Differential reproductive plasticity under thermal variability in a freshwater fish (Danio rerio).

Human-driven increases in global mean temperatures are associated with concomitant increases in thermal variability. Yet, few studies have explored the impacts of thermal variability on fitness-related traits, limiting our ability to predict how organisms will respond to dynamic thermal changes. Among the myriad organismal responses to thermal variability, one of the most proximate to fitness-and, thus, a population's ability to persist-is reproduction. Here, we examine how a model freshwater fish (Danio rerio) responds to diel thermal fluctuations that span the species's viable developmental range of temperatures. We specifically investigate reproductive performance metrics including spawning success, fecundity, egg provisioning and sperm concentration. Notably, we apply thermal variability treatments during two ontogenetic timepoints to disentangle the relative effects of developmental plasticity and reversible acclimation. We found evidence of direct, negative effects of thermal variability during later ontogenetic stages on reproductive performance metrics. We also found complex interactive effects of early and late-life exposure to thermal variability, with evidence of beneficial acclimation of spawning success and modification of the relationship between fecundity and egg provisioning. Our findings illuminate the plastic life-history modifications that fish may undergo as their thermal environments become increasingly variable.

A Qualitative Analysis of the Mental Health Training and Educational Needs of Firefighters, Paramedics, and Public Safety Communicators in Canada.

Background-Public safety personnel (PSP) are at heightened risk of developing mental health challenges due to exposures to diverse stressors including potentially psychologically traumatic experiences. An increased focus on protecting PSP mental health has prompted demand for interventions designed to enhance resilience. While hundreds of available interventions are aimed to improve resilience and protect PSPs' mental health, research evidence regarding intervention effectiveness remains sparse. Methods-Focus groups with PSP elicited a discussion of psychoeducational program content, preferred modes of program delivery, when such training should occur, and to whom it ought to be targeted. Results-The results of thematic analyses suggest that PSP participants feel that contemporary approaches to improving mental health and resilience are lacking. While welcomed, the provision of sporadic one-off mental health and resilience programs by organizations was seen as insufficient, and the available organizational mental health supports were perceived as being questionable. The available programs also left participants feeling insufficiently prepared to deal with personal mental health problems and in discussing mental health concerns with co-workers. Conclusions-Participants reported needing more engaging methods for delivering information, career-long mental health knowledge acquisition, and a systems approach to improve the workplace culture, particularly regarding mental health.

Meat in a Seat: A Grounded Theory Study Exploring Moral Injury in Canadian Public Safety Communicators, Firefighters, and Paramedics.

The work of public safety personnel (PSP) is inherently moral; however, the ability of PSP to do what is good and right can be impeded and frustrated, leading to moral suffering. Left unresolved, moral suffering may develop into moral injury (MI) and potential psychological harm. The current study was designed to examine if MI is relevant to frontline public safety communicators, firefighters, and paramedics. Semi-structured interviews (n = 3) and focus groups (n = 3) were conducted with 19 participants (public safety communicators (n = 2); paramedics (n = 7); and firefighters (n = 10)). Interviews and focus groups were audio-recorded, transcribed, coded, and constantly compared in accordance with the grounded theory method. A conceptual theory of "frustrating moral expectations" emerged, with participants identifying three interrelated properties as being potentially morally injurious: chronic societal problems, impaired systems, and organizational quagmires. Participants navigated their moral frustrations through both integrative and disintegrative pathways, resulting in either needing to escape their moral suffering or transforming ontologically. The current study results support MI as a relevant concept for frontline PSP. Given the seriousness of PSP leaving their profession or committing suicide to escape moral suffering, the importance of the impact of MI on PSP and public safety organizations cannot be ignored or underestimated. Understanding the similarities and differences of morally injurious exposures of frontline PSP may be critical for determining mental health and resilience strategies that effectively protect PSP.

Compromised Conscience: A Scoping Review of Moral Injury Among Firefighters, Paramedics, and Police Officers.

BACKGROUND: Public Safety Personnel (e.g., firefighters, paramedics, and police officers) are routinely exposed to human suffering and need to make quick, morally challenging decisions. Such decisions can affect their psychological wellbeing. Participating in or observing an event or situation that conflicts with personal values can potentially lead to the development of moral injury. Common stressors associated with moral injury include betrayal, inability to prevent death or harm, and ethical dilemmas. Potentially psychologically traumatic event exposures and post-traumatic stress disorder can be comorbid with moral injury; however, moral injury extends beyond fear to include spiritual, cognitive, emotional or existential struggles, which can produce feelings of severe shame, guilt, and anger. OBJECTIVE: This scoping review was designed to identify the extant empirical research regarding the construct of moral injury, its associated constructs, and how it relates to moral distress in firefighters, paramedics, and police officers. METHODS: A systematic literature search of peer-reviewed research was conducted using databases MEDLINE, EMBASE, APA PsychInfo, CINHAL PLUS, Web of Science, SCOPUS, and Google Scholar. Included studies were selected based on the inclusion criteria before being manually extracted and independently screened by two reviewers. RESULTS: The initial database search returned 777 articles, 506 of which remained after removal of duplicates. Following review of titles, abstracts, and full texts, 32 studies were included in the current review. Participants in the articles were primarily police officers, with fewer articles focusing on paramedics and firefighters. There were two studies that included mixed populations (i.e., one study with police officers, firefighters, and other emergency service workers; one study with paramedic and firefighter incident commanders). Most studies were qualitative and focused on four topics: values, ethical decision-making, organizational betrayal, and spirituality. CONCLUSION: Public safety organizations appear to recognize the experience of moral distress or moral injury among public safety personnel that results from disconnects between personal core values, formal and informal organizational values, vocational duties, and expectations. Further research is needed to better understand moral distress or moral injury specific to public safety personnel and inform training and treatment in support of public safety personnel mental health.

Healthcare leadership and applied philosophy: An essential resource.

As healthcare professionals we are committed to the efficient and effective operation of our institutions. Bureaucratic structures, rules, regulations, policies, and of course, measurements, are the tools-at-hand. While there is nothing inherently pernicious about efficient, effective, and measured institutions, we argue what is critically missing in this environment is humanity and authenticity at the cost of meaningful work. The solutions we offer are found in the realm of philosophy and in particular that branch of philosophy that deals with first principles - what is a nurse; what is a patient; what is a hospital?

Le leadership en santé et la philosophie appliquée : une ressource essentielle.

En qualité de professionnels de la santé, nous sommes déterminés à assurer l'exploitation efficiente et efficace de nos établissements. Les outils dont nous disposons sont les structures bureaucratiques, les règles, les règlements, les politiques et, bien sûr, les mesures. Il n'y a rien de foncièrement pernicieux à avoir des établissements efficients, efficaces et mesurés, mais nous soutenons que l'humanité et l'authenticité manquent cruellement dans cet environnement, au prix d'un travail significatif. Les solutions que nous proposons appartiennent au milieu de la philosophie, et particulièrement au secteur qui repose sur des principes fondamentaux : qu'est-ce qu'une infirmière, qu'est-ce qu'un patient, qu'est-ce qu'un hôpital?

Resilience and organisational empowerment among long-term care nurses: effects on patient care and absenteeism.

AIM: To study resilience among long-term care (LTC) nurses and its relationship to organisational empowerment, self-reported quality of care, perceptions of resident personhood (i.e. viewing another person as a person, implying respect) and absenteeism. BACKGROUND: Although resilience has been examined among nurses, it has not been studied in LTC nurses where resident rates of dementia are high, and nurses may experience stress affecting care and the way residents are perceived. METHOD: A sample of one hundred and thirty LTC nurses from across North America completed a series of questionnaires. RESULTS: Resilient nurses were more likely to report higher quality of care and to view residents as having higher personhood status (despite deteriorating cognitive function). Resilience was not predictive of absenteeism. Organisational empowerment did not add to the predictive power of resilience. CONCLUSIONS: Resilience is of importance in LTC nursing research and future studies could examine this construct in relation to objectively measured resident outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: Our findings suggest that interventions to improve LTC staff resilience would be important to pursue and that consideration should be given to resilience in optimizing the match between potential staff members and LTC positions.

The influence of individual and organizational factors on person-centred dementia care.

OBJECTIVES: Although some individual and organizational contributors to person-centred care or quality of care have been studied, they have rarely been examined together. Our goal was to investigate the association of personal and organizational-environmental characteristics with self-reported person-centred behaviours in long-term residential care settings. METHOD: We asked 109 long-term care staff from two Canadian long-term care homes to complete scales assessing self-reported person-centred care, organizational support for person-centred care, beliefs about personhood in dementia, and burnout. Independent variables included four employee background characteristics (age, gender, occupation, and years of education), beliefs about personhood in dementia, burnout, and three aspects of organizational support for person-centred care (the physical environment of residents, collaboration on care, and support from management). Dependent variables included five aspects of person-centred care: autonomy, personhood, knowing the person, comfort care, and support for relationships .We used multiple linear regression analysis and changes in R(2) to test variable associations. RESULTS: Including organizational variables in regression models resulted in statistically significant (p < .05) changes in R(2) for each of the five dependent variables. Including personal variables resulted in statistically significant changes in R(2) for some dependent variables, but not others. In particular, including employee background characteristics resulted in a statistically significant change in R(2) for comfort care, and including beliefs about personhood and burnout resulted in statistically significant changes in R(2) for personhood but not for other dependent variables. CONCLUSION: Organizational characteristics are associated with several aspects of person-centred dementia care. Individual characteristics, including gender, beliefs about personhood, and burnout, appear to be more important to some aspects of person-centred dementia care (e.g., respect for personhood and comfort care) than others.

Finding Meaning in the Work of Nursing: An International Study.

Sixty nurses from five countries (Canada, India, Ireland, Japan, and Korea) took part in 11 focus groups that discussed the question: Do you consider your work meaningful? Fostering meaning and mentorship as part of the institutional culture was a central theme that emerged from the discussions. In this article, we begin with a background discussion of meaning and meaningful work as presented in the literature related to existentialism and hardiness. Next, we describe the method and analysis processes we used in our qualitative study asking how nurses find meaning in their very challenging work and report our findings of four themes that emerged from the comments shared by nurses, specifically relationships, compassionate caring, identity, and a mentoring culture. After offering a discussion of our findings and noting the limitations of this qualitative study, we conclude that nursing leaders and a culture of mentorship play an important role in fostering meaningful work and developing hardy employees.

Discourse on medicine: meditative and calculative approaches to ethics from an international perspective.

Heidegger's two modes of thinking, calculative and meditative, were used as the thematic basis for this qualitative study of physicians from seven countries (Canada, China, India, Ireland, Japan, Korea, & Thailand). Focus groups were conducted in each country with 69 physicians who cared for the elderly. Results suggest that physicians perceived ethical issues primarily through the lens of calculative thinking (76%) with emphasis on economic concerns. Meditative responses represented 24% of the statements and were mostly generated by Canadian physicians whose patients typically were not faced with economic barriers to treatment due to Canada's universal health care system.

The Personhood in Dementia Questionnaire (PDQ): establishing an association between beliefs about personhood and health providers' approaches to person-centred care.

PURPOSE OF THE STUDY: Interest in person-centred dementia care has flourished in the last two decades. Despite growing interest in the development and implementation of person-centred approaches to dementia care, important empirical questions remain. For instance, although Kitwood (1997) emphasized that personhood, a status extended by others, is at the heart of person-centred care, to our knowledge, no one has demonstrated empirically that beliefs about patient status influence how care is provided. The purpose of this series of three studies was to operationalize Kitwood's definition of personhood in order to test this hypothesis. DESIGN AND METHODS: To operationalize Kitwood's definition of personhood, we generated items to create the Personhood in Dementia Questionnaire (PDQ; Study 1). We then completed preliminary tests of the PDQ's convergent and discriminant validity (Study 2). Finally, we examined the PDQ's relationships with other constructs such as burnout and job satisfaction, and we used linear regression to test the hypothesis that health providers' beliefs about personhood influence intended approaches to dementia care (Study 3). RESULTS: In Study 1, we generated a pool of 64 potential questionnaire items. In Study 2, a 20-item version of the PDQ demonstrated good internal consistency, resistance to socially desirable responding, and evidence of convergent and discriminant validity. In Study 3, PDQ scores accounted for a significant proportion of variance in health providers' intended approaches to dementia care, including pain management. PDQ scores were not related to job satisfaction or to most aspects of burnout. IMPLICATIONS: These results provide the first direct empirical evidence of Kitwood's (1997) theory that beliefs about patient personhood have the potential to influence health providers' care decisions, including decisions about pain management.

A controlled investigation of continuing pain education for long-term care staff.

BACKGROUND: The underassessment and undertreatment of pain in residents of long-term care (LTC) facilities has been well documented. Gaps in staff knowledge and inaccurate beliefs have been identified as contributors. OBJECTIVES: To investigate the effectiveness of an expert-based continuing education program in pain assessment/management for LTC staff. METHODS: Participants included 131 LTC staff members who were randomly assigned to either an interactive pain education (PE) program, which addressed gaps in knowledge such as medication management, or an interactive control program consisting of general dementia education without a specific clinical focus. Participants attended three sessions, each lasting 3 h, and completed measures of pain-related knowledge and attitudes/beliefs before, immediately after and two weeks following the program. Focus groups were conducted with a subset of participants to gauge perception of the training program and barriers to implementing pain-related strategies. RESULTS: Analysis using ANOVA revealed that PE participants demonstrated larger gains compared with control participants with regard to pain knowledge and pain beliefs. Barriers to implementing pain-related strategies certainly exist. Nonetheless, qualitative analyses demonstrated that PE participants reported that they overcame many of these barriers and used pain management strategies four times more frequently than control participants. CONCLUSIONS: Contrary to previous research, the present study found that the interactive PE program was effective in changing pain beliefs and improving knowledge. Continuing PE in LTC has the potential to address knowledge gaps among front-line LTC providers.

Culture and organizational climate: nurses' insights into their relationship with physicians.

Within any organization (e.g. a hospital or clinic) the perception of the way things operate may vary dramatically as a function of one's location in the organizational hierarchy as well as one's professional discipline. Interorganizational variability depends on organizational coherence, safety, and stability. In this four-nation (Canada, Ireland, Australia, and Korea) qualitative study of 42 nurses, we explored their perception of how ethical decisions are made, the nurses' hospital role, and the extent to which their voices were heard. These nurses suggested that their voices were silenced (often voluntarily) or were not expressed in terms of ethical decision making. Finally, they perceived that their approach to ethical decision making differed from physicians.

The spirit of sport, morality, and hypoxic tents: logic and authenticity.

The World Anti-Doping Agency (WADA) has recently made a decision to allow the use of hypoxic tents amid a significant amount of controversy over the morality of their use for athletic training purposes. Currently, altitude training is considered moral, but other means of improving aerobic performance are not; for example, blood doping. Altitude training and blood doping have similar results, but the methods by which the results are achieved differ greatly. The controversy lies in how the use of a hypoxic device falls within WADA's philosophy, which will then dictate future policy. This paper discusses the influence of a hypoxic environment on human physiology, altitude training's influence on athletic performance, the concept of authentic physiology, and moral behaviour that is the foundation for logical debate.

An analysis of the ethical and linguistic content of hospital mission statements.

An analysis of the ethical and functional linguistic content of Canadian hospital mission statements was conducted. The ethical content analysis identified deontology as the dominant ethical orientation. The functional linguistic analysis revealed a trend toward the depersonalization and objectification of action. Implications for formulating effective mission statements were discussed.

A study of thematic content in hospital mission statements: a question of values.

We examined the content of Canadian hospital mission statements using thematic content analysis. The mission statements that we studied varied in terms of both content and length. Although there was some content related to goals designed to ensure organizational visibility, survival, and competitiveness, the domain of values predominated over our entire coding structure. The primary value-related theme that emerged concerned the importance of patient care.

The problem of pain management among persons with dementia, personhood, and the ontology of relationships.

While pain is common among seniors, it is not adequately treated or managed. In particular, pain in seniors with dementia is often undertreated and undermanaged. Although the undertreatment of pain among persons with cognitive impairments represents a serious ethical concern for pain clinicians, most writers in the area explain the undertreatment of pain by focusing on issues related to liability, fears of addiction to opioids, and erroneous beliefs that pain is a normal part of the ageing process. We argue that the philosophical notion of personhood must also be given careful attention when considering the problem of pain undermanagement. In this paper, we consider the undertreatment of pain among seniors with dementia, while focusing on the ontology of relationships and on existential philosophy. Moreover, we outline a series of recommendations to help minimize the probability of pain undertreatment in this population and to encourage considerations relating to personhood when treating people with dementia.

The ethical ideologies of psychologists and physicians: a preliminary comparison.

The ethical ideologies of psychologists (who provide health services) and physicians were compared using the Ethics Position Questionnaire. The findings reveal that psychologists tend to be less relativistic than physicians. Further, we explored the degree to which physicians and psychologists report being influenced by a variety of factors (e.g., family views) in their ethical decision making. Psychologists were more influenced by their code of ethics and less influenced by family views, religious background, and peer attitudes than were physicians. We argue that these differences reflect the varied professional cultures in which practitioners are trained and socialized.

Ethical orientation, functional linguistics, and the codes of ethics of the Canadian Nurses Association and the Canadian Medical Association.

The literature on codes of ethics suggests that grammatical and linguistic structures as well as the theoretical ethical orientation conveyed in codes of ethics have implications for the manner in which such codes are received by those bound by them. Certain grammatical and linguistic structures, for example, tend to have an authoritarian and disempowering impact while others can be empowering. The authors analyze and compare the codes of ethics of the Canadian Nurses Association (CNA) and the Canadian Medical Association (CMA) in terms of their ethical orientation and grammatical/linguistic structures. The results suggest that the two codes differ substantially along these two dimensions. The CNA code contains proportionally more statements that provide a rationale for ethical behaviour; the statements of the CMA code tend to be more dogmatic. Functional grammar analysis suggests that both codes convey a strong deontological tone that does not enhance the addressee's ability to engage in discretionary decision-making. The nurses' code nonetheless implies a collaborative relationship with the client, whereas the medical code implies that the patient is the recipient of medical wisdom. The implications of these findings are discussed.

Ethical principles of the American Psychological Association: an argument for philosophical and practical ranking.

Unlike the American Psychological Association (APA), the Canadian Psychological Association has adopted a code of ethics in which principles are organized in order of importance. The validity of this hierarchical organization has received some empirical and theoretical support. We conducted a theoretical analysis that revealed conceptual justification for a ranking of the 6 principles in the APA code. Such a ranking could assist psychologists in making more informed and consistent moral choices when confronted with ethical dilemmas that involve conflicts among principles.