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Protection Motivation Theory and Environmental Health Behaviors: A Systematic Mapping

  • Kim, Hyun Kyoung
    • International Journal of Advanced Culture Technology
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    • v.10 no.3
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    • pp.164-173
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    • 2022
  • This study aimed to explore the themes and parameters of environmental health behaviors based on Rogers' protection motivation theory through a systematic mapping review. Using a systematic approach, a literature review was conducted of articles that adopted Rogers' protection motivation theory. A total of 11 articles on protection motivation theory using participants and environmental health as outcomes were identified in a search of CINAHL, Cochrane Library, EMBASE, Eric, PsycARTICLES, PubMed, and RISS between September 1 and September 8, 2021. Themes related to the environment and personal behaviors between 2002 and 2021 were extracted. The parameters based on protection motivation theory were identified through systematic mapping as fear appraisal, rewards of maladaptive response, severity, vulnerability, costs of adaptive response, response efficacy, self-efficacy, and intention. Self-efficacy and response efficacy considerably affected environmental health behaviors. Emotional fear appeal related to environmental hazards motivates an internal process that alters the threat appraisal and their coping appraisal. Environmental behavior perception and intention influenced on environmental health behaviors with small effect sizes. Therefore, a deeper understanding of the severity of environmental health issues could lead to the development of helpful, effective, and intensive interventions to promote healthcare among the vulnerable population.

Effects of Physical and Mental Health on Quality of Life in Middle-aged Adults by Gender (성별에 따른 중년 성인의 신체건강 및 정신건강이 삶의 질에 미치는 영향)

  • Bang, So Youn
    • Journal of Information Technology Applications and Management
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    • v.29 no.2
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    • pp.27-37
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    • 2022
  • This study was attempted to identify the effects of physical and mental health on quality of life in middle-aged adults by gender. The Data were analyzed for 4,511 adults (2,260 men, 2,251 women) aged 45 to 65 who had no missing values in major variables based on the data of the 2016 Korea Health Panel. According to the data, the quality of life in middle-aged adults was .92 (±.08) for men and .91 (±.10) for women, which was significantly higher than that of women (t=3.54, p<.001). Factors affecting the quality of life in middle-aged men were subjective health status (β=.40, p<.001), stress (β=-.17, p<.001) and education level (β=.10, p<.001), and these variables explained 23% of the quality of life (F=227.28, p<.001). Factors affecting the quality of life in middle-aged women were subjective health status (β=.40, p<.001), stress (β=-.11, p<.001), education level (β=.05, p=.011) and anxiety (β=-.05, p=.022), and these variables explained 21% of the quality of life (F=145.42, p<.001). Based on the results of this study, the group with low level of education in middle-aged adults needs health management, education on how to relieve stress, and intensive management to improve the quality of life. In addition, the differentiated approach should be required to reduce anxiety in middle-aged women.

Overseas Research Trends Related to 'Research Ethics' Using LDA Topic Modeling

  • YANG, Woo-Ryeong;YANG, Hoe-Chang
    • Journal of Research and Publication Ethics
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    • v.3 no.1
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    • pp.7-11
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    • 2022
  • Purpose: The purpose of this study is to derive clues about the development direction of research ethics and areas of interest which has recently become a social issue in Korea by confirming overseas research trends. Research design, data and methodology: We collected 2,760 articles in scienceON, which including 'research ethics' in their paper. For analysis, frequency analysis, word clouding, keyword association analysis, and LDA topic modeling were used. Results: It was confirmed that many of the papers were published in medical, bio, pharmaceutical, and nursing journals and its interest has been continuously increasing. From word frequency analysis, many words of medical fields such as health, clinical, and patient was confirmed. From topic modeling, 7 topics were extracted such as ethical policy development and human clinical ethics. Conclusions: We founded that overseas research trends on research ethics are related to basic aspects than Korea. This means that a fundamental approach to ethics and the application of strict standards can become the basis for cultivating an overall ethical awareness. Therefore, academic discussions on the application of strict standards for publishing ethics and conducting researches in various fields where community awareness and social consensus are necessary for overall ethical awareness.

Qualitative Literature Study: How Intrinsic Motivation Impacts Nurses' Job Satisfaction

  • Ho-Jin LEE
    • The Journal of Industrial Distribution & Business
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    • v.15 no.6
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    • pp.17-24
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    • 2024
  • Purpose: The current study explores the impact of intrinsic motivation on nurses' job satisfaction, taking a close look at the current literature to answer what the relationship is between low/high intrinsic motivation and workplace productivity of nurses in their work at individual and collective levels. Data and methodology: The current research utilized a hybrid of descriptive and systematic review research designs. According to Huntington-Klein (2021), a research design refers to the researcher's method or approach. It includes a detailed explanation of the processes followed by identifying research variables, their evaluation, data collection and analysis. Results: A systematic literature review of the various sources (found in the reference section) revealed critical findings regarding the topic. The following are the four significant impacts of intrinsic motivation on nurses' job satisfaction: (1) Positive Attitude and Feeling, (2) Inherent Needs, (3) Productivity and Performance, and (4) Navigating Challenges of External Rewards. Conclusions: Therefore, the current study could conclude that intrinsic motivation is essential in enhancing the productivity of the nurses. Intrinsically driven or motivated nurses find it unnecessary to be supervised or pushed to work and achieve excellence. They would be proactive towards working and achieving the desired results.

The Meaningful Association Between Employee Workplace Stress and the Type of Organizational Culture

  • Ho-Jin LEE
    • East Asian Journal of Business Economics (EAJBE)
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    • v.12 no.2
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    • pp.43-50
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    • 2024
  • Purpose: The present study investigates if the type of organizational culture influences the level of job-related stress. This study is significant because creating the need to explore the concept to become more informed on the best practices to promote and foster a positive culture that prioritizes workers, it could result in a healthier workforce, improved organizational performance, and success. Research design, data and methodology: Examining previous studies by other researchers was the primary research tool for this study. The organized approach of gathering data and assessing related work was vital in developing a fundamental basis for advancing knowledge on this concept while enhancing theory development and drawing more informed conclusion. Results: These four types, including the clan, adhocracy, hierarchical, and market cultures, contribute significantly in revealing four associations between the two variables, including (i) supportive culture and reduced stress, (ii) high pressure and increased stress, (iii)autonomous culture and variable stress levels, and (iv) open culture and low-stress levels. Conclusions: The literature affirms a multifaceted link between employee workplace stress and organizational culture type. The findings show that these cultures are crucial in influencing the level of stress among employees. All four types were hypothesized to have a significant relationship with job stress.

Qualitative study on the key elements of obesity counseling in Korean Medicine

  • Sungha Kim;Seung Eun Chung;Kyungsun Han;Sunmi Choi;Jun-Hwan Lee
    • The Journal of Korean Medicine
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    • v.44 no.4
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    • pp.1-13
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    • 2023
  • Objectives: Weight counseling is an inevitable process for patients with obesity who intend to lose weight; however, the contents of real-world counseling practices remain uncertain in Korean medicine (KM) practice. This study aimed to explore the structure and constituents of obesity counseling in KM. Methods: Qualitative methods were used to explore the structure of weight counseling and clinicians' approaches to weight counseling, particularly the advice and main constituents of weight counseling in KM. Nine KM clinicians (4 women, 5 men) from nine clinics completed face-to-face, individual and semi-structured interviews from September 2019 to February 2020 in Seoul, Daejeon, Cheonan, Seongnam, Asan, and Hwaseoug. The interviews were digitally recorded, transcribed verbatim, and categorized based on their constituents. Results: During weight loss counseling, the six principal constituents of KM identified were: planning with patients, motivation, correcting misinformation on weight loss, dietary and exercise advice, medication guidance, and customized guides for each type. Conclusion: Clinicians with in-depth knowledge about obesity prescribed personalized guidance for exercise, diet, and medication through an integrative approach. The study results provide an in-depth understanding of weight counseling in KM. These six constituents could guide the counseling provided by clinicians in obesity care.

A Research Study on the Sexual Awareness of Teenagers. Their Parents and Teachers in an Urban Area (일부 시 지역 고교생.학부모.교사들의 성의식 조사)

  • Lim, Mi-Lim;Yang, Soon-Ok;Lee, Kwang-Ok
    • Research in Community and Public Health Nursing
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    • v.12 no.3
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    • pp.755-772
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    • 2001
  • The specific purpose of this study was as follows: 1) To identify the level of sexual awareness and demand for sex education of teenagers, their parents and teachers. 2) To investigate the attitude toward and acceptance of heterosexual friendships by teenagers, their parents and teachers. 3) To identify the experience and direction of sex education of parents and teachers. For this purpose, this study selected 341 male and female teenagers at three high schools located in a city, 119 parents with high school students and 243 elementary/middle/high school teachers. The structured questionnaire was distributed to each of them and returned by them. This study was conducted over the period between June 1. 2001 and Aug 31. 2001. A total of 720 questionnaires were distributed to them and 703 were returned. Data analysis was conducted to obtain percentage and frequency using the SAS program. As a result, the following findings were obtained: Parents and teachers showed a similar attitude about sexual awareness, but teenagers showed a different attitude. In terms of the level of feeling of and interest in 'sex', teenagers, parents and teachers were comfortable in accepting it. As for sexual curiosity in puberty, 84.8% of the parents and 95.5% of the teachers responded that it was natural, whereas only 14.7% of teenagers responded that it was natural. But As for the item that 'sex is natural as one of human needs', 3.6% of the teenagers, 16.8% of the parents and only 1.2% of the teachers responded that it was not. As for the item that 'A man has a stronger sexual impulse than a woman', 6.1% of the teenagers, 16.8% of the parents and 17.3% of the teachers responded that it was not. 64.2% of the teenagers and 90.2% of the teachers responded that it was impossible to overcome the sexual impulse, whereas only 8.4% of the parents responded that it was possible. As for the item of masturbation, 64.5% of the teenagers responded that it was possible for male students and not possible for female students. 67.2% of the parents and 91.1% of the teachers responded that it was possible regardless of sex. As for the item of an attitude toward virginal purity, both the parents and teachers showed that virginal purity was important for both man and woman, but teenagers showed a weak awareness of virginal purity. As for the item, 'It is possible to have sexual intercourse with a lover during adolescence', 20.2% of the teenagers, 79% of the parents and 87.7% of the teachers responded that it was impossible. As for the item 'It is necessary to keep premarital virginal purity for a happy married life', 21.1% of the teenagers, 74.8% of the parents and 55.1% of the teachers responded that it was necessary, which shows that teenagers had a different opinion than parents and teachers. In case of pregnancy in adolescence, most of the responding teenagers, parents and teachers chose abortion. As for the item 'female refusal on male sexual approach', respondents accepted female refusal as they did for orders of teachers, parents and adolescents. As for item 'An assaulter is entirely to blame for sexual assault', all of three groups responded in the affirmative.

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A Study on the Actual Condition of the Adult-smoking in a Region (일 지역 성인의 흡연실태)

  • Chong Young-sook
    • Journal of Korean Public Health Nursing
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    • v.13 no.1
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    • pp.97-113
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    • 1999
  • To investigate the actual condition of the adult-smoking in Chinan County. I used self-reporting questionnaires among 923 residents living in nine districts selected at random among the sites of eleven eup-myons from December 28. 1998 to January 6. 1999. collected data and analyized using SPSS. The smoking rate of adults in Chinan County was $36.9\%$. There was a significant difference in smoking rate according to the age. gender, education and job among general characteristics. The smoking rate in group of above 40s was about $40\%$ and that of the male took $55.5\%$ which was higher than that of female and the smoking rate of the people having high-school education was the highest$(46.2\%)$. With regard to the career. the smoking rate of the farmers ranked first$(46.1\%)$. Therefore anti-smoking business for smokers should be focused on above 40 years old, males. people having high school education and farmers. As the result of the survey of smoking habits of 340 people who smoke currently, the average smoking begining age was 21.8 and $81.5\%$ among them was between 16-25 years old. $4.4\%$ was under 15. during around the elementary school. Most motives to smoke were as followed; curiosity or taste$(33.6\%)$, relief of stress $(31.2\%)$, peer presure$(26.5\%)$ And considering the amount of the cigarette which is smoked per day, the case which is less than a pack of cigarettes was highest as $75.5\%$ and the people who smoke over one pack of cigarettes took $24.5\%$. As for the kind of tobacco which is smoked, how to smoke and the desire for the smoking, most case was toxin was moderate$(47.8\%)$ or mild$(46.9\%)$. shallowly$(49.0\%)$ or deeply$(46.3\%)$ and under stress$(33.4\%)$. after meals$(27.8\%)$, during drink$(15.7\%)$ and so on. The highest point marked among the factors of smoking motives was 'the reduce of negative emotion' $(3.27\pm1.00)$. followed by 'uncomfortable habits' $(2.87\pm1.02)$, 'addiction' $(2.84\pm1.06)$. 'habit' $(2.74\pm1.12)$. 'pleasure' $(2.70\pm1.04)$. 'stimulus' $(2.59\pm.90)$, 'sensation-exercise satisfaction' $(2.42\pm.97)$. Smokers smoke to reduce the negative emotions when angry in most common case. depressed. anxious. uncomfortable. lone. ashamed or embarrased. and intend to solve the certain problem. etc. Other motives are uncomfortable habit. addiction. habit. pleasure and the pursuit of stimulus. The level of nicotine dependence of adults m Chinan County was 10.57 which amount to 'high' wholly. As the resulf of the level of nicotine dependence score. the people who are low in the level of nicotine was $33.5\%$. the people who are high was $48.2\%$. very high was $18.4\%$. The approach for anti-smoking for smokers should be conducted differently according to the level of the nicotine. For the people who are in low level of nicotin dependence the prohibition of the smoking should be guided through the approach to foster strong will. for those who are in 'high' by acquiring proper method for the prohibition of smoking. and for those who are 'very high' the anti-smoking should be induced by providing proper program because of the possibility of the suffer from abstinence syndrome. The difference of the level of nicotine with the general characteristics of the objects had not statistically significant difference. The difference of the level of nicotine dependence accompanied by smoking habit had statistically significant difference according to the amount of smoke, the kind of tobacos. smoke inhale habit. In other words, the group of heavy smokers had higher level of the nicotine dependence than that of the light smokers relatively and the group which smoke strong taboaco has higher level of nicotine than that of which smoke mild or moderate. And the group of smokers who smoke deeply has higher level of nicotine than that who smoke shallowly or nonswallow. Aa a result of the analysis of the correlation between smoking motive factors and the level of nicotine, there was the indication that people who smoke for the decrease of the negative emotion. habit, pleasure. stimulus. sensation-exercise satisfaction had high level of the nicotine dependence. As the result of the anti-smoking will of smokers. $65.0\%$ of them had prohibition of smoking will. $29.3\%$ had no will to quit smoke. The most important reason for anti-smoking was health. $67.9\%$ had experience to try to quit smoke and the biggest reason to fail to quit smoking was the lack of the will power to keep anti-smoking. $52.8\%$ of them were advised to stop smoking from their spouses or children. only $2.8\%$ were by medical. The people who have the opinion to need anti-smoking education were $69.6\%$. Therefore when the business for the hygine of the mouth for adult is set. it should be centered on the people who have intention of prohibition of the smoking and help to quit smoking by way of other affirmative counter-program not smoking under stress.

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A Grounded theory Approach on the Experience of Sexual Abuse Victims (성폭력 피해여성의 경험에 관한 연구)

  • Kim, Kyung-Hee;Nam, Sun-Young;Chee, Soon-Ju;Kwon, Hye-Jin;Chung, Yeon-Kang
    • Journal of the Korean Society of School Health
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    • v.9 no.1
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    • pp.77-98
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    • 1996
  • This studies designed to work out a theoretical framework on the experience of sexual abuse from the perspective of grounded theory in an effort to provide more practical and efficient nursing intervention for female victims. The subcategories identified were "sexual abuse", "threatening", "absent mindness", "embarrassment", "horripilation", "dizziness", "wondrousness", "filthiness", "sexual curiosity", "violence level", "victim's age", "neighbors response", "victims personality", "common experience", "sexual abuse information", "family relations", "level of familiarity", "hiding", "suppression", "self-torture", "self-protection", "avoidance", "asking aid", "withdrawal", "hatred", "confusion", "dodging, "remmant", and "pursuing". The 29 subcategories given above were further integrated into 16 categories such as "victimizedness", "being astounded", "filthiness", "degree", "developmental stage", "response pattern", "personality", "rarity", "information availability", "family support", "cover-up", "escaping", "informing", "negative internalization", and "positive pursuit of change". The core categories linked to all the other categories turned out to be "being taken aback" and "filthiness" incorporating the relevant subcategories. A total of 23 theoretical hypothesis emerged in the process of analyzing data. 1. the grater sexual curiosity, the weaker the senses of being taken aback and filthiness. 2. The weaker sexual curiosity, the stronger the senses of being taken aback and filthiness. 3. The stronger the level of violence, The more violent the senses of being taken aback and filthiness. 4. The lower the level of violence, the weaker the senses of being taken aback and filthiness. 5. The younger the victims, the stronger the senses of being taken aback and filthiness. 6. The older the victims, The weaker the senses of being taken aback and filthiness. 7. 'Escaping' will transpire regardless of the given circumstances. 8. The weaker the senses of being taken aback and filthiness, the more probable 'informing' and 'escaping' transpire. 9. The stronger the senses of being taken aback and filthiness, the more probable 'informing' and 'escaping' transpire. 10. The more protective the response from 'informing' and 'escaping' transpire around, the more likely the response to being taken aback' and 'filthiness' will be 'informing' and 'escaping'. 11. The more repelling the response from around, the more likely the response to 'being taken aback' and 'filthiness' will be 'covering-up' and 'escaping'. 12. The more open minded the personality of the subject, the more likely the response to 'being taken aback' and 'filthiness' will be 'informing' and 'escaping'. 13. The more closed the personality of tile subject, the more likely the response to 'being taken aback' and 'filthiness' will be 'covering-up' and 'escaping'. 14. The more frequent the experience of sexual abuse, the more likely the response to 'being taken aback' and 'filthiness' will be 'informing' and 'escaping'. 15. The less frequent the experience of sexual abuse, the more lilely the response to 'being taken aback' and 'filthiness' will be 'covering-up' and 'escaping'. 16. The more available information concerning sexual abuses, the more likely response to 'being taken aback' and 'filthiness' will be 'informing' and 'escaping. 17. The less available information concerning sexual abuses, the more likely the response to 'being taken aback' and 'filthiness' will be 'covering-up' and 'escaping'. 18. The more cohesive the family of the subject, the more likely the response to 'being taken aback' and 'filthiness' will be 'informing' and 'escaping'. 19. The less cohesive the family of the subject, the more likely the response to 'being taken aback' and 'filthiness' will be 'covering-up' and 'escaping'. 20. The less familiar the subject is with the abuser, the more likely the response to 'being taken aback' and 'filthiness' will be 'informing' and 'escaping'. 21. The less familiar the subject is with the abuser, the more likely the response to 'being taken aback' and 'filthiness' will be 'covering-up' and 'escaping. 22. The more likely the response to 'being taken aback' and 'filthiness' is 'informing and 'escaping', the more positive changes the subject will pursue. 23. The more likely the response to 'being taken aback' and 'filthiness' is 'covering-up' and 'escaping', the more negative changes the subject will pursue. The following four hypotheses were conformed in the process of data analysis. 1) In case the level of violence is strong but 'being taken aback' and 'filthiness' in weak because of strong sexual curiosity and also if information concerning sexual abuse is not readily available and the frequency is low, negative internationalization marked by 'covering-up' and 'escaping' will take place despite the fact the subject is open-minded, the family is cohesive and the abuser is unfamiliar. 2) In case the level of violence is weak but 'being taken aback' and 'filthiness' is weak combined with weak sexual curiosity and also if information concerning sexual abuse is readily available and the response from around is protective and the frequency is high, the subject will pursue positive changes to 'being taken aback' and 'filthiness', further aided by the fact that the subject is open-minded, the family is cohesive and the abuser is unfamiliar. 3) In case the level of violence is strong and 'being taken abuse' and 'filthiness' is strong because of weak sexual curiosity and also if information concerning sexual abuse is reading available and the response from around is readily available and the response from around is protective and the frequency is low, the subject will persue positive changes marked by 'informing' and 'escaping' despite the fact that the family cohesion is weak and the abuser is familiar. 4) In case the level of violence is strong and 'being taken aback' and 'filthiness' is strong because of weak sexual curiosity and also if information concerning sexual abuse is not readily available and the response from around is respelling and the frequency is low negative internalization like 'covering-up' and 'escaping' will take place, further aggravated by the fact that the subject's personality is closed, family cohesion is weak, and subject is familiar. On the basis of the above finding, it is recommended that nursing intervention should focus on promoting the milieu conductive to the victims pursuing positive changes along with the adequate aids from protection facilities as well as from the people around them.

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An integrated Method of New Casuistry and Specified Principlism as Nursing Ethics Methodology (새로운 간호윤리학 방법론;통합된 사례방법론)

  • Um, Young-Rhan
    • Journal of Korean Academy of Nursing Administration
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    • v.3 no.1
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    • pp.51-64
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    • 1997
  • The purpose of the study was to introduce an integrated approach of new Casuistry and specified principlism in resolving ethical problems and studying nursing ethics. In studying clinical ethics and nursing ethics, there is no systematic research method. While nurses often experience ethical dilemmas in practice, much of previous research on nursing ethics has focused merely on describing the existing problems. In addition, ethists presented theoretical analysis and critics rather than providing the specific problems solving strategies. There is a need in clinical situations for an integrated method which can provide the objective description for existing problem situations as well as specific problem solving methods. We inherit two distinct ways of discussing ethical issues. One of these frames these issues in terms of principles, rules, and other general ideas; the other focuses on the specific features of particular kinds of moral cases. In the first way general ethical rules relate to specific moral cases in a theoretical manner, with universal rules serving as "axioms" from which particular moral judgments are deduced as theorems. In the seconds, this relation is frankly practical. with general moral rules serving as "maxims", which can be fully understood only in terms of the paradigmatic cases that define their meaning and force. Theoretical arguments are structured in ways that free them from any dependence on the circumstances of their presentation and ensure them a validity of a kind that is not affected by the practical context of use. In formal arguments particular conclusions are deduced from("entailed by") the initial axioms or universal principles that are the apex of the argument. So the truth or certainty that attaches to those axioms flows downward to the specific instances to be "proved". In the language of formal logic, the axioms are major premises, the facts that specify the present instance are minor premises, and the conclusion to be "proved" is deduced (follows necessarily) from the initial presises. Practical arguments, by contrast, involve a wider range of factors than formal deductions and are read with an eye to their occasion of use. Instead of aiming at strict entailments, they draw on the outcomes of previous experience, carrying over the procedures used to resolve earlier problems and reapply them in new problmatic situations. Practical arguments depend for their power on how closely the present circumstances resemble those of the earlier precedent cases for which this particular type of argument was originally devised. So. in practical arguments, the truths and certitudes established in the precedent cases pass sideways, so as to provide "resolutions" of later problems. In the language of rational analysis, the facts of the present case define the gounds on which any resolution must be based; the general considerations that carried wight in similar situations provide warrants that help settle future cases. So the resolution of any problem holds good presumptively; its strengh depends on the similarities between the present case and the prededents; and its soundness can be challenged (or rebutted) in situations that are recognized ans exceptional. Jonsen & Toulmin (1988), and Jonsen (1991) introduce New Casuistry as a practical method. The oxford English Dictionary defines casuistry quite accurately as "that part of ethics which resolves cases of conscience, applying the general rules of religion and morality to particular instances in which circumstances alter cases or in which there appears to be a conflict of duties." They modified the casuistry of the medieval ages to use in clinical situations which is characterized by "the typology of cases and the analogy as an inference method". A case is the unit of analysis. The structure of case was made with interaction of situation and moral rules. The situation is what surrounds or stands around. The moral rule is the essence of case. The analogy can be objective because "the grounds, the warrants, the theoretical backing, the modal qualifiers" are identified in the cases. The specified principlism was the method that Degrazia (1992) integrated the principlism and the specification introduced by Richardson (1990). In this method, the principle is specified by adding information about limitations of the scope and restricting the range of the principle. This should be substantive qualifications. The integrated method is an combination of the New Casuistry and the specified principlism. For example, the study was "Ethical problems experienced by nurses in the care of terminally ill patients"(Um, 1994). A semi-structured in-depth interview was conducted for fifteen nurses who mainly took care of terminally ill patients. The first stage, twenty one cases were identified as relevant to the topic, and then were classified to four types of problems. For instance, one of these types was the patient's refusal of care. The second stage, the ethical problems in the case were defined, and then the case was analyzed. This was to analyze the reasons, the ethical values, and the related ethical principles in the cases. Then the interpretation was synthetically done by integration of the result of analysis and the situation. The third stage was the ordering phase of the cases, which was done according to the result of the interpretation and the common principles in the cases. The first two stages describe the methodology of new casuistry, and the final stage was for the methodology of the specified principlism. The common principles were the principle of autonomy and the principle of caring. The principle of autonomy was specified; when competent patients refused care, nurse should discontinue the care to respect for the patients' decision. The principle of caring was also specified; when the competent patients refused care, nurses should continue to provide the care in spite of the patients' refusal to preserve their life. These specification may lead the opposite behavior, which emphasizes the importance of nurse's will and intentions to make their decision in the clinical situations.

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