Dependency is fundamental to caring relationships. However, given that dependency implies asymmetry, it also brings moral problems for nursing. In nursing theory and theories of care, dependency tends to be framed as a problem of self‐determination—a tendency that is mirrored in contemporary policy and practice. This paper argues that this problem frame is too narrow. The aim of the paper is to articulate additional theoretical ‘problem frames’ for dependency and to increase our understanding of how dependency can be navigated in (...) practices of long‐term care. It does so by way of an empirical ethical analysis of how care professionals tackle the problem of dependency in group homes for people with intellectual disabilities. The paper refers to these practices of mitigating the problem of dependency as ‘dependency work’, a phrase borrowed from Eva Kittay. The analysis of dependency work suggests that for care professionals, dependency is a threefold problem: one of self‐determination, one of parity and one of self‐worth. These findings suggest that patient autonomy cannot be a full solution to the problem of dependency in long‐term care relations. But they also show that dependency as such is not a problem that can be solved, as attempts to mitigate it only serve to tighten the dependency relationship further. This is the paradox of dependency work. (shrink)

The implementation of skills labs in Danish nursing education can, in itself, be viewed as a complexity. The students are expected to eventually carry out their work in a situated hospital practice, but they learn their professional skills in a different space altogether, detached and removed from the hospitals and practising on plastic dummies. Despite the apparent artificiality of the skills lab, this article will show that it is possible to analyse some of the fundamental aspects of care in nursing (...) by ethnographically following this phenomenon of simulation‐based training. These particular aspects of care are not explicated in the curriculum or textbooks; however, they surfaced once this crooked approach to studying care in a simulated practice was applied. The article start from the assertion that detached engagements are not recognized within the field of nursing education as an equal component to attachments. Yet empirical cases from the skills lab and hospitals illustrate how students sometimes felt emotionally attached to plastic dummies and how experienced nurses sometimes practised a degree of detachment in relation to human patients. Detached engagements will therefore be presented as part of care practices of nurses – rendering the ability to detach in engagement with patients a professional skill that students also need to learn. In the analysis to follow, attached and detached engagements are located on an equal plane by integrating both into the same conceptual framework, rather than imposing a priori notions about their dialectic relation. The analysis shows that it is the particular intertwinement of attachment and detachment that gives care its fundamental meaning. In conclusion, the need for a conceptual shift from a strong emphasis on attached engagement to a more balanced analytical approach to care work, as involving both attached and detached engagement within Danish nursing education, is advocated. (shrink)

Unlike sonographic examinations, sonic fetal heartbeat monitoring has received relatively little attention from scholars in the social sciences. Using the case of fetal heartbeat monitoring as part of midwifery prenatal care in Germany, this contribution introduces music as an analytical tool for exploring the aesthetic dimensions of obstetrical surveillance practices. Based on ethnographic stories, three orchestrations are compared in which three different instruments help audiences to listen to what becomes fetal heartbeat music and to qualify fetal and pregnant lives in (...) relation to each other. In the Doppler-based orchestration, audible heartbeat music is taken as a sign of a child in need of parental love and care cultivated to listen. The Pinard horn makes esoteric fetal music that can be appreciated by the midwife as a skilled instrumentalist alone and helps to enact a child hidden in the belly. The cardiotocograph brings about soothing music and a reassuring relationship with a child but also durable scripts of juridical beauty. This material-semiotic analysis amplifies how well-being is shaped in midwifery prenatal care practices. (shrink)

This paper articulates dignity as relational engagement in concrete care situations. Dignity is often understood as an abstract principle that represents inherent worth of all human beings. In actual care practices, this principle has to be substantiated in order to gain meaning and inform care activities. We describe three exemplary substantiations of the principle of dignity in care: as a state or characteristic of a situation; as a way to differentiate between socio-cultural positions; or as personal meaning. We continue our (...) analysis by presenting cases on dignity in care related to us in focus groups with medical professionals. Our empirical ethical lens is in this paper is to analyse, not the meaning of dignity, but the way in which it emerges in practices where it is pursued, within relationships between people, technologies, places, regulations, and the values cherished by or embedded in them. We show that professional caregivers recognize in the dignity of the person they care for their own dignity; giving up on the one implies no less than giving up on the other. This ‘mirrored experience’ of dignity expresses itself in professional’s engagement with the situation. The value of this engagement, we argue, lies not primarily in realizing the particular content of the values at stake. We point to the importance of engagement itself, even if the values engaged with cannot be realized to the full, and even if competing versions of dignity are at stake simultaneously. In this way the caregivers provide us with interesting examples of moral actorship in situations of conflicting values. (shrink)

Discussing the workings of technology in care as aesthetic rather than as ethical or epistemological interventions focusses on how technologies engage in and change relations between those involved. Such an aesthetic study opens up a repertoire to address values that are abundant in care, but are as yet hardly theorized. Kamphof studies the problem that sensor technology reveals things about the elderly patients without the patients being aware of this. I suggest improvement of these relations may be considered in aesthetic (...) terms, for instance by developing the affective quality of people’s technological relationships. (shrink)

This article is a written version of the lecture for the IPONS conference in Stockholm. The article starts from the claim that there is no such thing as technology, only different variations of technologies. These technologies, plural, all have their specific workings that we can only learn about by studying these empirically, by analysing the relations between people and their technologies. These relations are always unpredictable, as it is not given beforehand what values the participants pursue. Studying and understanding the (...) workings of healthcare technology is a crucial task for nursing studies, as nurses are often key actors in making these devices work. The article hands the reader some tools to engage in the study of technologies in practice, using an empirical ethics approach. (shrink)

In this paper, we argue that ‘good care’ in residential nursing homes is enacted through different care practices that are either inspired by a ‘professional logic of care’ that aims for justice and non-maleficence in the professional treatment of residents, or by a ‘relational logic of care’, which attends to the relational quality and the meaning of interpersonal connectedness in people’s lives. Rather than favoring one care logic over the other, this paper indicates how important aspects of care are constantly (...) negotiated between different care practices. Based on the intricate everyday negotiations observed during an ethnographic field study at an elderly nursing home in Germany, the paper puts forth the argument that care is always a matter of tinkering with different, sometimes competing ‘goods’. This tinkering process, which unfolds through ‘intuitive deliberation’, ‘situated assessment’ and ‘affective juggling’ is then theorized along the conceptualization of a ‘practical ethics of care’: an ethics which makes no a priori judgments of what may be considered as good or bad care, but instead calls for momentary judgments that are pliable across changing situations. (shrink)

Nursing research using concept analysis plays a critical role for knowledge development, particularly when concerning to broad and foundational concepts for nursing practice, such as dignity. This study aimed to synthesize research concerning concept analysis of dignity in nursing care. Based on a literature review, electronic databases were searched using the terms “dignity,” “human dignity,” “concept analysis,” and nurs*. Papers in Portuguese or English were included. The research synthesis was conducted independently by two reviewers. A total of 35 citations were (...) identified and seven papers were included. Six studies were elected using Walker and Avant concept analysis methodology while one applied the Beth Rodgers evolutionary model. The concept of dignity has been studied by nurses, and its attributes, antecedents, consequences, and similar concepts were synthesized into a definition. Dignity emerged as a fundamental concept in nursing ethics and the main attributes synthesized were personhood, sociability, respect, and autonomy. The antecedents identified were: facilitators—patient focus care, recognition, education, and ethical competence; threats—vulnerability and organizational environment. The consequences were positive coping, empowerment, and dignity preservation. The synthesis of these seven studies using concept analysis provided a clear definition of dignity. These findings challenge future research and education, particularly for the study of undergraduate and postgraduate nursing education programs to enhance skills for preserving patient dignity in clinical practice. (shrink)

The discussion around dignity in nursing philosophy has been underway for many years. The literature still lacks philosophical arguments that would justify the thesis that all people have dignity. Scholars who defend dignity as an intrinsic value most often refer to Kant. However, Kant does not seem to be the most suitable candidate to defend the thesis that all human beings possess dignity. In this paper, I attempt to show that Aristotle's and Aquinas's views can help justify this thesis. To (...) this end, I distinguish between actual dignity, potential dignity, and existential dignity. I state that all human beings have existential dignity or potential dignity. (shrink)

This essay looks closely at metaphors and other figures of speech that often feature in how Americans talk about dementia, becoming part of cultural narratives: shared stories that convey ideas and values, and also worries and fears. It uses approaches from literary studies to analyze how cultural narratives about dementia may surface in conversations with family members or health care professionals. This essay also draws on research on a notable social effect of legalizing medical aid in dying: patients may find (...) it easier to bring up a range of concerns, regardless of whether they have any interest in hastening their own death. The essay proposes that health care professionals rethink an idea prominent within their own culture: that conversations about the end of a person's life are inherently difficult. This framing may make it hard for people facing dementia to bring up their concerns about what lies ahead. We suggest a different way to think about these conversations, using the metaphor of “opening the door” to represent inviting a patient to bring up issues of deepest concern. (shrink)