Virtue ethics and nursing: on what grounds?

Within the nursing ethics literature, there has for some time now been a focus on the role and importance of character for nursing. An overarching rationale for this is the need to examine the sort of person one must be if one is to nurse well or be a good nurse. How one should be to live well or live a/the good life and to nurse well or be a good nurse seems to necessitate a focus on an agent's character as well as actions because character is (for the most part) expressed in action (e.g. see Laird). This paper will give an overview of the reasons for the role and importance of character in nursing practice and explain its relation to nursing's frequent use of virtue ethics in order to recommend caution. While the paper agrees that the role of character is important in nursing caution is needed in both how much moral and thus normative, emphasis is being placed on the psychology of character and on the drift to virtue ethics. The psychological which may be explanatory needs to be linked with the normative, and a justification for the normative is needed. A justification as virtue ethics is contested, and nursing practice does not need to take on this explanatory and justificatory burden. A tentative proposal raised but not discussed in depth in this paper is that when an ultimate explanation or explanatory ground is needed, nursing practice leads quite naturally to a form of consequentialism as well as a realist metaethic. On this account, there are two levels of moral thinking, and nursing practice entails the virtues at one level and leads quite naturally to moral thinking at another more critical level of the criterion of what makes something right and good independently of character.     

Obstetric fistula: what about gender power?

Despite over 40 years of research there has been little progress in the prevention of obstetric fistula and women continue to suffer in unacceptable numbers. Gender power imbalance has consistently been shown to have serious implications for women's reproductive health and is known to persist in regions where obstetric fistula occurs. Yet, there is limited research about the role gender power imbalance plays in childbirth practices that put women at risk for obstetric fistula. This information is vital for developing effective maternal health interventions in regions affected by obstetric fistula.     

The gin epidemic: much ado about what?

While there is no doubt that the era of the 'gin epidemic' was associated with poverty and social unrest, the surge in gin drinking was localized to London and was a concomitant, not the cause, of these problems. The two main underlying social problems were widespread overcrowding and poverty. The former was related to an unprecedented migration of people from the country to London. The latter stemmed from an economic ideology called 'poverty theory', whose basic premise was that, by keeping the 'inferior order' in poverty, English goods would be competitive and would remain that way since workers would be completely dependent on their employers. Widespread overcrowding and poverty led to societal unrest which manifested itself in increased drunkenness when cheap gin became available after Parliament did away with former distilling monopolies that had kept prices high. Reformers ignored the social causes of this unrest and, instead, focused on gin drinking by the poor which they feared was endangering England's wealth and security by enfeebling its labour force, and reducing its manpower by decreasing its population. Part of this hostility was also related to gin itself. While drunkenness was often spoken of affectionately when it was induced by beer, England's national drink, gin was considered a foreign drink, and therefore less acceptable. These concerns were voiced less often after the passage of the Tippling Act of 1751, which resulted in an increase in gin prices and decreased consumption. However, the second half of the century was also a period in which England's military victory over the French gave it new wealth and power, which dispelled upper-class fears about an enfeebled and dissolute working class. It was also an era when new public health measures, such as mass inoculation against smallpox, and a decrease in the marrying age, led to a population increase that dispelled reformist fears about manpower shortages. The conclusion is that, while the lower cost of gin sparked the 'gin epidemic', the social unrest associated with this unprecedented surge in gin consumption was exacerbated, rather than caused, by the increase in drinking.     

Interventions: what works, what doesn't?

This review examines the evidence for the effectiveness of occupational stress interventions. Three types of interventions are considered: psychotherapy and counselling services, stress management training, and organizational level interventions. The review concludes that there is good evidence that, for specific mental health problems, formal psychotherapy is effective in terms of reducing individual symptoms. Other forms of intervention have been less well evaluated. The evidence that exists indicates that counselling services and stress management training have modest but short-term effects on individual well-being. Organizational interventions have insignificant effects on individual well-being and on organizational outcomes.     

Educating adolescents about puberty: what are we missing?

Adolescents undergo significant physical and cognitive changes during their pubertal development. These changes contribute to and impact their future development. Educating adolescents at an early age about their expected development decreases the possible anxiety associated with this period of life and also helps adolescents make better choices in regards to their sexuality. In order to assess the degree of education regarding pubertal development and sexuality, we conducted a survey of late adolescents (Median age 19 years) and parents of adolescents. A total of 409 adolescents (237 females, 172 males) and 124 parents completed the survey. 14.4% of teens (36.6% of males and 2% of females) reported that no one spoke to them prior or during puberty about pubertal development or sexuality issues. Teens receiving some form of puberty/sexuality education did so at a median age of 13 for girls and 15 for boys. More than one source of information was the most common (49%) followed by mother only (20%). 85% of parents reported talking to their teens about pubertal development and sexuality. There were several differences between areas reported covered by parents but not by teens, for example 72% of parents reported talking to their teens about gender differences in growth but only 31% of teens reported being spoken to about that. Areas that are very poorly covered are breast development in boys and sexual assault/date rape in girls at 5% and 26% respectively. In summary, it appears that we continue to do a relatively poor job in educating our kids about their development and sexuality and we do it late. Boys are even less likely than girls to be talked to about many areas of pubertal development and sexuality and when that is done, it is done at a later age.     

Health care report cards: what about consumers' perspectives?

Though the report card style is seen by many as a way to create better-informed consumers, very little is actually known about how consumers will respond to health care report cards. Report cards are only one of many factors that influence health care decision making. Much consumer-oriented effort and fine-tuning will be required to make report cards effective. Using the approach called "social marketing" as a framework, specific examples are used to outline some ideas for more intensive pursuit of consumers' perspectives in the design and distribution of report cards.     

Health administration: service before self, but . . . what about pay?

Author peers throuth the 'perpetual fog' that is pay--pay policy, pay restraint, pay freeze--to try to discern the way wages are negotiated, the 'lumpy' aspect of the structure and the problems of job evaluation and reward; matters which, he says, will keep Whitley in steady and altruistically gainful employment for some time to come.