Introduction

2018 ◽  
Author(s):  
Cynda Hylton Rushton
Keyword(s):  
Moral Distress ◽  
System Transformation ◽  
Ethical Practice ◽  
Full Spectrum ◽  
Moral Stress ◽  
The Core ◽  
Individual Strategies ◽  
Moral Resilience

This introductory chapter covers the book editor’s personal and professional journey to provide the background for the book. The contours of the book are outlined. They include the nature of moral suffering and illustrate moral distress as a type of moral suffering. A pathway for examining moral adversity as the instigator of moral stress, which unrelieved can lead to moral suffering including moral distress, moral outrage and moral injury and the role of moral resilience including moral repair is outlined. The concept of integrity as the core of moral resilience and the dimensions of resilience that inform the concept of moral resilience are applied in the context of healthcare. Individual strategies to transform moral suffering and cultivate moral resilience and restore integrity are suggested. System transformation is possible by applying the Conscious Full Spectrum approach as a template for moral resilience and ethical practice in healthcare.

Moral Resilience

2018 ◽  
Keyword(s):  
Moral Distress ◽  
Self Regulation ◽  
Radical Change ◽  
Moral Foundations ◽  
Self Awareness ◽  
Ethical Practice ◽  
Healthcare Organizations ◽  
Full Spectrum ◽  
The Individual ◽  
Moral Resilience

Suffering is an unavoidable reality in healthcare. Not only are patients and families suffering but also the clinicians who care for them. Commonly the suffering experienced by clinicians is moral in nature, in part a reflection of the increasing complexity of health care, their roles within it, and the expanding range of available interventions that challenge their moral foundations. Moral suffering is the anguish that arises occurs in response to moral adversity that challenges clinicians’ integrity: the inner harmony that arises when their essential values and commitments are aligned with their choices and actions. The sources and sequelae of moral distress, one type of moral suffering, have been documented among clinicians across specialties. Transforming their suffering will require solutions that expanded individual and system strategies. Moral resilience, the capacity of an individual to restore or sustain integrity in response to moral adversity, offers a path forward. It encompasses capacities aimed at developing self- regulation and self-awareness, buoyancy, moral efficacy, self-stewardship and ultimately personal and relational integrity. Whether it involves gradual or profound radical change clinicians have the potential to transform themselves and their clinical practice in ways that more authentically reflect their character, intentions and values. The burden of healing our healthcare system is not the sole responsibility of individuals. Clinicians and healthcare organizations must work together to transform moral suffering by cultivating the individual capacities for moral resilience and designing a new architecture to support ethical practice. Used worldwide for scalable and sustainable change, the Conscious Full Spectrum approach, offers a method to solve problems to support integrity, shift patterns that undermine moral resilience and ethical practice, and leverage the inner potential of clinicians and leaders to produce meaningful and sustainable results that benefit all.

Moral Distress

2018 ◽  
Author(s):  
Alisa Carse ◽  
Cynda Hylton Rushton
Keyword(s):  
Clinical Practice ◽  
Patient Care ◽  
Moral Distress ◽  
Ethical Practice ◽  
Moral Resilience

Moral distress, a response to moral adversity that imperils integrity under conditions of constraint, has been studied for more than three decades. The context of clinical practice, the complexities of healthcare, clinicians’ roles, and broader society, alongside exponential advances in technology and treatment, create circumstances that regularly imperil integrity. These circumstances create the conditions for burnout, disengagement, and imperiled patient care. Specifically, they foster powerlessness, frustration, anger, diminished moral responsiveness, disillusionment, and shame. The cumulative dynamic of moral distress results in myriad detrimental consequences affecting the bodies, emotions, minds, and souls of clinicians. Transforming these experiences requires a shift in orientation toward restoring and preserving integrity by cultivating capacities of moral resilience and strategies to foster systemic ethical practice.

Introduction

2018 ◽  
Author(s):  
Mokal et
Keyword(s):  
Basic Assumption ◽  
Small And Medium Enterprises ◽  
Modular Approach ◽  
Legal Regime ◽  
The Core ◽  
Medium Enterprises ◽  
The Way

This introductory chapter provides an overview of the Modular Approach to the insolvency of micro, small, and medium enterprises (MSMEs). The Modular Approach shares with standard insolvency regimes the core objectives of preserving and maximizing value in the insolvency estate, ensuring distribution over an appropriate period of time of the highest feasible proportion of that value to those individuals and entities entitled to it, providing due accountability for any wrongdoing connected with the insolvency, and enabling discharge of over-indebted natural persons. The Modular Approach differs from standard processes, however, in the way it pursues these objectives. Its basic assumption is that the parties to an insolvency case are best placed to select the tools appropriate to that case. The role of the legal regime should be to make these tools available to the parties in a maximally flexible way, while creating the correct incentives for their deployment.

scholarly journals Towards collective moral resilience: the potential of communities of practice during the COVID-19 pandemic and beyond

2021 ◽  
pp. medethics-2020-106764 ◽  
Author(s):  
Janet Delgado ◽  
Serena Siow ◽  
Janet de Groot ◽  
Brienne McLane ◽  
Margot Hedlin
Keyword(s):  
Communities Of Practice ◽  
Moral Distress ◽  
Ethical Challenges ◽  
Ethical Practice ◽  
Group Settings ◽  
Healthcare Settings ◽  
Mutual Engagement ◽  
Starting Point ◽  
Group Experiences ◽  
Moral Resilience

This paper proposes communities of practice (CoP) as a process to build moral resilience in healthcare settings. We introduce the starting point of moral distress that arises from ethical challenges when actions of the healthcare professional are constrained. We examine how situations such as the current COVID-19 pandemic can exponentially increase moral distress in healthcare professionals. Then, we explore how moral resilience can help cope with moral distress. We propose the term collective moral resilience to capture the shared capacity arising from mutual engagement and dialogue in group settings, towards responding to individual moral distress and towards building an ethical practice environment. Finally, we look at CoPs in healthcare and explore how these group experiences can be used to build collective moral resilience.

Mapping the Path of Moral Adversity

2018 ◽  
Author(s):  
Cynda Hylton Rushton
Keyword(s):  
Moral Distress ◽  
Focal Points ◽  
Moral Stress ◽  
Neutral State ◽  
Alternative Path ◽  
Moral Repair ◽  
Moral Resilience

An alternative path for addressing moral adversity and the resultant moral suffering engages the focal points in a cycle of imperiled integrity in response to moral harms, wrongs, failures, or other forms of moral adversity. Initially moral stress, a neutral state of readiness to respond that will eventually involve an appraisal as positive or negative, may be experienced. Depending on this appraisal and individual capabilities, moral stress may be rebalanced, released, or resolved, engaging our moral resilience to proactively or prospectively respond to moral adversity. Alternatively, when the moral stress of imperiled integrity exceeds our capacities and becomes unmanageable or overwhelming, it can instigate a pathway leading to moral suffering that includes moral distress, outrage, and injury. In some instances moral suffering leads to recalcitrant or persistent forms of moral decline. When moral resilience including a process of moral repair is leveraged, integrity can be restored.

Designing Sustainable Systems for Ethical Practice

2018 ◽  
Author(s):  
Cynda Hylton Rushton ◽  
Monica Sharma
Keyword(s):  
Healthcare Organization ◽  
Conceptual Basis ◽  
Ethical Practice ◽  
Full Spectrum ◽  
Specific Change ◽  
Sustainable Solutions ◽  
Sustainable Systems ◽  
Organizational Interventions ◽  
Organizational Integrity ◽  
Moral Resilience

A conceptual basis for designing individual, team, and system interventions to cultivate individual moral resilience and a culture that enables ethical practice is necessary to create sustainable solutions to address moral adversity. It broadens the lens of inquiry to focus on culture, inviting a more robust view of the elements that support ethical practice as well as individual, team, and organizational integrity. Responses to moral adversity are typically partial. In contrast, the Conscious Full Spectrum approach responds to diverse conditions that cause moral adversity to help people innovate, generate breakthroughs, and sustain the specific change that is needed to establish the desired result. This approach helps change-makers recognize patterns, create alternatives, and design tactics, programs, or initiatives that cultivate moral resilience and foster a culture of ethical practice. Individual, team, and organizational interventions are vital in shifting the culture of a healthcare organization.

Individual moral disengagement and bystander behavior in bullying: The role of moral distress and collective moral disengagement.

2020 ◽  
Vol 10 (1) ◽  
pp. 38-47 ◽  
Author(s):  
Gianluca Gini ◽  
Robert Thornberg ◽  
Tiziana Pozzoli
Keyword(s):  
Moral Disengagement ◽  
Moral Distress ◽  
Bystander Behavior

Does a Ribosome Really Read? On the Cognitive Roots and Heuristic Value of Linguistic Metaphors in Molecular Genetics. Part 2

2020 ◽  
Vol 63 (2) ◽  
pp. 46-62
Author(s):  
Suren T. Zolyan
Keyword(s):  
Information Processing ◽  
Genetic Information ◽  
Formal Organization ◽  
Dual Nature ◽  
Reading Frame ◽  
The Core ◽  
Genetic Information Processing ◽  
Cognitive Frame ◽  
Effective Instrument

We discuss the role of linguistic metaphors as a cognitive frame for the understanding of genetic information processing. The essential similarity between language and genetic information processing has been recognized since the very beginning, and many prominent scholars have noted the possibility of considering genes and genomes as texts or languages. Most of the core terms in molecular biology are based on linguistic metaphors. The processing of genetic information is understood as some operations on text – writing, reading and editing and their specification (encoding/decoding, proofreading, transcription, translation, reading frame). The concept of gene reading can be traced from the archaic idea of the equation of Life and Nature with the Book. Thus, the genetics itself can be metaphorically represented as some operations on text (deciphering, understanding, code-breaking, transcribing, editing, etc.), which are performed by scientists. At the same time linguistic metaphors portrayed gene entities also as having the ability of reading. In the case of such “bio-reading” some essential features similar to the processes of human reading can be revealed: this is an ability to identify the biochemical sequences based on their function in an abstract system and distinguish between type and its contextual tokens of the same type. Metaphors seem to be an effective instrument for representation, as they make possible a two-dimensional description: biochemical by its experimental empirical results and textual based on the cognitive models of comprehension. In addition to their heuristic value, linguistic metaphors are based on the essential characteristics of genetic information derived from its dual nature: biochemical by its substance, textual (or quasi-textual) by its formal organization. It can be concluded that linguistic metaphors denoting biochemical objects and processes seem to be a method of description and explanation of these heterogeneous properties.

Exploring the Mechanism of Lingzhu San in Treating Febrile Seizures by Using Network Pharmacology

2020 ◽  
Vol 23 ◽  
Author(s):  
Xiao Zhou ◽  
Xiao-Fei Zhang ◽  
Dong-Yan Guo ◽  
Yan-Jun Yang ◽  
Lin Liu ◽  
...  
Keyword(s):  
Febrile Seizures ◽  
Network Pharmacology ◽  
Biological Processes ◽  
Active Compounds ◽  
Potential Core ◽  
R Language ◽  
The Core ◽  
Multiple Factors ◽  
Therapeutic Mechanism

Objective: Lingzhu San (LZS) is a traditional Chinese medicine (TCM) prescription which can be effective in treating febrile seizures (FS) and has few researches on the mechanisms. In order to better guide the clinical use of LZS, we used the research ideas and methods of network pharmacology to find the potential core compounds, targets and pathways of LZS in the complex TCM system for the treatment of FS, and predict the mechanism. Materials and Methods: Databases such as BATMAN, TCMSP, TCMID, and SWISS TARGET are used to mine the active compounds and targets of LZS, and the target information of FS was obtained through GENECARDS and OMIM. Using Venny2.1.0 and Cytoscape software to locked the potential core compounds and targets of FS. The R language and ClusterProfiler software package were adopt to enrich and analyze the KEGG and GO pathways of the core targets and the biological processes and potential mechanisms of the core targets were revealed. Results: 187 active compounds and 2113 target proteins of LZS were collected. And 38 potential core compounds, 35 core targets and 775 metabolic and functional pathways were screened which involved in mediating FS. Finally, the role of the core compounds, targets and pivotal pathways of LZS regulated FS in the pathogenesis and therapeutic mechanism of FS was discussed and clarified. Conclusions: In this paper, the multi-compounds, multi-targets and multi-pathways mechanism of LZS in the treatment of FS was preliminarily revealed through the analysis of network pharmacology data, which is consistent with the principle of multi-compounds compatibility of TCM prescriptions and unified treatment of diseases from multiple angles, and it provides a new way for TCM to treat complex diseases caused by multiple factors.

Acid ceramidase, a double-edged sword in cancer aggression: A minireview

2020 ◽  
Vol 20 ◽  
Author(s):  
Helen Shiphrah Vethakanraj ◽  
Niveditha Chandrasekaran ◽  
Ashok Kumar Sekar
Keyword(s):  
Cell Fate ◽  
Cancer Progression ◽  
Potential Role ◽  
Tumour Progression ◽  
Acid Ceramidase ◽  
The Core ◽  
The Past ◽  
Sphingosine 1 Phosphate ◽  
Key Enzyme

: Acid ceramidase (AC), the key enzyme of the ceramide metabolic pathway hydrolyzes pro-apoptotic ceramide to sphingosine, which by the action of sphingosine-1-kinase is metabolized to mitogenic sphingosine-1-phosphate. The intracellular level of AC determines ceramide/sphingosine-1-phosphate rheostat which in turn decides the cell fate. The upregulated AC expression during cancerous condition acts as a “double-edged sword” by converting pro-apoptotic ceramide to anti-apoptotic sphingosine-1-phosphate, wherein on one end, the level of ceramide is decreased and on the other end, the level of sphingosine-1-phosphate is increased, thus altogether aggravating the cancer progression. In addition, cancer cells with upregulated AC expression exhibited increased cell proliferation, metastasis, chemoresistance, radioresistance and numerous strategies were developed in the past to effectively target the enzyme. Gene silencing and pharmacological inhibition of AC sensitized the resistant cells to chemo/radiotherapy thereby promoting cell death. The core objective of this review is to explore AC mediated tumour progression and the potential role of AC inhibitors in various cancer cell lines/models.

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