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We are asking what motivates human beings to reflect morally, which is both a philosophically interesting question and one that would seem necessarily interesting for anyone involved in character education. What motivates us to think about subjects with a moral eye, makes us reason our way to moral clarity, and sustains our efforts until we reach moral judgments. Here, we limit the response to this question to the moral theories of Hobbes and Hume, from which we hope to infer how these two philosophers would have responded to the question themselves. Hobbes thinks we derive moral standards through reflection on how we ought to live our lives so as to avoid the state of war and achieve a peaceful, comfortable existence in which we may hope for more of the same. Achieving this existence depends on coming to know the means to a state of peace and living according to those means, according to the laws of nature. We discern the means to peace through reasoning driven by desire not for immediate goods but for “long term” goods. The desire necessary to discover moral laws is trained on what is “commonly a good”—on public interest, not on private. The impartial desire necessary to discern and seek such a good is only possible in a quiet mind. Moral reflection is motivated by the desire to know the means to peace driving a quiet mind. Hume also acknowledges the necessity of moral reflection. Beyond having social and psychological incentives for taking an interest in morality, we are moved to moral reflection by our natural passion for the “good of mankind,” which Hume calls the affection of humanity . This passion moves us to reflect morally only when we are disposed to the attitude which he refers to as the principle of sympathy and are thinking from a general point of view. Sympathy conveys to us the relevant pleasure and pain of others, and the general point of view frees us from self-centeredness. The affection of humanity moves us to moral judgment, approval of what benefits and disapproval of what diminishes humankind.

OBJECTIVE:The Leadership Education and Development (LEAD) Program was designed to transform care at the bedside by empowering clinical nurses as leaders. BACKGROUND:The heart of LEAD was enhancing communication skills of clinical nurses with clinical colleagues and, most importantly, patients and families. Key concepts of leadership/management were includedpersonal awareness, personal leadership skills/abilities, leading change, leading others individually and in teams, enhancing the patient/provider experience, and the leadership role in outcomes management. METHODS:A quantitative, longitudinal, survey design was used with 2 cohorts. The program consisted of six 4-hour sessions for 3 to 6 months. Leadership practices were measured before program implementation, at the end of the program, and 3 months after program completion. RESULTS:There were significant increases in leadership practices sustained 3 months after program completion. A range of other outcome measures was included. CONCLUSIONS:There is a need for additional leadership development programs for clinical nurses.

Background Parent carers of children with special educational needs or disability are at higher risk of poor mental and physical health. The need for a tailored, peer-led group programme was raised by parent carers, who co-developed the Healthy Parent Carers programme with researchers. This study aimed to test the feasibility of programme delivery in community settings, and the feasibility and acceptability of a randomised controlled trial design. Methods Participants were individually randomised with concealed allocation to a structured group programme and access to online resources (intervention), or access to the online resources only (control). Measures of wellbeing and secondary and economic outcomes were collected before randomisation, immediately post-intervention, and 6 months post-intervention. Descriptive statistics on recruitment and attrition, demographics, attendance, and fidelity of intervention delivery were analysed with feedback on the acceptability of the trial design. Results One hundred and ninety-three parent carers expressed an interest in taking part. Ninety-two participants recruited from across six sites were randomised (47 intervention, 45 control). Lead and assistant facilitators were trained and delivered the group sessions. Sixteen (34%) participants in the intervention arm did not attend any sessions, and attendance varied across sites and sessions. One participant withdrew post-randomisation, and 83 (90%) participants completed outcome measures at the six-month follow-up. Conclusions The study demonstrated that it was feasible to deliver the programme in community settings. The number of parent carers who expressed interest signifies the need for such a programme and the feasibility of recruiting to a definitive trial. Loss to follow-up was low. Further research is needed to explore ways to reduce barriers to participation in person and assess the feasibility and acceptability of programme content and delivery for more ethnically diverse groups, and potentially using interpreters. Given the Covid-19 pandemic and delivery format feedback, there is also a need to investigate remote or blended delivery strategies. Although the results indicate that a definitive trial is feasible, programme impact would be strengthened through exploration of these uncertainties. Trial registration ISRCTN, ISRCTN15144652 , registered on 25 October 2018, ClinicalTrials.gov , NCT03705221 , registered on 15 October 2018.

Background Parent carers of disabled children are at increased risk of mental and physical health problems. They often experience challenges to maintaining good health which have implications for their well-being and their ability to care for their children. In response to these needs, researchers and parent carers developed the Healthy Parent Carers (HPC) programme. It is a peer-led, group-based intervention that promotes behaviours associated with health and well-being. The aims of this trial are to assess the acceptability of the HPC programme and the feasibility of its delivery in the community and to assess the feasibility and acceptability of the design of the definitive trial to evaluate the programme’s effectiveness and cost-effectiveness. Methods We will establish six research sites and train facilitators to deliver the manualised intervention. Parent carers of children with special educational needs and disabilities will be individually randomised, stratified by group delivery site, to either take part in a group programme and online resources (intervention) or to receive access to the online resources only (control). Measures of mental health; well-being; health-related quality of life; health behaviours; patient activation; protective factors such as resilience, social connections, and practical support; and use of health care, social care, and wider societal resources will be collected before randomisation (baseline), immediately post-intervention, and 6 months later. Recruitment of participants, adherence to the programme, and the dose received will be assessed. Group sessions will be audio-recorded to evaluate the fidelity of delivery and participant engagement. Participants’ and facilitators’ feedback on the programme content and delivery, their experience, and the acceptability of the outcome measures and trial design will be collected through feedback forms, interviews, and focus groups. Discussion This trial will assess whether the programme delivery and evaluative trial design are feasible, to inform whether to progress to a definitive randomised controlled trial to test the effectiveness and cost-effectiveness of the Healthy Parent Carers programme. Trial registration ISRCTN, ISRCTN151144652 , registered on 25 October 2018 ; ClinicalTrials.gov, NCT03705221 , registered on 15 October 2018.

Individuals high or low in self-reported social skill were recruited opportunistically. When presented with everyday social scenarios ending with an awkward request or offer, the high social skill participants more often used sophisticated strategies that showed greater consideration for all parties. By contrast, the low skill participants were more reliant on simple strategies including acquiescence or refusal, and the emotional tone of their responses was less positive. Greater reliance on sophisticated rather than simple strategies may be linked to more successful social interactions. The potential implications are considered for understanding everyday performance in skilled individuals and populations with limited social skills, such as those with autistic spectrum disorders.

OBJECTIVE:The purpose of this study was to describe perceptions of structural empowerment of clinical nurse managers (CNMs) in 1 large healthcare system. BACKGROUND:The recruitment and retention of CNMs are crucial to the future of healthcare institutions. Understanding the extent to which CNMs feel supported in the work environment and have access to resources, information, support, and opportunities to learn and develop will be beneficial to organizational effectiveness. METHODS:The sample included 140 CNMs from 1 large healthcare system in the northeastern United States. RESULTS:Consistent with previous research, CNMs in the present study had moderate levels of empowerment. They had lower than expected subscale scores on the resources subscale and acceptable scores on the subscales of support, formal power, and informal power. CONCLUSIONS:In the current changing healthcare environment, it is important to gain more understanding of the role of CNMs who are crucial to quality care and patient and nurse satisfaction. This study provides important baseline information about perceptions of structural empowerment among CNMs. Interventions that can be initiated to enhance the CNM empowerment are presented.

Goal: We hope our book will encourage children to consider nursing as a career worthy of their intellect and talents and inspire them to learn more about each of the remarkable nurses described in our book. In the last survey posted in 2018 from the U.S. Department of Health and Human Resources describing the makeup of the registered nurse work force in the U.S, 73% were white, non-Hispanic, 10.2% were Hispanic/Latino, 7.8% were African American, 5.2% were Asian and 0.3% Native American. Five nurses were critical in the creation of professional nursing organizations and five were activists whose dedication resulted in the specialties of nurse midwifery, clinical nurse specialists, hospice care, public health nursing and school nursing.

While the US trade balance should continue to improve in the coming months. this improvement could be slowed by the net appreciation of the dollar over the last 2 years against most major currencies. The more than 25% rise of the dollar against the Japanese yen over the last 15 months is of particular concern. US exports are expected to rise more rapidly than imports in 1990, mainly because foreign economies are projected to grow faster than the US economy. Foreign demand for US exports, particularly for manufactured and other nonagricultural goods, should rise more quickly than the domestic demand for foreign goods. Agricultural exports will not be a major contributor to US export growth in 1990. Imports of agricultural products are predicted to remain at the record levels reached in 1989. Domestic demand for petroleum products should be at about the same level as in the previous 2 years, but import volume is expected to increase further because of the continued decline of US oil production.