[Relationship between Moral Concerns and Problem-Solving Behaviors for Outpatient Nurses Working in Palliative Care Accredited Educational Facilities].

The purpose of this study was to examine the moral concerns and problem-solving behavior for outpatient nurses in palliative cancer care. The target of this study was 284 outpatient nurses(22.9%)out of 1,241 respondents. As a result, it was concluded that outpatient nurses providing palliative cancer care have higher ethical concerns than nurses working in acute care hospitals. In addition, the more moral concerns there were, the more nurses manage their care according to patient's individual circumstances. In the future, it is necessary to provide education on the moral concerns of outpatient nurses and the problem-solving behavior for nurses so that patients in the final stages of life and their families can spend a better time.

Motivations matter: moral and health-related motives indirectly relate to differential psychological health indicators among vegetarians.

Due to rising popularity of vegetarianism in recent years, research interest has surged in examining the relationship between vegetarianism and psychological health. However, given inconsistent findings in prior research, the answer to whether practicing vegetarianism is associated with better or worse psychological health is still elusive. The present investigation aimed to demonstrate that vegetarians are not homogeneous in terms of psychological experiences, such that it is crucial to consider the motives behind vegetarians' dietary choice when examining their psychological health. In a survey study with 266 vegetarians and 104 omnivores, it was shown that health vegetarians displayed higher levels of disordered eating as compared to moral vegetarians and omnivores. Mediation analyses further revealed that, among vegetarians, health motivation was positively correlated with disordered eating tendencies, indirectly linking it with poorer psychological health; moral motivation was positively correlated with prosocial behavior, which in turn predicted better psychological health. These findings have implications for understanding the psychological health of vegetarians with different dietary motives and for developing interventions to promote their psychological health.

How would you describe a mentally healthy college student based on Chinese culture? A qualitative research from the perspective of college students.

BACKGROUND: Promoting college students' mental health remains a significant concern, necessitating a clear understanding of what constitutes good mental health. Variations in the conceptualizations of mental health across cultures, typically derived from academic and authoritative perspectives, have overlooked insights from laypeople. This study aims to investigate the characteristics of mentally healthy college students within Chinese cultural contexts, emphasizing perspectives provided by college students themselves. METHODS: Undergraduates with self-reported mental health scores ≥ 7 were randomly selected for in-depth interviews. The sample (N = 17, 59% female) had a mean age of 20.82 ± 1.33 years and represented diverse regions, backgrounds, and academic fields. Thematic analysis was used in the analysis of the qualitative data, involving initial coding to identify 168 manifestations of mental health among college students, followed by categorizing them into 18 characteristics through focused coding. These characteristics were then organized into five themes via core coding. The Delphi method was utilized to validate the themes with 3 experts, ensuring the trustworthiness of the final findings. RESULTS: Eighteen characteristics of mentally healthy college students emerged from the interviews, categorized into 5 themes: (1)Value Pursuit (i.e. Having a sense of responsibility and mission and being willing to dedicate oneself to the country at any time.); (2)Life Attitude (i.e. Staying positive and having the ability and quality to cope with hardships.); (3)Interpersonal Ideals (i.e., Showing filial respect to parents appropriately.); (4)Behavior Ability(i.e., Studying diligently and learning well.); and (5)Self-cultivation (i.e., Possessing good qualities advocated by Confucianism, Buddhism, and Taoism coexist harmoniously.). Most of these characteristics directly reflect traditional Chinese culture or culture that has changed with the times. At the same time, some are a reflection of modern Chinese new culture. CONCLUSIONS: On the whole, the characteristics of mentally healthy college students are diverse and with rich connotations, focusing on the individual's relationship with the country, family, and others, and are good expressions of Chinese cultural features, such as the balance of Yin and Yang, the coexistence of Confucianism, Buddhism, and Taoism, and highlight moral attributes. In essence, these traits hold profound importance in advancing the mental health of Chinese college students.

The influence of psychological resilience and nursing practice environment on nurses' moral courage: A cross-sectional study.

AIM: To determine the relationship between psychological resilience, nursing practice environment, and moral courage of clinical nurses and also the factors influencing moral courage. DESIGN: Cross-sectional study. METHODS: 586 nurses from a general hospital were selected by convenience sampling method in January 2023. The general information questionnaire, Nurses' Moral Courage Scale (NMCS), Resilience Scale, and Practice Environment Scale (PES) were measured. Hierarchical linear regression analysis was used to explore the influencing factors of clinical nurses' moral courage. RESULTS: Nurses' average moral courage score was 79.00 (69.00, 91.00). The nurses' moral courage was positively correlated with psychological resilience and nursing practice environment. Multivariate linear regression analysis showed that psychological resilience and nursing practice environment entered the regression equation, accounting for 23.4% of the total variation. Psychological resilience and nursing practice environment are the main factors affecting the moral courage of clinical nurses. Nursing managers should conduct moral courage training, develop a decent nursing practice environment, pay attention to the psychological emotions of nurses, and actively build a safe, open, and supportive atmosphere for moral behaviour.

Moral distress measurement in animal care workers: a systematic review.

OBJECTIVES: The mental health of veterinary and other animal health professionals is significantly impacted by the psychological stressors they encounter, such as euthanasia, witnessing animal suffering and moral distress. Moral distress, initially identified in nursing, arises when individuals are aware of the right action but are hindered by institutional constraints. We aimed to review existing research on moral distress scales among animal care workers by focusing on the identification and psychometric validity of its measurement. DESIGN: Two-step systematic review. First, we identified all moral distress scales used in animal care research in the eligible original studies. Second, we evaluated their psychometric validity, emphasising content validity, which is a critical aspect of patient-reported outcome measures (PROMs). This evaluation adhered to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). The results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES: PubMed, EMBASE and PsycINFO to search for eligible studies published between January 1984 and April 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included original (primary) studies that (1) were conducted in animal care workers; (2) describing either the development of a moral distress scale, or validation of a moral distress scale in its original or modified version, to assess at least one of the psychometric properties mentioned in COSMIN guidelines. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used standardised methods to search, screen and code included studies. We considered the following information relevant for extraction: study reference, name and reference of the moral distress scale used, psychometric properties assessed and methods and results of their assessments. The collected information was then summarised in a narrative synthesis. RESULTS: The review identified only one PROM specifically adapted for veterinary contexts: the Measure of Moral Distress for Animal Professionals (MMD-AP), derived from the Measure of Moral Distress for Healthcare Professionals (MMD-HP). Both MMD-HP and MMD-AP were evaluated for the quality of development and content validity. The development quality of both measures was deemed doubtful. According to COSMIN, MMD-HP's content validity was rated as sufficient, whereas MMD-AP's was inconsistent. However, the evidence quality for both PROMs was rated low. CONCLUSION: This is the first systematic review focused on moral distress measurement in animal care workers. It shows that moral distress is rarely measured using standardised and evidence-based methods and that such methods should be developed and validated in the context of animal care. PROSPERO REGISTRATION NUMBER: CRD42023422259.

Implementation of the Dementia Isolation Toolkit in long-term care improves awareness but does not reduce moral distress amongst healthcare providers.

BACKGROUND: Healthcare providers may experience moral distress when they are unable to take the ethically or morally appropriate action due to real or perceived constraints in delivering care, and this psychological stressor can negatively impact their mental health, leading to burnout and compassion fatigue. This study describes healthcare providers experiences of moral distress working in long-term care settings during the COVID-19 pandemic and measures self-reported levels of moral distress pre- and post-implementation of the Dementia Isolation Toolkit (DIT), a person-centred care intervention designed for use by healthcare providers to alleviate moral distress. METHODS: Subjective levels of moral distress amongst providers (e.g., managerial, administrative, and front-line employees) working in three long-term care homes was measured pre- and post-implementation of the DIT using the Moral Distress in Dementia Care Survey and semi-structured interviews. Interviews explored participants' experiences of moral distress in the workplace and the perceived impact of the intervention on moral distress. RESULTS: A total of 23 providers between the three long-term care homes participated. Following implementation of the DIT, subjective levels of moral distress measured by the survey did not change. When interviewed, participants reported frequent experiences of moral distress from implementing public health directives, staff shortages, and professional burnout that remained unchanged following implementation. However, in the post-implementation interviews, participants who used the DIT reported improved self-awareness of moral distress and reductions in the experience of moral distress. Participants related this to feeling that the quality of resident care was improved by integrating principals of person-centered care and information gathered from the DIT. CONCLUSIONS: This study highlights the prevalence and exacerbation of moral distress amongst providers during the pandemic and the myriad of systemic factors that contribute to experiences of moral distress in long-term care settings. We report divergent findings with no quantitative improvement in moral distress post-intervention, but evidence from interviews that the DIT may ease some sources of moral distress and improve the perceived quality of care delivered. This study demonstrates that an intervention to support person-centred isolation care in this setting had limited impact on overall moral distress during the COVID-19 pandemic.

Relationship between academic procrastination, self-esteem, and moral intelligence among medical sciences students: a cross-sectional study.

BACKGROUND: Academic procrastination is a widespread phenomenon among students. Therefore, evaluating the related factors has always been among the major concerns of educational system researchers. The present study aimed to determine the relationship of academic procrastination with self-esteem and moral intelligence in Shahroud University of Medical Sciences students. METHODS: This cross-sectional descriptive-analytical study was conducted on 205 medical sciences students. Participants were selected based on inclusion and exclusion criteria using the convenience sampling technique. The data collection tools included a demographic information form, Solomon and Rothblum's Procrastination Assessment Scale-Students, Rosenberg Self-Esteem Scale, and Lennick and Kiel's Moral Intelligence Questionnaire, all of which were completed online. The data were analyzed using descriptive statistics and inferential tests (multivariate linear regression with backward method) in SPSS software. RESULTS: 96.1% of participating students experienced moderate to severe levels of academic procrastination. Based on the results of the backward multivariate linear regression model, the variables in the model explained 27.7% of the variance of academic procrastination. Additionally, self-esteem (P < 0.001, ß=-0.942), grade point average (P < 0.001, ß=-2.383), and interest in the study field (P = 0.006, ß=-1.139) were reported as factors related to students' academic procrastination. CONCLUSION: According to the findings of this study, the majority of students suffer from high levels of academic procrastination. Furthermore, this problem was associated with low levels of self-esteem, grade point average, and interest in their field of study.

Modeling children's moral development in postwar Taiwan through naturalistic observations preserved in historical texts.

A core issue in the interdisciplinary study of human morality is its ontogeny in diverse cultures, but systematic, naturalistic data in specific cultural contexts are rare to find. This study conducts a novel analysis of 213 children's socio-moral behavior in a historical, non-Western, rural setting, based on a unique dataset of naturalistic observations from the first field research on Han Chinese children. Using multilevel multinomial modeling, we examined a range of proactive behaviors in 0-to-12-year-old children's peer cooperation and conflict in an entire community in postwar Taiwan. We modeled the effects of age, sex, kinship, and behavioral roles, and revealed complex interactions between these four variables in shaping children's moral development. We discovered linkages between coercive and non-coercive behaviors as children strategically negotiated leadership dynamics. We identified connections between prosocial and aggressive behaviors, illuminating the nuances of morality in real life. Our analysis also revealed gendered patterns and age-related trends that deviated from cultural norms and contradicted popular assumptions about Chinese family values. These findings highlight the importance of naturalistic observations in cultural contexts for understanding how we become moral persons. This re-analysis of historically significant fieldnotes also enriches the interdisciplinary study of child development across societies.

The impact of volunteer service on moral education performance and mental health of college students.

BACKGROUND: Moral education in colleges and universities is an important part of the talent training system, including moral education curriculum, moral education practice, mental health education. Volunteer service is a public welfare act in which volunteers volunteer their time, knowledge, property, technology, with the ultimate goal of helping others and serving the society without personal compensation. As an innovative form of moral education practice in colleges and universities, college students' voluntary service is of great significance in promoting the reform and innovation of moral education, enhancing the affinity, appeal and influence of moral education, and building a positive psychology for college students. SUBJECTS AND METHODS: As an effective carrier of moral education practice in colleges and universities, voluntary service is helpful to enhance the effectiveness of moral education practice and construct the positive psychology of college students. This project is based on the actual situation of college students participating in volunteer services, and collected the volunteer services of 4545 college students in Zhejiang Province. Through model construction and data modeling, the correlation between college students' participation in volunteer service and their moral education performance and mental health was analyzed, and the basic path and guarantee measures to promote the role of volunteer service in moral education and positive psychological construction were deeply explored. RESULTS: From the correlation analysis of students' voluntary service participation, moral education performance and voluntary service motivation, students' attributes are determined according to their voluntary service participation, so as to predict their moral education performance and mental health level. CONCLUSION: College students' voluntary service is partially positively related to their moral education performance and mental health. In order to improve students' moral education performance and mental health, we can optimize the participation frequency, participation duration, participation ways and type structure of voluntary service, constantly increase the participation frequency of voluntary service, increase the duration of voluntary service, broaden the participation ways of voluntary activities, and enrich the types of voluntary service activities.

Moral decision-making at night and the impact of night work with blue-enriched white light or warm white light: a counterbalanced crossover study.

BACKGROUND: Cognitive function, including moral decision-making abilities, can be impaired by sleep loss. Blue-enriched light interventions have been shown to ameliorate cognitive impairment during night work. This study investigated whether the quality of moral decision-making during simulated night work differed for night work in blue-enriched white light, compared to warm white light. METHODS: Using a counterbalanced crossover design, three consecutive night shifts were performed in blue-enriched white light (7000 K) and warm white light (2500 K) provided by ceiling-mounted LED luminaires (photopic illuminance: ∼200 lx). At 03:30 h on the second shift (i.e. twice) and at daytime (rested), the Defining Issues Test-2, assessing the activation of cognitive schemas depicting different levels of cognitive moral development, was administered. Data from 30 (10 males, average age 23.3 ± 2.9 years) participants were analysed using linear mixed-effects models. RESULTS: Activation of the post-conventional schema (P-score), that is, the most mature moral level, was significantly lower for night work in warm white light (EMM; estimated marginal mean = 44.3, 95% CI = 38.9-49.6; pholm=.007), but not blue-enriched white light (EMM = 47.5, 95% CI = 42.2-52.8), compared to daytime (EMM = 51.2, 95% CI = 45.9-56.5). Also, the P-score was reduced for night work overall (EMM = 45.9, 95% CI = 41.1-50.8; p=.008), that is, irrespective of light condition, compared to daytime. Neither activation of the maintaining norms schema (MN-score), that is, moderately developed moral level, nor activation of the personal interest schema (i.e. the lowest moral level) differed significantly between light conditions. The MN-score was however increased for night work overall (EMM = 26.8, 95% CI = 23.1-30.5; p=.033) compared to daytime (EMM = 23.1, 95% CI = 18.9-27.2). CONCLUSION: The results indicate that moral decisions during simulated night work in warm white light, but not blue-enriched white light, become less mature and principle-oriented, and more rule-based compared to daytime, hence blue-enriched white light may function as a moderator. Further studies are needed, and the findings should be tentatively considered.Trial registration: ClinicalTrials.gov (ID: NCT03203538) Registered: 26/06/2017; https://clinicaltrials.gov/study/NCT03203538.

The quality of moral decision-making, seen as the activation of cognitive schemas depicting different levels of moral development, was reduced during simulated night work in warm white light, but not blue-enriched light, compared to daytime.The quality of moral decision-making sems to be reduced during simulated night work, compared to daytime.More studies assessing the impact of night work and light interventions on the quality of moral decision-making are needed to validate these tentative findings.

How social evaluations shape trust in 45 types of scientists.

Science can offer solutions to a wide range of societal problems. Key to capitalizing on such solutions is the public's trust and willingness to grant influence to scientists in shaping policy. However, previous research on determinants of trust is limited and does not factor in the diversity of scientific occupations. The present study (N = 2,780; U.S. participants) investigated how four well-established dimensions of social evaluations (competence, assertiveness, morality, warmth) shape trust in 45 types of scientists (from agronomists to zoologists). Trust in most scientists was relatively high but varied considerably across occupations. Perceptions of morality and competence emerged as the most important antecedents of trust, in turn predicting the willingness to grant scientists influence in managing societal problems. Importantly, the contribution of morality (but not competence) varied across occupations: Morality was most strongly associated with trust in scientists who work on contentious and polarized issues (e.g., climatologists). Therefore, the diversity of scientific occupations must be taken into account to more precisely map trust, which is important for understanding when scientific solutions find their way to policy.

Moral injury, race-related stress and post-traumatic stress disorder in a trauma-exposed Black population.

BACKGROUND: Race-related stress (RRS) is an unrecognized source of moral injury (MI)-or the emotional and/or spiritual suffering that may emerge after exposure to events that violate deeply held beliefs. Additionally, MI has not been explored as a mechanism of risk for post-traumatic stress disorder (PTSD) in trauma-exposed civilians. We examined relations among exposure to potentially morally injurious events (moral injury exposure, MIE), related distress (moral injury distress, MID), and RRS in Black Americans. Potential indirect associations between RRS and PTSD symptoms via MID were also examined. METHODS: Black Americans (n = 228; 90.4% female; Mage = 31.6 years. SDage = 12.8 years) recruited from an ongoing study of trauma completed measures assessing civilian MIE and MID, RRS, and PTSD. Bivariate correlations were conducted with MIE and MID, and mediation analysis with MID, to examine the role of MI in the relationship between RRS and PTSD symptom severity. RESULTS: MIE was significantly correlated with cultural (r = 0.27), individual (r = 0.29), and institutional (r = 0.25) RRS; MID also correlated with cultural (r = 0.31), individual (r = 0.31), and institutional (r = 0.26) RRS (ps < 0.001). We found an indirect effect of RRS on PTSD symptoms via MID (ß = 0.10, p < 0.005). CONCLUSIONS: All types of RRS were associated with facets of MI, which mediated the relationship between RRS and current PTSD symptoms. MI may be a potential mechanism through which RRS increases the risk for PTSD in Black individuals.

The sociocultural influences in Lawrence Kohlberg's life: a psychobiography.

Lawrence Kohlberg (1927-1987) was a moral development specialist and moral teacher. He is considered an exceptional individual due to the success he obtained from developing his Theory of Moral Development. Throughout Kohlberg's life, there was a reciprocal influence between Kohlberg's development and the sociocultural influences of his time, guiding his life story. This psychobiography used a longitudinal, single-case research design from the qualitative paradigm, utilising the descriptive-interpretive approach to explore the influences which shaped major life events in Kohlberg's life. This research design enabled the illumination of how sociocultural circumstances shaped various spheres in Kohlberg's life, such as his identity, education, career path and vocational success. This was done through using Bronfenbrenner's Bioecological Theory of Human Development Framework, by including its enmeshed, most up-to-date scientific research design, the Proximal-Person-Context-Time Model.

Measuring moral distress in health professionals using the MMD-HP-SPA scale.

BACKGROUND: Moral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes. METHODS: A regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice. RESULTS: The mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9). CONCLUSIONS: Female, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals.

Reciprocity in ambiguous situations: Default psychological strategies underlying ambiguity resolution in moral decision-making.

When deciding whether to reciprocate trust, people are typically strongly influenced by how much trust their interaction partner has originally shown them. If a partner has placed a lot of trust in you, there is a strong motivation to reciprocate, and indeed this factor often outweighs pro-self considerations to maximize one's own financial payout. However, one important unanswered question in this regard is what people decide to do when this prior information is ambiguous; that is, when they do not know for sure exactly how trusting their partner has been. How then do people decide to reciprocate? This study utilizes a novel version of the Trust Game to directly address this question. Here, we develop, and validate, a computational model-based approach to quantify and categorize how participants assessed the trustworthiness of an unfamiliar partner when making reciprocity decisions. We find that participants spontaneously use their prior experience about the trustingness of game partners in general to inform their reciprocity decisions, even when they had the opportunity to strategically assume that their new, unfamiliar, partners were untrusting, and hence could have justified lower reciprocation rates.

"Just pee in the diaper" - a constructivist grounded theory study of moral distress enabling neglect in nursing homes.

BACKGROUND: A growing body of evidence shows that many nursing home residents' basic care needs are neglected, and residents do not receive qualitatively good care. This neglect challenges nursing staff´s professional and personal ideals and standards for care and may contribute to moral distress. The aim of this study was to investigate how nursing staff manage being a part of a neglectful work culture, based on the research question: "How do nursing home staff manage their moral distress related to neglectful care practices?" METHODS: A qualitative design was chosen, guided by Charmaz´s constructivist grounded theory. The study was based on 10 individual interviews and five focus group discussions (30 participants in total) with nursing home staff working in 17 different nursing homes in Norway. RESULTS: Nursing staff strive to manage their moral distress related to neglectful care practices in different ways: by favouring efficiency and tolerating neglect they adapt to and accept these care practices. By disengaging emotionally and retreating physically from care they avoid confronting morally distressing situations. These approaches may temporarily mitigate the moral distress of nursing staff, whilst also creating a staff-centred and self-protecting work culture enabling neglect in nursing homes. CONCLUSIONS: Our findings represent a shift from a resident-centred to a staff-centred work culture, whereby the nursing staff use self-protecting strategies to make their workday manageable and liveable. This strongly indicates a compromise in the quality of care that enables the continuation of neglectful care practices in Norwegian nursing homes. Finding ways of breaking a downward spiralling quality of care are thus a major concern following our findings.

Forming Evaluations of Moral Character: How Are Multiple Pieces of Information Prioritized and Integrated?

Evaluating other people's moral character is a crucial social cognitive task. However, the cognitive processes by which people seek out, prioritize, and integrate multiple pieces of character-relevant information have not been studied empirically. The first aim of this research was to examine which character traits are considered most important when forming an impression of a person's overall moral character. The second aim was to understand how differing levels of trait expression affect overall character judgments. Four preregistered studies and one supplemental study (total N = 720), using five different measures of importance and sampling undergraduates, online workers, and community members, found that our participants placed the most importance on the traits honest, helpful, compassionate, loyal, and responsible. Also, when integrating the information that they have learned, our participants seemed to engage in a simple averaging process in which all available, relevant information is combined in a linear fashion to form an overall evaluation of moral character. This research provides new insights into the cognitive processes by which evaluations of moral character are formed.