This long-awaited sequel to Benner's earlier book, From Novice to Expert, this volume further analyzes and examines the nature of clinical knowledge and judgment, using the authors' major new research study as its base. The authors interviewed and observed the practice of 130 hospital nurses, mainly in critical care, over a 6-year period, collecting hundreds of clinical narratives from which they have refined and deepened their explanation of the stages of clinical skill acquisition and the components of expert practice.

Essays discuss the themes of worldliness, affectedness, understanding, and the care-structure found in Heidegger's work on the nature of existence.

The predominant model of the body in modern western medicine is the machine. Practitioners of the biomechanical model reduce the patient to separate, individual body parts in order to diagnose and treat disease. Utilization of this model has led, in part, to a quality of care crisis in medicine, in which patients perceive physicians as not sufficiently compassionate or empathic towards their suffering. Alternative models of the body, such as the phenomenological model, have been proposed to address this crisis. According (...) to the phenomenological model, the patient is viewed as an embodied person within a lived context and through this view the physician comes to understand the disruption illness causes in the patient’s everyday world of meaning. In this paper, I explore the impact these two models of the patient’s body have had on modern medical practice. To that end I first examine briefly the historical origins of the biomechanical and phenomenological models, providing a historical context for the discussion of each model’s main features in terms of machine-world and life-world. Next, I discuss the impact each model has had on the patient–physician relationship, and then I examine briefly the future development of each model. The meaning of illness vis-à-vis each model of the patient’s body is finally examined, especially in terms of how these two models affect the patient’s interpretation of illness. The paper concludes with a discussion of the biomechanical and phenomenological models, in terms of the quality of care crisis in modern western medicine. (shrink)

A noted philosopher and member of the Institute for Cognitive and Brain Science examines flaws in current understandings about consciousness while proposing a radical solution that argues that consciousness must not be limited to the confines of the brain.

Most mainstream attempts to understand the “placebo effect” invoke expectancy theory, arguing that expecting certain outcomes from a treatment or intervention can manifest those outcomes. Expectancy theory is incompatible with the phenomena of placebo responses, more appropriately named “meaning responses.” The expectancy account utilizes reflexive consciousness to connect a world of conceptual representations to mechanical physiology. An alternative account based upon Merleau-Ponty's motor intentionality argues that the body understands and is capable of responding to meanings without the need for any (...) conceptual or linguistic content. A motor intentional framework of meaning poses dramatic implications for the interpretation of clinical trials and in the clinical practice of medicine. Most strongly, it argues that the empathic physician can facilitate the physiologic effects of treatments through skillful participation and manipulation of the meaning response. (shrink)

A scientific community cannot practice its trade without some set of received beliefs. These beliefs form the foundation of the "educational initiation that prepares and licenses the student for professional practice". The nature of the "rigorous and rigid" preparation helps ensure that the received beliefs are firmly fixed in the student's mind. Scientists take great pains to defend the assumption that scientists know what the world is like...To this end, "normal science" will often suppress novelties which undermine its foundations. Research (...) is therefore not about discovering the unknown, but rather "a strenuous and devoted attempt to force nature into the conceptual boxes supplied by professional education". (shrink)

Knud Ejler Løgstrup’s _The Ethical Demand_ is the most original influential Danish contribution to moral philosophy in this century. This is the first time that the complete text has been available in English translation. Originally published in 1956, it has again become the subject of widespread interest in Europe, now read in the context of the whole of Løgstrup’s work. _The Ethical Demand_ marks a break not only with utilitarianism and with Kantianism but also with Kierkegaard’s Christian existentialism and with (...) all forms of subjectivism. Yet Løgstrup’s project is not destructive. Rather, it is a presentation of an alternative understanding of interpersonal life. The ethical demand presupposes that all interaction between human beings involves a basic trust. Its content cannot be derived from any rule. For Løgstrup, there is not Christian morality and secular morality. There is only human morality. _The Ethical Demand _is of the highest relevance to contemporary debate, especially around those issues raised by Levinas. It will exert a steadily increasing influence both in theology and philosophy. (shrink)

Thomas S. Kuhn's classic book is now available with a new index.

This is the first volume to systematically explore the range of contemporary thought concerning the body and draw out its crucial implications for medicine.

First-person accounts from practicing nurses provide students with expert role models in this authoritative yet personal text that focuses on patients' responses to stress. The breadth and value of the nursing experience is reinforced as nurses share how their caring made a critical difference for patients and their families. This text, winner of two American Journal of Nursing Book of the Year Awards in 1988, is an ideal supplement for courses in advanced medical/surgical nursing, community health nursing, and particularly for (...) nursing trends and issues courses. (shrink)

A revised translation of Heidegger's most important work.

We are even less aware of our internal organs and the physiological processes that keep us alive. In this fascinating work, Drew Leder examines all the ways in which the body is absent—forgotten, alien, uncontrollable, obscured.

Using three paradigm cases of persons living with Parkinson's Disease (PD) the authors make a case for augmenting and enriching a Cartesian medical account of the pathophysiology of PD with an enriched understanding of the lived body experience of PD, the lived implications of PD for a particular person's concerns and coping with the illness. Linking and adding a thick description of the lived experience of PD can enrich caregiving imagination and attunement to the patient's possibilities, concerns and constraints. The (...) work of Merleau-Ponty is used to articulate the middle terms of the lived experience of dwelling in a lifeworld. Examining lived experience of embodied intentionality, skilled bodily capacities as highlighted in Merleau-Ponty's non-mechanistic physiology opens new therapeutic, coping and caregiving possibilities. Matching temporal rhythms can decrease the stress of being assisted with activities of daily living. For example, caregivers and patients alike can be taught strategies for extending their lived bodily capacities by altering rhythms, by shifting hyperactivity to different parts of the body and other strategies that change the perceptual experience associated with walking in different environment. A medical account of the pathophysiology of PD is nessessary and useful, but not sufficient for designing caregiving in ways that enrich and extend the existential skills of dwelling of persons with PD. The dominance of mechanistic physiology makes caregivers assume that it is the 'real discourse' about the disease, causing researchers and caregivers alike to overlook the equally real lived experience of the patient which requires different descriptive discourses and different sources of understanding. Lack of dialogue between the two discourses is tragic for patients because caregivers need both in order to provide attuned, effective caregiving. (shrink)

Embodied knowledge in chronic illness and injury When people experience chronic illness or serious injury, changes occur not just within their physical bodies but also in their embodiments, that is, how they view the world through their bodies. For such patients, dualistic (mind–body) notions of the body as object and the mind as subject can devalue experiences that are necessary for healing and for managing everyday problems related to their illness or injury. Nurses need to be able to guide people (...) with illness or injury to new levels of wellness, but may lack appropriate theoretical conceptualizations. Philosophies that underlie embodied knowledge — in particular, philosophies of Merleau‐Ponty and Polanyi — were explored yielding two new ways to understand the body. The body as ‘silent partner’ fosters an appreciation of the body's own subjectivity that can be enhanced in nursing care through sensitivity, listening, and creative coaching. Nurses can assist their patients to identify new and positive understandings of what their bodies mean to them after bodily changes. The body as ‘informant’ holds much promise for solving some of the everyday problems that people with chronic illness or injury experience. By using phenomenological and other naturalistic methods, researchers and patients can find clues to solving such problems, clues that are known through daily living but hidden beneath conscious awareness. As a result, some of the practical know‐how of the body as ‘informant’ can be transformed into testable nursing interventions. (shrink)