy and indicated that they would continue its use. Three major conclusions emerged: 1) students need to study more and more productively, 2) professors need to teach study strategies, structuring their courses to include study strategies as an integral part of the course content, and 3) metacognitive study strategies (both cognitive and effort management) and higher order thinking strategies should be taught and supported

Texas Law Review

Journal containing articles, notes, book reviews, and other analyses of law and legal cases

Prospecting otherwise : stirring culture´s role in tackling the climate emergency

No pico do progresso preconizado desde o modernismo, que “hipernormaliza” (Yurchak 2006) um entendimento antropocêntrico de agência absoluta sobre o planeta, tornam-se hoje gritantemente audíveis as vozes críticas dos não-humanos: enfrentamos uma iminente colisão frontal com “Gaia” (Lovelock e Margulis 1974) e um provável fim de mundo como o conhecemos. As alterações climáticas e os desequilíbrios impostos ao Sistema Planetário da Terra pairam como um “hiperobjecto” (Morton 2013). A presente investigação pretende reflectir sobre as implicações culturais da actual crise climática e ecológica, e explorar o papel das práticas artísticas contemporâneas no combate às tendências de negação, desinteresse e desconhecimento face à ameaça existencial vigente. A proposta toma a forma de um programa de artes performativas e visuais a apresentar em Portugal ao longo da temporada 2023/2024 – incluindo onze locais em todo o país –, fundado num processo de escuta profunda das preocupações da sociedade portuguesa relativamente às alterações climáticas e inspirado num amplo legado de iniciativas no âmbito da programação cultural associada a estas temáticas. Prospecting Otherwise (PO) [Prospectar outro Devir] propõe-se contribuir para uma imperativa mudança de paradigma cultural, tendo em vista reconfigurar, através da experiência artística, modos de conhecimento e construção de sentido face ao colapso, na expectativa de instigar uma alternativa “ecocêntrica” (Curry 2006) de modos de ser, aliada a uma nova “ética de possibilidade” (Appadurai 2013). Este projecto procura debater modos de catalisar a capacidade partilhada de mudança radical, desenhando novas orientações para o emergente devir planetário, humano e nãohumano, hoje antecipado pela crise climática.As humans reach the peak of modernity’s achievements, anthropocentric worldviews have become “hypernormalised” (Yurchak 2006). However, nonhuman critical voices are louder than ever: eminently facing a frontal collision with “Gaia” (Lovelock and Margulis 1974), humankind may soon witness an end to an all-too-human world. Climate change and the unbalances imposed on the Earth’s Planetary System loom as an “hyperobject” (Morton 2013). The present research intends to deepen the understanding of the cultural implications of the current climate crisis and explore the role of contemporary artistic practices in countering trends of denialism, disengagement, and unknowingness. This endeavour takes the form of a performing and visual arts programme unfolding in eleven different venues across Portugal and throughout one season (2023/2024) – Prospecting Otherwise (PO) –, grounded in a process of “deep listening” (Oliveros 2005) to Portuguese societal concerns regarding climate change and inspired in preceding cultural programming initiatives echoing these topics. PO sets to contribute to an imperative cultural paradigm shift: it aims at reconfiguring, through the experience of art, means of knowing and making sense of impending collapse, towards an alternative, “ecocentric” (Curry 2006), “ethics of possibility” (Appadurai 2013). This project aims at discussing and practising modes of catalysing shared capacity for radical change, which might enable gearing away from the anticipated planetary “extinction as usual” (Rowan 2015)

The Corruption Of Promise: The Insane Asylum In Mississippi, 1848-1910

The ideology of insane asylum reform, which emphasized the Enlightenment language of human rights and the humane treatment of the mentally ill, reached American shores in the early-mid-nineteenth century. When asylum reform began to disseminate throughout the United States, forward-thinking Mississippians latched onto the idea of the reformed asylum as a humane way to treat mentally ill Mississippians and to bolster the humanitarian image of a Southern slave society to its Northern critics. When the Mississippi State Lunatic Asylum opened in 1855, its superintendents were optimistic about the power of the state to meet mental healthcare needs. While Mississippi slave society was incredibly wealthy, it was not proportionally progressive, and the idealism of the asylum supporters encountered the stark reality of Mississippi’s anti-statist culture and legislative austerity, as well as the limits of the nascent field of psychology. Mississippi ultimately proved exceedingly resistant to reform. By the beginning of the twentieth century, overcrowding, underfunding, and racial psychology had spurred the asylum officials to deemphasize treatment and transform the insane asylum solely into a holding cell for the mentally ill