For a long time, discussion about scarce health care resource allocation was limited to allocation of medical resources, with the paradigmatic case being kidney transplants. This narrow focus on medical resource prevents us from seeing that there are many cases-- perhaps even the majority--in which time is the real scarce resource, particularly nurse time. What ethical principles should apply to nurse time as a scarce health care resource?

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...) used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

In Philip J. Ivanhoe’s introduction to his Readings from the Lu-Wang School of Neo-Confucianism, he argues convincingly that the Ming-era Neo-Confucian philosopher Wang Yang-ming (1472–1529) was much more influenced by Buddhism (especially Zen’s Platform Sutra) than has generally been recognized. In light of this influence, and the centrality of questions of selfhood in Buddhism, in this article I will explore the theme of selfhood in Wang’s Neo-Confucianism. Put as a mantra, for Wang “self-awareness is world-awareness.” My central image for this (...) mantra is the entire cosmos anthropomorphized as a doctor engaged in constant self-diagnosis, in which effort s/he is assisted by an entire staff of the nerves/nurses—individual humans enlightened as Wangian sages. In short, I will argue that the world for Wang could be meaningfully understood as a mindful, self-healing body within which humans are the sensitive nerves, using our mindful awareness to direct attention to the affected areas when injury or disease occurs. We are, and must thus recognize that we are, the bold but sensitive nervous system of the cosmos, sharing (like neurons) our loving excitement, carrying out (like a medical nurse) the doctor’s orders for the self-care of our cosmic body/medical corps. (shrink)

Every day nurses are required to make ethical decisions in the course of caring for their patients. Ethics in Nursing Practice provides the background necessary to understand ethical decision making and its implications for patient care. The authors focus on the individual nurse’s responsibilities, as well as considering the wider issues affecting patients, colleagues and society as a whole. This third edition is fully updated, and takes into account recent changes in ICN position statements, WHO documents, as well as (...) addressing current issues in healthcare, such as providing for the health and care needs of refugees and asylum seekers, bioethics and the enforcement of nursing codes. (shrink)

Nursing Theories and Nursing Practice, 2nd Edition, shows your undergraduate and graduate students how theory will help them improve the ways in which they practice nursing. It contains contributions by the original theorists, including discussion of how theories can be used in practice and examples of implementation written by nurses themselves. to help your students develop critical thinking skills, clear explanations of multiple ways of knowing are detailed, in addition to reflective practice, and background information on the (...) process of theory development. (shrink)

Today, many philosophers write on topics of contemporary interest, such as emerging technologies, scientific advancements, or major political events. However, many of these reflections, while philosophically valuable, fail to contribute to those who may benefit the most from them. In this article, we discuss our own experience of engaging with nursing researchers and practicing nurses. By drawing on the field of philosophical phenomenology, we intervene in a longstanding debate over the meaning of “empathy” in nursing, which has important (...) implications for nursing research, training, and practice. However, our intention is not only to introduce and discuss this philosophical intervention. Rather, we present this intervention as a model for how philosophers might successfully engage with the field of nursing, and perhaps with other fields as well, with the aim of effecting positive change in research or practice. The article proceeds in five parts. First, we introduce the problem of conceptual clarity in nursing and explain why many nursing concepts are still in need of refinement. Second, we discuss the origins of the concept of empathy in nursing and outline the challenges associated with borrowing theory from other fields. Third, we explain how nurses tend to conceptualize empathy today, drawing upon the psychological distinction between cognitive and emotional empathy. Fourth, we discuss our intervention in this debate and explain how we attempt to resolve existing conceptual confusions by developing the concept of empathy from the ground up. Fifth, we conclude by briefly reflecting upon some of the challenges of interdisciplinary engagement and providing some recommendations based upon our own experience. (shrink)

Starting from two observations regarding nursing ethics research in the past two decades, namely, the dominant influence of both the empirical methods and the principles approach, we present the cornerstones of a foundational argument-based nursing ethics framework. First, we briefly outline the general philosophical–ethical background from which we develop our framework. This is based on three aspects: lived experience, interpretative dialogue, and normative standard. Against this background, we identify and explore three key concepts—vulnerability, care, and dignity—that must be (...) observed in an ethical approach to nursing. Based on these concepts, we argue that the ethical essence of nursing is the provision of care in response to the vulnerability of a human being in order to maintain, protect, and promote his or her dignity as much as possible. (shrink)

Abstract: Background: Coronary artery disease remains the leading cause of morbidity and mortality Worldwide. Previous reviews pointed that nursing interventions are beneficial for coronary artery patients. However, most interventions focused on education and counselling, but not consistent with the outcome set; still did not consider patient’s coronary artery disease risky characteristics. Related studies in China also difficult to find. Therefore this study was conducted to investigate kinds of nursing interventions delivered to coronary artery patients and match them with (...) patient’s risk factors of coronary artery disease. Results of this study were expected to add new knowledge that will alert nurses to consider coronary artery risk factors which in turn might enable the development of appropriate approaches to improve patient’s wellbeing hence reduce frequent coronary artery morbidity and mortality. Methods: A descriptive, cross-sectional, retrospective design using clinical case notes was employed. Study was undertaken in coronary care wards at the teaching hospital in China from November 2017 to September 2018. Structured-literature supported self-designed questionnaire was utilized for data collection. Chi square (χ2) test and multivariate logistic regression for adjusted odds ratio with 95% confidence interval were used to compare the relationship among independent (patient’s risk coronary artery disease factors) and dependent (nursing interventions) categorical variables. Ethical permission was granted accordingly. Results: A total of 300 coronary artery patients’ case notes were audited with mean age 63±11.2 years. Of these 175 (58.3%) were males. 126(42%) were smoking and 224(74.7%) were hypertensive. More evidence based nursing interventions than education and counselling were found to be delivered to these patients. “Administer coronary artery disease medication and their instructions” was mostly delivered to many patients 291(97%) while “counsel to cope with stress” was the least one 60 (20.0%). Three of eight nursing interventions delivered significantly matched with three or all of these patient’s coronary artery risk variables (age, smoking, hypertension and diabetes) (p < 0.05 and/or < 0.01) with Adjusted odds ratio (95% CI) within their significant ranges. Conclusion: This study delivers valuable insight that, nurses in the studied teaching hospital delivered beneficial evidence based nursing interventions to patients with coronary artery disease which significantly matched with their risk factors of coronary artery illness. However, care for stress was low hence needs improvement. Furthermore, research is needed to get consistency of nursing interventions with patient’s end point clinical outcomes for further appraisal of nursing efforts in caring CAD patients . (shrink)

The COVID-19 pandemic put immense pressure on healthcare systems globally, including those of highly developed countries like the United States and United Kingdom. During the pandemic, professional nursing organizations were the first to call attention to the disproportionate pandemic-related deaths among Filipino nurses. These organizations played a central role in addressing the various crises Filipino nurses faced due to their vulnerabilities as frontliners, ethnic minorities, and migrants in their host countries. Using the Volatile, Uncertain, Complexity, and Ambiguous (VUCA) framework, (...) this monograph assesses the pandemic-response actions and strategies of PNAA and PNAUK, two Filipino nursing associations in the US and UK. The major themes suggest that the two organizations are multifunctional entities with the capacity to act as lobbyists, research organizations, and decision-makers when adapting, strategizing, and coping with VUCA conditions. These findings corroborate previous findings on the potentiality of diasporic nursing organizations in addressing the gaps in government support for migrant workers in the healthcare industry. (shrink)

As feminist theory explicates its fundamental principles – justice for the oppressed – it can lose its essential focus on the situation of women. One example is the inattention to nurses within feminist bioethics. Nurses deserve attention because most are women, but also because their lack of power is paradigmatic of patriarchy. Those examining ethics consultations should discuss whether nurses are allowed to request them. But feminists also need to imagine ways in which nurses can be heard when, for instance, (...) their worklives are “redesigned.” Doing so would also allow attention to other classes of the disempowered. (shrink)

The three learning modalities in nursing education are classroom meetings, skill laboratory practices, and clinical practice in hospital or community settings. In clinical internships, the collaborative self-directed learning method is highly encouraged among nursing students. The use of information and communication technologies (ICT) in clinical learning supports the implementation of evidence-based nursing and student-centered learning. The current study examines whether the relationship between social influence and ICT using intention is moderated by the daily duration of use and (...) the number of classmates being friends on social media. The Bayesian Mindsponge Framework (BMF) analytics was employed on a dataset of 702 Moroccan nursing students. We found that social influence was positively associated with nursing students’ intention to use ICT for clinical learning during the internship. This positive association was positively moderated by the daily duration of social media usage and negatively moderated by the number of classmates being friends on social media. These findings underscore the potential of using social media platforms to facilitate the incorporation of ICT and social media in nursing education and training. However, the adverse effects of social media on students’ mental well-being also need to be acknowledged and managed appropriately. (shrink)

Aims and Objectives The purpose of this paper was to clarify the concept of ethical conflict in nursing and highlight the importance of tackling this issue. -/- Background Ethical conflict is on the rise in the nursing context. It is associated with the compromise of nurses' well-being and patient care. However, there is no thorough conceptual understanding of this concept. -/- Design Concept analysis. -/- Methods Databases (PubMed, PsycINFO, CINAHL, Scopus, Embase, Web of Science and SocINDEX) were searched (...) for studies between 1984 and 2021. Both quantitative and qualitative studies related to ethical conflict in nursing were included. Walker and Avant's method of concept analysis was used to identify the defining attributes, antecedents and consequences of the concept of ethical conflict in nursing. We followed the PRISMA-ScR checklist to report the study. -/- Results Thirty studies were included for conceptualization. Defining attributes were divided into four categories: (1) emotional responses, (2) incompatible values, (3) competing interests and (4) ambiguous obligations. The antecedents were (1) ethical sensitivity, (2) negative ethical climate, (3) insufficient authority, (4) unrealistic expectations, (5) poor collaboration and (6) inadequate resources. The consequences were identified as (1) moral residue, (2) loss of identity, (3) professional burnout and (4) poor patient care. -/- Conclusions A unified conceptual model of ethical conflict in nursing shed light on the ethical issues nurses might come across in practice. Despite the fact that ethical conflict is inherently negative, we conceptualised this concept as a neutral fact and an opportunity for nursing action. The construct identification provides basis for both the development of practice and the development of staff support and education. (shrink)

As in many other fields of practical ethics, virtue ethics is increasingly of interest within nursing ethics. Nevertheless, the virtue ethics literature in nursing ethics remains relatively small and underdeveloped. This article aims to categorize which broad theoretical approaches to virtue have been taken, to undertake some initial comparative assessment of their relative merits given the peculiar ethical dilemmas facing nurse practitioners, and to highlight the prob- lem areas for virtue ethics in the nursing context. We find (...) the most common approaches fall into care approaches grounded in sentimentalist or feminist ethics, eudaimonist approaches grounded in neo-Aristotelianism, and those grounded in MacIntyre’s practice theory. Our initial assessment is that the eudaimonist approach fares best in terms of merit and relative to criticisms of virtue ethics. But an outstanding issue concerns the motivational psychology of virtuous nursing and whether virtue ethical accounts of right action are self-effacing, i.e. justify an act on grounds that cannot function as the agent’s reason for doing it if she is to act well. One of us, Newham, believes that a virtue consequentialist approach is the best response to these issues. Some form of pluralistic theory, such as Christine Swanton’s, may be needed to explain the many competing values and goods involved in ethical nursing. (shrink)

An elderly patient in a care home only wants human nurses to provide her care – not robots. If she selected her carers based on skin colour, it would be seen as racist and morally objectionable, but is choosing a human nurse instead of a robot also morally objectionable and speciesist? A plausible response is that it is not, because humans provide a better standard of care than robots do, making such a choice justifiable. In this paper, I show why (...) this response is incorrect, because robots can theoretically care as well as human nurses can. I differentiate between practical caring and emotional caring, and I argue that robots can match the standard of practical care given by human nurses, and they can simulate emotional care. There is growing evidence that people respond positively to robotic creatures and carebots, and AI software is apt to emotionally support patients in spite of the machine’s own lack of emotions. I make the case that the appearance of emotional care is sufficient, and need not be linked to emotional states within the robot. After all, human nurses undoubtedly ‘fake’ emotional care and compassion sometimes, yet their patients still feel adequately cared for. I show that it is a mistake to claim that ‘the human touch’ is in itself a contributor to a higher standard of care; ‘the robotic touch’ will suffice. Nevertheless, it is not speciesist to favour human nurses over carebots, because carebots do not suffer as the result of such a choice. (shrink)

Clinical practice is a part of the integral learning method in nursing education. The use of information and communication technologies (ICT) in clinical learning is highly encouraged among nursing students to support evidence-based nursing and student-centered learning. Through the information-processing lens of the mindsponge theory, this study views performance expectancy (or perceived usefulness) and effort expectancy (or perceived ease of use) as results of subjective benefit and cost judgments determining the students’ ICT using intention for supporting clinical (...) learning, respectively. Therefore, the study examines whether effort expectancy moderates the relationship between performance expectancy and the intention to use ICT among Moroccan nursing students. The Bayesian Mindsponge Framework (BMF) analytics was employed on a dataset of 702 Moroccan nursing students. We found that nursing students’ performance expectancy is positively associated with the intention to adopt ICT and social media, while effort expectancy positively moderates this relationship. Moreover, the model with effort expectancy as the moderator was discovered to have a significantly larger weight than the model with effort expectancy as the direct predictor, validating our information-processing reasoning. This study provides a new perspective on the interplay between the benefit and cost perceptions of ICT use to support clinical learning methods in nursing education. Moreover, given the limited education resources, especially in developing countries like Morocco, we recommend nursing education and training prioritize communicating the benefits of ICTs and social media over ease of use. Doing so would help improve the effectiveness and efficiency of nursing education and training while lowering costs. (shrink)

In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and (...) the other pillars of the EBN framework: clinical expertise; patient preferences and values. Drawing on an influential EBN handbook, section 1 presents the aims and features of EBN, including the normative principle that EBN should take place within a ‘context of caring’. We aim to understand this context and whether it can be neatly detached from the EBN framework, as the handbook seems to suggest. In section 2, we highlight the grounds for resistance to EBN from the nursing community, before mounting the argument that nursing practices can be understood fruitfully through feminist care ethics and/or virtue ethics lenses. In section 3, we deepen that analysis using Dalmiya’s concepts of care-knowing and care as a hybrid ethico-epistemic virtue, which are ideally suited to the complex practices of nursing. In section 4, we bring this rich understanding of care into conversation with EBN, showing that its framework cannot be adequately theorised without paying proper attention to care. Caring can be neither an innocuous background assumption of nor an afterthought to the EBN framework. (shrink)

La definizione di vita che il premio Nobel per la medicina Paul Nurse propone nel suo libro Che cosa è la vita? (Mondadori), qui recensito, si alimenta di cinque concetti fondamentali: cellula, gene, evoluzione per selezione naturale, processo chimico ed informazione.

Background Improving the competencies of nurses requires improving educational methods through the use of novel methods in teaching and learning. We aim to explore the perceptions of stakeholders (including nursing education directors, faculty members and nursing students) of the requirements of implementing innovative educational approaches in nursing. -/- Methods In this qualitative descriptive study, 19 participants, including educational directors, faculty members, and undergraduate and graduate nursing students, were selected through the purposeful sampling method. Achieving the theoretical (...) saturation in extracted categories was considered as a criterion for determining the sample size and the completion of sampling. The data were collected from December 2019 to May 2020 in nursing schools of Tehran, Iran, through in-depth semi-structured individual face-to-face interviews and were then analyzed based on the Graneheim and Lundman method. -/- Results Using qualitative content analysis, eight sub-themes and three themes were extracted. The extracted themes were ‘novel educational policymaking’, ‘Innovative education-oriented platform’, and ‘managing barriers of innovative educational approaches’. -/- Conclusions Developing and implementing innovative educational approaches entail providing appropriate context, structure, and required facilities by the policymaking system and educational authorities. In addition, developing capacity and related competencies of faculty members and students as the major stakeholders in employing these approaches is crucial. (shrink)

ABSTRACT In this article, I indicate how the naturalized and individualized conception of disability that prevails in philosophy informs the indifference of philosophers to the predictable COVID-19 tragedy that has unfolded in nursing homes, supported living centers, psychiatric institutions, and other institutions in which elders and younger disabled people are placed. I maintain that, insofar as feminist and other discourses represent these institutions as sites of care and love, they enact structural gaslighting. I argue, therefore, that philosophers must engage (...) in conceptual engineering with respect to how disability and these institutions are understood and represented. To substantiate my argument, I trace the sequence of catastrophic events that have occurred in nursing homes in Canada and in the Canadian province of Ontario in particular during the pandemic, tying these events to other past and current eugenic practices produced in the Canadian context. The crux of the article is that the COVID-19 pandemic has thrown into vivid relief the carceral character of nursing homes and other congregate settings in which elders and younger disabled people are confined. -/- KEYWORDS carceral, conceptual engineering, nursing home-industrial-complex, philosophy of disability, structural gaslighting. (shrink)

Background: The time before surgery is a traumatic period for patients. Despite this fact, no research has been conducted on nurses’ preoperative patient education in Ethiopia. This study aimed to assess preoperative patient education practices and associated factors among nurses working in East Amhara comprehensive specialized hospitals, Ethiopia, 2022. Methods: A hospital-based cross-sectional study was conducted with 416 nurses. Pretested, structured questionnaires were used to collect the data. Bivariable analysis was performed for each independent variable with a P-value < 0.25 (...) on the data imported to multivariate logistic regression analysis. AOR with a 95% CI and a P-value < 0.05 at a 5% level of significance were considered. Results: Only 38.5% of nurses were found to have good practices for preoperative patient education, with a response rate of 98%. Nurses with 6 years of work experience (AOR = 3.15, 95% CI: 1.692– 5.874), adequate time (AOR = 2.33, 95% CI: 1.119– 4.889), training (AOR = 4.27, 95% CI: 1.548– 11.796), age 25– 29 (AOR = 0.15, 95% CI: 0.070– 0.331), age 30– 34 (AOR = 0.25, 95% CI: 0.137– 0.479), and knowledge (AOR = 3.73, 95% CI: 2.222– 6.273) were significantly associated. Conclusion: Preoperative patient education practices among nurses were poor. Work experience, knowledge, training, and adequate time were found to be significant. Organize preoperative patient education programs for nurses that share experiences and provide ongoing training. (shrink)

Reflecting on group theory within clinical supervision offers useful vantage points from which to engage nursing and the helping professions in the task of supervisory practice. This paper presents reflective experiences of group clinical supervision training and practice through a critique of Hawkins and Shohet’s process centred model. The underlying premise of transference hypothesis is that experiences and memories from the past inform present behaviours. Little has been written about the hypothesis in relation to clinical supervision in nursing (...) and the helping professions. However, the hypothesis was criticised by John M. Shlien in the 1980s and remains pertinent today due to expansion into social and healthcare practice. Reflective autobiographical diary entries focus on the model’s two latter stages which propose the use of Sigmund Freud’s transference hypothesis. The work of Freud, Foulkes, Heidegger and Hawkins and Shohet are synthesised and conclude with a phenomenological suggestion that immediacy and openness are necessary ontological conditions for group clinical supervision. Valuing empathic attunement to better understand group clinical supervision may be more important than theoretical distractions for non-therapeutic clinical supervision practice. (shrink)

The purpose of this study is to find out that whether the jobs of nurses in Pakistan are fulfilling their necessary requirements or not. This issue is being analyzed by the relation of Person-Job (P-J) Fit with three different JobBehaviors and the whole relation is being tested under the moderation of Agreeableness, which is a personality trait of the Big5 Model. A survey method is deployed, questionnaires are used to obtain data. 120 Nurses were accessed from different hospitals of Islamabad/Rawalpindi. (...) Data were analyzed through statistical tests and regression analysis. Findings of the study highlight that P-J fit is related positively to job satisfaction of nurses and negatively to their Turnover Intentions.Where no significant impact of agreeableness as a moderator is found for this study. The Sample size was too small (120participants). This may restrict the generalizability of the studies. In the Pakistani context, only a limited study has been conducted on nurses. Thus, this piece of research will play a significant role in enhancing and boosting the confidence of deprived nurses of Pakistan by identifying the causes of negative job outcomes and help in mitigating those triggers. (shrink)

Socioeconomic status refers to the family's social and economic standing in society. It is measured by combining an individual or group's economic and social position, which is often based on income, education, and occupation. It significantly affects academic performance and even one's health status. The pandemic changed the educational system, causing a huge transition from traditional learning methods to online learning. This shift resulted in confusion, burden, and difficulty among students from different walks of life. This study was conducted to (...) determine the academic stress on online learning among nursing students in relation to their economic status and their ability to access technology. The study utilized a quantitative-correlational method aided by a standard questionnaire. Two hundred thirty-six University of Bohol nursing students enrolled in the second semester of SY 2021–2022 were included in the study by random selection. Data revealed a significant correlation between economic status and the level of stress related to academic expectations and a significant correlation between economic status and access to technology after being subjected to the Spearman rho test of correlation. However, no significant correlation was found between access to technology and the respondents' level of academic stress. (shrink)

The nursing profession must address climate change to protect and promote human health. Climate change activities as corporate social responsibility provide a promising avenue to both scale successful organizational initiatives and to generate hope, transformative improvements, and renewed professional commitments for nursing. Addressing climate change through corporate social responsibility is urgent and timely in the COVID-19 disaster recovery period for the nursing profession.

The sacrifices of nurses in hard-hit cities during the early stages of the COVID-19 pandemic and of family caregivers for people with late-stage Alzheimer’s disease present two puzzles. First, traditional accounts of supererogation cannot allow for the possibility of making enormous sacrifices that make one’s actions supererogatory simply to do what morality requires. These caregivers, however, are doing their moral duty, yet their actions also seem to be paradigmatic cases of supererogation. I argue that Dale Dorsey’s new account of supererogation (...) can solve this puzzle. Second, these caregivers often deny that they are heroic, but standard explanations of these assertions either diminish their sacrifice, say they are confused, or attribute to them a vice. If we want to understand them without diminishing them, we should instead see their denials as a response to what Beth DeVolder calls compulsory heroism. Compulsory heroism occurs when someone is foisted into the role of hero for doing their moral duty as a distraction from the social realities that make doing their duty involve inordinate sacrifice. (shrink)

Moral distress is the sense that one must do, or cooperate in, what is wrong. It is paradigmatically faced by nurses, but it is almost a universal occupational hazard.

Empathy is a topic of continuous debate in the nursing literature. Many argue that empathy is indispensable to effective nursing practice. Yet others argue that nurses should rather rely on sympathy, compassion, or consolation. However, a more troubling disagreement underlies these debates: There’s no consensus on how to define empathy. This lack of consensus is the primary obstacle to a constructive debate over the role and import of empathy in nursing practice. The solution to this problem seems (...) obvious: Nurses need to reach a consensus on the meaning and definition of empathy. But this is easier said than done. Concept analyses, for instance, reveal a profound ambiguity and heterogeneity of the concept of empathy across the nursing literature. Since the term “empathy” is used to refer to a range of perceptual, cognitive, emotional, and behavioral phenomena, the presence of a conceptual ambiguity and heterogeneity is hardly surprising. Our proposal is simple. To move forward, we need to return to the basics. We should develop the concept from the ground up. That is, we should begin by identifying and describing the most fundamental form of empathic experience. Once we identify the most fundamental form of empathy, we will be able to distinguish among the more derivative experiences and behaviors that are addressed by the same name and, ideally, determine the place of these phenomena in the field of nursing. The aim of this article is, consequently, to lay the groundwork for a more coherent concept of empathy and thereby for a more fruitful debate over the role of empathy in nursing. In Part 1, we outline the history of the concept of empathy within nursing, explain why nurses are sometimes warry of adapting concepts from other disciplines, and argue that nurses should distinguish between adapting concepts from applied disciplines and from more theoretical disciplines. In Part 2, we show that the distinction between emotional and cognitive empathy—borrowed from theoretical psychology—has been a major factor in nurses’ negative attitudes toward emotional empathy. We argue, however, that both concepts fail to capture the most fundamental form of empathy. In Part 3, we draw on and present some of the seminal studies of empathy that can be found in the work of phenomenological philosophers including Max Scheler, Edmund Husserl, and Edith Stein. In Part 4, we outline how their understanding of empathy may facilitate current debates about empathy’s role in nursing. (shrink)

The article explores the problem of preferable technological changes in the context of work. To this end, it addresses the ‘why’ (motives and values) and the ‘how’ (organizational forms) of automation from a normative perspective. Concerning the ‘why,’ automation processes are currently mostly driven by values of economic efficiency. Yet, since automation processes are part of the basic structure of society, as is the division of labor, considerations of justice apply to them. As for the ‘how,’ the article suggests ‘fair (...) hybrid cooperation’ as an alternative ideal to guide automation priorities. It is achieved when the division of labor between humans and machines does not hinder, and preferably enables, workers’ experience of certain primary qualities in their work activity. By analogy with Rawls’ primary goods, these are qualities that it is necessary for every worker to experience in order to pursue their life plans: security, self-direction, self-development, dignity, and recognition. According to this criterion, the tasks to automate first are those hindering these contributive primary qualities. This provides us with a normative vocabulary and a standard to orient automation decisions but also to assess existing organizational forms and envisage alternative cooperative imaginaries. To illustrate how the ideal may play out in the real world, the article concludes with a ‘fair hybrid cooperation test’ and a nurse bots case for meaningful work. (shrink)

Moral distress is a well-documented phenomenon in the nursing profession, and increasingly thought to be implicated in a nation-wide nursing shortage in the US. First identified by the philosopher Andrew Jameton in 1984, moral distress has also proven resistant to various attempts to prevent its occurrence or at least mitigate its effects. While this would seem to be bad news for nurses and their patients, it is potentially good news for philosophical counselors, for whom there is both socially (...) important and philosophically interesting work to be done. In an effort to encourage such work, this paper explicates the philosophical (as opposed to more purely psychological or institutional) contours of the problem. A subsequent paper, titled 'A Philosophical Counseling Approach to Moral Distress,' will highlight ways in which such a response would differ from the strategies so far deployed within the nursing profession. (shrink)

The exposure of doctors, nurses and other medical professionals to risks in the context of epidemics is significant. While traditional medical ethics offers the thought that these dangers may limit the extent to which a duty to care is applicable in such situations, it has less to say about what we might owe to medical professionals who are disadvantaged in these contexts. Luck egalitarianism, a responsibility-sensitive theory of distributive justice, appears to fare particularly badly in that regard. If we want (...) to maintain that medical professionals are responsible for their decisions to help, cure and care for the vulnerable, luck egalitarianism seems to imply that their claim of justice to medical attention in case of infection is weak or non-existent. The article demonstrates how a recent interpretation of luck egalitarianism offers a solution to this problem. Redefining luck egalitarianism as concerned with responsibility for creating disadvantages, rather than for incurring disadvantage as such, makes it possible to maintain that medical professionals are responsible for their choices and that those infected because of their choice to help fight epidemics have a full claim of justice to medical attention. (shrink)

Military doctors and nurses, working neither as pure soldiers nor as merely doctors or nurses, may face a ‘role conflict between the clinical professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, an insurer, the state, or in this context, military command’. This conflict is commonly called dual loyalty. This chapter gives an overview of the military and the medical ethic and of the resulting dual (...) loyalty problem for medical personnel working in the military. It considers how dual loyalties relate to being a professional, something medical personnel are the paradigmatic examples of, but also something military personnel claim to be. Against that background, the chapter elaborates on the medical rules of eligibility used in Afghanistan, and on the policies concerning military involvement in local healthcare, to see what the existing rules and policies are, and whose interests they serve. (shrink)

Military doctors and nurses, employees with a compound professional identity as they are neither purely soldiers nor simply doctors or nurses, face a role conflict between the clinical professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, an insurer, the state, or in this context, military command (London et al. 2006). In the context of military medical ethics this is commonly called dual loyalty (or, less (...) commonly, mixed agency). Although other professionals in the military, for instance counsellors or lawyers, might experience similar problems of dual loyalties, it seems that the dual loyalties experienced by military medical personnel are particularly testing. (shrink)

1. Animal Cruelty Industrial farming is appallingly abusive to animals. Pigs. In America, nine-tenths of pregnant sows live in “gestation crates. ” These pens are so small that the animals can barely move. When the sows are first crated, they may flail around, in an attempt to get out. But soon they give up. Crated pigs often show signs of depression: they engage meaningless, repetitive behavior, like chewing the air or biting the bars of the stall. The sows live like (...) this for four months. Gestation crates will be phased out in Europe by the end of 2012, but they will still be used in America.1 In nature, pigs nurse their young for about thirteen weeks. But in industrial farms, piglets are taken from their mothers after about ten days. Because the piglets are weaned prematurely, they develop a lifelong craving to suck and chew. But the farmers don’t want them sucking and chewing on other pigs’ tails. So the growers routinely snip off the tails of all their pigs. They do this with a pair of pliers and no anesthetic. However, the whole tail is not removed; a tender stump remains. The point is to render the area sensitive, so the pigs being chewed on will fight back. Which they do.2 Over 113 million pigs are slaughtered each year in America.3 Typically, these pigs are castrated, their needle teeth are clipped, and one of their ears is notched for identification —all without pain relief.4 In nature, pigs spend up to three quarters of their waking hours foraging and exploring their environment.5 But in the factory farms, “tens of thousands of hogs spend their entire lives ignorant of earth or straw or sunshine, crowded together beneath a metal roof standing on metal slats suspended over a septic tank. ”6 Bored, and in constant pain, the pigs must perpetually inhale the fumes of their own waste. These pigs often get sick, and their ill health is exacerbated by the overcrowding. In 2000, the U.S. Department of Agriculture compared hog farms containing over 10,000 pigs—which is the norm—with farms containing under 2,000 pigs. (shrink)

Charlotte Witt covers a remarkable amount of ground in this concise and elegantly written book. Coming in at under 150 pages, she artfully weaves together Aristotle’s theory of functions with contemporary work on cultural transmission and apprenticeship, ideas about self-creation with theories of aspiration and transformative experience, and reflections on the relationships among social norms and games with thoughts about social roles and the nature of hierarchy. At the heart of it is an elaboration and defense of a thoroughly externalist (...) account of social normativity. Witt takes skilled experts, especially artisans like chefs and carpenters, as paradigm cases for theorizing about social normativity. She uses them to argue that the ultimate source of many normative obligations is found not in the acquiescence, attitudes, or any other features internal to those on whom those obligations fall. Rather, the demands are rooted in the world itself, and flow from specific circumstances, especially from the constraints those circumstances impose on different actors in virtue of the tasks they need to perform. The result is a view that depicts social normativity not just as external to individuals but also unavoidably role specific; what is right for a chef is not necessarily right for a carpenter, and what makes for a good nurse might make for a poor drill sergeant. Witt’s presentation of this package of ideas is both careful and austere, and it makes for a wonderfully thought provoking read. Social Goodness: On the Ontology of Social Norms will reward the careful attention of anyone interested in social ontology, especially the metaphysical foundations of normativity, the nature of social norms, and the relationship between social roles and the self. (shrink)

This article will explore and summarise the four main ethical theories that have relevance for healthcare assistants. These are utilitarianism, deontology, virtue ethics, and principlism. Understanding different ethical theories can have a number of significant benefits, which have the potential to shape and inform the care of patients, challenge bad practice and lead staff to become better informed about areas of moral disagreement.

Goold and Stern (2006) offer a much needed dose of insight into the weakness of medical education from the perspective of resident and nonresident physicians. One of their findings pertains not to...

There is a global shortage of organs for transplantation and despite many governments making significant changes to their organ donation systems, there are not enough kidneys available to meet the demand. This has led scientists and clinicians to explore alternative means of meeting this organ shortfall. One of the alternatives to human organ transplantation is xenotransplantation, which is the transplantation of organs, tissues, or cells between different species. The resurgence of interest in xenotransplantation and recent scientific breakthroughs suggest that genetically-engineered (...) pigs may soon present a realistic alternative as sources of kidneys for clinical transplantation. It is therefore important for nurses and allied health professionals to understand what is involved in xenotransplantation and its future implications for their clinical practices. First, we explore the insufficiency of different organ donation systems to meet the kidney shortage. Second, we provide a background and a summary of the progress made so far in xenotransplantation research. Third, we discuss some of the scientific, technological, ethical, and economic issues associated with xenotransplantation. Finally, we summarise the literature on the attitudes of healthcare professionals toward xenotransplantation. (shrink)

Philosophers have become newly interested in the ethics of sex. One promising feature of this new discussion is that it has been broadening our moral lens to include individuals whose sexual interests have historically been denied or ignored. One such group is the elderly. Contrary to popular belief, many elderly people want to have sex and see it as a regular part of their lives. If society harbors ignorance about or prejudice against elderly sexuality, it harbors stronger views against the (...) sexual expression of elderly people with dementia. People with dementia are often prohibited by nursing‐home staff, sometimes in extreme ways, from having sex with their partners. This prohibition is at least partly motivated by the goal of protecting the vulnerable. However, cutting people with dementia off from sex has negative health effects and is a needless restriction of their autonomy. In this article, I argue that the expanding moral lens in sexual ethics should include the sexual expression of elderly individuals with dementia and that their sexual expression should be respected. Specifically, I argue that many people with dementia are competent to consent to sexual activity with their long‐term partners. (shrink)

Jake Greenblum and Ryan K Hubbard argue that physicians, nurses, clinical ethicists and ethics committee members should not cite religious considerations when helping patients (or their proxies) make medical decisions. They provide two arguments for this position: The Public Reason Argument and the Fiduciary Argument. In this essay, I show that the Public Reason Argument fails. Greenblum and Hubbard may provide good reason to think that physicians should not invoke their own religious commitments as reasons for a particular medical decision. (...) But they fail to show that it is wrong for physicians to cite the patient’s own religious commitments as reasons for a particular decision. As such, if Greenblum and Hubbard’s thesis is to survive, the Fiduciary Argument (or some unmentioned argument) will have to do the bulk of the work. (shrink)

"Kapitał społeczny ludzi starych na przykładzie mieszkańców miasta Białystok" to książka oparta na analizach teoretycznych i empirycznych, która przedstawia problem diagnozowania i używania kapitału społecznego ludzi starych w procesach rozwoju lokalnego i regionalnego. Kwestia ta jest istotna ze względu na zagrożenia i wyzwania związane z procesem szybkiego starzenia się społeczeństwa polskiego na początku XXI wieku. Opracowanie stanowi próbę sformułowania odpowiedzi na pytania: jaki jest stan kapitału społecznego ludzi starych mieszkających w Białymstoku, jakim ulega przemianom i jakie jest jego zróżnicowanie? Ludzie (...) starzy są tu postrzegani jako kategoria społeczna, czyli zbiór osób podobnych do siebie pod względem społecznie istotnych cech (takich jak wiek, posiadane role społeczne i świadomość korzystania ze świadczeń społecznych), którzy są świadomi tego podobieństwa i swojej odrębności od innych. Przyjmuje się ponadto, iż osoby takie przekroczyły 60. rok życia. Zakłada się też, że w zasobach ludzkich skumulowany jest kapitał ludzki, społeczny i kulturowy. Kapitał społeczny jest tu ujmowany szeroko jako potencjał współdziałania osadzony w powiązaniach międzyludzkich i normach społecznych, który może przynosić korzyści osobom, grupom i społeczeństwom. W części teoretycznej przedstawiono informacje o starości jako etapie w życiu jednostki, wyjaśniono pojęcie ludzi starych, omówiono społeczne teorie starzenia się, historyczne czynniki oddziaływające na położenie kategorii społecznej ludzi starych, zmiany ich miejsca w społeczeństwie polskim w trakcie transformacji ustrojowej i na początku XXI wieku, możliwe konsekwencje wzrostu długości życia w warunkach demokracji i kapitalizmu oraz charakterystykę problemu starzenia się ludności Białegostoku jako miasta pogranicza. Zaprezentowano też różnorodne koncepcje kapitału społecznego, sfery jego oddziaływania na rozwój społeczno-gospodarczy, jego stan w Polsce oraz wytyczne do strategicznego budowania jego zasobów. Przybliżono również wybrane informacje o aktywności ludzi starych w życiu publicznym, społecznym i gospodarczym jako kluczowych cechach ich kapitału społecznego. Porządkując różne stanowiska teoretyczne, wyniki badań i dane statystyczne, dążono do powiązania wielu rozproszonych źródeł w przekonaniu, iż jest to istotne w celu określenia i zagospodarowania zasobów kapitału społecznego seniorów, jak również niwelacji opóźnienia polskiej socjologii w zakresie badań nad ludźmi starymi. Pomimo, iż za podstawową perspektywę teoretyczną publikacji uznana została koncepcja kapitału P. Bourdieu, autor bierze również pod uwagę propozycje badawcze J.S. Colemana, R.D. Putnama, F. Fukuyamy, A. Giddensa, P. Sztompki i A. Sadowskiego. Drugi rozdział zawiera określenie ram metodologicznych badań przeprowadzonych na potrzeby tej publikacji. Omówiono przyjęte założenia badawcze oraz przybliżono sposób i przebieg realizacji badań. Przede wszystkim zdecydowano się na korzystanie z metody jakościowej i zastosowanie techniki wywiadu swobodnego ukierunkowanego. Uznano, iż podmiotowy kontakt z ludźmi starymi umożliwi dokładniejsze rozpoznanie kontekstu, w którym znajdują się zasoby ich kapitału społecznego. Jest to ważne, gdyż przenoszenie na rodzimy grunt opracowanych za granicą interpretacji działań ludzi starych i rozwiązań aktywizujących, może okazać się nieskuteczne lub wywołać negatywne efekty zewnętrzne. Ponadto w literaturze przedmiotu zwraca się uwagę na niedostatek badań gerontologicznych zgodnych z paradygmatem interpretatywnym. Badaniu poddano 26 respondentów w wieku od 60 do 89 lat żyjących w mieście Białystok związanych z jedną z dwóch różnych instytucji: Domem Pomocy Społecznej i Uniwersytetem Trzeciego Wieku. Poprzez porównywanie osób znajdujących się na dwóch biegunach aktywności społecznej możliwe było dostrzeżenie podobieństw i różnic w ich wyposażeniu kapitałowym, a zarazem w osiągniętych w ciągu życia pozycjach w strukturze klasowej i zasobach służących pomyślnej starości6. W trzecim rozdziale przedstawiona została część wyników analiz empirycznych. Przybliżono tu sposób, w jaki ludzie starzy myślą o podobnych sobie przodkach i osobach współczesnych, a także czynniki, w zależności od których zmienia się ich pozycja społeczna w mieście oraz problemy społeczne, jakie uznają za najważniejsze dla ludzi starych. Analizie poddano opinie o ich czasie wolnym, szansach i barierach aktywności ekonomicznej. Wyróżniono typy kapitału społecznego ludzi starych w zależności od instytucji, z którymi są związani oraz podejścia do postrzegania i wykorzystywania zróżnicowania wewnętrznego seniorów. Omówiono wizerunek seniorów w środkach masowego przekazu. Publikacja nie zawiera ścisłego zakończenia. W ostatnim rozdziale wskazano jedynie na główne wnioski płynące z badań oraz na potencjalne dalsze kierunki analiz. Uzupełnienie tego podejścia stanowią zamieszczone w aneksie zestawienia oddolnych technik budowania kapitału społecznego oraz podstawowych cech Miast Przyjaznych Starszemu Wiekowi. Z opracowania tego z pewnością będą mogli skorzystać nie tylko naukowcy zajmujący się tematyką ludzi starych, ale i pracownicy socjalni, politycy, pracodawcy, przedstawiciele mediów i organizacji pozarządowych oraz obywatele Białegostoku i innych miast. ** "Social Capital of Old People on the Example of Bialystok Residents" is a book based on theoretical and empirical study, which presents an issue of diagnosing and using of old people social capital in the local and regional development processes. This issue is significant because of the threats and challenges associated with process of rapid ageing of Polish society at the beginning of 21st century. Publication, in particular, is an attempt to give answers to the following questions: what is the state of old people social capital in Bialystok, what transformations it undergoes and how is it differentiated? In this study old people are viewed as a social category, which is a set of people similar to each other in terms of socially significant features (such as age, possessed social roles and awareness of received social benefits), who are aware of these similarities and differences between each other. Moreover, it is assumed, that such persons exceeded the 60 years of age. It is also assumed that human, social and cultural capital is accumulated in the human resources. Social capital is recognized here broadly as a potential for collaboration embedded in interpersonal relationships and social norms that may benefit individuals, groups and societies. The book consists of three chapters. The first, which is the theoretical part of work, includes information about: old age as a stage of individual life and explanation of the old people notion. It discusses social theories of ageing, historical factors affecting on the social position of old people category, changes in their place in Polish society during the system transformation and in the early 21st century. It describes the possible consequences of increased life expectancy for democracy and capitalism - including the concepts of society for all ages, silver economy. It also features ageing population issue, as well as social policy towards the elderly and old age in Bialystok as the borderland city. A variety of social capital concepts were presented; the spheres of its influence on socio-economic development, its status in Poland and guidelines for strategic building of its resources. Selected information on the activity of old people in public, social and economic life as key features of their social capital was brought closer. Putting various theoretical positions, results of research and statistical data in order was aimed to link many dispersed sources considering that it is relevant to identify and develop seniors' social capital resources, as well as leveling the delay of Polish sociology research on the elderly. Fundamental theoretical perspective of publication is the concept of capital according to P. Bourdieu. However, the proposals of J.S. Coleman, R.D. Putnam, F. Fukuyama, A. Giddens, P. Sztompka and A. Sadowski were also used. The second chapter contains a methodological framework for the purposes of study. Research assumptions, method and course of implementation of studies were discussed. The study is based on the qualitative method and the application of in-depth interview techniques. It was considered that the personal contact with old people will be more accurate than other research techniques to identify the context in which they social capital resources can be found. It is important because the transfer of developed abroad activating solutions and interpretations of old people actions may be ineffective or have negative external effects in the Polish context. Moreover, in the Polish science literature attention is paid to scarcity of gerontological research in accordance with the interpretive paradigm. Study involved 26 respondents aged 60 to 89 years living in Bialystok associated with one of two different institutions: nursing home for the elderly and University of the Third Age. By comparing the persons on two extremes of social activity it was possible to see similarities and differences in their capital equipment, and also in achievements of the life positions in the class structure and resources aimed at successful ageing. The third chapter presents the empirical analysis of the research results. This part outlines the way in which old people think about their ancestors and contemporary people. It also shows factors according to changes in their social position in the city, social issues which they consider most important for old people, their opinions about leisure time, opportunities and barriers of economic activity and types of old people social capital depending on the institution with which they are associated. Approach to the perception and use of internal disparities of seniors were also discussed. The analysis additionally contains the evaluation of senior citizens image in the polish mass media. This publication does not contain a strict ending. It only identifies the main conclusions of the research and potential directions of future analysis. Above all, older people could improve their position not by demanding increases in social benefits from which major parts are often taken away by their family members, but by highlighting their human, social and cultural capital. It is necessary to create favorable conditions for social and professional life of old people and their cooperation with members of local communities. Important role in this regard is played by institutions implementing three tasks: stimulating senior citizens' desire to satisfy previously unrealized needs; creating relationships between them so that they can solve their own problems and work for the others; and providing legal, social and vocational guidance. Stimulating cooperation between existing public, commercial and non-governmental sector organizations may serve to achieve these goals. The dissemination of bottom-up techniques of social capital building and checklist of essential features of Age-friendly Cities may also be important. -/- . (shrink)

To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effect. A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on "Death and Dying" was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on "Decisions near the End of Life". Practitioners accept the relevance of concepts widely disparaged (...) by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/withdrawing treatment. Within the UK nurses' group a "rationalist" axis of respondents who describe themselves as having "no religion" are closer to the bioethics consensus on withholding and withdrawing treatment. Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

In this chapter, we consider ethical and philosophical aspects of trust in the practice of medicine. We focus on trust within the patient-physician relationship, trust and professionalism, and trust in Western (allopathic) institutions of medicine and medical research. Philosophical approaches to trust contain important insights into medicine as an ethical and social practice. In what follows we explain several philosophical approaches and discuss their strengths and weaknesses in this context. We also highlight some relevant empirical work in the section on (...) trust in the institutions of medicine. It is hoped that the approaches discussed here can be extended to nursing and other topics in the philosophy of medicine. (shrink)

What Ivan Illich regarded in his Medical Nemesis as the ‘expropriation of health’ takes place on the surfaces and in the spaces of the screens all around us, including our cell phones but also the patient monitors and (increasingly) the iPads that intervene between nurse and patient. To explore what Illich called the ‘age of the show’, this essay uses film examples, like Creed and the controversial documentary Vaxxed, and the television series Nurse Jackie. Rocky’s cancer in his last film (...) (submitting to chemo to ‘fight’ cancer) highlights what Illich along with Petr Skrabanek called the ‘expropriation of death’. In contrast to what Illich denotes as ‘Umsonstigkeit’ – i.e., a free gift, given undeservedly, i.e., gratuitously – medical science tends to be tempted by what Illich terms scientistic ‘black magic’, taking over (expropriating) the life and the death of the patient in increasingly technological ways, a point underscored in the concluding section on the commercial prospects of xenotransplants using factory farm or mass-produced (and already for some time) human-pig mosaics or chimeras. (shrink)

Rescue workers have a stressful and risky occupation where being engaged is crucial to face physical and emotional risks in order to help other persons. This study aims to estimate work engagement levels of rescue workers (namely comparing nurses, firefighters, and police officers) and to assess the validity evidence related to the internal structure of the Portuguese versions of the UWES-17 and UWES-9, namely, dimensionality, measurement invariance between occupational groups, and reliability of the scores. To evaluate the dimensionality, we compared (...) the fit of the three-factor model with the fit of a second-order model. A Portuguese version of the instrument was applied to a convenience sample of 3,887 rescue workers (50% nurses, 39% firefighters, and 11% police officers). Work engagement levels were moderate to high, with firefighters being the highest and nurses being the lowest engaged. Psychometric properties were evaluated in the three-factor original structure revealing acceptable fit to the data in the UWES-17, although the UWES-9 had better psychometric properties. Given the observed statistically significant correlations between the three original factors, we proposed a 2nd hierarchal structure that we named work engagement. The UWES-9 first-order model obtained full uniqueness measurement invariance, and the second-order model obtained partial (metric) second-order invariance. (shrink)

abstract Is it permissible for a doctor or nurse to knowingly administer a placebo in a clinical setting? There is certainly something suspicious about it: placebos are typically said to be ‘sham’ treatments, with no ‘active’ properties and so giving a placebo is usually thought to involve tricking or deceiving the patient who expects a genuine treatment. Nonetheless, some physicians have recently suggested that placebo treatments are sometimes the best way to help their patients and can be administered in an (...) honest way. These physicians conclude that placebo treatments are a perfectly acceptable, and ethically unproblematic, mode of treatment. While I grant the common idea that placebos are deceptive is correct, I argue that widespread misunderstandings concerning why this is so has led proponents of placebo treatments to respond to the charge of deception in a way that misses the mark entirely. My goal in this paper, then, is to develop a precise conception of what makes something a placebo, which in turn will clarify the central charge concerning the ethics of placebo treatment, viz. that it is deceptive. (shrink)

Aims and objectives. Participant narratives from a feminist and queer phe- nomenological study aim to broaden current understandings of trauma. Examin- ing structural marginalisation within perinatal care relationships provides insights into the impact of dominant models of care on queer birthing women. More specifically, validation of queer experience as a key finding from the study offers trauma-informed strategies that reconstruct formerly disempowering perinatal relationships. Background. Heteronormativity governs birthing spaces and presents considerable challenges for queer birthing women who may also have (...) an increased risk of trauma due to structurally marginalising processes that create and maintain socially constructed differences. Design. Analysis of the qualitative data was guided by feminist and queer phe- nomenology. This was well suited to understanding queer women’s storied narra- tives of trauma, including disempowering processes of structural marginalisation. Methods. Semistructured and conversational interviews were conducted with a purposeful sample of thirteen queer-identified women who had experiences of birthing in rural Nova Scotia, Canada. Results. Validation was identified as meaningful for queer women in the context of perinatal care in rural Nova Scotia. Offering new perspectives on traditional models of assessment provide strategies to create a context of care that recon- structs the birthing space insofar as women at risk do not have to come out as queer in opposition to the expectation of heterosexuality. Conclusions. Normative practices were found to further the effects of structural marginalisation suggesting that perinatal care providers, including nurses, can challenge dominant models of care and reconstruct the relationality between queer women and formerly disempowering expectations of heteronormativity that govern birthing spaces. Relevance to clinical practice. New trauma-informed assessment strategies recon- struct the relationality within historically disempowering perinatal relationships through potentiating difference which avoids retraumatising women with re- experiencing the process of coming out as queer in opposition to the expectation of heterosexuality. (shrink)

ABSTRACT Objectives There is little research on moral uncertainties and distress of palliative and hospice care providers (PHCPs) working in jurisdictions anticipating legalising voluntary assisted dying (VAD). This study examines the perception and anticipated concerns of PHCPs in providing VAD in the State of Queensland, Australia prior to legalisation of the practice in 2021. The findings help inform strategies to facilitate training and support the health and well-being of healthcare workers involved in VAD. Design The study used a qualitative approach (...) to examine and analyse the perception and anticipated concerns of PHCPs regarding challenges of providing assisted dying in Queensland. Fourteen PHCPs were recruited using a purposive sampling strategy to obtain a broad representation of perspectives including work roles, geographical locations and workplace characteristics. Data were collected via one in-depth interview per participant. The transcripts were coded for patterns and themes using an inductive analysis approach following the tradition of Grounded Theory. Setting The study was conducted in hospital, hospice, community and residential aged care settings in Queensland, Australia. These included public and private facilities, secular and faith-based facilities, and regional/rural and urban facilities. Participants Interviews were conducted with fourteen PHCPs: 10 nurses and 4 physicians; 11 female and 3 male. The median number of years of palliative care practice was 17, ranging from 2 to 36 years. For inclusion, participants had to be practising palliative and hospice care providers. Results PHCPs are divided on whether VAD should be considered part of palliative care. Expectations of moral distress and uncertainty about practising VAD were identified in five areas: handling requests, assessing patient capacity, arranging patient transfers and logistical issues, managing unsuccessful attempts, and dealing with team conflicts and stigma. Conclusions The possibility of having to practise VAD causes moral distress and uncertainty for some PHCPs. Procedural clarity can address some uncertainties; moral and psychological distress, however, remains a source of tension that needs support to ensure ongoing care of both patients and PHCPs. The introduction of VAD post-legalisation may present an occasion for further moral education and development of PHCPs. (shrink)