Enhancing Content Validity Assessment With Item Response Theory Modeling.

BACKGROUND: Ensuring the validity of assessments requires a thorough examination of the test content. Subject matter experts (SMEs) are commonly employed to evaluate the relevance, representativeness, and appropriateness of the items. This article proposes incorporating item response theory (IRT) into model assessments conducted by SMEs. Using IRT allows for the estimation of discrimination and threshold parameters for each SME, providing evidence of their performance in differentiating relevant from irrelevant items, thus facilitating the detection of suboptimal SME performance while improving item relevance scores. METHOD: Use of IRT was compared to traditional validity indices (content validity index and Aiken's V) in the evaluation of items. The aim was to assess the SMEs' accuracy in identifying whether items were designed to measure conscientiousness or not, and predicting their factor loadings. RESULTS: The IRT-based scores effectively identified conscientiousness items (R2 = 0.57) and accurately predicted their factor loadings (R2 = 0.45). These scores demonstrated incremental validity, explaining 11% more variance than Aiken's V and up to 17% more than the content validity index. CONCLUSIONS: Modeling SME assessments with IRT improves item alignment and provides better predictions of factor loadings, enabling improvement of the content validity of measurement instruments.

Three Arguments Against Institutional Conscientious Objection, and Why They Are (Metaphysically) Unconvincing.

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection.

Health providers' reasons for participating in abortion care: A scoping review.

BACKGROUND: There is a global shortage of health providers in abortion care. Public discourse presents abortion providers as dangerous and greedy and links 'conscience' with refusal to participate. This may discourage provision. A scoping review of empirical evidence is needed to inform public perceptions of the reasons that health providers participate in abortion. OBJECTIVE: The study aimed to identify what is known about health providers' reasons for participating in abortion provision. ELIGIBILITY CRITERIA: Studies were eligible if they included health providers' reasons for participating in legal abortion provision. Only empirical studies were eligible for inclusion. SOURCES OF EVIDENCE: We searched the following databases from January 2000 until January 2022: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect and Centre for Agricultural and Biosciences International Abstracts. Grey literature was also searched. METHODS: Dual screening was conducted of both title/abstract and full-text articles. Health providers' reasons for provision were extracted and grouped into preliminary categories based on the existing research. These categories were revised by all authors until they sufficiently reflected the extracted data. RESULTS: From 3251 records retrieved, 68 studies were included. In descending order, reasons for participating in abortion were as follows: supporting women's choices and advocating for women's rights (76%); being professionally committed to participating in abortion (50%); aligning with personal, religious or moral values (39%); finding provision satisfying and important (33%); being influenced by workplace exposure or support (19%); responding to the community needs for abortion services (14%) and participating for practical and lifestyle reasons (8%). CONCLUSION: Abortion providers participated in abortion for a range of reasons. Reasons were mainly focused on supporting women's choices and rights; providing professional health care; and providing services that aligned with the provider's own personal, religious or moral values. The findings provided no evidence to support negative portrayals of abortion providers present in public discourse. Like conscientious objectors, abortion providers can also be motivated by conscience.

HHS Issues Revised Health Worker Conscience Rule.

The aim is to balance the rights of clinicians and patients.

Conscientious refusal or conscientious provision: We can't have both.

Some authors argue that it is permissible for clinicians to conscientiously provide abortion services because clinicians are already allowed to conscientiously refuse to provide certain services. Call this the symmetry thesis. We argue that on either of the two main understandings of the aim of the medical profession-what we will call "pathocentric" and "interest-centric" views-conscientious refusal and conscientious provision are mutually exclusive. On pathocentric views, refusing to provide a service that takes away from a patient's health is professionally justified because there are compelling reasons, based on professional standards, to refuse to provide that service (e.g., it does not heal, and it is contrary to the goals of medicine). However, providing that same service is not professionally justified when providing that service would be contrary to the goals of medicine. Likewise, the thesis turns out false on interest-centric views. Refusing to provide a service is not professionally justified when that service helps the patient fulfill her autonomous preferences because there are compelling reasons, based on professional standards, to provide that service (e.g., it helps her achieve her autonomous preferences, and it would be contrary to the goals of medicine to deny her that service). However, refusing to provide that same service is not professionally justified when refusing to provide that service would be contrary to the goals of medicine. As a result, on either of the two most plausible views on the goals of medicine, the symmetry thesis turns out false.

Understanding the extent of and limitations to conscientious objection to abortion by health care practitioners: A hermeneutic study.

The United Kingdom's Abortion Act 1967 has attracted substantial controversy, which has centred not only on the regulation of abortion itself, but also on the extent to which conscientious objection should be permitted. The aim of this study was to examine a range of healthcare professionals' views on conscientious objection and identify the appropriate parameters of conscientious objection to abortion. Gadamer's hermeneutic was utilised to frame this study. We conducted semi-structured interviews in two UK locations with 18 pharmacists, 17 midwives, 12 nurses and nine doctors, encompassing a mix of conscientious objectors and non-objectors to abortion. A multi-faceted in-depth data analysis led to the development of a hermeneutic of "respecting self and others". Four major themes of "doing the job", "entrusting to others", "acknowledging institutional power" and "being selective" and 18 subthemes contributed to this overarching theme. The complexity of the responses indicates that there is little consistency within and between each profession. They show that participants who were conscientious objectors were accepted by their colleagues and accommodated without detriment to the service, and that in larger hospitals, such as those where our work was carried out, it is possible to be employed in the service areas that include abortion while still being a conscientious objector. Finally, our results indicate that, by respecting of self and others, each profession should be able to accommodate conscience-based objections where individual practitioners seek to exercise them. Conscientious objectors as well as non-objectors have something to contribute to the ongoing development of the maternity and gynaecological services as abortion is only a small part of the work of these services.

Conscientious objection and barriers to abortion within a specific regional context - an expert interview study.

BACKGROUND: While most countries that allow abortion on women's request also grant physicians a right to conscientious objection (CO), this has proven to constitute a potential barrier to abortion access. Conscientious objection is regarded as an understudied phenomenon the effects of which have not yet been examined in Germany. Based on expert interviews, this study aims to exemplarily reconstruct the processes of abortion in a mid-sized city in Germany, and to identify potential effects of conscientious objection. METHODS: Five semi-structured interviews with experts from all instances involved have been conducted in April 2020. The experts gave an insight into the medical care structures with regard to abortion procedures, the application and manifestations of conscientious objection in medical practice, and its impact on the care of pregnant women. A content analysis of the transcribed interviews was performed. RESULTS: Both the procedural processes and the effects of conscientious objection are reported to differ significantly between early abortions performed before the 12th week of pregnancy and late abortions performed at the second and third trimester. Conscientious objection shows structural consequences as it is experienced to further reduce the number of possible providers, especially for early abortions. On the individual level of the doctor-patient relationship, the experts confirmed the neutrality and patient-orientation of the vast majority of doctors. Still, it is especially late abortions that seem to be vulnerable to barriers imposed by conscientious objection in individual medical encounters. CONCLUSION: Our findings indicate that conscientious objection possibly imposes barriers to both early and late abortion provision and especially in the last procedural steps, which from an ethical point of view is especially problematic. To oblige hospitals to partake in abortion provision in Germany has the potential to prevent negative impacts of conscientious objection on women's rights on an individual as well as on a structural level.

[Is individualized education for a medical students desirable? A common policy on how to handle medical students requests for individual adaptations is needed]. / Bör individualiserad utbildning för läkarstudenter eftersträvas?

In Sweden, freedom of conscience for health care professionals is not legally permitted. However, requests from medical students to adjust and/or skip compulsory learning activities because of their religious and moral convictions appear to get more abundant. This creates problems when learning activities are directly related to the examination objectives stated by the Higher Education Ordinance of Sweden. Allowing students to abstain from certain parts of the medical program raises difficulties as to what kind of convictions that should be accepted and to what degree. Questions arise regarding equality of learning opportunities, assessment, and reasonable resource allocation. We call for national debate regarding these issues, which different universities now are forced to handle on their own, with the aim of establishing a common approach.

The Association Between Religion and Healthcare Professionals' Attitudes Towards the Conscience Clause. A Preliminary Study From Poland.

Objectives: This study was designed to determine the relationship between religion and healthcare practitioners' attitudes towards conscience clauses in Poland. Methods: We developed a survey assessing impact of religion on attitudes healthcare professionals towards the conscience clause. These questions were explored using a sample of 300 Polish healthcare professionals. Results: The results indicate that religiosity was a significant predictor of acceptance of conscience clauses. It also influenced healthcare practitioners' opinions on medical professionals that should be granted the right to conscience clauses and medical services that may be denied on moral grounds. There was also a significant relationship between healthcare practitioners' religiosity and their eagerness to use conscience clauses in a situation of moral conflict. Finally, religious healthcare practitioners were more concerned about the personal consequences of using this right in a medical environment. Conclusion: This study shows that at the same time, both religious and non-religious healthcare professionals believed that the Polish regulations regarding conscience clause are unclear and inaccurate, therefore leading to misinterpretation and abuse regulation of law.

Critics Say New State "Conscience Laws" Give Physicians Carte Blanche to Refuse Patients.

This Medical News feature discusses state laws that protect physicians who refuse to provide certain services because of religious or moral beliefs.

The Modern Linguocognitive Aspect of the Concept of "conscience" in the Human Worldview.

The relevance of this work stems from the under-researched nature of the concept of "conscience", including its key attributes and functionality across various national contexts. This concept's analysis is shaped by the worldviews and cultures of distinct populations, as viewed through the lens of linguocognitive examination. This article aims to conduct an in-depth conceptual analysis of the term "conscience", examining its national nuances, linguistic paradigms, cognitive perception, the influence of mental processes on communication, and syntactic and stylistic markers. The methodology of the research is based on a conceptual approach to the study of the problem. The paper comprehends in detail the problems associated with established linguistic traditions on the example of English, French, German, Kazakh and Russian languages in linguocognitive terms of expression of extralinguistic reality, a comparative characteristic between different language systems is carried out, factors of influence on the perception of the term "conscience" in the national plan are indicated. The article's content is useful for examining conceptual fields and cultural spheres, analyzing mechanisms of lexical, structural, and stylistic design of concepts, identifying core and peripheral concepts, and considering worldviews, historical factors, and moral foundations of distinct ethnic groups.

The missing voices in the conscientious objection debate: British service users' experiences of conscientious objection to abortion.

BACKGROUND: The fourth section of the 1967 Abortion Act states that individuals (including health care practitioners) do not have to participate in an abortion if they have a conscientious objection. A conscientious objection is a refusal to participate in abortion on the grounds of conscience. This may be informed by religious, moral, philosophical, ethical, or personal beliefs. Currently, there is very little investigation into the impact of conscientious objection on service users in Britain. The perspectives of service users are imperative in understanding the real-world consequences and potential impact of conscientious objection and should be considered when creating and reviewing policies and guidelines. This research provided a platform for women and those who can become pregnant to share their experiences and opinions at a time when these voices are largely excluded in the great tradition of Western political philosophy and law-making processes. METHOD: Five service users were interviewed using a narrative interview approach to uncover their abortion journeys and experiences of conscientious objection. FINDINGS: The findings were presented as found poems and uncovered that doctors are not always: informing service users that they have a conscientious objection to abortion, giving service users enough information to access abortion (indirect referral), treating them non-judgmentally, and providing medically correct information. Service users did not experience burdens such as long waiting times and were still able to access legal abortion. However, service users did experience negative emotional effects, as they were often left feeling scared, angry, and hopeless when they were not referred and/or were mistreated. CONCLUSIONS: Findings indicate that conscientious objection could work in practice. However, it is currently failing some individuals on an emotional level, as not all doctors are adhering to guidelines. Conscientious objection in Britain needs to be addressed, to ensure service users receive fair, impartial, non-judgmental care.

When offering a patient beneficial treatment undermines public health.

Sometimes, offering someone beneficial care is likely to thwart the similar or more serious medical needs of more people. For example, when acute shortage is strongly predicted to persist, providing the long period on scarce intensive care that a certain COVID-19 patient needs is sometimes projected to block several future COVID-19 patients from receiving the shorter periods on intensive care that they will need. Expected utility is typically higher if the former is denied intensive care. A tempting initial account of such cases is that consequentialism supports denying care to that patient and nonconsequentialism supports providing that care. This paper argues that the consequentialist case is more complicated than it may initially seem and that nonconsequentialism sides more readily with denial of the beneficial treatment. It also shows that when denying it would directly enhance public health by a lot, either ethical approach would normally recommend denying it. Practical implications are discussed, including how to address conscientious objection to this shared recommendation.

A new approach to stress of conscience's dimensionality: Hindrance and violation stressors and their role in experiencing burnout and turnover intentions in healthcare.

AIMS: To identify a valid, longitudinally invariant factor model for stress of conscience and to investigate how stress of conscience dimensions associate with burnout and turnover intentions. BACKGROUND: There has been a lack of consensus about the number and content of stress of conscience dimensions, and a lack of longitudinal studies on its development and outcomes. DESIGN: A longitudinal, person-centred survey study using the STROBE checklist. METHODS: Healthcare personnel (n = 306) rated their stress of conscience in 2019 and 2021. Longitudinal latent profile analysis was used to identify different subgroups based on the employees' experiences. These subgroups were then compared in terms of burnout and organisational/professional turnover. RESULTS: Five subgroups were identified, where participants experienced: (1) hindrance-related stress (14%), (2) violation-related stress (2%), (3) both stress dimensions increasing over time (13%), (4) both high yet decreasing over time (7%), and (5) stable levels of low stress (64%). When both hindrance- and violated-related stress were high, it was a significant risk for burnout and turnover. Shortened, 6-item, two-dimensional scale for stress of conscience was found to be reliable, valid, and longitudinally invariant. CONCLUSION: On its own, hindrance-related stress (e.g. lowering one's aspirations for high-quality work) is less detrimental to well-being than when it is combined with violation-related stress (e.g. being forced to do something that feels wrong). IMPLICATIONS FOR THE PROFESSION PATIENT CARE: To prevent burnout and staff turnover in healthcare, different risk factors for stress of conscience need to be identified and addressed. PUBLIC CONTRIBUTION: Data were collected among public sector healthcare workers. RELEVANCE TO CLINICAL PRACTICE: If healthcare workers are forced to ignore their personal values at work, it poses a significant risk for their well-being and retention.

Registered nurses' exposure to high stress of conscience in long-term care.

BACKGROUND: In long-term care, registered nurses and other care providers often experience tensions between ideals and realities in the delivery of services, which can result in stress of conscience. Burnout, low quality of care and a tendency to leave the profession are perceived as consequences. OBJECTIVES: This study aimed to identify the socio-demographic and work-related factors associated with a high level of stress of conscience, particularly between nursing occupations. RESEARCH DESIGN: A cross-sectional survey was conducted among care providers who worked in Norwegian nursing homes and home care services in the spring of 2021. The sample consisted of 950 registered nurses and 1143 other care providers. Data were collected online using the Stress of Conscience Questionnaire (SCQ). ETHICAL CONSIDERATIONS: Participation was voluntary and based on consent. The study was approved by the Norwegian Center for Research Data. RESULTS: Registered nurses were nearly twice as likely to report high levels of stress of conscience compared to other care providers in long-term care. In addition, being a female, living alone, caring for their own children, working in an institution (versus home based), working >75% time, working shifts, not having scheduled meetings for ethical reflection and working in municipalities with a higher population density were factors associated with a high level of SCQ score. DISCUSSION: Knowledge of factors that increase the risk of high SCQ scores in registered nurses provides opportunities for prevention. Managers in long-term care should pay more attention to how work is distributed between the occupational groups and should facilitate real opportunities for ethical reflection. CONCLUSIONS: The results of this study show that registered nurses have particular exposure to high levels of stress of conscience compared to other care providers in long-term care. Particular attention should be paid to registered nurses working in nursing homes.

Patient-activist or ally? Assessing the effectiveness of conscience and beneficiary constituents in disease advocacy fundraising.

Disease advocacy organisations (DAOs) are critical for raising awareness about illnesses and supporting research. While most studies of DAOs focus on personally affected patient-activists, an underappreciated constituency are external allies. Building from social movement theory, we distinguish between beneficiary constituents (disease patients and their loved ones) and conscience constituents (allies) and investigate their relative fundraising effectiveness. While the former have credibility due to illness experience that should increase fundraising, the latter are more numerous. Our study is also the first to investigate where DAO supporters fundraise-through friendship- versus workplace-based networks-and how this interacts with constituent types. Our large-scale dataset includes 9372 groups (nearly 90,000 participants) active in the 'Movember' campaign, a men's health movement around testicular and prostate cancer. We find robust evidence that groups with more beneficiary constituents raise significantly greater funds per participant. Yet because conscience constituents are more numerous, they raise the majority of total aggregate funds. We also find an interaction effect: beneficiary constituents do better in friendship networks, conscience constituents in workplaces. Our findings bear implications for DAOs, indicating they may benefit by encouraging disease patient families to fundraise through friends, and for external allies to focus requests on workplace networks.

Unpredictable robots elicit responsibility attributions.

Do people hold robots responsible for their actions? While Clark and Fischer present a useful framework for interpreting social robots, we argue that they fail to account for people's willingness to assign responsibility to robots in certain contexts, such as when a robot performs actions not predictable by its user or programmer.

Self and Others: Empirical and Neuropsychoanalytic Considerations of Superego and Conscience.

Freud's mature theorizing about human morality entrenched the functioning of the superego in anxiety stemming from the fear of punishment, a view with which many later psychoanalysts took issue, producing a debate as to the distinction between superego and conscience. This debate would later be mirrored more broadly in academic psychology concerning distinctions between shame and guilt. This is an area where the clinical observations and theoretical discussions of psychoanalysis have subtly guided research in cognitive psychology and the cognitive and affective neurosciences. These areas, in turn, have both clarified and supported psychoanalytic theory and practice without negating the rich phenomenological and theoretical basis on which psychoanalysis rests.