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Nurses around the globe have been impacted psychologically and emotionally during and after the COVID-19 pandemic. The purpose of this study was to describe nurses' perspectives on the concepts of compassion fatigue, second victimhood, burnout, and moral injury. Eight nurses were interviewed either individually or in groups of two. Data were analyzed using conventional content analysis. The following themes were identified: waves of compassion fatigue, traumatization within second victimhood, never the same after chronic burnout, moral injury: nurses couldn't do their best, and connections across concepts. Results showed nurses were most familiar with burnout and compassion fatigue, which remain chronic struggles. Second victimhood and moral injury were more distinct experiences related to traumatic or morally distressing events and likely contributed to experiencing burnout or compassion fatigue. Nurses' suffering heightened during the COVID-19 pandemic and remains prominent three years later. Future research and interventions are urgently needed globally to reduce workplace stressors and promote nurse well-being.

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BACKGROUND: Clinical ethics consultants support mental health professionals in identifying and analyzing moral problems in clinical practice. OBJECTIVE: Presentation of key ethical concepts and normative theories that are relevant for clinical ethics consultation in mental healthcare. MATERIAL AND METHODS: Conceptual and ethical analyses. RESULTS: After distinguishing between morality, ethics and law, moral problems are differentiated from other types of problems encountered in clinical practice. Subsequently, key ethical concepts and the concept of moral distress are clarified. In relation to the normative framework a distinction is made between philosophical ethical theories and medical ethical theories, such as principlism and the ethics of care. Finally, justification tests for ethical decision-making in situations of danger to self or others based on the harm principle and soft paternalism are proposed. CONCLUSION: Knowledge of key ethical concepts and normative theories is important for the identification and analysis of moral problems in mental healthcare and should be given greater weight in the training of clinical ethics consultants.

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Research suggests that character attributes may enable youth to envision and perform civic actions that benefit society, but few studies have examined the longitudinal associations between character attributes and civic actions. As a response to this gap, this study investigated how specific character attributes (purpose, future mindedness, humility, and moral courage) may be differently linked to various civic actions (community service, political activities, social activism) cross-sectionally and longitudinally. Survey data were collected from 521 adolescents (Mage = 14.44, SD = 1.92, 58.5% girls, 60.8% White). Structural equation models demonstrated that purpose and future mindedness were positively associated with all three civic actions at Time 1, but not at Time 2. Humility was not associated with any Time 1 civic actions, but was negatively associated with Time 2 political activities. Moral courage was positively associated with Time 1 social activism and Time 2 political activities. Results illuminate the short-term interplay between character attributes and civic actions and point to internal resources that may promote different forms of youth civic action.

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Emotional artificial intelligence (AI), i.e., affective computing technologies, is rapidly reshaping the education of young minds worldwide. In Japan, government and commercial stakeholders are promulgating emotional AI not only as a neoliberal, cost-saving benefit but also as a heuristic that can improve the learning experience at home and in the classroom. Nevertheless, critics warn of a myriad of risks and harms posed by the technology such as privacy violation, unresolved deeper cultural and systemic issues, machinic parentalism as well as the danger of imposing attitudinal conformity. This study brings together the Technological Acceptance Model and Moral Foundation Theory to examine the cultural construal of risks and rewards regarding the application of emotional AI technologies. It explores Japanese citizens' perceptions of emotional AI in education and children's toys via analysis of a final sample of 2000 Japanese respondents with five age groups (20s-60s) and two sexes equally represented. The linear regression models for determinants of attitude toward emotional AI in education and in toys account for 44 % and 38 % variation in the data, respectively. The analyses reveal a significant negative correlation between attitudes toward emotional AI in both schools and toys and concerns about privacy violations or the dystopian nature of constantly monitoring of children and students' emotions with AI (Education: ßDystopianConcern = - .094***; Toys: ßPrivacyConcern = - .199***). However, worries about autonomy and bias show mixed results, which hints at certain cultural nuances of values in a Japanese context and how new the technologies are. Concurring with the empirical literature on the Moral Foundation Theory, the chi-square (Χ2) test shows Japanese female respondents express more fear regarding the potential harms of emotional AI technologies for the youth's privacy, autonomy, data misuse, and fairness (p < 0.001). The policy implications of these results and insights on the impacts of emotional AI for the future of human-machine interaction are also provided.

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Moral hazard is well known to life insurance underwriters and medical directors to increase the risk of adverse consequences to insured individuals. The underwriting investigation of proposed insureds at time of policy issue is done to ensure no likely moral hazard exists. However, not all situations involving moral hazard may be identified at time of underwriting and policy issue, and may only be identified at time of claim. Three cases that were underwritten for life expectancies in legal matters are described here as examples of moral hazard identified at time of severe injury and/or death. All three of these cases involved a woman who manipulated her male partner into situations that increased the man's risk of severe injury and/or death to the woman's financial benefit. Such "black widows" made a great deal of effort over an extensive period of time to ensure that the moral hazard set up for their male partners resulted in a substantial financial windfall through litigation. The moral hazard set up by a black widow thus can be considered by the life insurance industry as sufficiently anti-selective and speculative to deny a claim at any time after policy issue.

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Identifying the origins of moral sensitivities, and their elaboration, within infancy and early childhood is a challenging task, given inherent limitations in infants' behavior. Here, I argue for a multi-pronged, multi-method approach that involves cleaving the moral response at its joints. Specifically, I chart the emergence of infants' moral expectations, evaluations, generalization and enforcement, demonstrating that while many moral sensitivities are present in the second year of life, these sensitivities are closely aligned with, and likely driven by, infants' everyday experience. Moreover, qualitative differences exist between the moral responses that are present in infancy and those of later childhood, particularly in terms of enforcement (i.e., a lack of punishment in infancy). These findings set the stage for addressing outstanding critical questions regarding moral development, that include identifying discrete causal inputs to early moral cognition, identifying whether moral cognition is distinct from social cognition early in life, and explaining gaps that exist between moral cognition and moral behavior in development.

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We outline two accounts by which executive function (EF) supports children's moral reasoning: an emergence and an expression account. The emergence account postulates that EF supports the development of moral concepts because it relates to how children navigate their early social environments and how well they can internalize moral messages. The expression account postulates that EF supports children's in-the-moment moral reasoning for complex moral situations. We present data from two studies with preschool children to assess each account. In support of the emergence account, EF longitudinally and positively predicted moral reasoning, but only for children who have experienced moderate forms of peer conflict. In support of the expression account, EF was only correlated with judgments that required the coordination of multiple pieces of information (i.e., retaliation and criterion judgments). We conclude that EF is an important cognitive mechanism of moral development and discuss various implications of these findings for both moral development and EF theory.

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Psychiatric nurses face moral dilemmas that affect their mental health. We investigated whether sense of coherence (SOC) buffers psychiatric nurses' perceived effects of moral dilemmas on their psychological distress. A total of 418 nursing professionals in 6 psychiatric hospitals in Japan completed self-administered questionnaires. A negative correlation was observed between "patient rights" (r = -0.24, p < 0.001), "relationships other than patient" (r = -0.28, p < 0.001), "nursing care" (r = -0.25, p < 0.001) of moral dilemmas and "manageability" of SOC. Additionally, a negative correlation was observed between "patient rights" (r = -0.22, p < 0.001), "relationships other than patient" (r = -0.21, p < 0.001) of moral dilemmas and "comprehensibility" of SOC. Hierarchical multiple regression analysis used the Kessler Psychological Distress Scale-10 (K10), which assessed the degree of mental distress, as the dependent variable, and moral dilemmas and SOC as the independent variables, along with their interaction terms. The K10 scores significantly changed depending on the degree of moral dilemmas in the low SOC group, but not in the high SOC group. SOC buffers the effects of psychiatric nurses' perceived moral dilemmas on their psychological distress.

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Research has indicated a link between the moral circle and an individual's prosocial behaviour. However, it remains uncertain whether this relationship holds across a broader range of countries and is influenced by sociocultural contexts. Drawing from an international dataset encompassing 49,540 participants from 57 countries, this study examined the impact of the moral circle on an individual's generosity and the moderating role of cultural religiosity. The results revealed a significant positive association between moral circle and generosity in a cross-national context. Notably, in religious cultures, the connection between the moral circle and generosity was found to be weaker. Three robustness checks further affirmed that these findings are robust. The research confirmed a positive relationship between the moral circle and generosity in a multinational context but also highlighted the moderating role of cultural religiosity. This finding suggested that future research should further investigate how cultural and religious frameworks influence ethical behaviour.

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Insecure-attached adults are more likely to lie. However, it is unknown whether infant-parent attachment quality relates to lie-telling in early childhood. As in adults, lie-telling in early childhood might be related to attachment insecurity. However, a competing hypothesis might be plausible; lie-telling might be related to attachment security given that lie-telling in early childhood is considered an advancement in social-cognitive development. The current study is the first to investigate the link between insecure/secure and disorganized/non-disorganized attachment and lie-telling behavior in early childhood. Because lie-telling is studied in the context of cheating behavior, the association between cheating and attachment is additionally explored. A total of 560 Dutch children (287 girls) from a longitudinal cohort study (Generation R) were included in the analyses. Attachment quality with primary caregiver (secure/insecure and disorganized/non-disorganized attachment) was assessed at 14 months of age in the Strange Situation Procedure, and cheating and lie-telling were observed in games administered at 4 years of age. The results demonstrated no relationship of attachment (in)security and (dis)organization with cheating and lie-telling. Results are interpreted in light of evidence that lie-telling in early childhood is part of normative development. Limitations are discussed, including the time lag between assessments, the fact that lie-telling was measured toward a researcher instead of a caregiver, and the conceptualization of attachment in infancy versus adulthood. Attachment quality does not affect early normative lie-telling, but how and when it may affect later lying in children remains to be explored.

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This paper theoretically studies pharmaceutical innovation collaborations, where heterogeneous firms compete for heterogeneous academics. At an interim stage, the firm evaluates the project, which allows it to monitor academics and decide whether to terminate the project to avoid the loss from a future failure. This paper explores the contract, project termination strategy, and collaboration matching. The firm's innovation strategy (exploitations or explorations) determines the evaluation structure, which may affect the market equilibrium. By considering different innovation strategies, this paper shows that in each case, the equilibrium matching is unique (either positive or negative assortative). Consequently, the chosen innovation strategy plays a pivotal role in shaping equilibrium matching outcomes. These findings provide theoretical insights into pharma-academic alliances, shed light on the observed positive or negative assortative properties in the market, and advocate for the consideration of innovation strategies and evaluation structures in future research endeavors. Moreover, this paper also provides several empirical and policy implications.

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AIM: Compare the effects of Simulation with problem-based learning (SPBL) and Problem-based learning (PBL) in nursing ethics education on nursing students' moral sensitivity, empathy, critical thinking, test scores and teaching satisfaction. BACKGROUND: Promoting nursing students' individual and ethical and abilities through education is an essential way to improve their ethical performance and build trustful relationship with patients. Despite significant efforts in this area, few have evaluated the effectiveness of Simulation with problem-based learning and Problem-based learning as applied to nursing ethics education. DESIGN: A quasi-experimental design based on a non-equivalent control group pre-test/post-test. METHODS: A quasi-experimental design was used. Participants were 161 undergraduate nursing students from two levels of a university, 88 subjects in the experimental group were taught using Simulation with problem-based learning and 73 subjects in the control group were taught using Problem-based learning. A pre-test, post-test and questionnaire were used to assess the effectiveness of student nursing ethics education. χ2 test was used to examine group differences in students' characteristics and satisfaction with teaching post-intervention. Student's t-test was used to assess group differences in scale scores and test scores. RESULTS: Compared to the pre-test, empathy as well as critical thinking were significantly higher in the PBL group (P<0.05), but there was no significant change in moral sensitivity (P>0.05); moral sensitivity, empathy and critical thinking were significantly higher in the SPBL group (P<0.05). Moreover, this study also showed that improvement in moral sensitivity, empathy, critical thinking and grades was more significant in the SPBL group of nursing students compared to the PBL group (P<0.05) and no statistically significant difference was found between the two groups in terms of teaching satisfaction (P>0.05). CONCLUSION: The use of Simulation with problem-based learning in nursing ethics education has a positive impact on nursing students' competency development and knowledge acquisition. Nurse educators should consider this teaching method and promote change to increase the effectiveness of nursing ethics education.

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AIM: To assess the level of stress of conscience experienced by Polish nurses and midwives and its determinants. DESIGN: Descriptive cross-sectional study. METHODS: The study was conducted from March 2019 to December 2020 and included convenience sampling of nurses and midwives working in hospitals in south-eastern Poland. An adapted version of the stress of the conscience questionnaire was used. RESULTS: A total of 476 nurses and midwives completed the survey. The stress of conscience mean value was 67.57. There were no differences in stress of conscience between nurses and midwives. There were five predictors of stress of conscience for nurses: additional job, place of residence, care for patients over 65 years of age, satisfaction with one's salary and having specialised courses, for midwives: social status, work mode and postgraduate studies. CONCLUSION: With the knowledge of predictors of stress of conscience, educational institutions, policymakers and hospital managers should focus their interventions on the factors that lead to a higher level of stress of conscience. It is essential to provide psychological support, building positive relationships between colleagues and focusing on organisational conditions. IMPLICT: Further research in this area is therefore encouraged, along with pre- and postgraduate training in coping with challenging situations such as the death of a patient and caring for elderly patients with dementia or multiple diseases. The study identifies predictors of stress of conscience and problems that can influence their appearance. Factors that increase the stress of conscience, such as organisational conditions and caring after patients are over age 65, should receive special attention in clinical education and result in the provision of an increased level of support from supervisors. Policymakers should also direct their future actions towards the ageing population, staff shortages, the resignation from the profession by improving working conditions and reducing the stress of conscience. REPORTING METHOD: STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

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In this article we explore how people who experienced a stroke, transient ischaemic attack, or heart attack sought health care during the COVID-19 lockdown periods. Semi-structured interviews were conducted with 27 patients admitted to hospital between March 2020 and May 2021, and one carer who was recruited from cardiac and stroke rehabilitation services in two large acute NHS trusts in England. Drawing on concepts of candidacy, illness and moral work, we discuss how people's sense-making about their symptoms fundamentally shaped both their decisions about seeking help and the impact of COVID-19 on help seeking. Risk perception and interactional ritual chain theory allow further exploration of constructing symbols of national identity in times of crises, managing risk and levels of acceptable risk and critique of ambiguous national messaging over accessing health-care services for people with emergency health-care needs. Our findings have wider implications for supporting access into health care for those with life-threatening conditions under highly publicised strain on the health system, including winter pressure and staff strikes, as well as policymaking and public messaging.

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Moral cognition has largely been studied via dilemmas in which making a utilitarian choice causes instrumental harm (negative dimension). Studies of utilitarianism link this behavior with socioemotional unresponsiveness. However, there is a positive dimension of utilitarianism in which one sacrifices the good of oneself or close others for the overall welfare. We measured utilitarian choices multidimensionally in a patient with behavioral variant frontotemporal dementia (bvFTD), incorporating dilemmas accounting for negative and positive dimensions. Despite socioemotional deficits our patient was highly utilitarian in the positive, dimension of utilitarianism. This case study challenges the tendency to automatically associate bvFTD with antisocial tendencies.

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Purpose: There is robust evidence indicating the adverse association between childhood abuse and depressive symptoms. However, the ways in which childhood physical abuse is indirectly associated with adulthood depressive symptoms by alexithymia and moral disengagement remain poorly understood, particularly in the context of China. The present study aims to investigate how childhood physical abuse may be associated with depressive symptoms via the serial mediation effects of alexithymia and moral disengagement among college students in China. Methods: A total of 686 college students (female: 53.2%) aged from 17 to 28 years old (M = 21.33; SD = 2.53) were recruited from mainland China to participate in an online survey assessing the variables of interest. Structural equation modeling and multiple group analysis were performed using Mplus 7.0 to investigate the hypothesized model. Results: College students' experiences with childhood physical abuse was significantly associated with their depressive symptoms. This relationship was partially mediated by alexithymia and then by moral disengagement. Meanwhile, alexithymia and moral disengagement had a chain mediating effect on childhood physical abuse and depressive symptoms. Furthermore, multigroup analysis revealed that the association between alexithymia and depressive symptoms was stronger among rural students compared to urban students. Furthermore, the mediation model involving moral disengagement applies exclusively to rural students. Conclusion: Alexithymia and moral disengagement exerted serial mediating effect on the association between childhood physical abuse and depressive symptoms. This pattern was particularly pronounced among rural students. These findings underscore the importance of addressing both childhood adversity and maladaptive cognitive processes in the prevention and treatment of depression.

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Neuroimaging studies demonstrate that moral responsibility judgments activate the social cognition network, presumably reflecting mentalising processes. Conceptually, establishing an agent's intention is a sub-process of responsibility judgment. However, the relationship between both processes on a neural level is poorly understood. To date, neural correlates of responsibility and intention judgments have not been compared directly. The present fMRI study compares neural activation elicited by third-party judgments of responsibility and intention in response to animated pictorial stimuli showing harm events. Our results show that the social cognition network, in particular Angular Gyrus (AG) and right Temporo-Parietal Junction (RTPJ), showed stronger activation during responsibility vs. intention evaluation. No greater activations for the reverse contrast were observed. Our imaging results are consistent with conceptualisations of intention attribution as a sub-process of responsibility judgment. However, they question whether the activation of the social cognition network, particularly AG/RTPJ, during responsibility judgment is limited to intention evaluation.

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OBJECTIVES: The psychology of moral decision-making classically contrasts utilitarianism (based on consequences) and deontology (based on moral norms). Previous studies capitalizing on this dichotomy have suggested the presence of a utilitarian bias among patients with severe alcohol use disorder (SAUD). We aimed to further disentangle the processes involved in such bias through a more validated approach, the CNI model of moral decision-making. This model allows to go further than the classical approach by distinguishing sensitivity to consequences (C), to moral norms (N), and general preference for inaction over action (I) in response to moral dilemmas. METHODS: Thirty-four recently detoxified patients with SAUD and 34 matched control participants completed a battery of 48 dilemmas derived from the CNI model, as well as social cognition tasks. RESULTS: In contrast with the utilitarian bias suggested in previous studies based on the classical approach, patients with SAUD did not show an increased sensitivity to consequences in comparison with control participants. However, they showed a reduced sensitivity to moral norms, as well as a greater action tendency. These biases were not related to social cognition deficits. CONCLUSIONS: Patients with SAUD are not more utilitarian than healthy controls, this previously reported bias being artificially generated by the methodological limits of the classical approach. Instead, they present a reduced sensitivity to moral norms and an action bias, which might impact their interpersonal relations and contribute to the social isolation frequently reported in this population, thus identifying moral decision-making as a new therapeutic lever in SAUD.

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OBJECTIVE: The norms governing surgical training warrant a deeper understanding of students' experiences and interpretations of professionalism issues in their learning environment. However, there is scant empirical evidence to describe this process. To fill this gap, we analyzed students' perceptions related to professionalism, moral distress, and communication in the surgical clerkship, particularly regarding their clinical supervisors, whom we refer to as mentors. DESIGN: We retrospectively evaluated written case vignettes and survey responses from medical students on their surgical clerkships regarding their experiences of cases which raised professionalism concerns. Vignettes and surveys were part of standard curricular exercises and analyzed using both qualitative and quantitative methods. SETTING: Our study was conducted at a private academic medical college in the northeast with an affiliated institute of bioethics. PARTICIPANTS: Two-hundred forty-one third year medical students on their surgical clerkships participated through required curricular submissions of case vignettes and surveys. RESULTS: Vignettes and surveys from all 241 students were collected and analyzed. Of these, 106 (43.9%) were identified by the students as relating to professionalism, whereas the research team identified 148 (61.4%) cases as such. Major subtypes of professionalism concerns were categorized as "not showing proper respect" (38.5%), bias (30.4%) and "failure to meet medical standards of care" (29.1%). In professionalism cases, only 27.7% of students would emulate their mentor, 19.7% shared concerns with the mentor, and 58.8% experienced moral distress, all significantly worse than in nonprofessionalism cases (p < 0.001). CONCLUSIONS: With an abundance of professionalism concerns noted, students experienced high rates of moral distress and were unlikely to share concerns with clinical mentors who they generally did not wish to emulate. Attention should be paid to providing a formal curricular venue in which students can discuss their concerns, as untoward experiences in the learning environment risk harming their learning and professional identity development.

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Moral bioenhancement presents the possibility of enhancing morally desirable emotions and dispositions. While some scholars have proposed that moral bioenhancement can produce virtue, we argue that within a virtue ethics framework moral bioenhancement cannot reliably produce virtue. Moreover, on a virtue ethics framework, the pursuit of moral bioenhancement carries moral risks. To make this argument, we consider three aspects of virtue-its motivational, rational, and behavioral components. In order to be virtuous, we argue, a person must (i) take pleasure in doing the right thing and have the correct motivational attitudes; (ii) reason correctly about what is called for in a particular ethical dilemma; and (iii) intentionally and continuously practice and cultivate virtues. These dimensions of morality-in short: precisely those emphasized in a virtue ethics framework-cannot be consistently or reliably met using existing moral bioenhancement technology.