This research examines the direct influence of sexual harassment by superiors on subordinates’ young female trust in their superiors. The research also examines the mediating role of trust in the relationship between sexual harassment and continuous commitment as well as intention to leave. For this purpose, a pre-tested questionnaire survey was self-dropped and collected by the research team to young female professionals, who are in their early career (within five years of their career), in public hospitals in the cities of Tunis, Sfax and Sousse, Tunisia. The results were analyzed using SPSS and AMOS. The results of structural model, interestingly, showed no significant effect of sexual harassment by superiors on their subordinates’ trust. Hence, trust in superiors has no mediating role in the relationship between sexual harassment and continuous commitment as well as intention to leave. However, sexual harassment by superiors was found to directly and positively influence young female professionals’ intention to leave the job. Additionally, trust in superiors was found to negatively influence both young female professionals’ continuous commitment and their intention to leave. The results have certain theoretical and managerial implications, particularly in relation to young female professional in the healthcare sector, which is vital for Tunisia and every country. Healthcare is a unique industry, whose success depends on competent employees. Recent statistics  showed tThis research draws on social exchange theory (SET) and leader–member exchange (LME) to understand and examine the working relationship between subordinate female health professionals and their supervisors, especially young female doctors, who are under-researched in this context, since a plethora of research focuses on nurses . Social This research examines the influence of sexual harassment by superiors on subordinate female health professionals’ trust in their superiors. More specifically, it examines the mediating role of trust in superior in the relationship between sexual harassment and continuous commitment and the intention to leave. Trust derives from a range of subjective evaluations inherent in one’s relational background through which a person  decides whether to trust or not. Yet, sexual harassment by superiors toward subordinate women compromises their complex moral and emotional commitments. In extreme cases, some of them may not choose to adopt a continuous commitment, whereas others could leave their job. Sexually harassed young female health professionals will react by actively looking for working alternatives . A review of the literature to date shows some connections between organizational trust and the intention to leave  and, on This research examines the direct impact of sexual harassment by superiors and on young female health professionals’ trust in superiors. Additionally, the research examines the direct impact of trust in superiors on continuous commitment and intention to leave among young female health professionals. Furthermore, the research examines the indirect impact of sexual harassment on continuous commitment and intention to leave through trust in superiors. A proper understanding of these relationships will help in maintaining appropriate relationships between leaders and their employees and create a healthy and psychologically safe working environment for young female health professionals. The World Health Organization has identified the harasser in the health sector as a perpetrator of harassment, who can be in authority, respected, and trusted by his/her female subordinates . This haHypothesis 1.Sexual harassment by superiors negatively influences young female health professionals’ trust in their superiors.Sexual harassment can affect young female health professionals in a number of ways. This could include mental and physical health as well as advances in their career . They caHypothesis 2.Sexual harassment by superiors positively influences the intention to leave among young female health professionals.As highlighted earlier, sexual harassment has a negative consequence on employees’ mental and physical health . AccordiHypothesis 3.Trust in superiors negatively influences continuous commitment among young female health professionals.A recent study on Korean employees  showed tHypothesis 4.Trust in superiors negatively influences young female health professionals’ intention to leave.Trust (in organizations and superiors) is a predicator of intention to remain/leave the organization . ResearcHypothesis 5a.Trust in superiors fully mediates in the relationship between sexual harassment and continuous commitment.Hypothesis 5b.Trust in superiors partially mediates in the relationship between sexual harassment and the intention to leave.Research has confirmed that sexual harassment by superiors is a predicator of distrust in superiors  and the The research adopted a survey approach to achieve the purpose of the research. The survey was self-administered by young female doctors who are early in their career in healthcare (often within five years of their career). Five hundred questionnaires were distributed to young females in healthcare. The questionnaire were self-administered by young female health professionals in public hospitals in the cities of Tunis, Sfax and Sousse, Tunisia. In sum, 305 usable questionnaires were collected and deemed valid for analysis, which is a 61% response rate. The survey was distributed and collected by the research team members, who had access to the participants through their personal network. The research team confirmed that the collected data for research purposes and the respondents are anonymous. Hence, no personal data were collected from the respondents. Additionally, to protect the privacy of the hospitals and their participants, all personal information was eliminated from the analysis.The sorting of appropriate measurement scales is difficult. In fact, this stage is particularly important, as it influences the quality of the research. The more that measurement scales are valid and reliable, the more that the information is significant and consistent. In order to conduct empirical quantitative research, the appropriate scales to measure the selected variables were adopted see .The data collected in this stage of our research were first processed by means of the software SPSS 23. The factorial structure of the various scales was analyzed. In this context, the principal component analysis (PCA) with Varimax rotation was analyzed. The Kaiser criterion was programmed to only consider factors whose value is over “1”, which was accepted to fix the number of factors. As for the internal reliability of the scales, it was calculated using Cronbach’s alpha. Furthermore, the data collected were subjected to confirmatory factorial analysis to verify whether the factor structure, which appeared during the explorative phase, was valid. The quality of the scale adjustment was then estimated using structural equation models (SEM) through the software AMOS 23. A series of statistical indicators, widely used in literature, made it possible to evaluate the good adjustment. Parameters were estimated using the maximum likelihood statistical method. According to Roussel et al. , this meThe communities indicating the information quality of the starting variable, which are restored by the factor/s, obtained at the end of the analysis. In other words, the part of the variable explained by the factors used.The percentage of variance returned by factors; in some studies, the threshold of satisfaction is fixed a priori in terms of percentage of variance explained. It is consequently appropriate to hold the number of factors necessary to reach this threshold.Factorial contributions: the quality of analysis is evaluated also at the level of each variable by examining the factor loading.Kaiser’s criterion: If the starting point of the analysis is a correlation matrix, the classic Kaiser’s criterion consists in holding the factors whose eigenvalue is more than one. On the contrary, if it comes to a variance–covariance matrix, one can use Kaiser’s criterion to exclusively hold those factors, which represent more than 1/p% of the total variance; p is the number of affirmations on the scale. We shall also examine the KMO test to discover whether our sample is appropriate or not for the PCA, or simply to answer the question about the fact that our data are factorable or not.Cronbach’s alpha was used as an indicator to measure the reliability of the various elements, which are supposed to help measuring a phenomenon . Reliabip-value = 0.000 < 0.05); therefore, we reject the null hypothesis. The reliability analysis shows a Cronbach’s alpha of “0.940”. It could be said that this specific measurement scale for sexual harassment is more than satisfactory. With regard to the scale of sexual harassment, the variable is confirmed through the identification of three elements, which represent more than “72.956%” of the total variance explained. Sexual harassment has three main factors: risks perceived in relation to the scale of the challenge (3 items), the law of silence due to the cultural weight (6 items), and sexual harassment acts (4 items). These 13 items were minimized into 8 items, according to factor loading. The KMO index evaluated at “0.918” shows that the data about the measurement of this construct lend themselves well to the factorial analysis. As for the Bartlett test, we notice an alternative hypothesis, i.e., that the correlation matrix does not coincide with the unitary matrix  was adopted to use the models of structural equations. This kind of approach makes it possible to analyze the causal connections among the variables of the theoretic model. In this respect, El Akremi  stated t2/df equal to “1.982” is much lower than “5”. In this regard, according to Jöreskog and Sörbom [2/df is lower than “5”. The RMR, “0.034” and the RMSEA, “0.057” are considered acceptable. The NFI, TLI, CFI and RFI, respectively, of “0.986, 0.989, 0.993, 0.977”, are close to “1”. The standardized RMR is equal to “0.0179”, thus being very close to “0”. The CAIC of the model is much lower than the CAIC of the saturated model, thus showing a good parsimony of the model. The Joreskög Rhô φJD is equal to “0.892”. Consequently, the scale has good reliability. The model to measure sexual harassment shows a good correspondence to the data. The ratio xd Sörbom  the ratiJD, it is equal to “0.875”. Consequently, the scale has good reliability.The trust model shows a RMSEA evaluated as very good. Furthermore, the goodness of adjustment of this model is quite satisfactory. In fact, GFI, NFI, RFI and CFI show values very close to “1” . The CAI2/df ratio equal to “2.631” is very satisfactory. The CAIC is much lower than the CAIC of the saturated model, thus showing a good thriftiness of the model. The Joreskög Rhô φJD is equal to “0.911”. Therefore, the scale has good reliability. As a result, the adjustment quality of this dimension is very satisfactory. The model of the intention to leave shows a RMSEA of “0.073”, which is an acceptable index. Browne and Cudeck  confirme2/df ratio, equal to “2.443”, is much lower than “5”. The RMR index, “0.015”, is excellent, as it is very close to zero. The RMSEA reports a satisfactory value of “0.069”. GFI, AGFI, NFI, NNFI, RFI and CFI are close to “1”. The CAIC of the model is much lower than the CAIC of the saturated model, thus showing a good thriftiness of the model. The Joreskög Rhô φJD is equal to “0.966”. Consequently, the scale has good reliability. The model has a quite good adjustment quality. Descriptive results of the first order confirmatory factor analysis are presented in As for the measurement model of the continuous commitment, it shows an excellent adjustment to the data. In fact, the chi-square value is low, “4.88”, and the xIt should be noted that the elements of each concept of the model significantly changed in consequence of the exploratory and confirmatory factorial analyses. In fact, during the whole purification phase of the measurement tools, the items which showed anomalies were removed. Afterward, the global quality of the adjustment of the final model was confirmed. The final model with its regression coefficients is discussed.Average variance extracted for all the constructs was acceptable and more than 0.5 . Both coThe model shows a RMSEA of “0.0240”, which is considered to be a satisfactory index by Didellon and Valette-Florence . The RMRAccording to Butler , trust iThe results showed that sexual harassment by superiors is sufficiently correlated to the intention to leave. When sexual harassment increases by “1”, the intention to leave increases by “0.309”. Hence, it could be argued that the intention to leave is a behavior through which the sexually harassed woman, aware of her skills, qualifications and added value, reacts by looking for alternative jobs. This empirical observation demonstrates that sexual harassment is a real problem for young female employees. Some of them with very promising qualifications and skills can give up and finally leave their corporations and look for another job, where a healthy organizational atmosphere can let them work in safety. This causes a heavy loss of talent ,46 and, The results showed that trust is negatively correlated to both continuous commitment and the intention to leave among young female health professionals. In fact, when trust increases by “1”, the continuous commitment and intention to leave decrease respectively by “0.319” and “0.090”. In that case, trust strengthens the perception of mutual responsibilities and associated identities . Trust bQuite rightly, Gurviez  stated tThe results of current research have some implications for scholars and policymakers in the healthcare sector. For the theoretical implications, the results, interestingly, showed that trust in superiors has no mediation role between sexual harassment by superiors and young female professionals’ intention to leave nor their continuous commitment. This is because sexual harassment has no significant influence on trust in superiors. In other words, if sexual harassment by superiors takes place, young females respond directly by their intention to leave the job. Therefore, it is vital that researchers pay sufficient attention to understanding sexual harassment by superiors than in building trust in superiors. Furthermore, the current research adopted a holistic model which combines together sexual harassment by superiors, trust in superiors, continuous commitment and intention to leave, where sexual harassment is the explanatory variable. Policymakers should have a crucial role in preventing sexual harassment toward anyone, especially young female professionals, through proper legislation and regulation as well as strict implementation of these regulations. The privacy of females who report sexual harassment should be highly protected by the administration in the healthcare sector and policymakers. This will help them report any unwelcome and unethical behaviors, including sexual harassment. This research concentrated on classical hierarchical sexual harassment, i.e., the one from the immediate superior to his subordinate. The research completely avoided two further kinds of sexual harassment: horizontal sexual harassment between colleagues and what is called “counter-power harassment” in the sense given by O’Connell and Korabi , who disThe research has the following research contributions: a theoretical and a managerial one. On the theoretical level, though the literature ascertained connections between trust in superiors and intention to leave on the one hand and trust and organizational commitment on the other, there was no published research to the best of the researchers’ knowledge-without necessarily being exhaustive, which combines the three aspects at the same time, where sexual harassment is the explanatory variable. On the managerial level, our research highlighted many rules. This study revealed that sexual harassment is a very serious and even tragic problem for young female professionals. Preventing and fighting sexual harassment toward women must be taken seriously and become a challenge for corporations, which should ensure a healthy and safe environment. The ostrich policy does not solve the problem. On the contrary, cowardice allows the proliferation and encouragement of sexual harassment in the workplace. Some women employees, though deserving of successful careers, end up surrendering and dropping out of their fields of activity. This is a costly loss of talent in all professional circles. The intention to leave her company is a behavior by which a sexually harassed woman, fully aware of her skills and added value, reacts by actively looking for working alternatives.The current research has some limitations, which could open the door for further research opportunities. Despite the fact that sexual harassment can be conducted by anyone to both males and females, the current research was limited to sexual harassment by superiors and its influence on subordinates’ trust, continuous commitment and intention to leave, particularly among young female professionals in public hospitals in three main cities of Tunisia. Hence, the results may be limited to other societies with same context and culture. Further research could examine sexual harassment in a wider context and different culture.


In recent years, increased demand has put pressure on child and adolescent psychiatric services in Sweden . A lack n = 5), most likely due to the impact of COVID-19 on occupational tasks. Although the pandemic has increased the amount of online-delivered training, the TRT developers had aspirations to provide remote training prior to the pandemic. There is a perceived need in war-torn areas, such as Syria, where a remote training has been delivered. Yet, to the best of our knowledge, online TRT training has not been evaluated.In March 2020, COVID-19 motivated the swift decision to conduct a planned TRT training remotely, leaving limited time for preparation. The course included 20 participants from across Sweden and was held by an instructor highly experienced in delivering TRT training, but not online. The same instructor conducted a second online training in June 2020, to which fewer participants signed up  were contacted via e-mail and a social media group, asking those who were interested in participating to contact the researchers. The interview participants were all female, aged 40–60 years, working with children , reflecting the demographic of the wider training attendees. The interviews, lasting an average of 30–min, were recorded, transcribed, and analyzed using systematic text condensation . To keep up with questions in the chat. She was very good at it, but it must have been very strenuous” (Interview 6). The lower number of participants in the second training was believed to facilitate learning; “If you’re 6, it is perfectly ok to interrupt with a question, but if you are 10 to 15 it becomes much more difficult” (Interview 9).Participants had expected on-site training to involve active practicing of techniques and were positively surprised this was feasible online. Activities involving the body , were perceived as better suited for on-site training due to the restricted view of the instructor and other attendees on screen. Other techniques  were thought to be easier online as physical distance might decrease self-awareness.The teaching methods had been varied, which had been important to maintain focus online. The participants gave suggestions to further increase learning, such as more visual aids, having the physical TRT manual, and receiving instructions beforehand on how to prepare for practicing techniques.Online TRT training was perceived to demand more than on-site in terms of concentration, flexibility, structure, and previous experience: “I thought about those [participants] who have never heard of it [trauma] /…/ I’m pretty familiar with it. And yet it took quite a lot of energy to sit like this in front of the computer. So it’s great that she [the teacher] put in many short breaks” (Interview 4). Group discussion was regarded as important for learning and to enable future peer support, the absence of which was considered particularly detrimental to participants without previous experience.Similarly, the teacher’s experience of TRT was seen as fundamental: “I thought it would be trickier to try the techniques and learn them. But no /…/ that probably depended very much on the teacher’s ability to convey it so pedagogically and methodically, as she is so comfortable with the manual” (Interview 1).The online course met the participants’ needs; they felt more confident to work with children who had experienced trauma: “I work a lot with decreasing the fear of trauma. It’s so charged, you’re so scared to make a mistake /…/ knowing that there is a method kind of discharges a lot of what feels so charged. Because we could actually offer something here in our municipality” (Interview 3). Yet, a need was expressed to rehearse the manual. Those from the latter training had received an appreciated booster session (an independent decision of the training provider): “It was super good. Even if it wasn’t new, some questions had come up and you get this reminder” (Interview 8).Participants were eager to hold a TRT group, seeing a clear need among the children they met. Yet, they also voiced insecurities: “It feels like a pretty big challenge, a lot to keep track of /…/ But the needs are great and this is a great support, so I definitely want to do this” (Interview 7). One participant was holding a TRT group, and others described that they had wanted to, or even planned to, but had not been able due to social restrictions during the pandemic or lacking the required facilitation partner. A supportive structure at the workplace and support from other group leaders seemed to increase confidence about holding groups. However, online training was believed to make it less likely that participants stayed in touch: “It can be good to have these contacts, to exchange experiences /…/ to give each other good advice. And those contacts may not be made naturally because you don’t talk to each other during the breaks, you are only active during the training itself. So that’s probably what you miss [when training online], so I think you might need to have some plan for that in advance” (Interview 2).Based on the findings of the interviews, recommendations for future online TRT training were developed and presented back to the participants in a Web-based, anonymous survey after the interviews were concluded. Table This study has various limitations. Participants volunteered, which could create selection bias. They were mostly female school staff, but this reflects the real-world intervention setting. It was a small-scale qualitative evaluation; thus, the results cannot be expected to be generalizable to an international context or all online professional training. However, data saturation was achieved, and the participants worked in different geographical areas in Sweden and had different background knowledge of trauma and group support, which can promote transferability. Cross-checking  was used to achieve dependability and confirmability.The participants described increased confidence to support children who have experienced trauma, echoing previous findings that training community professionals can lead to empowerment and better understanding of mental health issues . OverallInteraction was highly valued, aligning with the social constructivist perspective asserting that learning is formed through social processes such as conversation , as wellInsecurities about holding a TRT group echo previous implementation research and thus should not be attributed to the online format. For instance, organization-level characteristics and post-training support, identified as important in this study, also significantly predicted the use of a community-based parenting program . MoreoveThis study suggests the online format might be more challenging for professionals without previous trauma training. This differs from a recent study evaluating an online teacher education in trauma-informed care, which reported all participants experienced enhanced performance on attitudes towards trauma and self-efficacy, regardless of previous training . Yet, th


As the numbers of people with dementia worldwide rises, there is a need for improved knowledge and awareness about the condition across the healthcare workforce. There are concerns that traditional models of healthcare education, which focus on short-term episodes of care, limit student understanding of long-term conditions. We therefore designed and delivered the Time for Dementia programme at five Universities in the UK. Through longitudinal contact with families living with dementia, healthcare students gain increased understanding about the experiences of living with dementia. However, implementing new educational models brings challenges. To enable implementation of similar programmes in other educational institutions, this study aimed to identify the common barriers and facilitators of implementing these types of longitudinal programmes at scale.n = 6), programme administrators (n = 4), and Alzheimer’s Society staff (n = 2) that had key responsibilities for implementing Time for Dementia. Interview questions explored participants experiences, the facilitators, and the challenges encountered when implementing the programme. Interviews were audio recorded, transcribed verbatim, and analysed using inductive thematic analysis.To understand the facilitators and barriers of implementing a longitudinal dementia educational programme, a qualitative study was completed. Between October and December 2018, twelve in-depth semi-structured interviews were completed with university teaching staff (The analysis identified five key themes: “Leadership characteristics”, “Organisational and student buy-in”, “Perceived value and motivating factors”, “Team coalition and support”, and “Time and fit”. Implementation of the programme was enhanced by resilient leaders managing the challenges of curricular change. Their belief in the value of the programme, stakeholder buy-in, and supportive team working enabled challenges to be overcome. Workload was reduced and student buy-in increased as time progressed and as more resources became available. A flexible approach to implementation was recommended to ensure the programme fits within the established curriculum.Curricular change is a challenging task, yet necessary, if we are to improve care for people with long term conditions such as dementia. This study highlights the common barriers and facilitators experienced when implementing a longitudinal educational programme at scale. The findings presented in this study can be used by other educational institutions to manage curricular change efforts. Currently, over 885,000 people have dementia in the UK  with an Educational initiatives provided at undergraduate level could enhance student knowledge and attitudes towards dementia, however, there is a lack of evidence and policy direction about the type of dementia education required –18. TradWorking in partnership with Alzheimer’s Society and local NHS trusts, the Time for Dementia (TfD) programme  was desiWhatever the emerging evidence of the value of such approaches, implementing new educational models into undergraduate healthcare programmes requires change to an established curriculum, and such change is complex . There aThese findings can help understand the factors involved in longitudinal curricular change. However, there are significant differences between LICs and programmes like TfD. Both include a longitudinal component, however, LICs are traditionally designed for medical students that actively participate in patient care, and are under the supervision of a clinician . It is tTo support the future implementation and spread of such programmes, the aim of this study was to identify the barriers and facilitators encountered when implementing a longitudinal dementia educational programme as part of the core curriculum.A qualitative study was designed and carried out in 2018 across the five universities that had implemented TfD. This study was underpinned by an interpretivist paradigm. Interpretivism subscribes to constructivism  and the Participants were invited to take part if they had experience in the implementation or oversight of TfD in one of the five universities. Eligible participants included three groups: university lecturers, TfD administrators, and TfD family network staff. University lecturers were tasked with implementing the programme at a faculty or discipline specific level and held primary teaching roles in medicine, nursing, physiotherapy, and occupational therapy. TfD administrators based within the universities managed the co-ordination of student visits. TfD network staff included a manager and support workers that co-ordinated the recruitment of families and supported universities during implementation and oversight of the programme. Thirteen participants were identified as eligible and were initially approached via email. Of those, twelve individuals responded to the email expressing their interest. These individuals were followed up and all agreed to take part in an in-person interview.Semi-structured in-depth interviews were carried out between October and December 2018. Face to face interviews were arranged at a time and place to suit participants. Participation was voluntary and informed written consent was obtained. Socio-demographic data was collected, and interviews completed. A topic guide was developed following a review of the literature exploring curricular change and the implementation of longitudinal healthcare programmes. To assess its suitability, the topic guide was reviewed by two individuals with experience in leadership, change management, and implementing change. The topic guide explored the role of participants in their organisation and with the programme, the factors that enhanced implementation, challenges to internal delivery, and challenges to wider delivery. Interviews were digitally recorded using an encrypted recorder and lasted between 30 and 75 min. Interviews were transcribed verbatim and checked for accuracy by the lead author. Following this, audio files were deleted. A non-identifiable code was assigned to each transcript, and identifiable data was removed. All study data was stored on password protected university computers. Field notes were completed following visits documenting the setting and reflections.Data analysis was supported using QSR NVivo Version 11 software  to collaThis study was approved by the Health Research Authority, National Research Ethics Service, NRES Committee London-Queens Square, reference number: 15/LO/0046.Twelve participants took part in the study. Their mean age was 45.8 years (SD 9.8), 83% of the sample were university based, and all participants were female. Participant demographics are described in Tables Five overarching themes were identified: “Leadership characteristics”, “Organisational and student buy-in”, “Perceived value and motivating factors”, “Team coalition and support”, and “Time and fit”. Table “I think the other thing is you’ve got to be really proactive; you’ve got to be willing to realise there are going to be challenges and problems, but actually you’re going to work round them and you’re going to make it happen…” (Participant 12)Confidence was viewed as an important leadership trait facilitating implementation and day to day running of TfD. The ability to take ownership of the programme, instil confidence at an organisational level, manage challenging issues, and have appropriate authority to make curricular decisions was deemed as centrally important. Key university staff were identified as being responsible for implementing TfD at an organisational level and embedding the programme into their respective curriculum. These staff reported clear understanding of their responsibilities, however some felt apprehensive during the implementation phase due to uncertainty about the task ahead. These feelings were intensified by a lack of time and additional workload associated with the change effort. However, resilient attitudes and acceptance of these challenges facilitated positive approaches and problem-solving.“I think it’s that whole buy-in about people (other lecturers) championing the project, about championing it for students as well, because ultimately these lecturers will be personal tutors to these students. So, if a personal student comes and says “Oh, I’m doing this dementia project and I don’t like it,” if the lecturer doesn’t understand what it’s all about, they might agree with the student, they might send the wrong messages...” (Participant 11)The importance of organisational buy-in was highlighted as both a facilitating factor and a barrier to implementing TfD. The importance of building a vision and gaining support from the senior faculty members, for example the Vice Chancellor, helped to increase organisational ownership and recognition of the programme’s importance. Raising awareness of the programme amongst wider faculty was identified as a challenge given the limited time available. However, this was seen as a necessity as the wider faculty could have a pivotal role in influencing student buy-in.“I think them seeing the families engaging with them, kind of when they start their studies, I think it just helps to take the mystery out of it.” (Participant 4)As more students completed the programme, student buy-in was enhanced over time through peer-to-peer influence and acceptance that TfD was part of their curriculum.“ … with the first two or three cohorts, they weren’t always as engaged as they should have been … this year we had a special session with one of the families for them, that were just telling from their experience about having the student visits and also their daily lives with dementia. I think that actually, it clicks with the students … ” (Participant 4)Engaging students was challenging in the initial phases of implementation. However, proactive approaches enhanced student engagement. This was achieved through tailored introduction and preparation sessions prior to the programme beginning. The involvement of families living with dementia and student advocates attending these sessions helped increase student buy-in.“I think personally, I was very excited, but I think there was a general excitement about being involved in something that was so innovative … actually, to incorporate the voice of people with dementia, you know, it really, for me, has made it more meaningful.” (Participant 3)Participants reported that their belief in the value of the programme was a driving force in motivating them to implement TfD despite the challenges. They reported a sense of positivity and pride that the programme was successfully implemented within their university. Some felt the innovative aspects of TfD were highly valuable to their organisation, demonstrating progressive and modern approaches to curricular delivery and being at the forefront for change. Recognition of the programme importance through awards and media interest was viewed by some to add value, as was the opportunity for networking opportunities with colleagues from other universities implementing the programme.the fact of being involved in something with different universities, having those contact points with different universities and contact points with the Alzheimer's Society, which I probably wouldn’t have had, if it hadn’t have been for the project, so actually now having those... that networking side of it, I think is also really beneficial … ” (Participant 12)“ … Improving dementia education was identified as a high priority and all participants discussed their belief in the value of TfD as a way of achieving this. Their vested interest in this priority motivated their decision to be involved in the programme. This sense of value originated from personal and professional experiences and their understanding of the limitations of traditional dementia education.“I think that having a visit from [supporting TfD Team member] made some of those anxieties significantly reduced, because she was quite confident and, you know, she was very much like “we’ve done this before, you know, it’s fine”. So, I think that that helped.” (Participant 9)Team coalition (through the stakeholders involved in the programme) was a critical element to the implementation of TfD. Team commitment and enthusiasm was felt to be a driving force behind the ability to manage perceived and actual challenges. A dedicated support TfD team consisting of BSMS and Alzheimer’s Society staff, provided guidance to each university in the implementation of TfD. Support was provided through regular on-site meetings, and the provision of templates and resources, for example student facing documents and teaching plans. This support was perceived by participants as essential, and paramount in alleviating anxiety about the implementation process. Knowledge and expertise within the supporting team were reassuring for participants.Close working relationships between the supporting team and individual universities enabled collaborative working across organisations. However, as confidence grew following implementation, the need for more clarity in roles was highlighted.“ … having that (administration) support in early and having your resources there and making sure … all your ducks in a row before you even entertain the idea of introducing it to the students … .” (Participant 8)Once appointed, administrators helped to reduce workload and time pressures.Unsurprisingly, the early stages of implementation were identified as being the most taxing for participants. A lack of protected time or dedicated resources, such as administrative support, increased workload for university lecturers. Some participants felt administrators need to be employed and in position earlier in the implementation phase.“ … we just basically looked at these are the modules, and it fits well with and so it meant our course underwent a periodic review, so it’s a five-year review process every course goes under, so as part of that review process then we incorporated the TfD within those modules … ” (Participant 8)Implementing a new educational model into an already crowded curriculum was recognised as being difficult. Caution about the programme’s fit was identified to ensure it was positioned appropriately within the curriculum and made sense to students, for example, within an existing curriculum module with similar objectives. For one site, implementing the programme during a scheduled periodic review of the curriculum facilitated its implementation.“ … implementing TfD in a new university has to have a degree of flexibility … because actually if it doesn’t fit within your curricula, it doesn’t fit, and I think there has to be that degree of flexibility with how it is actually implemented and introduced within universities.” (Participant 3)To facilitate implementation, a degree of flexibility was suggested for new sites.In general, participants agreed that once implemented the challenges reduced significantly. With the passing of time, student engagement increased, wider faculty awareness improved, and the programme was well recognised in the organisational context.This study aimed to identify the barriers and facilitators encountered when implementing a longitudinal educational programme, at scale, into existing undergraduate healthcare programmes. Five key themes were identified: “Leadership characteristics”, “Organisational and student buy-in”, “Perceived value and motivating factors”, “Team coalition and support”, and “Time and fit”.Leadership traits were evident throughout this study’s findings. This is unsurprising given the complexities of managing curricular change . FacilitThe degree of compatibility and complexity into its implementation is an important consideration for universities . ParticiMotivation is considered a persuasive factor toward the willingness to change . The relSuccessfully managing curricular change depends on effective team working , and theA collaborative environment and human resource development are necessary to manage curricular change. Internal network support was viewed as a necessary part of this, and participants identified senior management, wider faculty and student buy-in as important agents to establishing and maintaining a collaborative environment . ResistaStudents had little autonomy of decision-making about taking part in TfD as it was a mandatory part of their undergraduate education. However, efforts to foster extrinsic motivational factors by providing a supportive environment (peer to peer reassurance and wider faculty awareness) and socially contextual activities (preparation and introduction sessions), appear to have increased motivation and ultimately, buy-in. To enhance readiness and buy-in, students are introduced to TfD several months before the programme starts. A session lasting 1 h is facilitated by Alzheimer Society staff, a university lecturer, a family living with dementia, a student with previous experience of the programme, and a TfD administrator. The introduction session provides students with an overview of dementia, an overview of TfD, and family and student experience of the programme. This session also introduces students to members of the TfD team and provides key contact details.In the month before the start of TfD, students attend a preparation session lasting 2–3 h. The session is facilitated by Alzheimer’s Society staff, a university lecturer, and TfD staff. Topics covered in the preparation session include further information on TfD, the purpose of the programme and its relevance to student learning, preparing for visits, safety considerations, the role of Alzheimer’s Society in the programme, and an interactive session to address the students’ hopes and concerns. Finally, a handbook is provided to all students and contains information that includes advice about visiting families, suggested topics to explore, recommended structure for visits, what to do if issues arise, and key contact details.The student body must be considered as a powerful coalition member and it is imperative that universities build student buy-in as a facilitating factor when implementing the programme.There are two main limitations to this study. First, all participants were female and of similar ethnic origin, although this was indicative of the overall population of the teams involved in the implementation of TfD at the time of data collection. This may have limited the generation of themes and further research is needed to include a diverse sample as the programme is implemented in new sites.Second, this study found resistance to change was not commonly experienced by participants from the wider faculty or organisation. This suggests their organisation may already have had a culture more conducive to and accepting of change. It may be that this represents the possibility that the universities involved were ‘innovators’ and/or ‘early adopters’ and so might differ from the later categories  of adopters at institutions less primed for this change . TherefoHowever, it is a strength that TfD was implemented by universities delivering health professional undergraduate training in Kent, Surrey, and Sussex, so there was no selection based on willingness to participate within the region, aiding generalisability. When presented with the possibility of participation, with the costs covered by Health Education England, all the universities in the region cooperated enthusiastically. A further strength is that the good quality qualitative approach used here has generated novel and practical guidance about the implementation of a condition specific longitudinal model in universities.Good quality dementia education is a priority for the healthcare workforce. Recognising the limitations of traditional undergraduate dementia education, five universities in the UK have taken a progressive approach by implementing a novel dementia longitudinal educational programme. Managing curricular change can be daunting and a challenge, however with the right preparation and leadership in place, the task is readily achievable. Committed leaders that believed in the value of the programme facilitated its implementation, and efforts were enhanced by organisational buy-in and team coalition building. Programme fit, managing time, and availability of resources during the implementation phase requires careful consideration in new implementation sites. Findings from this study should be useful for universities planning similar longitudinal programmes.


Surveillance programs supporting the management of One Health issues such as antibiotic resistance are complex systems in themselves. Designing ethical surveillance systems is thus a complex task (retroactive and iterative), yet one that is also complicated to implement and evaluate . The governance of health surveillance requires attention to ethical concerns about data and knowledge  and empowerment ethics, also referred to as a form of responsible self-governance. Ethics in reflexive governance operates as a systematic critical-thinking procedure that aims to define its value: What are the “right” criteria to justify how to govern “good” actions for a “better” future? The objective is to lay the foundations for a methodological framework in empirical bioethics, the rudiments of which have been applied to a case study to building reflexive governance in One Health. This ongoing critical thinking process involves “mapping, framing, and shaping” the dynamics of interests and perspectives that could jeopardize a “better” future. This paper proposes to hybridize methods to combine insights from collective deliberation and expert evaluation through a reflexive governance functioning as a community-based action-ethics methodology. The intention is to empower individuals and associations in a dialogue with society, which operation is carried out using a case study approach on data sharing systems. We based our reasoning on a feasibility study conducted in Québec, Canada (2018–2021), envisioning an antibiotic use surveillance program in animal health for 2023. Using the adaptive cycle and governance techniques and perspectives, we synthesize an alternative governance model rooted in the value of empowerment. The framework, depicted as a new “research and design (R&D)” practice, is linking operation and innovation by bridging the gap between Reflexive, Evaluative, and Deliberative reasonings and by intellectualizing the management of democratizing critical thinking locally (collective ethics) by recognizing its context . Drawing on the literature in One Health and sustainable development studies, this article describes how a communitarian and pragmatic approach can broaden the vision of feasibility studies to ease collaboration through public-private-academic partnerships. The result is a process that “reassembles” the One Health paradigm under the perspective of global bioethics to create bridges between the person and the ecosystem through pragmatic ethics. Second, empowerment must lead individuals and communities to make their own changes, as autonomous and self-determining agents who acknowledge local values and constraints as criteria for change. Third, power must lead to awareness of our individual and social actions, which should also lead to self-responsibility and even to accountability mechanisms: an “abductive” approach  in Quebec, Canada. Data from this surveillance system in public health could allow both scientific research and informed decision-making. The research question here, in bioethics, is about the promotion and education of critical thinking in technology and health, not only of scientists and policymakers but of all stakeholders. Building on a pragmatic approach to bioethics, this reasoning is driven by, first: How could empowerment ethics ease the “bridging” between cognitive and collective? From a synthesis of One Health methodologies and paradigms, the reasoning continues with a framework laying out the theoretical rudiments for a hybrid method to understand: How can we embed person-to-person dialogue in a collective assemblage to engage social groups in a negotiation process? Dialogue is supported by reflective critical thinking approaches, while social negotiation moves this cognitive to the level of collective interaction supported by ethical deliberation approaches. Finally, learnings from the case study will give answers to How can a community of beings and things become “reflexive,” conscious, and responsible, i.e., the “ought to be” empowered?Since 2017, the Government of Quebec has been considering developing surveillance programs that integrate efforts in health prevention between several ministries and sectors . This type of policy could be improved by its connection with several advanced theories in various fields that converge in practice under the perspective and terminologies of One Health and sustainable development. A challenge for One Health, in such a policy context, is to deepen the decision-maker's understanding of the pertinent theories while avoiding reduction to a set of expert buzzwords or jargon that then complicate translation into practical terms .One of the policy objectives set by the Government was to develop a well-articulated program that had community-based meaning and criteria  for a surveillance system of antibiotic use in animal health (agriculture and pets). Its program arose in a social context where several sectors, particularly in human, animal, and environmental health, had already implemented initiatives dealing with outbreaks, pharmaceuticals, and, notably, antimicrobial governance based on systems of information and communication technologies (SICT) used for surveillance purposes. In animal health, different committees, associations, and groups are involved in leading these reflections through participation in formal and informal working groups. These activities aim to produce detailed application procedures that would then be laid out in an action plan for the management of antibiotic use, surveillance, and governance for all sectors of veterinary practice and food productionMinistère de l'agriculture, des pêcheries et de l'alimentation (MAPAQ) mandated a feasibility study of the implementation of a surveillance program on the use of antibiotics in animals in Quebec (2018–2021). Several recommendations emerged from the resulting consensus-building process (2019–2020) within the veterinary and agricultural community, notably:In light of these different initiatives, the To build data systems and information platforms and their use based on trust,To co-construct a common normative language,To design a collaborative governance regime to shape the functioning of the program.Aiming to implement a methodology for this collaborative collective thinking, the multidisciplinary team in charge of the feasibility study made a distinction between “consultation” and “concertation” to unpack the consensus-building nature of the methodological process. The consultation aims to gather information from a group to inform experts in developing the “best” model possible (the feasibility aspect), while concertation seeks for consensus among a group to deliberate about which criteria are “best” , in order to give an acceptable orientation to the developing model (see here the clear distinction between descriptive and appreciative knowledge further developed in the last section).The concertation phase of the feasibility study, which began with 60 representatives, eventually brought together 100, an extensive recruitment process aimed at saturating the perspectives covered by the different sectors of activity , practice , and professions . The two concertation events made it possible to collectively deliberate on the overall vision and were then followed by 12 consultations that brought together different stakeholders in small groups (6–16 participants per group) to deepen the discussion. Subsequent focused individual interviews made it possible to add reflexive details to the perspectives  of key actors involved in the process . Human and environmental sectors  were not the focus of the discussions; instead, the focus was on the ethical challenge of implementing a new technosocial program and developing a policy to manage the use of antibiotics in animal health. Nevertheless, many of the participants were invited to group discussions and interviewed separately to further explore their views on how the animal health situation is nested within the larger context of One Health. Ethics approval was received for the research phase of this project from the University Research Ethics Committee (anonymous); all participants were informed of the nature and scope of the project, the confidentiality mechanisms in place, and gave their consent to participate.One of the notable challenges of contemporary methodologies is to account for multi-scale relationships, building a bridge between the individual, the social, and the global. Ten Have  introducFaculté de Médecine Vétérinaire at the Université de Montréal (FMVUM) was mandated by MAPAQ to conduct a large-scale empirical and social project. By reviewing, commenting upon, and critiquing the rudiments of this philosophical model, both the team and participants contributed to testing and enriching the model, as intended by good reflective practice. As an employee for this project, one of the authors, Boudreau LeBlanc , was given the task to develop a model to manage the ethical challenges with deploying consultation and concertation processes and to ensure the reflexivity of the experts and the deliberation of the collective . One solution to the challenge of bridging reflexivity and deliberation was to include the micro, meso, and macroscales in discussions, although this also introduced other ethical challenges, namely the subjectivity of each actor . Thus, it was obvious that a collective ethic was needed to set ground rules so that the actors could cooperate and co-construct the governance system. The feasibility study (2018–2021) conducted in Quebec, Canada, to evaluate the possible implementation of a monitoring system for the use of antibiotics in veterinary medicine was thus an ideal opportunity to study in situ how such a collective ethic could be implemented in a complex system in a way that leads to empowerment  and collective deliberation . Without pragmatism in the ethics of science, researchers and communities will struggle to produce effective and adaptive networks, norms, and actions because the interests of the various stakeholders  will not be articulated or aligned  and are made accessible through philosophical reasoning , 29. Eth aligned , 6.A practice of empowerment ethics should be developed by and for a community , 31. In Design a practical model of change,Set up a collaborative governance structure early in the thinking process,Co-construct a common language to give purpose to, and a framework for, points 1 and 2.As theorized by Latour , such a This ethics-science-society organizational approach highlighted in Beever and Whitehouse's  work in Research and Development must shift to a more integrative practice, coined here as adaptive Reflective-Evaluative-Deliberative cycle.To build reflexive governance for SICTs development, we propose a community-based action-ethics methodology. The methodology bridges expert evaluation and collective deliberation in a way to empower individual stakeholders and engage group leaders . ProjectEvaluation  is a key technique for bridging philosophy, science, and society through practical reasoning methods. Evaluation and deliberation must be conceived as independent methods given their distinct philosophical criteria and end (epistemology and teleology). To do so, reflexivity tools are crucial to avoid logical fallacies and to deepen and enrich the program value. However, these three methods benefit from being driven in parallel as interdependent methodologies , 42. Thedisciplined) form of “collective ethics.” Collective ethics could become an end for deliberation. Deliberative reasoning has a foot in the political and scientific “arena,” both of which may or may not be conducted ethically. Collective ethics seeks to establish “ground rules” as starting principles that are analyzed from multiple angles , including from the sciences and society as a “hybrid forum”  is a common reasoning process in day-to-day life. Deliberation aims at collectively examining, justifying, and questioning reasoning. However, political and professional deliberations should be about ethical justification, not scientific or political ones, or any private interest. Deliberation can be based on critical and evaluative reasoning, which would lead to a . This “prospective science” is intellectualized as experiential learning (yet past), with the aim of archiving the common ground for cooperation, such as a vision, models, and theories  of change  to abstract reflection , allowing feedback from both sides: evaluation and deliberation. But reflexivity is tied to the  challenges of both philosophy and science, to which pragmatism provides some answers. Judging reflexive thoughts is a matter of dialogues, integrity, and trust, even of bidirectional relationships, of a continuous search for consensus, and of collective duty to empower people to question these “thoughts.” Expertise from philosophy or science must be careful not to become a (normative) dictature , even unf change , 39, 53.Following Huxtable and Ives'  framewor“Mapping” the ideas to generate a hybrid ethical theory,“Framing” to be reliable to a case,“Shaping” is a proper (micro) normative theory for change.A Companion to Bioethics  is a social collective on the edge of transformation, meaning to be reorganized or “reassembled” according to Latour's work  to ground the normative knowledge that should support decision-making. “Fact” means knowledge and empirical observations , while “value” is about philosophical questioning and self-critical reasoning. Values are given to qualifying, notably uncertainty, bias, even the usefulness and successfulness of decisions  goal? Where should ethics occur in decision-making processes to empower critical thinking from individuals to the whole organization? Is it by the mandating government , the responsible team , or individuals (representatives of private interests)? The three kinds of reasoning—reflexive, evaluative, and deliberative—integrate distinctive approaches from empirical bioethics into the project management process . All thrright “location” to position ethics in governance. Mapping means here, first, acknowledging an adequate theory in ethics (see above A Pragmatic Bioethics Approach) and, second, choosing the best deliberative strategies to put it in practice (see below). A hybrid methodology that connects reflection, deliberation, evaluation and decision in a systemic process is detailed in Deliberation is part of decision-making processes and in the This reflexive “roadmap” with several checkpoints  guided tgood “preparation”  must be designed in close collaboration with the people to whom the norms apply. Norms must be co-constructed, emerge from large social collectives, and be deliberated through an adaptive cycle of iteration. Normative thinking will lead to strategy , but must first (Step 1) build on ethical analysis. Strategic and ethical thinking must eventually hybridize into one process of reasoning through iterative deliberation and learning from feedback (Step 2).Potter and Lisa  critic “the field, such as “consultations” and “interviews” could provide, which describes the community and its understanding of the change at stake. In that sense, deliberation needs to be data-driven, but not exclusively, because it must also be knowledge-driven by a process of transfer and “translation” , then on the value of its SICT program and development (2021), and (to come) on norms for responsible conduct. Governance must be evaluated and deliberate at each “start” . This meever better future—the scene (Step 1). For example, by laying the groundwork for a new proposal on the formal perspective of an Agreement in Principle for Responsible Animal Health Data Sharing (2021–2022). This Agreement must be initiated by design to acknowledge the “right” principle to apply for good collaborative governance —as they choose what best insights are meant for the community and about the future of society.good, to move toward a consensual justification and thus binding decisions. The usefulness of such tools is not in their mapping of social system complexity , judicious (risk vs. advantage), and responsible (short vs. long-term accountability) surveillance program for antimicrobial use. Conceptual roadmaps are useful to nuance and negotiate the positions of the various stakeholders  about the meaning of what is mplexity , 80, butmplexity , 82. A mmaps (as the one depicted above) became pragmatic analytical “tools” and could support professionals or other actors in their day-to-day decision-making. These hybrid tools can be designed for individual or collective use. These tools focus on structuring critical reasoning to get through complicated choices; they aim to identify, nuance, and contextualize tensions that transcend the decision-maker. These tools can also be seen as evolving roadmaps of the One Health paradigm and an advance in applied ethics (such a tool is proposed in the last section). When applied to a case, these roadmaps emerge from a confluence of expert and community perspectives as both have relevant viewpoints. However, roadmaps should evolve based on experience, not mere intuition. Real-world feedback is a core asset for the ongoing process of reassembling what is collectively conceived as a good change supported by intelligible methods from the field perspective.When assembled with bioethical methodologies or approaches to guide the bioethicist in the use of theories in practices, deliberative Applied to the case of a feasibility study in veterinary public health, in Québec, Canada, we will see how methodological innovations are implemented by people, institutions, and theories in constant evolution: a complex that “weaves together” three dimensions of “global” existence  that we have called “community” above , 15. Thiviability, livability, and equity. These fields act as a driving force for interdisciplinarity, notably political economy and ecology  that scale data sharing to knowledge transfer, translation, and applications. The philosophy advanced in the case study was based on learning: antibiotic use surveillance supporting both national antimicrobial governance policies through public reporting and refining individual conduct through voluntary benchmarking.Although there have been technical advances with SICT, an ongoing challenge in ethics remains to bridge the gap between experts and the community. A possible solution lies in critical deliberation and evaluation . Along tTo ease the functioning of SICT, one of the upstream goals must be to develop a common consensual language that puts everyone “around the table” on the same “terms” . “Language” here means helping each person or group to move beyond their position and broaden their perspective to a collective reference point . “Common” means a collective assemblage, joined under one “roof,” in constant “recruitment” of social actors, diverse  in problems, abilities, and ideas, but all interested in managing the same “problem” . The casThe case study highlighted the challenge of transforming a collaborative regime  into a governance body (administrative practices) whose functioning is acceptable for stakeholders—i.e., justified by collaborative ethics—and still meets the expectations of sponsors, mandatories, and society . The solInter-ethics opens deliberation on the (intern) program and (extern) partnership policies and values. Bioethicists are key to the functioning of large organizations such as companies, research groups, and public services. The functioning transcends (as singular) the ability to foresee a decision-maker, as the Chief executive officer (CEO), even the Chief information officer (CIO). Hermeneutic approaches, such as the maieutic process of Socratic dialogue  in a deontological or legal perspective, the pragmatic ethics approach shifts the emphasis from the “imperative” to a deeper collective deliberation process that democratizes thinking about such ethical criteria as good, right, and better. Pragmatic ethics recommend, first of all, putting aside the prioritization of which is “right” or “wrong” between scientific, traditional, and alternative knowledge and beliefs  and build consensus for action. Indeed, some deontological positions are inevitable (the “why-s”) and create conflictual ethical points of view : Who shod Potvin  in publiright course of action, meaning the “justify normative knowledge” that will lead to responsible actions, requires the involvement of many people from various disciplines. Appreciative knowledge is the key to expanding the perspective, for example, the Government of Canada's Categorization of Antimicrobial Drugs Based on Importance in Human Medicine, which is normative, seeks to prevent harm by adding such antimicrobial governance insights to medical practice. The “inter” of the “interdisciplinary” is about quality: Who or what is bridging? Too often, the “appreciative” fields of knowledge, carried by the humanities or the human sciences, are underrepresented. Co-building collective ethics as a structuring process of a One Health transdisciplinary program will help to highlight, “in action,” those missing pieces for normative practices.However, strategic analysis is a “descriptive to normative” knowledge translation process. This translation must be combined with an ethical analysis to prevent fallacies. For example, medical diagnosis (prescriptive) must be based on history and Biology (descriptive), but overall, the transition from one to the prescription of a particular treatment (an antibiotic) must be based on the clinical judgment of the physicist. The action-ethics framework presented here proposes such a “descriptive/appreciative-to-normative” knowledge translation process applied to political processes. Defining the right after all? Notably about data access or even antimicrobial governance. Is it the Law, the people, the market, the activists…? In terms of relativism, these dimensions—legal, civil, financial, associative—pose “truths” of equal importance. Pragmatism in ethics does not, in any way, reject the importance of deep debates, nor the negotiation of these dimensions, or the radical questioning of the way things are done , and society—introduces a confusing mess of terminologies, methodologies, and philosophies that must proceed throughout the program  development. At a minimum, proceeding with this “mess” in practice requires ethics: critical thinking, codes of conduct, and responsible organizations for an ever-learning process in ethics. Extended to society, a postnormal philosophy of sciences  proposesolutions  to incluolutions , 104. Asolutions  and tranolutions  are to bA pragmatic bioethics approach will be crucial to achieving this goal. To seek precision, the sciences tend to fall into the specialization process (disciplines and techniques) and lose the “big picture” as Saxe  has noteHow can we seek Global acceptability? How can we mobilize science paradigms to set a “feasible” normative theory leading to a co-built code of ethics for empowering the community?  Shaping levels of knowledge are about building consensus and deepening the reasoning of each stakeholder from their own point of observation to define the problem and interest in its resolution. A vision of change must transcend all dimensions of existence to question fallacious reasoning all along with the life of the surveillance program coming from integrating levels and points . For example, to see and coordinate, search for, or create a governance body with authority over financial planning, institutional sustainability, and stakeholder accountability . Deliberation : the experience of life as a person and as a collective  whose experience and context become accessible from the attentive “eye” and reflective strategies conducted in a community as a space/time, transgenerational and multispecies concept —“What exLevels of knowledge : sophisticated tools ranging from technologies to theories helping to deepen reasoning, to justify decision-making, or directly to change the conditions of existence—“What should it be?”Points of observation : the intellectual lenses leading to subjective action of the expert and from the community  to assess the effects of decisions on several patterns and scales—“What do we want to do?” “What could it be?” and “How will it be done?”existence—the observable (objective) and the being (subjective). Physics, for instance, is not only a scientific discipline but also a dimension of existence ; thus, giving physicomathematical architecture to science paradigms toward natural laws, notably in chemistry, biology, pharmacy, and also engineering, medicine, management, and any kind of evaluation techniques on antibiotics or environment  insights—the pharmacokinetics of antibiotics, the probabilities of resistance genes, the microbial ecology studying natural evolution, and ecotoxicological geography of heavy metals , such as the psychology of antibiotic users and the ecology of antimicrobial components. Recognizing this fallacy, descriptive knowledge must not prescribe actions on its own—e.g., the statement: “This antibiotic will cure that disease”—without being understood through the lens of scientificness  and as human power and will, interwoven with belief and values, and embedded in conflicting interests and missions  experience of life  as a community-based action-ethics methodology, although they will for this bridging process is not a given at the start.appreciative) and State laws (normative), while the latter refers to scientific observations (descriptive) such as those of physics (fact), while policies and diagnostics can change, and even less stable are the beliefs (opinion). These levels of knowledge, its strength, and even possible progression are not really messy but require an ongoing process of communication, management, questioning, and transparency to avoid fallacies : the value of ideas and advances. These values become shared appreciative knowledge under community-based ethical analysis, which integrates academic, political, and civil perspectives as Global evaluative insights  are valid when framed by models or conducted within controlled environments, but fail in the real world, notably the ecological (in situ) surveillance of antimicrobial resistance (action-research), but also more broadly in society (as action-ethics), requiring educational tools to operate: the example of the antimicrobial footprint  through convergence with applied sciences and practices, as initiated in One Health and sustainable development. Theories remain crucial to understanding what is observed, e.g., through the anthropological , the sociological , and the biological .One of the main aspects to be considered goes beyond knowledge and existence and enters the area of actions. This perspective, or  future”  and is a future” . The pos future” . Indeed, future” , meaningThink globally while acting locally, as individuals within the  collective, (biotic) community, even (planetary) ecosystems? How do we evaluate locally (for us) while deciding globally ? How do we do planning (long-term) while implementing (short-term)? How do we regulate (decide) while questioning the norms, guidelines, and understanding that have been established?  pathways to operate instead of (appreciative) guidelines to dictate (normative knowledge). The ultimate goal was to support the actual will in those fields of study to build reflexive governance, notably in One Health, to address the issues concerning the pharmaceutical agents necessary for medical practice (the antibiotic cure), but modifying the environmental conditions (the problem of antibiotic resistance).This paper seeks to lay the foundations for a methodological framework in empirical bioethics. Instead of focusing on ethical theories in philosophy or sciences, we reviewed the methodological literature in empirical bioethics, One Health and Sustainable Development study to lay foundations in pragmatism (J Dewey)— and collective practices, which leads to empowerment ethics. This operation translates the adaptive governance cycle into a new ethical technique of “R&D”: Project management in Research & Development, the one that confines them into two parts, must shift to a more integrative practice, called here the adaptive Reflective-Evaluative-Deliberative cycle. These communications and knowledge systems open to a perspective bridging the biological, social, and intellectual Latourian's collective and biotic community concepts to responsibilize the former over the latter.To bridge the gap between person-to-person dialogues and social negotiation processes, the operational pathway goes through comanagement techniques and must target cooperation nodes. Notably, the manager must bridge the gap between the construction of the community-based action-ethics methodology to R&D practice from the start: at the time of policy (see: GPHP), program [see: . The question we should be asking, then, is: How should we manage an Open dialogue between data producers and users within the community to start local changes? With empowerment ethics focusing on transparency, translation, negotiation, and arbitration, what we should call reflexive governance, we can engage groups and collectively drive cultural change and the willingness to accelerate it (an Openness to data), and then connect communities  to reach the broader perspective of One Health and the Sustainable development of its programs, even its paradigm.The ethical conflicts between the cognitive and the collective—as the singular will and common good—can only be managed through an open dialogue that continuously seeks The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.AB was responsible for the conception and ideas presented in this article, contributed to the planning, and conduct of the qualitative survey described in the article as a case study. CA and BW-J reviewed the initial manuscript, contributed to the text through changes to structure and addition of new content, and approved the final manuscript. All authors contributed to the article and approved the submitted version.This article was supported by funding (Ph.D. scholarships) from the Institut de Valorisation des DOnnées (IVADO), the Global One Health Network (G1HN), Centre de Recherche en Santé Public (CReSP) and the International Observatory on the Societal Impacts of AI and Digital Technologies (OBVIA). The corresponding author was an employee of the Faculté de Médecine Vétériaire at the Université de Montréal, hired to accompany the feasibility study on the implementation of a monitoring system for antibiotic use in veterinary medicine in Quebec by the Center for Expertise and Clinical Research in Animal Health and Welfare (CERCL) mandated by the Ministère de l'Agriculture, des Pêcheries et de l'Alimentation du Québec (MAPAQ).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.