Rationalization and Reflection Differentially Modulate Prior Attitudes Toward the Purity Domain.

Outside Western, predominantly secular-liberal environments, norms restricting bodily and sexual conduct are widespread. Moralization in the so-called purity domain has been treated as evidence that some putative violations are victimless. However, respondents themselves disagree: They often report that private yet indecent acts incur self-harm, or harm to one's family and the wider community-a result which we replicate in Study 1. We then distinguish two cognitive processes that could generate a link between harmfulness and immorality, and recreate them in Studies 2 and 3: Colombian and British participants were randomly assigned to either reflect (decide whether acts are harmful and reconsider their initial moral judgments) or rationalize (decide whether acts are immoral and reconsider their initial harmfulness beliefs). In both countries, reflection promoted opposition to unjust, but not impure, behavior. Additionally, in both countries, ruminating on the moral status of impure acts elevated beliefs in the acts' harmfulness. We conclude by suggesting that rationalization aggravates, while reflection mitigates, intergroup disagreement regarding putative violations of purity and decency.

Attitudes of Older Chinese Patients Toward Death and Dying.

BACKGROUND: Due to the aging population of China, the need for palliative care will increase. However, one of the barriers to utilization of palliative care is the traditional belief that talking about death and dying is taboo. OBJECTIVE: The aim of this study was to examine to what extent older Chinese patients were willing to answer questions about death and dying by asking them about "fear of death" and their desire to "use advanced life support when dying." DESIGN: Survey questionnaire. SETTING/SUBJECTS: Convenience sample (N = 993 hospitalized patients). RESULTS: Only 215 (21.7%; 95% confidence interval [CI] 16.2%-27.1%) and 99 (9.9%; 95% CI 4.1%-15.8%) patients did not answer the questions related to "fear of death" and "use of advanced life support when dying," respectively, while 439 (44.2%; 95% CI 38.7%-49.7%) answered "yes" and 339 (34.1%; 95% CI 28.7%-39.6%) answered "no" for "fear of death" and 382 (38.5%; 95% CI 32.6%-44.3%) answered "yes" and 512 (51.6%; 95% CI 45.7%-57.4%) answered "no" for "use of advanced life support when dying." In multinomial logistic regression analysis, fear of death was associated with younger age, lowest level of function, and desire to use advanced life support. CONCLUSIONS: The majority of older patients were willing to answer the two questions about death and dying. About one-third of patients were not afraid of death, and older patients were less likely to be afraid of death. More than 50% of patients answered that they would not choose advanced life support when dying. More research in this area is needed to help advance palliative care in China.

Taboo and the different death? Perceptions of those bereaved by suicide or other traumatic death.

Views differ on how far the subject of death has ever been taboo in Western Society. Walter (1991) criticised the way the 'taboo thesis' has been presented, arguing that it has often been 'grossly overdrawn and lacking in subtlety'. Research suggests that suicide and other traumatic death may be particularly difficult for people to talk about or even acknowledge. We interviewed 80 people bereaved due to suicide, or other traumatic death and used interpretative thematic analysis to consider whether the 'death taboo' is evident in these bereavement narratives. People referred to suicide as a different, even stigmatised, death but we also found that those bereaved through other traumatic death felt that their reactions had to be contained and relatively silent. The exception was those bereaved through terrorism or train crash, who were encouraged to grieve openly and angrily: reactions to deaths which are seen as 'private troubles' differ from reactions to deaths which are seen as 'public issues'. Using a symbolic interactionist approach we conclude that the shock and suddenness of the death is tied up both with the circumstances of the death (suicide, murder, accident, terrorism) and the attendant consequences for the social acceptance of public displays of mourning.

Addressing the taboo of medical error through IGBOs: I got burnt once!

BACKGROUND: An I Got Burnt Once (IGBO) is a near-miss or actual clinical event, related to patient safety, that leaves a lasting impact on the health professional (HP) involved. The purpose of this study was to collect and categorize IGBOs from a variety of pediatric HPs and to determine whether the individual's clinical practice was altered as a result. METHODS: Semistructured interviews involved recollection of an IGBO and subsequent changes in clinical practice. The IGBOs were classified into one of the seven Canadian Medical Education Directives for Specialists (CanMEDS) roles and outcome of the event. RESULTS: Of the 38 pediatric HPs approached (25 doctors and 13 female nurses), 35 recalled an IGBO. Most (74 %) were classified to the CanMEDS Medical Expert role (with subcategorization into diagnostics (37 %), treatment (34 %), and clinical management (31 %) followed by communicator (14 %) and collaborator (12 %) roles). Half (55 %) of the respondents considered the IGBO event to be potentially life threatening event to the patient, resulting in no harm (63 %), disability (14 %), and fatality in 17 % of the cases. Most respondents (92 %) stated that IGBOs affected their medical practice for months and sometimes years after the event. CONCLUSIONS: Most practitioners can recall an IGBO in their clinical practice. IGBOs may be a potential source of medical risk avoidance and reduction strategies, and worthy of further investigation by "deep dives" or root cause analysis.

TB questions, East Kwaio answers: community-based participatory research in a remote area of Solomon Islands.

INTRODUCTION: East Kwaio is a remote region on the island of Malaita, Solomon Islands. Atoifi Adventist Hospital (the Hospital) is the only hospital and tuberculosis (TB) services provider in the region. If people come to the Hospital with TB, they are usually admitted for the two-month intensive phase of treatment as there are no community-based TB services. Most people walk or travel by canoe to the Hospital as there are no roads. East Kwaio is known to have high rates of TB; however, it has a low case detection rate and low treatment completion. The aims of this study were to explore why people with TB, especially from the mountain areas, present to the Hospital so late in their illness or do not present at all. The study was part of a larger project to strengthen the research capacity of local health workers and community leaders, supported by visiting researchers from Australia. METHODS: Semi-structured interviews with TB patients, a focus group of key informants and direct interaction with a community with a history of TB were used to explore reasons why people present to the Hospital late in their TB illness. RESULTS: Four interviews and a focus group of 12 key informants were conducted and a mountain hamlet with a history of TB was visited. The results represent the data from the interviews and the focus group. The time delay in presenting to the Hospital from when participants first became unwell ranged between two and three years. In the mountain hamlet, two additional people with probable TB were seen who had not presented to the Hospital during illnesses of five and nine months. Reasons for delays included: seeking care from traditional healers; the challenge of accessing health services due to distance, cost and cultural issues different from the Hospital's worldview; social isolation when in hospital; and being old so not having long to live. Delays in diagnosis of people with TB will increase the risk of transmission to family and through hamlets and villages. This study has led to plans being developed to build a more culturally appropriate TB ward and community treatment program. CONCLUSIONS: The study has identified TB questions that need East Kwaio answers. It has shown that a small project can inform the development of important changes to TB services, such as the redevelopment and relocation of the TB ward. To enable TB control, the local health services need to develop an understanding of, and appropriately engage with, traditional beliefs that influence how people interact with Hospital TB treatment and management. This is the case even if the beliefs are based on a worldview different than that of the health service providers. Ongoing operational research is required into TB diagnosis and treatment services and the many factors that contribute to the high TB burden in this remote area.

Transcultural nursing: its importance in nursing practice.

Transcultural nursing is an essential aspect of healthcare today. The ever-increasing multicultural population in the United States poses a significant challenge to nurses providing individualized and holistic care to their patients. This requires nurses to recognize and appreciate cultural differences in healthcare values, beliefs, and customs. Nurses must acquire the necessary knowledge and skills in cultural competency. Culturally competent nursing care helps ensure patient satisfaction and positive outcomes. This article discusses changes that are important to transcultural nursing. It identifies factors that define transcultural nursing and analyzes methods to promote culturally competent nursing care. The need for transcultural nursing will continue to be an important aspect in healthcare. Additional nursing research is needed to promote transcultural nursing.

An intergenerational approach to understanding Taiwanese American adolescent girls' and their mothers' perceptions about sexual health.

Taiwan-born mothers' perceptions of sexual health affect their Taiwanese American girls' sexual perceptions. Taiwanese American girls grow up balancing two different cultural influences (Taiwanese and American) while living in the majority society. The process of balancing two different cultures is called bi-cultural straddling. Four separate focus group interviews with two sets of mothers and daughters ( N = 20) were conducted to understand intergenerational transmission of thoughts, perceptions, values, and attitudes associated with sex-related taboos and their impact on sexual communication, safety, and sexual health of second-generation Taiwanese American girls. The findings suggest that mother-daughter relationships, particularly mothers' traditional cultural values, influence their daughters' decision-making process. A secondary finding suggests that these girls tend to experience mental strain if they decide to go against their mothers' advice. Implications are that maternal involvement should be increased and further studies conducted to understand mother-daughter relationships, their pattern of sexual-related communicating, and expectations.

Knowledge, attitudes and beliefs about menarche of adolescent girls in Anand district, Gujarat.

A questionnaire survey of knowledge, attitudes and beliefs towards menstruation was made in 22 schools in Anand district, Gujarat state. Of 900 schoolgirls aged 11-17 years, only 38.5% felt comfortable about menarche and only 31.0% believed that menstruation was a normal physiological process. Many (37.2%) had not been informed about menarche before its onset and 48.2% felt they were not mentally prepared. The major sources of information were the mother (60.7%) or an elder sister (15.8%); teachers and others relatives played a small role. In this area of India, many families continue the custom of celebrating the first menarche and observing social restrictions.

Ecological influences of sexuality on early adolescent African American females.

African Americans make up the greater proportion of AIDS cases in adolescent girls but little is understood about the development of sexual risk behaviors during the early adolescent years. This article will explore ecological factors influencing adolescent sexual risk behaviors. In the focus groups, which were conducted using 28 African American mothers and their early adolescent daughters, 2 major themes emerged: exposure and support systems. Mothers described the impact community had on their daughters and how monitoring and support systems worked together to control exposure. The girls detailed the different ways they were impacted by the community. Attitudes the girls adopted from their exposures resulted in risk-taking behaviors or a determination to positively impact the community. Community was shown to be the context of the acquisition of sexual knowledge and attitudes. These findings support the development of interventions to address the impact of community on the participation of sexual risk behaviors.

Oficinas em sexualidade humana com adolescentes / Workshop in human sexuality with adolescents

O presente trabalho tem por objetivo apresentar uma experiência de intervenção em orientação sexual com adolescentes em uma cidade do interior de Minas Gerais. Foram sujeitos da intervenção 50 estudantes da 8ª série do ensino fundamental de uma escola municipal da cidade, divididos em 4 grupos, sendo relatada aqui a experiência vivida em um deles, contando com 13 participantes, com idades variando entre 13 e 15 anos, sendo 8 do sexo masculino e 5 do sexo feminino. Utilizando a metodologia de Oficinas em Dinâmica de Grupo procurou-se, juntamente com os adolescentes, a reflexão e elaboração de sentimentos, comportamentos e conhecimentos compartilhados face à sexualidade, levando em consideração suas angústias e inseguranças relacionadas ao tema, e concentrando-se em dialogar sobre os aspectos afetivos e históricos envolvidos na vivência da sexualidade. A partir da análise dos processos grupais, articulados a uma conscientização ético-política dos sujeitos envolvidos, observou-se uma reconstrução/ressignificação dos sentidos atribuídos à sexualidade, ao pertencimento de gênero e ao contexto social mais amplo.

The objective of this study was to determine how the intervention in sexual guidance was experienced by adolescents in a small city in Minas Gerais. The research involved 50 8th grade students of the municipal elementary school, divided into 4 groups. This article focuses on only one of these groups, with 13 members, 8 male and 5 female, of ages varying from 13 to 15 years old. The methodology used was that of workshops in group dynamics in order for the adolescents to reflect on their feelings, behavior and knowledge, in relation to sexuality. Participants' distress and insecurity in facing the topic were taken into consideration, and emphasis was placed on the emotional aspect and the life history of the subjects involved, in their experiences with sexuality. The analysis of this group process, demonstrated a reconstruction / re-definition of meaning for the ideas related to sexuality, to gender and to the wider social context.