After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

The purpose of this paper is to present the theoretical and philosophical assumptions of the Nursing Manifesto, written by three activist scholars whose objective was to promote emancipatory nursing research, practice, and education within the dialogue and praxis of social justice. Inspired by discussions with a number of nurse philosophers at the 2008 Knowledge Conference in Boston, two of the original Manifesto authors and two colleagues discussed the need to explicate emancipatory knowing as it emerged from the Manifesto. Our analysis (...) yielded an epistemological framework based on liberation principles to advance praxis in the discipline of nursing. This paper adds to what is already known on this topic, as there is not an explicit contribution to the literature of this specific Manifesto, its significance, and utility for the discipline. While each of us have written on emancipatory knowing and social justice in a variety of works, it is in this article that we identify, as a unit of knowledge production and as a direction towards praxis, a set of critical values that arose from the emancipatory conscience-ness and intention seen in the framework of the Nursing Manifesto. (shrink)

This paper draws on classical theories of wisdom to explore the organisational impact of nurses on Australian general practice. Between 2004 and 2008, numbers of general practice nurses doubled, the most rapid influx of nurses into any Australian workplace over the decade. Using data from the Australian General Practice Nurses Study, we argue that nurses had a positive impact because they introduced techne at the organisational level and amplified phronesis in clinical activities. In its Hippocratic formulation, techne refers to a (...) field of definable knowledge, which is purposeful and useful and requires mastery of rational principles. Nursing, with its focus on system and accountability, brought techne out of the GP’s consulting room and into the general practice as a whole. Nurses also exemplify phronesis, an Aristotelian virtue connoting a reasoned and honourable capacity to make judgements: the practical wisdom that defines the interaction between clinician and patient in general practice. At a time of significant GP shortage, doctors and nurses began to collaborate around their more complex and time-consuming patients, leading to a deepening of phronesis in the workplace. By bringing techne to bear on the organisation, and complementing and enhancing phronesis, nurses propel organisational wisdom in general practices. (shrink)

Nursing practice as bricoleur activity: a concept explored The debates concerning the nature of nursing practice are often rooted in tensions between artistic, scientific and magical/mythical practice. It is within this context that the case is argued for considering that nursing practice involves bricoleur activity. This stance, which is derived from the work of Levi‐Strauss, conceives elements of nursing practice as an embodied, bricoleur practice where practitioners draw on the ‘shards and fragments’ of the situation‐at‐hand to resolve the needs of (...) the individual patient for whom they care. This conceptualisation of nursing practice will be analysed with a particular emphasis on its implication for nursing epistemology, pedagogy and praxis. The evidence to support this argument is drawn from empirical work that investigated nurses’ use of intuition, the work of Levi‐Strauss, and issues in nursing epistemology and ontology. The paper itself is written from the perspective of a bricoleur who uses ‘bits and pieces’ from the domains of nursing, philosophy, psychology, education, sociology and anthropology. (shrink)

It is frequently claimed that nursing is vital to the safe, humane provision of health care and health service to our populations. It is also recognized however, that nursing is a costly health care resource that must be used effectively and efficiently. There is a growing recognition, from within the nursing profession, health care policy makers and society, of the need to analyse the contribution of nursing to health care and its costs. This becomes increasingly pertinent and urgent in a (...) situation, such as that existing in Ireland, where the current financial crisis has lead to public sector employment moratoria, staff cuts and staffing deficits, combined with increased patient expectation, escalating health care costs, and a health care system restructuring and reform agenda. Such factors, increasingly common internationally, make the identification and effective use of the nursing contribution to health care an issue of international importance. This paper seeks to explore the nature of nursing and the function of the nurse within a 21st century health care system, with a focus on the Irish context. However, this analysis fits into and is relevant to the international context and discussion regarding the nursing workforce. This paper uses recent empirical studies exploring the domains of activity and focus of nursing, together with nurses perceptions of their role and work environment, in order to connect those findings with core conceptual questions about the nature and function of nursing. (shrink)

How should nursing knowledge advance? This exploration contextualizes its evolution past and present. In addressing how it evolved in the past, a probable historical evolution of its development draws on the perspectives of Frank & Gills's World System Theory, Kuhn's treatise on Scientific Revolutions, and Foucault's notions of Discontinuities in scientific knowledge development. By describing plausible scenarios of how nursing knowledge evolved, I create a case for why nursing knowledge developers should adopt a post‐structural stance in prioritizing their research agenda(s). (...) Further, by adopting a post‐structural stance, I create a case on how nurses can advance their disciplinary knowledge using an engaging post‐colonial strategy. Given an interrupted history caused by influence(s) constraining nursing's knowledge development by power structures external, and internal, to nursing, knowledge development can evolve in the future by drawing on post‐structural interpretation, and post‐colonial strategy. The post‐structural writings of Deleuze & Guattari's understanding of ‘Nomadology’ as a subtle means to resist being constrained by existing knowledge development structures, might be a useful stance to understanding the urgency of why nursing knowledge should advance addressing the structural influences on its development. Furthermore, Bhabha's post‐colonial elucidation of ‘Hybridity’ as an equally discreet means to change the culture of those constraining structures is an appropriate strategy to enact how nursing knowledge developers can engage with existing power structures, and simultaneously influence that engagement. Taken together, ‘post‐structural stance’ and ‘post‐colonial strategy’ can refocus nursing scholarship to learn from its past, in order to develop relevant disciplinary knowledge in its future. (shrink)

The purpose of this article is to re-examine an ethic of care as the main ethical approach to nursing practice in light of past and present developments in nursing ethics, and to briefly speculate whether or not it will survive within nursing in the future. Overall, it is maintained throughout that the terms ?caring?, ?nursing? and an ?ethic of care? are inextricably linked. This is because, it is argued, professionally focused nursing practices are based predominantly on a well-recognised moral commitment (...) to deliver expert care, and that a care-based ethic is the major factor in the construction and maintenance of these practices. Subsequently, the influences and developments of a caring ethic in nursing are firstly re-examined, and the discussion is supported by evidence from more recent nursing research and theoretical developments. Consideration is given to the philosophical underpinnings of both care theory and caring ethics, and the fundamental importance of caring in nursing, as an interpersonal relationship and as an appropriate ethical response, is made transparent. Finally, an outline of the future possibilities that may affect an ethic of care in nursing is offered. (shrink)

The purpose of this paper is to present the theoretical and philosophical assumptions of the Nursing Manifesto , written by three activist scholars whose objective was to promote emancipatory nursing research, practice, and education within the dialogue and praxis of social justice. Inspired by discussions with a number of nurse philosophers at the 2008 Knowledge Conference in Boston, two of the original Manifesto authors and two colleagues discussed the need to explicate emancipatory knowing as it emerged from the Manifesto . (...) Our analysis yielded an epistemological framework based on liberation principles to advance praxis in the discipline of nursing. This paper adds to what is already known on this topic, as there is not an explicit contribution to the literature of this specific Manifesto , its significance, and utility for the discipline. While each of us have written on emancipatory knowing and social justice in a variety of works, it is in this article that we identify, as a unit of knowledge production and as a direction towards praxis, a set of critical values that arose from the emancipatory conscience-ness and intention seen in the framework of the Nursing Manifesto. (shrink)

This paper explores the issue of life and its relevance to nursing, through Aristotle's philosophy and an Aristotelian interpretation of Nightingale's Notes on Nursing. Life as process and becoming has ontological status in Aristotle's philosophy and this dynamism is particularly relevant for nursing. The paper presents aspects of Aristotle's philosophy of life: his account of life as inherent powers of the individual, his analysis of change and time, and his understanding of sickness and health as qualitative states of living beings. (...) It is shown how the Greek medical‐philosophical tradition, continued by Galenic medicine and hygiene into modern time, influenced Nightingale's nursing. Individuals' life‐maintaining metabolic relations to their surroundings are investigated through Aristotle and modern philosophy of biology and through Nightingale's nursing emphasis on the patient's relation to her or his immediate surroundings. It is argued that Nightingale's concern is really the processes of individual life, which in sickness necessitate temporally continuous nursing observation. Humans' radical dependency on their surroundings is actualized as interpersonal interdependency. The paper argues that the end of nursing care, the telos for which sake it is practised, is inherent in the individual course of the patients' life. When life processes are affected by sickness, infirmity, medical interventions or mental suffering, individuals need competent help to live – and to live as well as possible. It is suggested that the special responsibility of nursing is to facilitate, relieve and protect individual life continuously during such times. (shrink)

Immer mehr Menschen verbringen ihren Lebensabend in Einrichtungen der Altenpflege. Zusätzlich zur Sorge um physische, psychische und soziale Belange gilt es, deren spirituelle Bedürfnisse zu berücksichtigen. Ziel dieser Arbeit war es, die spirituellen Bedürfnisse von alten Menschen in Langzeitpflegeeinrichtungen zu erfassen. Gleichzeitig wurde untersucht, welche spirituellen Bedürfnisse Pflegende bei den ihnen anvertrauten Bewohner/-innen wahrnehmen. Dabei wurden Übereinstimmungen bzw. Unterschiede identifiziert. Daten aus 28 Einzelinterviews mit Bewohnerinnen und Bewohnern und 9 Fokusgruppeninterviews mit Mitarbeitenden wurden mittels Qualitativer Inhaltsanalyse ausgewertet und unter die (...) Kernkategorien „Sinn“, „Verbundenheit“, „Transzendenz“ kategorisiert. Die Kategorien beider Befragtengruppen wurden einem Vergleich unterzogen. Trotz zahlreicher Übereinstimmungen in den Aussagen beider Gruppen bleiben Defizite in der Wahrnehmung von Pflegenden. Aus den Ergebnissen der Arbeit werden Schlussfolgerungen für die Einbeziehung der spirituellen Dimension der alten Menschen in die pflegerische Arbeit im Seniorenheim gezogen und Empfehlungen ausgesprochen. (shrink)

Once a term used primarily by moral philosophers, “moral distress” is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? “Plight” encompasses not (...) only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of “efficiency,” is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals’ moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim. (shrink)

Over the past several decades, nurses have been increasingly theorizing about the relationships between culture, health, and nursing practice. This culture theorizing has changed over time and has recently been subject to much critical examination. The purpose of this paper is to identify the challenges impeding nurses' ability to build theory about the relationships between culture and health. Through a historical overview, I argue that continued support for the essentialist view of culture can maintain a limited view of complex race (...) relations. I also argue that attempts to apply culture theory, without knowledge of important historical, political, and economic factors, has often resulted in oversimplified versions of what was originally intended. Furthermore, I argue that individual-level interventions alone will be insufficient to address health inequities related to culture. Despite new critical conceptualizations of culture and the uptake of cultural safety, nursing scholars must better address the broader organizational, population, and political interventions needed to address inequities in health. I conclude with suggestions for how nurses might proceed with culture theorizing given these challenges. (shrink)

The current viewpoint on technology seems to derive from the optimistic idea of the existence of pre-established harmony that any technological progress leads to people's health, and welfare. But history has shown us that this is not always the case, and that we must select the proper direction which leads to health and welfare. For that purpose, this article presents the viewpoint of technology as a kind of human care service, along with the lessons from nursing theories. Five leading nursing (...) theories are introduced as well as their implications for technology. ‘The nursing model of technology’ is then presented. (shrink)

A ‘good enough’ nurse: supporting patients in a fertility unitIn this paper, I discuss the findings of an ethnographic study of a fertility unit. I suggest that caring as ‘emotional awareness’ and ‘non‐caring’ as ‘emotional distance’ may be forms of nursing akin to Fabricius’s (1991) arguments around the ‘good enough’ nurse. This paper critiques caring theories and contributes to the debates over the nature of caring in nursing. I discuss the implications raised for nurses if patients want a practical approach (...) to caring and do not expect an emotionally intimate relationship from nurses. (shrink)

Background: In recent years, operating theatre nurse students’ education focused on ethics, basic values and protecting and promoting the patients' dignity in perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient’s care during surgery. Objective: The objective of this study was to present what operating theatre nursing students perceived and interpreted as undignified caring in perioperative practice. Research design: The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan’s critical (...) incident technique. Participants and research context: Operating theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation. Ethical considerations: The study was approved by the Karlstad University's Research Ethics Committee. Findings: The findings show careless behaviour and humiliating actions among health professionals. Health professionals commit careless acts by rendering the patient invisible, ignoring the patient’s worry and pain and treating the patient as an object. They also humiliate the patient when speaking in negative terms about the patient’s body, and certain health professionals blame the patients for the situation they are in. Health professionals lack the willingness and courage to protect the patient’s dignity in perioperative practice. Discussion: In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act. Conclusion: The findings reveal that patients were exposed to unnecessary suffering; furthermore, the operating theatre nurse students suffered an inner ethical conflict due to the undignified caring situations they had witnessed. (shrink)

This paper explores the relationship between temporal continuity in nursing and temporal features of sickness. It is based on phenomenological and hermeneutical philosophy, empirical studies of sickness time, and the nursing theories of Nightingale, of Benner and of Benner and Wrubel. In the first part, temporal continuity is defined as distinct from interpersonal continuity. Tensions between temporal continuity and discontinuity are discussed in the contexts of care management, of conceptualisations of disease and of time itself. Temporal limitations to the methodological (...) concept of situation are discussed. The main part of this paper explores nurses' possibilities to relate to their patients' time, and how temporal features of sickness may warrant temporal continuity of nursing. Three temporal characteristics of sickness are discussed: the immediacy of patients' suffering, the basic continuity of life through sickness and health care, and the indeterminism and precariousness of sickness. The timing of nursing acts is discussed. The paper explores how sickness is both part of the continuity of life, and threatens this continuity. It concludes that this tension is implicitly recognised in the temporal continuity of nursing, which allows for discontinuous and continuous aspects of sickness time. Nurses accordingly perceive the sick person's time at several levels of temporality, and distinguish highly complex temporal processes in their patients' trajectory. Temporal continuity provides the time, flexibility, and closeness for nurses to perceive and act into time dimensions of individual sickness. The paper shows that temporal continuity of nursing is grounded in temporal characteristics of severe sickness. It suggests that temporal continuity is an important theoretical concept in nursing. (shrink)

This paper examines Florence Nightingale's realist philosophy of science by comparing it to the contemporaneously dominant philosophy of positivism. It starts by adumbrating the tenets of positivism and continues by assessing the degree to which Nightingale accepted or rejected those tenets. It is argued that while she accepted much of positivism, on realist grounds she opposed its belief in phenomenalism, its rejection of speculative philosophy, its separation of fact and value, and its rejection of religion. Following an examination of how (...) Nightingale's philosophy impinged on her approach to nursing and health care, the paper concludes with a comparison of her ideas with those of modern realism and a discussion of the contemporary salience of her ideas. It is argued that while some aspects of her approach may no longer provide an appropriate basis for modern nursing, her environmental approach, her transcendental realism, and her adherence to caring values may still be of use to contemporary nurses. (shrink)

One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk management/legal considerations; quality improvement/safety initiatives; meeting regulatory and accreditation standards; and patient care delivery/evidence based practice. (...) Following a brief history of the transition from the paper record to the EHR, the authors discuss unintended or contested consequences resulting from this change. These changes primarily reflect changes in the organization and amount of clinician work and clinician‐patient relationships. The paper is not a research report but was informed by an institutional ethnography the aim of which was to understand how the EHR impacted clinicians and administrators in a large, urban hospital in the United States. The paper was also informed by other sources, including the philosophies of Jacques Ellul, Don Idhe, and Langdon Winner. (shrink)

This article reports on an empirical investigation of long-term use of a groupware system in a spatially and massively distributed network of educators. It is a case study based investigation aimed at understanding the impacts of collaboration technology in supporting social interaction. The paradigm of social constructivism and the perspective of structuration are proposed as frameworks for understanding the impacts of technology on mediating social interaction. Utilizing these perspectives in an empirical investigation, the case study findings demonstrate how collaboration technology (...) can serve as a change agent in transforming the culture and structure of social interaction. This is enacted in two ways: through the various meanings which people construct when interacting with technology and in benefiting from the structural properties of a system through its technical affordances. (shrink)

This article characterizes Florence Nightingale's nursing reform as the cleaning of the Victorian home which she found unheimlich. She laid strong emphasis on an improvement in the hygiene of the house as a significant part of nursing, and, by establishing the nurse as a new occupation, gave the surplus of unmarried women a decent means of escape from the stifling domesticity in which they had been helplessly trapped. Her nursing at once reformed and reinforced the traditional role of woman as (...) a domestic figure, for she created the nurse as a mother figure in charge of the home space. In the Crimean War, Nightingale successfully nursed the idea of England as Home by attending to the dying soldiers at the front. Her crusade to nurse the unhomely space into a home, however, dismissed one uncanny place inside the imperial Home that needed urgent nursing, that is, Ireland, which had been suffering from the Great Famine and its aftermath. Nightingale confronted Irish Sisters of Mercy, who came to the Crimea to save the lives and souls of the Irish soldiers. These Irish nuns not only embodied the memories of the Famine which they had recently relieved, but also threatened Nightingale's single female authority by representing Ireland as a nation through their equally motherly presence. The service of the Irish nuns in the Crimean War was erased from the myth of the Lady with the Lamp. Nightingale could establish herself as an authoritative female subject and assumed the voice of England only by suppressing another female voice which challenged England's competence in Home management. (shrink)

Like most goods‐producing sectors in the West, modern health‐care systems have been profoundly changed by globalization and the neoliberal policies that attend it. Since the 1970s, the role of the welfare state has been considerably reduced; funding and management of health systems have been subjected to wave upon wave of reorganization and assimilated to the private sector. At the same time, neoliberal policy has imposed the notion of patient empowerment, thus turning patients into consumers of health. The literature on nursing (...) has accordingly reported on the significant repercussions on all aspects of the profession, from delivery of care and treatment, through training for new nurses, to legislated policy reforms regarding the role and responsibilities of modern nurses. In light of these developments, this paper analyses and theorizes about the way the injection of neoliberal policy is linked to and affects the practice of nursing. Drawing on a number of Nietzschean arguments, we begin with an exploration of the complex effects of neoliberalism, bureaucratization, and technocratization on the health system and the practice of nursing. Our main theoretical point here is that neoliberal policy engenders and promotes a neoliberal tide, which results in the conversion of the values that drive modern nursing practice. We then examine this tide in the light of Nietzsche's concepts. Starting with an analysis based on the ontology of the will to power, we show that nurses are dominated by neoliberal values embedded in technocratic and bureaucratic ideologies. Finally, we argue that the application of neoliberal policy constitutes a form of domestication from which one might potentially be freed through the Nietzschean concept of transvaluation of values. This transvaluation, as its freeing from some of the neoliberal tide, may be accomplished in accordance with a hierarchy of specific life‐affirming values for nursing culture and practice. (shrink)

This article highlights the distinction between the ‘art of nursing’ and ‘fine art’. While something in the nature of nursing can be described as ‘the art of nursing’, it is not to be misunderstood as ‘fine art’ or craft. Therefore, the term ‘aesthetic’ in relation to nursing should not be linked to the aesthetic of modern art, but instead to a broader and more general meaning of the word. The paper's main focus is the aesthetic experience, which is treated in (...) a hermeneutic way and elucidated from classical sources and the philosophy of nursing and from Art. The paper argues that the pioneers used the term ‘art of nursing’ in a metaphorical way to say something more specific on the nature of nursing. The term illustrates the nurse's ability to practise at the highest possible level of excellence. (shrink)

This article highlights the distinction between the ‘art of nursing’ and ‘fine art’. While something in the nature of nursing can be described as ‘the art of nursing’, it is not to be misunderstood as ‘fine art’ or craft. Therefore, the term ‘aesthetic’ in relation to nursing should not be linked to the aesthetic of modern art, but instead to a broader and more general meaning of the word. The paper's main focus is the aesthetic experience, which is treated in (...) a hermeneutic way and elucidated from classical sources and the philosophy of nursing and from Art. The paper argues that the pioneers used the term ‘art of nursing’ in a metaphorical way to say something more specific on the nature of nursing. The term illustrates the nurse's ability to practise at the highest possible level of excellence. (shrink)

Abstract Unlike bioethicists who contend that there is a morality common to all, H. Tristan Engelhardt (1996) argues that, in a pluralistic secular society, any morality that does exist is loosely connected, lacks substantive moral content, is based on the principle of permission and, thus, is a morality between moral strangers. This, says Engelhardt, stands in contrast to a substance-full morality that exists between moral friends, a morality in which moral content is based on shared beliefs and values and exists (...) in communities that tend to be closely knit and religiously based. Of what value does Engelhardt's description of ethics as moral friends and moral strangers have for nursing? In this essay, I attempt to show how Engelhardt's description serves to illustrate how the nursing community historically had been one of moral friends but has gradually become one of moral strangers and, hence, at risk of failing to protect patients in their vulnerability and of compromising the integrity of nursing. Building on Engelhardt's concepts, I suggest we might consider modern nursing like a moral family to the extent that members might at times relate to one another as moral strangers but still possess a desire and a need to reconnect with the common thread that binds us as moral friends. Nursing is a practice discipline. Given the challenges of modern bioethics, an applied ethic is needed to give moral direction to clinicians as we strive to conduct ourselves ethically in the practice of our profession. To that end, nursing should reflect upon and seek to reconnect with the content-full morality that is historically and religiously based. (shrink)

A framework for “improvisational” social acts and communication is introduced by referring to the idea of “relationalism” such as natural farming, permaculture and deep ecology. Based on this conception, the notion of Existential Graph by C. S. Peirce is introduced. The notion of extended self in deep ecology is substantiated based on the Roy Adaptation Model in Nursing Theory and Narrative approaches. By focusing on Leibnizian notions of space and time and by introducing Petri net, a spatio-temporal model of improvisation (...) is constructed. This model is expected to substantiate the interesting notion of “Ba” proposed by H. Shimizu reflecting Japanese culture. (shrink)