Race, Morality, Moral Distress and Clinical Decision Making Among Mental Health Professionals

Background: Clinical decision-making (CDM) in mental healthcare is both evaluatively and ideologically complex. Literature has demonstrated that such decisions are often morally challenging; mental health professionals (MHPs) draw on a wide range of values and professional/ personal factors to make decisions. It has further been suggested that dominant discourses and normative attitudes, namely racial attitudes, continue to influence structures and practices within CDM, thus contributing to the racial disparities evidenced across the spectrum of mental healthcare. Aims: To explore associations between sociodemographic and professional factors and moral values, moral distress and CDM in mental healthcare. In particular, to explore the influence of racial attitudes on CDM processes. Methods: A cross-sectional design was used. A sample of adults working in UK mental healthcare (n=450) were recruited online through convenience and purposive sampling. Participants were presented with seven vignettes to assess CDM and racial bias, and completed series of measures concerning demographic factors, moral values, moral distress and racial attitudes. Results: Findings highlighted significant variation in participants endorsement of the seven moral values measured, in moral distress scores and in CDM. The overall level of moral distress was relatively high (mean MMD-HP score = 98.82). A number of professional and sociodemographic factors were found to predict CDM. Colour-blind racial attitudes were most consistently associated with CDM. Additionally, racial attitudes influenced CDM indirectly; greater endorsement of the moral values of deference and group loyalty increased the influence of racial attitudes on CDM. Conclusions: There is significant variation in CDM processes among MHPs; decisions are influenced by a range of factors and are often morally challenging. While moral distress may be one consequence of the broad and ideologically complex nature of CDM in mental healthcare, another is that this largely enables decisions to be shaped by dominant discourses, namely, racial attitudes. Thus, the whiteness present within society is reflected in mental health CDM

Programs of Guidance and Counseling as They Relate to Young People and Their Preparation for Work

There is evidence on every hand that one of the important needs in present day and future education is good guidance and counseling. Although some guidance and counseling programs have been in operation for many years, only recently have they blossomed forth into the significant place in education which they now occupy. The rapid growth has brought about numerous problems, many of which are yet unsolved. Among these important unsolved problems are the following: What are the real duties and responsibilities of counselors? Is vocational guidance receiving its proper emphasis? How well informed about vocations are the counselors and how well informed should they be? How do students acquire occupational information? How can counselors best assist students in making realistic assessment of their own potentialities and in choosing their life\u27s work in harmony with their capabilities and interests? These, and other equally important problems, are worthy of serious study and consideration

Using a Pearl Harvested Synonym Ring for the Creation of a Digital Index on Giftedness

This thesis examined the use of a pearl harvested synonym ring in the creation of a digital index on the subject of giftedness, with the goal of better defining the available information in the field and facilitating information retrieval. The pearl harvested synonym ring was used in the retrieval of citations relating to giftedness in the ERIC database. A content analysis of these citations provided the list of topics that would form the basis of a digital index. When the topics retrieved using the pearl harvested synonym ring were compared to the indices of two textbooks on gifted education, they were found to be more comprehensive and better representative of the field. The results of this study have potential implications in the improvement of digital indexing techniques, better understanding of academic fields of study, and creating a standard procedure for scoping reviews

Comparison of manikin-based simulators and patient monitor simulators within paramedic education : the student perspective

Objective Investigate the impact to paramedic students of patient monitor simulators, when compared with manikin-based simulators within an educational programme. Design An exploratory study using an online questionnaire to gain qualitative and quantitative data. Setting One London university delivering a paramedic science programme. Participants A total of 136 paramedic students sponsored by a UK ambulance service were approached for this study. Data were received from 43 respondents (32%). Main outcome measures Comparison of simulators and their effect on student development through the identification of the student’s own perceived ability following use, perception of other’s ability (fellow students studying same course) following use and perception of the two pieces of simulation equipment available. Results The majority of respondents identified that simulation both increased their confidence and ability to demonstrate new knowledge and skills during simulation (97%) and further increased their ability to manage real patients (95%). Respondents agreed that there were advantages and disadvantages of using simulation, but these were not in line with those identified in previous studies. Instead of the human factors and non-technical skills outlined, students were much more practically focused on how the equipment performed. Conclusions This study suggests that there is a clear link between simulation and increased student confidence, but any issues encountered with the simulator equipment can reduce this benefit, causing the student’s learning environment to falter. Transitioning to monitor-based simulators is seen as a positive move, although the integration of manikins with this equipment is identified as being necessary. https://stel.bmj.com/content/4/2/65. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/bmjstel-2017-00025

EFFECTS OF ASPIRATION VERSUS NEUROTOXIC LESIONS OF THE AMYGDALA ON EMOTIONAL RESPONSES IN MONKEYS

All previous reports describing alterations in emotional reactivity after amygdala damage in monkeys were based on aspiration or radiofrequency lesions which likely disrupted fibers of passage coursing to and from adjacent ventral and medial temporal cortical areas. To determine whether this associated indirect damage was responsible for some or all of the changes described earlier, we compared the changes induced by aspiration of the amygdala to those induced by fiber-sparing neurotoxic lesions. Four different stimuli, two with and two without a social component, were used to evaluate the expression of Defense, Aggression, Submission, and Approach responses. In unoperated controls, Defense and Approach behaviors were elicited by all four stimuli, "social" and inanimate alike, whereas Aggression and Submission responses occurred only in the presence of the two "social" stimuli. Furthermore, all Defense reactions were reduced with an attractive inanimate item, while Freezing was selectively increased with an aversive one. Relative to controls, monkeys with neurotoxic amygdala lesions showed the same array of behavioral changes as those with aspiration lesions, namely reduced fear and aggression, increased submission, and excessive manual and oral exploration. Even partial neurotoxic lesions involving less than two-thirds of the amygdala significantly altered fear and manual exploration. These findings convincingly demonstrate that the amygdala is crucial for the normal regulation of emotions in monkeys. Nevertheless, since some of the symptoms observed after neurotoxic lesions were less marked than those seen after aspiration lesions, the emotional disorders described earlier after amygdalectomy in monkeys were likely exacerbated by the attendant fiber damage

The role of effective communication and trustworthiness in determining guests’ loyalty

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.This study investigates the role of trustworthiness and effective communication in the development of guests’ loyalty within the hotel sector. We propose and test a conceptual model that differentiates between two types of loyalty: attitudinal and behavioral. As hotels can control and manage how they communicate their desired characteristics to guests, we posit effective communication and a hotel’s trustworthiness as the key concepts in building loyalty. This study reports on the findings of a study based on 322 hotel guests. Data were analyzed using structural equation modeling. The results reveal that implementing effective communication methods leads to a trustworthy image, which in turn has a positive impact on attitudinal and behavioral loyalty. This research provides hotel managers with strategic directions for cultivating guest loyalty

The effect of ocean acidification on organic and inorganic speciation of trace metals

Rising concentrations of atmospheric carbon dioxide are causing acidification of the oceans. 20 This results in changes to the concentrations of key chemical species such as hydroxide, 21 carbonate and bicarbonate ions. These changes will affect the distribution of different forms 22 of trace metals. Using IPCC data for pCO2 and pH under four future emissions scenarios (to 23 the year 2100) we use a chemical speciation model to predict changes in the distribution of 24 organic and inorganic forms of trace metals. Under a scenario where emissions peak after 25 the year 2100, predicted free ion Al, Fe, Cu and Pb concentrations increase by factors of up 26 to approximately 21, 2.4, 1.5 and 2.0 respectively. Concentrations of organically complexed 27 metal typically have a lower sensitivity to ocean acidification induced changes. 28 Concentrations of organically-complexed Mn, Cu, Zn and Cd fall by up to 10%, while those 29 of organically-complexed Fe, Co and Ni rise by up to 14%. Although modest, these changes 30 may have significance for the biological availability of metals given the close adaptation of 31 marine microorganisms to their environment