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Background: This paper describes and critically reflects on how children and young people (CYP) acted as public advisors to coproduce health information materials about Long Covid for younger audiences. This work was underpinned by the Lundy model, a framework which provides guidance on facilitating CYP to actively contribute to matters which affect them. Methods: Coproduction activity sessions took place with CYP in schools as well as video conferences with a CYP stakeholder group and CYP with Long Covid. Activities encouraged CYP to focus on the content, format, and design of materials and used problem‐based and collaborative learning to encourage engagement with the project. Using a range of methods and open discussion, CYP codesigned a series of Long Covid health information materials for younger audiences. Results: Sixty‐six CYP (aged 10–18), and two young adults were involved. CYP codesigned specifications for the final materials and provided feedback on early designs. The project led to the development of a series of health information materials targeted at CYP: a short social media campaign with six short videos and a 12‐page illustrated leaflet about Long Covid; released on social media and distributed in local area. All the CYP were positive about the project and their involvement. Discussion: Involving CYP led to the development of innovative and engaging information materials (influence). Developing rapport was important when working with CYP and this was facilitated by using approaches and activities to establish an environment (space) where the CYP felt comfortable sharing their views (voice) and being listened to (audience) by the adults in the project. Working with external groups who are willing to share their expertise can help the meaningful involvement of voices 'less heard'. Public Contribution: One CYP coapplicant contributed to the project design and facilitation of PPIE sessions, 64 CYP were involved in the PPIE sessions to design and feedback on materials. Two young adult media producers worked with CYP to produce these materials, another CYP supported this process. Three public contributors were involved in the preparation of this manuscript. [ABSTRACT FROM AUTHOR]

Introduction: Research with young people (YP) is ethically challenging and bound in a complex maze of issues relating to power, voice and representation. Such sensitivities mean that the challenges raised in researching marginalised YP are often hard to navigate. This paper reports on research carried out with YP to explore links between mental health, school exclusion and involvement in criminal gangs. It aims to provide a practical guide to negotiating some of the methodological and ethical challenges experienced. Method: In‐depth interviews conducted with 28 YP (aged 14–24 years) who were gang involved or seen to be at risk of gang involvement. Research was conducted in youth clubs, alternative provision and youth justice settings. Results: Observations/Reflections We reflect on how navigating ethics can create barriers to involving YP as primary informants in research. We consider why it is important to overcome these hurdles and how public engagement work with recognised gatekeepers and the use of creative interview methods can facilitate meaningful encounters, where YP feel able to share valuable insights into their lives. Conclusion: Alongside a number of specific learning points, the paper reflects on theories behind research with YP, including the need for recognition of power imbalances and reflexivity. It concludes with thoughts on the practical realities of achieving meaningful participation or an 'authentic voice' with marginalised groups and the importance of this in informing policy and practice. Patient or Public Contribution: The focus of this work was to collect experiences of YP who are recognised as gang‐involved or at risk of being so, with a view to informing health and education policies. The scoping study for the project involved extensive public engagement work with YP exploring and trialling suitable methods of accessing, recruiting and ultimately interviewing this target group. This is central to the discussion within the body of the paper. [ABSTRACT FROM AUTHOR]

Human milk (HM) is a highly evolutionary selected, complex biofluid, which provides tailored nutrition, immune system support and developmental cues that are unique to each maternal–infant dyad. In the absence of maternal milk, the World Health Organisation recommends vulnerable infants should be fed with screened donor HM (DHM) from a HM bank (HMB) ideally embedded in local or regional lactation support services. However, demand for HM products has arisen from an increasing awareness of the developmental and health impacts of the early introduction of formula and a lack of prioritisation into government‐funded and nonprofit milk banking and innovation. This survey of global nonprofit milk bank leaders aimed to outline the trends, commonalities and differences between nonprofit and for‐profit HM banking, examine strategies regarding the marketing and placement of products to hospital and public customers and outline the key social, ethical and human rights concerns. The survey captured information from 59 milk bank leaders in 30 countries from every populated continent. In total, five companies are currently trading HM products with several early‐stage private milk companies (PMCs). Products tended to be more expensive from PMC than HMB, milk providers were financially remunerated and lactation support for milk providers and recipients was not a core function of PMCs. Current regulatory frameworks for HM vary widely, with the majority of countries lacking any framework, and most others placing HM within food legislation, which does not include the support and care of milk donors and recipient prioritisation. Regulation as a Medical Product of Human Origin was only in place to prevent the sale of HM in four countries; export and import of HM was banned in two countries. This paper discusses the safety and ethical concerns raised by the commodification of HM and the opportunities policymakers have globally and country‐level to limit the potential for exploitation and the undermining of breastfeeding. Key messages: The number and scope of human milk (HM) profit‐making companies is increasing globallyCurrent regulatory frameworks for HM vary widelyProducts offered by private milk companies (PMCs) are generally more expensive than from HM banksSome PMCs are adopting marketing practices traditionally associated with breast milk substitute companies.The health benefits of HM‐based fortifiers compared to bovine milk‐based fortifiers are unclear and may be marginal [ABSTRACT FROM AUTHOR]

Introduction: Facilitators to implement shared cancer follow‐up care into clinical practice include mechanisms to allow the oncologist to continue overseeing the care of their patient, two‐way information sharing and clear follow‐up protocols for general practitioners (GPs). This paper aimed to evaluate patients, GPs and radiation oncologists (ROs) acceptance of a shared care intervention. Methods: Semi‐structured interviews were conducted pre‐ and post intervention with patients that were 3 years post radiotherapy treatment for breast, colorectal or prostate cancer, their RO, and their GP. Inductive and deductive thematical analysis was employed. Results: Thirty‐two participants were interviewed (19 patients, 9 GPs, and 4 ROs). Pre intervention, there was support for GPs to play a greater role in cancer follow‐up care, however, patients were concerned about the GPs cancer‐specific skills. Patients, GPs and ROs were concerned about increasing the GPs workload. Post intervention, participants were satisfied that the GPs had specific skills and that the impact on GP workload was comparable to writing a referral. However, GPs expressed concern about remuneration. GPs and ROs felt the model provided patient choice and were suitable for low‐risk, stable patients around 2–3 years post treatment. Patients emphasised that they trusted their RO to advise them on the most appropriate follow‐up model suited to their individual situation. The overall acceptance of shared care depended on successful health technology to connect the GP and RO. There were no differences in patient acceptance between rural, regional, and cancer types. ROs presented differences in acceptance for the different cancer types, with breast cancer strongly supported. Conclusion: Patients, GPs and ROs felt this shared cancer follow‐up model of care was acceptable, but only if the RO remained directly involved and the health technology worked. There is a need to review funding and advocate for health technology advances to support integration. Patient or Public Contribution: Patients treated with curative radiotherapy for breast, colorectal and prostate cancer, their RO and their GPs were actively involved in this study by giving their consent to be interviewed. [ABSTRACT FROM AUTHOR]

Introduction: Dysphagia affects up to 70% of care home residents, increasing morbidity and hospital admissions. Speech and language therapists make recommendations to support safe nutrition but have limited capacity to offer ongoing guidance. This study aimed to understand if recommendations made to support safe and effective care are implemented and how these relate to the actual care delivered. Methods: Eleven mealtimes with residents with dysphagia were observed during 2020 using a tool capturing 12 elements of expected practice. Staff actions during mealtimes were compared with adherence to residents' care plans and speech and language therapist recommendations. Results: Written recommendations predominantly focused on food and fluid modification. Observations (n = 66) revealed food texture, posture, and alertness were adhered to on 90% of occasions, but alternating food and drink, prompting and ensuring swallow completed adherence was less than 60%. Thickened fluids frequently did not align with required International Dysphagia Diet Standardisation Initiative levels. Nutrition care provided in the dining room was less safe due to a lack of designated supervision. Conclusion: Care homes need to be supported to establish a safe swallowing culture to improve residents' safety and care experience. WHAT THIS PAPER ADDS: What is already known on this subject?: Dysphagia is associated with considerable morbidity and mortality and has been identified as an independent risk factor for mortality in nursing home residents.There is evidence that compensatory swallowing strategies, safe feeding advice and dietary modifications can reduce the risk of aspiration pneumonia.Care for nursing home residents at mealtimes is often task‐centred and delegated to those with limited training and who lack knowledge of useful strategies to support the nutrition and hydration needs of residents with dysphagia. What this study adds?: Written advice from speech and language therapists on safe nutrition and hydration for residents with dysphagia is focused mainly on food and fluid modification.Nurses and healthcare assistants have limited understanding of International Dysphagia Diet Standardisation Initiative levels or safe swallowing strategies and recommended practices to support safe nutrition care for residents with dysphagia are inconsistently applied especially when residents are eating in dining areas.Care homes are not aware of Royal College of Speech and Language Therapists guidance on how safe nutrition care of residents with dysphagia should be supported. What are the clinical implications of this work?: Care homes need to prioritise a safe swallowing culture that ensures that residents with swallowing difficulties are assisted to eat and drink in a way that enhances their mealtime experience and minimises adverse events that may result in hospital admission.Speech and language therapists could play an important role in training and supporting care home staff to understand and use safe swallowing strategies with residents with dysphagia.The Royal College of Speech and Language Therapists could provide more assistance to care homes to support and guide them in how to implement safe feeding routines.Care home staff have limited knowledge about how to implement safe feeding routines and need more guidance from speech and language specialists on how they can support residents with dysphagia to eat safely.Creating a safe swallowing culture within care homes could help to improve nutrition care and enhance patient safety. [ABSTRACT FROM AUTHOR]

Background: Above cuff vocalisation (ACV) involves the application of an external flow of air via the subglottic port of a tracheostomy. ACV can facilitate vocalisation and may improve swallowing and quality of life for patients with a tracheostomy. A recent systematic review highlighted the limited evidence available for the acceptability, effectiveness, safety or optimal implementation of ACV. Aims: To explore the experience of healthcare professionals (HCPs) using ACV and their perceptions of best practice. Methods and Procedures: Semi‐structured interviews were conducted with a range of HCPs with experience using ACV. Topics included: experiences with ACV, management of ACV, opinions about ACV, impact of COVID‐19, future directions for ACV and impact on length of stay. Interviews were conducted online from December 2020 to March 2022. Data were analysed using reflexive thematic analysis. Outcomes and Results: Twenty‐four HCPs were interviewed from seven countries and five professional groups. Four interconnected themes were developed: (1) moral distress amplifying the need to fix patients; (2) subjectivity and uncertainty leading to variations in practice and purpose; (3) knowledge and experience leading to control and caution; and (4) worth a try or a last resort. Theme four contained three sub‐themes: (a) part of the toolbox; (b) useful but limited tool; and (c) following the patient's lead. The moral distress experienced by HCPs and their essential 'need to fix' patients seems to underpin the varied opinions of ACV. These opinions appear to be formed primarily on the basis of experience, because of the underlying subjectivities and uncertainties. As knowledge and experience with ACV increased, and adverse events were experienced, most HCPs became more cautious in their approach to ACV. Conclusions and Implications: More research is needed to reduce the subjectivities and uncertainties surrounding ACV. The implementation of standardised procedures, processes, and competencies may help to reduce the frequency of adverse events and support a more controlled approach. Widening the focus of the purpose of ACV to include swallowing may help to maximise the potential benefits. WHAT THIS PAPER ADDS: What is already known on the subject: There is limited and low‐quality evidence for above cuff vocalisation (ACV) and clinical application and practice varies substantially. However, the reasons for this variation in practice and healthcare professionals' (HCPs') opinions of ACV were unclear. What this study adds: HCPs' experiences and opinions of ACV vary as a result of the uncertainty and subjectivity surrounding ACV compounded by their personal experiences with it. A need for caution also appears to emerge as HCPs become more familiar and experienced with using ACV. What are the clinical implications of this work?: Implementing standardised procedures, safety processes and competencies may help to compensate for the uncertainty and subjectivity surrounding ACV and may reduce the frequency of adverse events. Widening the focus of purpose of ACV, including swallowing in addition to communication, may increase the number of potential candidates and increase the potential benefits of ACV. Using multidisciplinary team (MDT) simulation training for ACV competency development might help to improve MDT working and ACV implementation. [ABSTRACT FROM AUTHOR]

Purpose: Driven by the shortage in qualified nurses and the high percentage of aging populations, the past decade has witnessed a significant growth in the use of robots in nursing, especially in countries like Japan. This article is a scoping review of the different tracks in which robots are used in nursing. Whereas assistive robots are used for physical care, including service and monitoring tasks, social assistive robots focus on the cognitive and emotional well‐being of patients in need of companionship. Methods: A total of six electronic databases were used in the search for journal papers and conference proceedings. The key words used in searching the databases were nursing OR nurses, AND robots OR robotics. Topics covering surgical robotics, nursing education robotics, and clinical procedures were excluded. Findings: A total of 1,758 articles were retrieved, from which 69 articles were included in the final review. The analysis of the chosen papers led to the categorization of robots into two main categories: assistive robots and social assistive robots. Conclusions: After a detailed review of the state of the art in assistive robots and social assistive robots, an insight into the future of robotics in this field is provided. The recommendations include the need to intensify research on human robot interaction, greater focus on monitoring robots, and analysis of the psychological barriers that need to be surmounted to achieve more tolerance and higher acceptance of robots. Clinical Relevance: For researchers and developers to provide suitable technological solutions, a full understanding of robotics in nursing is needed. An overview of the most recent applications and their proper categorization is key to finding areas for contribution. [ABSTRACT FROM AUTHOR]

Introduction: To explore academia perceptions and experience with unethical authorship practices in their respective institutions.Method: 21 in-depth interviews were carried out.Results: Our analysis revealed variability in experiences with various types of unethical authorship practices among the interviewees. Second, we found that unethical authorship practices are not so unusual among academia although the exact numbers of incidents are unknown due to the fact that such practices are seldom reported. Third, our interviewees revealed that the culture of 'publish or perish' could be the main contributor to unethical practices of authorship because publication records are the main criteria for researcher's career evaluation besides, others, which are set by the university.Conclusion: It was suggested that the institution must play a proactive role in educating and promoting awareness on authorship guidelines, through education and training, ethical leadership as well as promoting the importance of publication ethics. [ABSTRACT FROM AUTHOR]

Research on common‐ingroup identity has mainly focused on consequences and potential benefits of inclusive social categorizations. However, very little is yet known about processes and conditions that could facilitate such inclusive social categorizations. In this paper, with four studies (N = 582) set in a post‐conflict context of Bosnia and Herzegovina and with members of two ethnic groups (Bosniaks and Serbs), we have demonstrated how perceptions of intergroup moral similarity can act as an important precursor of common‐ingroup identity at the national level. We report both cross‐sectional as well as experimental evidence demonstrating how perceptions of intergroup moral similarity boost common‐ingroup identifications in socially relevant context using members of real adversary social groups. Moreover, we show that learning about outgroups' morally admirable behaviours can facilitate inclusive social categorizations. [ABSTRACT FROM AUTHOR]

Throughout the course of scholarly history, some concepts have been notoriously hard to define. The 'common good' is one such concept. While the common good has a long and contested scholarly history, social psychology research on folk theories – lay beliefs that represent an individual's informal and subjective understanding of the world – may provide a key for unlocking this nebulous concept. In the current paper, we analysed lay definitions of the common good using the linguistic inquiry and word count's meaning extraction method. From a nationally representative Australian sample of open‐ended text responses (n = 14,303), we uncovered a consistent conceptual structure, with nine themes corresponding to three core aspects: (i) outcomes and objects, (ii) principles and processes and (iii) stakeholders and beneficiaries. From this, we developed a working definition of the folk concept of the common good: 'achieving the best possible outcome for the largest number of people, which is underpinned by decision‐making that is ethically and morally sound and varies by the context in which the decisions are made'. A working definition benefits the academic community and society more broadly, particularly when diverse stakeholders come together to act for the common good to address shared challenges. [ABSTRACT FROM AUTHOR]

Current evidence suggests understaffing is related to poor quality and missed care in a global context, but this relationship is complex. There is also a research gap for quality in mental health care in the United Kingdom that includes a wider set of patient outcomes. This paper aims to investigate RMN's perception of quality of care on their last shift, their self‐reported reasons for compromised care and potential impact on patient outcomes. A mixed methods approach, we used descriptive statistics to create a framework within which to qualitatively analyse data from the 2017 Royal College of Nursing (RCN) employment survey to consider the complex relationship between understaffing and care quality. We established three themes: 'Understaffing', 'Professional Code Expectations and Moral Distress' and 'Management'. In line with the current evidence; lack of resources and understaffing were consistently present throughout. Nurses also felt pressure from the Nursing and Midwifery Council (NMC) code of conduct which in turn instilled shame and fear for their registration when they were unable to achieve the standards expected. This was further exacerbated by poor management and supervision; leading nurses to reflect on poor outcomes for patients which compromised not only legal rights but safety of patients and staff alike. We conclude that focusing on staffing numbers alone is unlikely to improve care quality. [ABSTRACT FROM AUTHOR]

Multimodal data have the potential to explore emerging learning practices that extend human cognitive capacities. A critical issue stretching in many multimodal learning analytics (MLA) systems and studies is the current focus aimed at supporting researchers to model learner behaviours, rather than directly supporting learners. Moreover, many MLA systems are designed and deployed without learners' involvement. We argue that in order to create MLA interfaces that directly support learning, we need to gain an expanded understanding of how multimodal data can support learners' authentic needs. We present a qualitative study in which 40 computer science students were tracked in an authentic learning activity using wearable and static sensors. Our findings outline learners' curated representations about multimodal data and the non‐technical challenges in using these data in their learning practice. The paper discusses 10 dimensions that can serve as guidelines for researchers and designers to create effective and ethically aware student‐facing MLA innovations. Lay Description: What is already known about this topic: Many MLA systems are designed without learners' involvement.Understanding of how multimodal data can support learners' authentic needs is needed.MLA have the potential to enable the automated generation of models to provide real‐time feedback. What this paper adds: Understanding how learners perceive multimodal data and the learning context.The findings outline the soft challenges in using multimodal data in the learning practice.Ten dimensions were identified to serve as guidelines for researchers and designers.The paper reports learners' perspectives describing new, intriguing, and under‐developed ideas about potential uses of multimodal data in educational context.The discussion on the need for human‐centred design approaches for educational technologies has been presented. Implications for practice and/or policy: Relevant pointers for what is appropriate and ethically necessary when designing learning technologies.Change in perspective among educators, on how they address progress and engagement in learning. [ABSTRACT FROM AUTHOR]

This paper addresses how unequal power dynamics in research with young children in disadvantaged communities can be negotiated through co‐reflexivity. It explores this through two different projects, the "London Study" and the "Beirut Study", which researched the play of young children from families living with disadvantage in two distinct cultures. First, we highlight similarities between both studies' methodological and ethical approaches that were designed to 'listen' to the children, ensure 'ongoing consent' and co‐create knowledge through co‐reflexivity. We then draw on data from each study to demonstrate how, in their unique contexts, co‐reflexivity was crucial to address researcher–child power dynamics. [ABSTRACT FROM AUTHOR]

It is uncontroversial to claim that the extent to which health care interventions benefit patients is a relevant consideration for health care priority setting. However, when effects accrue to the individual patient, effects of a more indirect kind may accrue to other individuals as well, such as the patient's children, friends, or partner. If, and if so how, such relational effects should be considered relevant in priority setting is contentious. In this paper, we illustrate this question by using disease‐modifying drugs for Alzheimer's disease as a case in point. The ethical analysis begins by sketching the so‐called prima facie case for ascribing moral weight to relational effects and then moves on to consider a number of objections to it. We argue that, whereas one set of objections may be dismissed, there is another set of arguments that poses more serious challenges for including relational effects in priority setting. [ABSTRACT FROM AUTHOR]

This paper investigates whether the voluntary deductible in the Dutch health insurance system reduces moral hazard or acts only as a cost reduction tool for low-risk individuals. We use a sample of 14,089 observations, comprising 2,939 individuals over seven waves from the Longitudinal Internet Studies for the Social sciences panel for the analysis. We employ bivariate models that jointly model the choice of a deductible and health care utilization and supplement the identification with an instrumental variable strategy. The results show that the voluntary deductible reduces moral hazard, especially in the decision to visit a doctor (extensive margin) compared with the number of visits (intensive margin). In addition, a robustness test shows that selection on moral hazard is not present in this context. [ABSTRACT FROM AUTHOR]

Newborn infants are among those most severely affected by humanitarian crises. Aid organisations increasingly recognise the necessity to provide for the medical needs of newborns, however, this may generate distinctive ethical questions for those providing humanitarian medical care. Medical ethical approaches to neonatal care familiar in other settings may not be appropriate given the diversity and volatility of humanitarian disasters, and the extreme resource limitations commonly faced by humanitarian aid missions. In this paper, we first systematically review existing guidelines relating to the treatment and resuscitation of newborns in humanitarian crises, finding little substantive ethical guidance for those providing humanitarian healthcare. We next draw on paradigm cases and published literature to identify and describe some of the major ethical questions common to these settings. We divide these questions into quality of life considerations, allocation of limited resources, and conflicting cultural norms and values. We finally suggest some preliminary recommendations to guide ethical decision-making around resuscitation of newborns and withdrawal of treatment in humanitarian settings. [ABSTRACT FROM AUTHOR]

Over 20 years of research has enhanced our understanding about the methodological and ethical benefits and challenges of involving children and young people in research. Concurrently, the increasing bureaucratisation of research ethics governance within UK universities has reified expectations about the methods used to gain informed consent for research participation. This paper explores how social researchers in the UK are navigating this tension and whether there is any scope for innovation through the use of technologies in how children and young people provide informed consent to take part in research. We conclude there is a need for the co‐creation of research information with children and young people and greater transparency by sharing creative solutions. [ABSTRACT FROM AUTHOR]

Abstract: This paper examines parents' legal argumentation in 15 appealed care order (child removal) cases in one Norwegian district court, asking on what grounds parents appeal their case. I investigate the pragmatic, ethical, and moral bases in arguments by applying a discourse ethics framework, viewing argumentation as either justifications or excuses of the parenting in question. The analysis reveals complex reasons for appealing, displaying parents both justifying and excusing both specific situations and the totality of their parenthood. Parents primarily apply pragmatic and ethical adversarialism, followed by pragmatic blaming and claims of change, moral justifications about due process, and ethical excuses about age and own life histories. Interestingly, normalization emerges as a third strategy, where parents explicitly aim to widen the scope of parental normality and adequacy, challenging the common defense dichotomy. The study provides new insight into an important and sensitive field, and indicates that parents engage in similar concrete strategies when, most often unsuccessfully, defending their parenthood. [ABSTRACT FROM AUTHOR]

Aim: To explore nursing students' moral distress (MD) experiences in clinical settings. Design: An interpretative phenomenological analysis (IPA) design was employed. Methods: Purposive sampling was used. In‐depth semi‐structured face‐to‐face interviews were conducted from December 2020 to June 2021 with nursing students who were taking the internship course in clinical settings. Data analysis was conducted following Dickman et al.'s (1989) method. Results: Ten nursing students participated in this study. Three main themes were identified, including (1) negative learning environments, (2) internal disgust and (3) threats to professional identity. Conclusion: Findings showed that value conflict, lack of knowledge of ethical standards and its application, and unprofessional approaches result in negative environmental learning perceptions from the nursing students. Therefore, due to being unable to change the situation, they start to feel guilt and shame and, as a result, decide to escape the problem instead of managing it. These feelings lead to internal disgust. This issue indicates the importance of improving the knowledge and perception of these situations. Thus, nursing students must be prepared for the real world, where their ideals are constantly challenged. MDs were experienced as threats to dignity, inequality, distrust, and change of mentality towards nursing, characterised as threats to professional identity. It is suggested to inquire about the process of nursing students' resiliency in morally disturbing situations to deduce the suitable approach for clinical education. [ABSTRACT FROM AUTHOR]

This paper examines the ethical issues which arose as part of a qualitative study with children who had experienced sexual abuse and the implications of these ethical issues for the methodology and conduct of the study. The ethical dimensions addressed include protection of the therapeutic relationship, anonymity, confidentiality, safeguarding (child protection), consideration of the sensitivity of the issue, informed consent, the right to withdraw and storage of data. The study formed one component of a service evaluation of a network of therapeutic projects provided by Action for Children, offering interventions for trauma following child sexual abuse. Children and young people's perspectives were collected using a child-friendly activity book designed to elicit their views on the service. The paper highlights the importance of conducting research which adheres to ethical guidelines and reflects upon the process of designing a study which incorporates them. The research was funded by Action for Children and managed by a steering group comprising managers from the organisation. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Biobanks for long-term research pose challenges to the legal and ethical validity of consent to participate. Different models of consent have been proposed to answer some of these challenges. This paper contributes to this discussion by considering the meaning and value of consent to participants in biobanks. Empirical data from a qualitative study is used to provide a participant view of the consent process and to demonstrate that, despite limited understanding of the research, consent provides the research participants with some level of control and a form of self determination that they value. Participation is framed as a moral act of a responsible citizen providing reinforcement of self identity. Consent symbolizes the trust invested in researchers and research institutions to use the biobank for the public good. The paper argues that consent continues to play an important role in biobank participation and that a participant view should inform proposals to modify consent processes. [ABSTRACT FROM AUTHOR]

This paper discusses health policy and systems research in complex and rapidly changing contexts. It focuses on ethical issues at stake for researchers working with government policy makers to provide evidence to inform major health systems change at scale, particularly when the dynamic nature of the context and ongoing challenges to the health system can result in unpredictable outcomes. We focus on situations where 'country ownership' of HSR is relatively well established and where there is significant involvement of local researchers and close ties and relationships with policy makers are often present. We frame our discussion around two country case studies with which we are familiar, namely China and South Africa and discuss the implications for conducting 'embedded' research. We suggest that reflexivity is an important concept for health system researchers who need to think carefully about positionality and their normative stance and to use such reflection to ensure that they can negotiate to retain autonomy, whilst also contributing evidence for health system change. A research process informed by the notion of reflexive practice and iterative learning will require a longitudinal review at key points in the research timeline. Such review should include the convening of a deliberative process and should involve a range of stakeholders, including those most likely to be affected by the intended and unintended consequences of change. [ABSTRACT FROM AUTHOR]

Background: Public involvement in research (PIR) can improve research design and recruitment. Less is known about how PIR enhances the experience of participation and enriches the data collection process. In a study to evaluate how UK care homes and primary health‐care services achieve integrated working to promote older people's health, PIR was integrated throughout the research processes. Objectives: This paper aims to present one way in which PIR has been integrated into the design and delivery of a multisite research study based in care homes. Design: A prospective case study design, with an embedded qualitative evaluation of PIR activity. Setting and participants: Data collection was undertaken in six care homes in three sites in England. Six PIR members participated: all had prior personal or work experience in care homes. Data collection: Qualitative data collection involved discussion groups, and site‐specific meetings to review experiences of participation, benefits and challenges, and completion of structured fieldwork notes after each care home visit. Results: PIR members supported recruitment, resident and staff interviews and participated in data interpretation. Benefits of PIR work were resident engagement that minimized distress and made best use of limited research resources. Challenges concerned communication and scheduling. Researcher support for PIR involvement was resource intensive. Discussion and conclusions: Clearly defined roles with identified training and support facilitated involvement in different aspects of the data collection process. This can also ensure that vulnerable older people who participate in research have a positive experience that reinforces the value of their views. [ABSTRACT FROM AUTHOR]

The article analyses the decision-making process between doctors and parents of babies in neonatal intensive care. In particular, it focuses on cases in which the decision concerns the redirection of care from full intensive care to palliative care at the end of life. Thirty one families were recruited from a neonatal intensive care unit in England and their formal interactions with the doctor recorded. The conversations were transcribed and analysed using conversation analysis. Analysis focused on sequences in which decisions about the redirection of care were initiated and progressed. Two distinct communicative approaches to decision-making were used by doctors: 'making recommendations' and 'providing options'. Different trajectories for parental involvement in decision-making were afforded by each design, as well as differences in terms of the alignments, or conflicts, between doctors and parents. 'Making recommendations' led to misalignment and reduced opportunities for questions and collaboration; 'providing options' led to an aligned approach with opportunities for questions and fuller participation in the decision-making process. The findings are discussed in the context of clinical uncertainty, moral responsibility and the implications for medical communication training and guidance. A Virtual Abstract of this paper can be accessed at: [ABSTRACT FROM AUTHOR]

Aim: Moral courage among healthcare workers has been extensively studied. However, few studies have been conducted on oncology specialist nurses, who frequently encounter complex moral situations. This study aimed to describe the current situation regarding moral courage and explored its influence on oncology specialist nurses in China. Design: This was an exploratory, descriptive study. Methods: A convenience sample of 390 nurses was conducted from 15 hospitals in Sichuan Province, China, between March and May 2023. Participants were assessed using the Moral Distress Scale‐Revised, Nurses' Moral Courage Scale and the Moral Sensitivity Questionnaire. Results: The results demonstrated that moral courage was negatively associated with moral distress, and positively associated with moral sensitivity. Having a master's degree or above, an intermediate title or senior title, medical ethics training, moral distress or moral sensitivity contributed to explaining 54.1% of the variance in moral courage. Conclusions: Moral courage was associated with several factors. Developing clinical intervention strategies and effective teaching methods will be critical for improving moral courage. No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]

Context: In vitro fertilisation (IVF) is now a common assisted reproductive technology (ART) procedure globally, with 8 million children alive today having been conceived utilising IVF. For many patients, IVF is a difficult experience with many discontinuing treatment because of emotional, relationship and financial stress, or intolerable physical side effects of hormone treatments. Design and Participants: A qualitative study, in which 31 professionals and 25 patients from the ART sector in Australia were interviewed. The interviews were analysed using codebook thematic analysis. Results: Our data indicates there are 'silences' within the therapeutic relationship of IVF, which may limit the capacity for patients to prepare emotionally, financially, or medically for the procedure, and may contribute to psychological distress and dissatisfaction with care. These 'silences' include what the patient 'is not told' by their clinician or 'does not hear' and what the patient feels they 'cannot say'. Discussion: Drawing upon the work of Jay Katz, Charis Thompson, and Miles Little on 'silences' and performance in clinical practice, we argue that although IVF is a complex and multifaceted procedure that is often conducted in a commercial setting, the clinical and therapeutic relationship between doctor and patient remains pivotal to the experiences of patients. The 'silences' within this relationship may impact negatively on decision‐making, and on the delivery and experience of care. Conclusions: Careful attention to the realities of IVF treatment in the clinic room (and awareness of the performances that hide them) should allow for more present and compassionate care. Such care may leave patients more satisfied with their experience and their choices, regardless of treatment outcomes. Patient or Public Contribution: This article draws on interviews with patients who had undergone or were currently undergoing IVF, as well as a range of representatives from the ART community (including reproductive medicine specialists, general practitioners, fertility nurses, counsellors, administrators in ART businesses and embryologists). [ABSTRACT FROM AUTHOR]

Today's global challenges necessitate the cooperation of the international community. In two studies, this paper investigates global identity and absolute moral standards as two important predictors of solidarity and collective action intentions. In Study 1 ( N = 450), we found evidence for parallel direct effects of global identity and absolute standards on intergroup solidarity and indirectly on collective action intentions. Similar, albeit weaker, effects were found for real behavior (a donation). Study 2 ( N = 124) experimentally manipulated participants' moral standard. Participants in the absolute standard condition were more willing to participate in collective action than participants who were experimentally focused on a gradual standard. Additionally, Study 2 replicated the indirect effects of global identity and absolute moral standards that we found in Study 1. The results show the important role of global identity and absolute moral standards as independent motivators of collective action. [ABSTRACT FROM AUTHOR]

There is increasing interest in the need to address the ethical dilemmas related to the engagement of adolescents in sexual and reproductive health (SRH) research. Research projects, including those that address issues related to STIs and HIV, adverse pregnancy outcomes, violence, and mental health, must be designed and implemented to address the needs of adolescents. Decisions on when an individual has adequate capacity to give consent for research most commonly use age as a surrogate rather than directly assessing capacity to understand the issues and make an informed decision on whether to participate in research or not. There is a perception that adolescents participating in research are more likely to be coerced and may therefore not fully comprehend the risk they may be taking when engaging in research. This paper examines the various ethical issues that may impact stakeholders' decision making when considering engaging adolescents in SRH research in Nigeria. It makes a case for lowering the age of consent for adolescents. While some experts believe it is possible to extrapolate relevant information from adult research, studies on ethical aspects of adolescents' participation in research are still needed, especially in the field of sexual and reproductive health where there are often differences in knowledge, attitudes and practices compared to adults. The particular challenges of applying the fundamental principles of research ethics to adolescent research, especially research about sex and sexuality, will only become clear if more studies are conducted. [ABSTRACT FROM AUTHOR]

From a folk perspective, gossipers (individuals who talk about the behaviours of others) are considered to be immoral individuals, doing harm to those they discuss. However, this folk perspective sits uneasily with recent claims that gossipers may actually do some good. In particular, it has been suggested that gossipers who share diagnostic information about the morality of social targets may help audiences to identify targets who are trustworthy and those who are not. In this way, gossipers may help audiences adaptively regulate their relationships. In this paper, we examined whether audience perceptions of gossiper morality are influenced by their perceptions that the content of gossip is able to help them regulate their relationships. Participants in two scenario studies and a realistic interaction study were presented with gossip items drawn from a pool of 24 unique behavioural descriptions and asked to rate their perceptions of the gossiper and the content of the gossip item. As predicted, participants perceived gossipers as more moral when gossipers shared the diagnostic morality gossip that participants perceived to serve relationship regulatory functions. [ABSTRACT FROM AUTHOR]

Considering recent corporate scandals, organizations have increased their efforts to curb unethical employee behavior. However, little is known about whether leaders comply with these efforts and how they respond to unethical employee behavior, especially when unethical actions benefit the organization. By integrating arguments from social identity and moral disengagement theories, we develop and test a model to explain how leaders respond to unethical pro‐organizational behavior (UPB) among employees. Results from one multi‐wave, multi‐source field study and one experiment showed that leader perceptions of employee UPB were positively related to leader trust in employees when leaders identified strongly with their organization or when they had a strong propensity to morally disengage. Moreover, the results revealed an important three‐way interaction effect. Leaders put considerable trust into UPB‐enacting employees when leaders both identified strongly with the organization and showed high levels of moral disengagement. In contrast, they put little trust into UPB‐enacting employees when leaders identified weakly with the organization and reported low moral disengagement. Furthermore, results showed that leader trust ultimately translated into perceived leader justice toward employees. These findings provide new and important insights into when organizations can(not) rely on their leaders to manage unethical employee behaviors. [ABSTRACT FROM AUTHOR]

Aim: To examine Registered Nurses (RNs') and nursing students' perspectives on factors contributing to moral distress and the effects on their health, well‐being and professional and career intentions. Design: Joanna Briggs Institute mixed‐methods systematic review and thematic synthesis. Registered in Prospero (Redacted). Methods: Five databases were searched on 5 May 2021 for studies published in English since January 2010. Methodological quality assessment was conducted in parallel with data extraction. Results: Searches yielded 2343 hits. Seventy‐seven articles were included. Most were correlational design and used convenience sampling. Studies were mainly from North America and Asia and situated in intensive and critical care settings. There were common, consistent sources of moral distress across continents, specialities and settings. Factors related to perceived inability or failure to enact moral agency and responsibility in moral events at individual, team and structural levels generated distress. Moral distress had a negative effect on RNs health and psychological well‐being. Patient or Public Contribution: No patient or public contribution to this systematic review. [ABSTRACT FROM AUTHOR]

Commentary to: Should academic journals publish e ‐ cigarette research linked to tobacco companies? [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 203-211 Diabetes and end of life: ethical and methodological issues in gathering evidence to guide care Introduction: Providing palliative care for people with diabetes at the end of life is part of the chronic disease care trajectory, but end of life care is complex and the presence of diabetes further complicates management. Aim: The aim of the paper is to discuss the ethical and methodological issues encountered when undertaking research to develop guidelines for managing diabetes at the end of life and the strategies used to address the issues. Method: The issues emerged as we developed guidelines for managing diabetes at the end of life, which included conducting individual interviews with 14 people with diabetes requiring palliative care and 10 family members. A reflexive researcher journal was maintained throughout the guideline development process. The interview transcripts and researcher's journal were analysed to determine key methodological, ethical and researcher-related issues. Findings: Key themes were vulnerability of the sampling population, methodological issues included recruiting participants and ensuring rigor, ethical issues concerned benefit and risk, justice, autonomy, privacy, professional boundaries and informed consent. Researcher-related issues were identified such as managing participant distress and their own emotional distress. People were willing to discuss end of life diabetes management preferences. Conclusions: Undertaking research with people at the end of life is complex because of their vulnerability and the ethical issues involved. However, the ethical principles of autonomy and justice apply and people should be given the relevant information and opportunity to decide whether to participate or not. [ABSTRACT FROM AUTHOR]

Net neutrality is the focus of an important policy debate that is tied to technological innovation, economic development, and information access. We examine the role of human values in shaping the Net neutrality debate through a content analysis of testimonies from U. S. Senate and FCC hearings on Net neutrality. The analysis is based on a coding scheme that we developed based on a pilot study in which we used the Schwartz Value Inventory. We find that the policy debate surrounding Net neutrality revolves primarily around differences in the frequency of expression of the values of innovation and wealth, such that the proponents of Net neutrality more frequently invoke innovation, while the opponents of Net neutrality more frequently invoke wealth in their prepared testimonies. The paper provides a novel approach for examining the Net neutrality debate and sheds light on the connection between information policy and research on human values. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper provides part of an analysis of the use of the Maori term whakapapa in a study designed to test the compatibility and commensurability of views of members of the indigenous culture of New Zealand with other views of genetic technologies extant in the country. It is concerned with the narrow sense of whakapapa as denoting biological ancestry, leaving the wider sense of whakapapa as denoting cultural identity for discussion elsewhere. The phenomenon of genetic curiosity is employed to facilitate this comparison. Four levels of curiosity are identified, in the Maori data, which penetrate more or less deeply into the psyche of individuals, affecting their health and wellbeing. These phenomena are compared with non-Maori experiences and considerable commonalities are discovered together with a point of marked difference. The results raise important questions for the ethical application of genetic technologies. [ABSTRACT FROM AUTHOR]

The role of applied theatre in engaging both lay and professional publics with debate on health policy and practice is an emergent field. This paper discusses the development, production performance and discussion of 'Inside View'. The objectives were to produce applied theatre from research findings of a completed study on genetic prenatal screening, exploring the dilemmas for women and health professionals of prenatal genetic screening, and to engage audiences in debate and reflection on the dilemmas of prenatal genetic screening. 'Inside View' was developed from a multidisciplinary research study through identification of emergent themes from qualitative interviews, and development of these by the writer, theatre producer and media technologist with input from the researchers. Inside View was performed in London and the Midlands to varied audiences with a panel discussion and evaluation post performance. The audiences were engaged in debate that was relevant to them professionally and personally. Knowledge translation through applied theatre is an effective tool for engaging the public but the impact subsequently is unclear. There are ethical issues of unexpected disclosure during discussion post performance and the process of transforming research findings into applied theatre requires time and trust within the multidisciplinary team as well as adequate resourcing. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2010; 24; 38-45 The objectives of this article are to present a measurement instrument for virtues, and to examine the link between virtues and health. The instrument was tested by the occupational health care at a large Finnish pulp and paper manufacturer and was shown to be consistent, valid and reliable. In developing the scale, we had two samples of employees and used factor analysis and partial least squares modelling (PLS) on both samples. Factor analysis showed that pride is the most important virtue, followed by love and generosity. In the PLS analysis, we found virtues to significantly reduce the number of sick days. In addition, we found significant relationships between virtues and fatigue, depression and happiness. Virtuous behaviour decreased sick leave and depression. The virtues had a positive influence on happiness and on improvement in one's health. The results show that by taking into account virtues in working life, companies can significantly improve their employees' well-being. The measurement instrument helps broaden the traditional view on health and is meant to be used by health care professionals in their daily practice. By addressing a person's physical, mental and virtual well-being, health care practitioners can take care of employees on a broader level than before. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to assess the level of moral courage among nurses in China, and to explore related influential factors, to help nursing managers take measures to improve nurses' moral courage. Design: A cross‐sectional study. Methods: The data adopted a convenient sampling method. From September to December 2021, 583 nurses from five hospitals in Fujian Province completed the Chinese version of the Nurses' Moral Courage Scale (NMCS). Data were analysed using descriptive statistics, chi‐square test, T‐test, Pearson correlation analysis and multiple regression analysis. Results: The Chinese nurses perceived themselves, on average, as morally courageous. The mean NMCS score was 3.64 ± 0.692. The six factors showed statistically significant correlations (p < 0.05) with moral courage. Regression analysis showed that the main factors influencing nurses' moral courage were active learning of ethics knowledge and nursing was a career goal. Conclusion: This study provides the self‐evaluation level and related influencing factors of Chinese nurses' moral courage. There is no doubt that nurses still need strong moral courage to face unknown ethical problems and challenges in the future. Nursing managers should pay attention to the cultivation of nurses' moral courage, using various forms of educational activities to help nurses alleviate moral problems and improve their moral courage, to maintain patients' access to high‐quality nursing. [ABSTRACT FROM AUTHOR]

The study of the physical activity engagement (PA) has given rise to a relevant research agenda in a wide range of fields, such as its close relationship with subjective well-being, self-perceived health and social capital. Previous evidence has identified interrelationships among these variables, but without considering different levels of physical activity. We have thus considered three levels of activity: light (walking), moderate and vigorous. Structural Equation Modelling (SEM) is undertaken on data from Spain's National Health Survey in 2011–2012 to analyse these interrelationships. The SEM shows a simultaneous and bidirectional relationship between different levels of PA (moderate and vigorous activities) and happiness, with a more robust association stemming from happiness to PA than vice versa. This relationship is mediated through health. From a policy perspective, this implies a virtuous circle: involvement in different levels of PA increases happiness and self-perceived health, while happiness involves higher PA and subsequent positive increases in health and happiness. Nevertheless, this virtuous circle does not always run successfully when social capital is considered to mediate the relationship between PA and happiness, which might explain why it has proven to be very difficult for health policymakers to fight against inactivity and a sedentary lifestyle within a great part of the population. Highlights We investigate bidirectional interrelationships between different levels of physical activity (PA) and happiness. We consider the mediation role played by self-perceived health (SPH) and social capital. Our results highlight a network of association between different levels of PA, SPH, social capital and happiness. SPH positively mediates this relationship for any type of PA level, whereas social capital only mediates positively when vigorous PA is developed. From a health policy perspective, the simultaneity between PA levels and happiness implies a virtuous circle. [ABSTRACT FROM AUTHOR]

Punishment is expected to have an educative, behaviour‐controlling effect on the transgressor. Yet, this effect often remains unattained. Here, we test the hypothesis that transgressors' inferences about punisher motives crucially shape transgressors' post‐punishment attitudes and behaviour. As such, we give primacy to the social and relational dimensions of punishment in explicating how sanctions affect outcomes. Across four studies using different methodologies (N = 1189), our findings suggest that (a) communicating punishment respectfully increases transgressor perceptions that the punisher is trying to repair the relationship between the transgressor and their group (relationship‐oriented motive) and reduces perceptions of harm‐oriented and self‐serving motives, and that (b) attributing punishment to relationship‐oriented (vs. harm/self‐oriented, or even victim‐oriented) motives increases prosocial attitudes and behaviour. This research consolidates and extends various theoretical perspectives on interactions in justice settings, providing suggestions for how best to deliver sanctions to transgressors. [ABSTRACT FROM AUTHOR]

Since the introduction of commercial video games in the 1970s, video game players have attracted the perhaps undeserving but negative stereotype of being unpopular and socially dysfunctional. However, with gamers increasing in numbers that now reach billions worldwide, the contents of gamer stereotypes may be in flux. The current study investigated the content of gamer stereotypes along the dimensions of physical/social attractiveness, warmth, competence, and morality as a function of genre violence level and gamer identity. Male and female participants (656 U.S. and 428 Indian) completed an online survey on the MTurk platform, rating social stereotypes of gamers in high‐violence and low‐violence genres on 22 adjective pairs and answering questions about gamer identity. Results revealed positive gamer stereotypes, especially in the low‐violence genres in both the United States and India. Low‐identifiers' stereotypes were less favourable in the high‐violence than in the low‐violence genres; this tendency diminished among high‐identifiers. This study suggests that, whereas once gamers were seen negatively, they are now seen remarkably positively. The implications of such positive views of those engaging in violent gaming are discussed. [ABSTRACT FROM AUTHOR]

Interpersonal transgressions threaten victims, offenders, and their relationships, often leading the parties to ruminate about the wrongdoing, not only individually but also together, in acts of co‐rumination. We investigate how two forms of co‐rumination—co‐reflection and co‐brooding—influence, or are influenced by, individual rumination and victim forgiveness or offender self‐forgiveness. Our study used a prospective‐longitudinal‐dyadic design (N = 110 dyads), where relationship couples were recruited prior to an incident and, once a partner reported feeling wronged by the other, completed repeated surveys over four time‐points 24–48 h apart. Cross‐lagged panel models indicated that co‐rumination was related to increased subsequent individual rumination; forgiveness and self‐forgiveness were related to reduced subsequent co‐rumination; and self‐punitiveness showed positive feedback cycles with co‐brooding and offender rumination, whereas genuine self‐forgiveness seemed to draw on co‐reflection via individual rumination and, in turn, reduced co‐reflection. Co‐rumination plays an important, yet complex, role within processes of moral repair. [ABSTRACT FROM AUTHOR]

Background: This article aims to understand moral distress in carers of people with an intellectual disability during the COVID‐19 pandemic. Method: Nine staff carers of seven people with an intellectual disability, who had been participants of the IDS‐TILDA study in Ireland, who died during the COVID‐19 pandemic participated in in‐depth, semi‐structured telephone interviews. Template analysis was used to analyze the interviews. Results: Obstructions in performing their duties left carers feeling powerless and experiencing moral conflict distress, moral constraint distress and moral uncertainty distress. Most managed to connect to the moral dimension in their work through peer support, understanding they fulfilled the wishes of the deceased, and/or thinking about how they or others did the best they could for the person they were caring for. Conclusions: This research demonstrates that while restrictions may have been effective in reducing the spread of COVID‐19, they were potentially damaging to carer wellbeing. [ABSTRACT FROM AUTHOR]

Objective: To explore in a sample of school nurses (SN) in California the impact of the COVID‐19 pandemic on school nurse health services, how school nurses mitigated the impact of COVID‐19, and moral distress levels among school nurses. Design and Methods: Nineteen (N = 19) school nurses who work in K‐12 schools in California, USA participated in a mixed‐methods approach involving qualitative descriptive design, inductive content analysis, and descriptive statistics. Interviews were conducted in August and September 2021. Results: Five themes emerged: (1) role of the SN during the COVID‐19 pandemic, (2) coordination with school administration, (3) COVID‐19 related challenges and disruptions to care, (4) moral distress, and (5) coping during the pandemic. Conclusion: The pandemic had a profound impact on school nurses. This study provides school nurse perspectives of the impact of COVID‐19 on services they delivered, the unique skills of school nurses essential to mitigation strategies, and moral distress school nurses encountered during the pandemic. Understanding the important role school nurses had during the pandemic is paramount to fully contextualize the contributions they made within public health nursing practice and inform preparedness for future pandemics. [ABSTRACT FROM AUTHOR]

This article explores complementary and alternative medicine (CAM) organisations' legitimation efforts that face extra obstacles as they are subject to more than one institutional logics (hybrids) and operate in a contested organisational space (hostile environment). CAM organisations espouse the health and market logics and their practices are questioned at an institutional level. The study is conducted in Portugal, where the legalisation of CAM therapies was a contested process over 10 years. Taking an abductive approach and drawing on qualitative interviews, the authors analyse CAM managers' efforts to legitimise their practices and build viable organisations despite hostile conditions. Contrary to prior studies of hybrid healthcare organisations, CAM organisations derive moral legitimacy from the market logic rather than the health logic. The findings show that relationships, trust‐building and consumer education appear to be the primary vehicles for establishing pragmatic legitimacy. Thus, pragmatic legitimacy relies on the health logic. The market logic dominates the pursuit of moral legitimacy through financial sustainability, human capital, marketing communications and partnerships, and advocating complementarity with biomedicine. We propose a model through which organisations use pragmatic legitimacy to enhance moral legitimacy and to create recursive feedback between moral and pragmatic legitimacy on the path to cognitive legitimacy. [ABSTRACT FROM AUTHOR]

People who consider themselves moral sometimes use self‐serving justifications to rationalize their selfish behaviours. Previous studies have tested the role of ambiguity in justifying wrongdoings, but it remains unclear whether ambiguity also plays a role in justifying promise‐breaking behaviour and whether heterogeneity exists. To investigate justification in promise‐breaking, we introduced a new experimental paradigm called the card‐guessing task and used hierarchical cluster analysis to classify participants based on their promise‐breaking decisions in unambiguous and ambiguous conditions. Experiment 1 revealed three clusters of solutions: Cluster 1 always kept their promises (i.e., keepers); Cluster 2 only exploited the vague promises and broke their promises in the ambiguous condition (i.e., intermediates); Cluster 3 tended to take advantage of vague promises and broke their promises irrespective of ambiguity (i.e., breakers). Experiment 2 confirmed that participants in the three clusters differed in their norm‐abiding preferences and social value orientations. Keepers were more altruistic and had a stronger sense of norm compliance than intermediates and breakers. In conclusion, our study demonstrates that self‐serving justifications were more likely to be employed by people who are moderately sensitive to deviation from social norms, which has implications for strategic interventions and policy formulation concerning unethical behaviour. [ABSTRACT FROM AUTHOR]

We investigated whether any differences in the psychological conceptualization of hate and dislike were simply a matter of degree of negativity (i.e., hate falls on the end of the continuum of dislike) or also morality (i.e., hate is imbued with distinct moral components that distinguish it from dislike). In three lab studies in Canada and the United States, participants reported disliked and hated attitude objects and rated each on dimensions including valence, attitude strength, morality, and emotional content. Quantitative and qualitative measures revealed that hated attitude objects were more negative than disliked attitude objects and associated with moral beliefs and emotions, even after adjusting for differences in negativity. In Study 4, we analysed the rhetoric on real hate sites and complaint forums and found that the language used on prominent hate websites contained more words related to morality, but not negativity, relative to complaint forums. [ABSTRACT FROM AUTHOR]

The biopsychosocial model is currently considered by most researchers and clinicians to be the best approach to low back pain (LBP) care. The model was popularised in LBP care in response to some clear deficiencies in earlier biomedical approaches and is now widely recommended in clinical guidelines and policy statements. Yet the biopsychosocial approach has also been critiqued for its narrow conceptualisation and application. In this article, we explore how attending to the multidimensionality of LBP in practice goes beyond a biopsychosocial approach. We engaged with 90 ethnographic observations of clinical practices, 22 collaborative dialogues with clinicians, and eight consultatory meetings with people with experience of LBP to consider the sociomaterialities of clinical practices in two settings: a private physiotherapy practice and a public multidisciplinary pain clinic. Drawing on the work of Annemarie Mol and Rosi Braidotti, our analyses suggest that sociomaterial practices, involving human and non‐human actors, produced multiple objects of clinical attention and ethical concerns about how to attend to this multiplicity well. We argue that the multiplicity of LBP is attended well by reimagining: (1) clinical settings as 'becoming more‐than‐sterile environments' where objects, furniture and elements such as tears and laughter help to provide a relational, welcoming and comfortable space to all bodies with LBP; (2) differences through 'becoming minoritarian' where considering power relations allows actions towards connectiveness and belonging; and (3) disciplinary boundaries through 'becoming interdisciplinary within' where actions expand traditional scopes of practice. The flux of these multiple becomings moves clinical practice and conceptualisations beyond the biopsychosocial approach to consider a new ethico‐onto‐epistemological approach to LBP care. They invite clinical practices that engage with an ethical multiplicity of LBP care, providing a better understanding of how places, objects, emotions, power, bodies and professions are interconnected and come together in everyday practice. [ABSTRACT FROM AUTHOR]

This article presents an analysis of personal diaries kept by health‐care staff within a specialist NHS Trust in England during the initial 3 months of the COVID‐19 pandemic. It adopts a moral sensemaking perspective to explore how NHS employees mobilised and reframed ideas of right and wrong in order to make sense of unprecedented uncertainty and displacement. By focussing on how the macro and micro politics of the pandemic were played out in the organisation, the study finds that polarised moral judgements were invoked in order to justify and rationalise a broad array of associated emergent emotions, intuitions, behaviours and practices. This polarisation of moral responses could be seen as a desire to bring order out of chaos and put matters back into place following displacement. This is inevitably an ongoing, complex and variegated enterprise whose results can be as often discomforting as they can be reassuring. Indeed, while moral sensemaking was partly beneficial for staff in that it promoted a greater sense of camaraderie and support for others, it also appeared to have darker consequences in terms of staff wellbeing and the development of more impermeable social boundaries across the organisation through processes of moral 'othering'. [ABSTRACT FROM AUTHOR]

Introduction: The informed consent process is key to safeguarding the autonomy of the participant in medical research. For this process to be valid, the information presented to the potential participant should meet their needs and be understood by them. The i‐CONSENT project has developed 'Guidelines for adapting the informed consent process in clinical trials' which aim to improve informed consent so that they are easier to understand and better adapted to the needs and preferences of the target population. The best way to tailor information to the characteristics and preferences of the target population is to involve the community itself. Methods: Following guidelines developed by i‐CONSENT, assent materials were co‐created for a mock clinical trial of the human papillomavirus vaccine in adolescents. During the process, two design thinking sessions were conducted involving a total of 10 children and 5 parents. The objectives of the sessions were to find out the children's opinion of the informed consent (assent in their case) process in clinical trials, identify the parts that were most difficult to understand and alternatives for their presentation and wording, identify the preferred formats for receiving the information and the main characteristics of these formats, design a video explaining the clinical trial and evaluate a tool for assessing comprehension. Results: Assent materials were co‐created in three formats: a web‐based material following a layered approach; a video in story format; a pdf document with an innovative way of presenting information compared to traditional assent documents. In addition, the Comprehension of Assent Questionnaire was co‐designed, based on the Quality of Informed Consent questionnaire. Conclusion: The design thinking methodology has proven to be an easy and useful tool for involving children in designing information tailored to their needs and preferences. Patient or Public Contribution: A sample of the target population participated in the design and piloting of the materials created using design thinking methodology. In addition, patient representatives participated in the design and evaluation of the guidelines developed by the i‐CONSENT project that were followed for the development of the materials in this study. [ABSTRACT FROM AUTHOR]