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)

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)

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)

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)

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)

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)

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)

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)

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)

Aims and Objectives. This article uses the concept of embodiment to demonstrate a conceptual approach to applied phenomenology. -/- Background. Traditionally, qualitative researchers and healthcare professionals have been taught phenomenological methods, such as the epoché, reduction, or bracketing. These methods are typically construed as a way of avoiding biases so that one may attend to the phenomena in an open and unprejudiced way. However, it has also been argued that qualitative researchers and healthcare professionals can benefit from phenomenology’s well-articulated theoretical (...) framework, which consists of core concepts, such as selfhood, empathy, temporality, spatiality, affectivity, and embodiment. -/- Design. This is a discursive article that demonstrates a conceptual approach to applied phenomenology. -/- Method. To outline and explain this approach to applied phenomenology, the Discussion section walks the reader through four stages of phenomenology, which progress incrementally from the most theoretical to the most practical. -/- Discussion. Part one introduces the philosophical concept of embodiment, which can be applied broadly to any human subject. Part two shows how philosophically trained phenomenologists use the concept of embodiment to describe general features of illness and disability. Part three illustrates how the phenomenological concept of embodiment can inform empirical qualitative studies and reflects on the challenges of integrating philosophy and qualitative research. Part four turns to phenomenology’s application in clinical practice and outlines a workshop model that guides clinicians through the process of using phenomenological concepts to better understand patient experience. -/- Conclusion and Relevance to Clinical Practice. A conceptual approach to applied phenomenology provides a valuable alternative to traditional methodological approaches. Phenomenological concepts provide a foundation for better understanding patient experience in both qualitative health research and clinical practice, and therefore provide resources for enhancing patient care. (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)

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 claim is made in the book, Applied Ethics, published under the auspices of the Australian Association for Professional and Applied Ethics (AAPAE), that it can strengthen ethical behaviour. That claim, embodied in the subtitle, is based on more than a half dozen practices set out in the book. In total, they are drawn from an examination of ethical practices across fourteen different disciplines. The purpose of this paper is to outline and support that claim, drawing primarily on chapters of (...) the book, but also drawing on a small amount of additional information. The research on the ethical issues in each of these disciplines, and the writing of the chapters, were undertaken by members and associates of AAPAE. The fourteen disciplines were Marketing, Business, Accounting, Pharmacy, Nursing, Medicine, Veterinary & Animal Ethics, Engineering, Information and Communications Technology (ICT), Journalism, Policing, Politics, the Law and the Sciences. The findings have significance for the teaching of ethics by moral philosophers, for not all ethics classes follow the practices suggested by these findings. A few of the practices are even rejected by some moral philosophers. That the practices will improve ethical behaviour is the principal position taken by this paper. -/- . (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)

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)

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.

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)

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)

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)

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)

The professional situation is considered a major interface of practicum training, here conceived as a School of conjunction, a school where one learns to make links, a foundation for the engineering of professionalization. The notion of situation is here developed based on the study of a data corpus elaborated during an experience with a practicum training model centred on writing and the construction of the professional situation by a subject-actor-author of the situation, in interaction with others, in the context of (...) nurse training. The analysis and interpretation of data brings to light a complex and unique unit, constructed in the space-time of a professional practice, a process during which several states succeed one another. The critical moment in action characterizes this unit; it is central to the process, mobilizing reflection in action, internal deliberation, and action-related decision. La situation professionnelle est identifiée comme interface majeure de la formation en alternance conçue ici comme une Ecole de la conjonction, une école où l’on apprend à relier, fondement d’une ingénierie de professionnalisation. La notion de situation est approfondie à partir de l’étude d’un corpus de données constitué au fil de l’expérimentation d’un modèle de formation en alternance centrée sur l’écriture et la construction de la situation professionnelle par un sujet-acteur-auteur de la situation, en interaction avec autrui, dans le contexte de la formation en soins infirmiers. L’analyse et l’interprétation des données permettent de mettre en évidence une unité singulière complexe, construite dans l’espace-temps d’une pratique professionnelle, un processus au cours duquel plusieurs états se succèdent. Le moment critique dans l’action la caractérise ; il occupe la place centrale du processus, mobilisant réflexion dans l’action, délibération intérieure et décision d’action. (shrink)

The professional situation is considered a major interface of practicum training, here conceived as a School of conjunction, a school where one learns to make links, a foundation for the engineering of professionalization. The notion of situation is here developed based on the study of a data corpus elaborated during an experience with a practicum training model centred on writing and the construction of the professional situation by a subject-actor-author of the situation, in interaction with others, in the context of (...) nurse training. The analysis and interpretation of data brings to light a complex and unique unit, constructed in the space-time of a professional practice, a process during which several states succeed one another. The critical moment in action characterizes this unit; it is central to the process, mobilizing reflection in action, internal deliberation, and action-related decision. La situation professionnelle est identifiée comme interface majeure de la formation en alternance conçue ici comme une Ecole de la conjonction, une école où l’on apprend à relier, fondement d’une ingénierie de professionnalisation. La notion de situation est approfondie à partir de l’étude d’un corpus de données constitué au fil de l’expérimentation d’un modèle de formation en alternance centrée sur l’écriture et la construction de la situation professionnelle par un sujet-acteur-auteur de la situation, en interaction avec autrui, dans le contexte de la formation en soins infirmiers. L’analyse et l’interprétation des données permettent de mettre en évidence une unité singulière complexe, construite dans l’espace-temps d’une pratique professionnelle, un processus au cours duquel plusieurs états se succèdent. Le moment critique dans l’action la caractérise ; il occupe la place centrale du processus, mobilisant réflexion dans l’action, délibération intérieure et décision d’action. (shrink)

Patient and public involvement is widely thought to be important in the improvement of health care delivery and in health equity. Purpose: The article examines the role of experiential knowledge in service co-production in order to develop opiate substitution treatment services (OST) for high-risk opioid users. Method: Drawing on social representations theory and the concept of social identity, we explore how experts’ by experience and registered nurses’ understandings of OST contain discourses about the social representations, identity, and citizenship of the (...) participants and the effects these may have on developing or hindering inclusive and bottom-up forms of patient and public involvement. Results: The meeting sessions that potentially offer room for creativity and problem-solving fail to provide any new propositions for fixing the system. The health care professionals primarily identify themselves as regulators who protect the correctness of their actions and show little interest in considering experiential knowledge on opioid addiction. Conclusion: The participation of patients has been one of the prominent reforms implemented in health care. The goal of client-centered thinking is often emphasised; however, the implementation is not simple due to the strongly institutionalised knowledge and related working patterns and practices in health care. (shrink)

Background: When infertility is diagnosed, physicians have the difficult task to break bad news. Their communication skills play a central role in improving patients' coping abilities and adherence to infertility treatments. However, specific guidelines and training courses on this topic are still lacking. The aim of the present study is to provide some practical advice for improving breaking bad news in infertility diagnosis through a systematic literature review of qualitative and quantitative studies. Methods: Electronic searches were performed in the MEDLINE, (...) Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Psychology and Behavioral Sciences Collection databases. All articles focusing on the communication of the diagnosis of infertility were included. The main findings of each included article were then summarized. Results: Literature search identified 11,838 references that were screened for eligibility. Full texts of 81 articles were retrieved, and their analysis led to the inclusion of 4 articles, which treated the theme of communication of infertility only partially. The main addressed aspects concerning the communication of the infertility diagnosis were the following: the value that patients give to healthcare professionals' communication skills; the importance of giving clear information on diagnostic procedures and treatments in order to decrease patients' anxiety; and the importance of involving both partners. Conclusions: This review pointed out that the communication of the infertility diagnosis is still underinvestigated. Specific guidelines are currently not available, but other protocols could be used. Taking into account the principal aspects of communication highlighted with this review, in this study, we suggested an adaptation of the original SPIKES protocol that could be used by healthcare professionals for the communication of the infertility status. (shrink)

With significant advances in equal rights for lesbians, gay men, bisexual and transgender (LGBT) citizens, achieved across the western world during the past few decades, one group that continues to be overlooked is LGBT elders. This article examines the unique discrimination and homophobia faced by older LGBT people living in nursing and residential care homes. It investigates ways in which these environments construct and perpetuate heteronormativity by addressing the needs of heterosexual residents, while at the same time, failing to (...) meet the specific preferences of their LGBT residents. The assumption of heterosexuality in residential care is the ‘norm’ whereby non-normative sexualities are negated. For those considering long-term care, the fear of alienation and having to go back into the ‘closet’ is of profound concern. The argument most frequently presented to counter this is training managers and care staff to deliver non-discriminatory health and social care practices, targeting the unique needs of LGBT residents. However, from within the gay community has come a solution to end the type of homophobic behavior often encountered in mainstream care environments. This has seen the radical and sometimes controversial growth in alternative forms of retirement housing for gay older adults, in the United States of America, the United Kingdom, and across Europe. This article explores these schemes, taking into account criticism that deems such positive discrimination is contrary to the principles of equality legislation and the spirit of social inclusion. (shrink)

The dissertation, comprising a clinical intervention and three supporting studies, aimed to assess if it is possible to prevent nonsynostotic plagiocephaly while promoting safe infant sleeping practices. Five individuals were trained to assess cranial asymmetry and then reliability-tested; the interpreted results indicate substantial strength of rater-agreement. Intervention participants were allocated to group. Only intervention group nurses participated in the continuing education on plagiocephaly developed for nurses. A survey compared information intervention and control group parents received from nurses; intervention group parents (...) were significantly more aware of recommendations than the controls. Nurse education was evaluated by asking intervention and control group nurses and parents two open-ended questions; the intervention group reported new re-positioning strategies. The effect of the intervention on cranial shape was evaluated by assessing asymmetry at 2, 4, and 12 months (176 intervention group; 92 controls). It was nine times more common that cranial asymmetry at two months reversed by four months when parents were aware of written recommendations from their nurse (OR = 9.09 [0.02; 0.48], p = 0.004) when adjusted for group. An infant’s risk of asymmetry persisting until 12 months was significantly reduced in the intervention group (RR = 0.35 [0.13; 0.94], p = 0.03). Preventing brachycephaly was difficult. Conclusions: the assessors were considered reliable; educating nurses promoted the integration of new recommendations in practice; the intervention was associated with early reversal of nonsynostotic plagiocephaly. (shrink)

This article is about an intervention or approach in mental health care that has been developed from hermeneutics, more specifically the hermeneutics of Ricoeur. In this intervention photography is used as a means to assist patients in a process of meaning making from experiences in their life world. It aims at empowerment and strengthening the agency of patients. It does so by facilitating storytelling. Mimesis, as interpreted by Ricoeur, was found to be a central concept with which we could explain (...) the therapeutic working of the approach and legitimize its ethical claims of empowerment and recovery. Another aspect is the concordance between narrative and action, as described by Ricoeur, which has a pendant in the goal orientation of the photography intervention. At the same time demonstrations and experiences from professional practice (nurses applying the intervention) will give us feedback on the theory and enrich it with new insights, e.g. on ‘iconic representation’. (shrink)

Concerns of moral distress in health care have never been more relevant. In her book, Health Care Ethics Through the Lens of Moral Distress, Kristen Jones-Bonofiglio provides a comprehensive review of the effects of moral distress on providers and health care delivery, while highlighting the complexities of making ethical decisions in practice. Jones-Bonofiglio’s thoroughness and use of interdisciplinary, historical, and cultural scholarship makes this book an excellent introductory resource on moral distress for health care providers and researchers alike.

Many philosophers hold that if an agent acts intentionally, she must know what she is doing. Although the scholarly consensus for many years was to reject the thesis in light of presumed counterexamples by Donald Davidson, several scholars have recently argued that attention to aspectual distinctions and the practical nature of this knowledge shows that these counterexamples fail. In this paper I defend a new objection against the thesis, one modelled after Timothy Williamson’s anti-luminosity argument. Since this argument relies on (...) general principles about the nature of knowledge rather than on intuitions about fringe cases, the recent responses that have been given to defuse the force of Davidson’s objection are silent against it. Moreover, the argument suggests that even weaker theses connecting practical entities with knowledge are also false. Recent defenders of the thesis that there is a necessary connection between knowledge and intentional action are motivated by the insight that this connection is non-accidental. I close with a positive proposal to account for the non-accidentality of this link without appeal to necessary connections by drawing an extended analogy between practical and perceptual knowledge. (shrink)

According to a rich tradition in philosophy of action, intentional action requires practical knowledge: someone who acts intentionally knows what they are doing while they are doing it. Piñeros Glasscock argues that an anti-luminosity argument, of the sort developed in Williamson, can be readily adapted to provide a reductio of an epistemic condition on intentional action. This paper undertakes a rescue mission on behalf of an epistemic condition on intentional action. We formulate and defend a version of an epistemic condition (...) that is free from any luminosity commitments. While this version of an epistemic condition escapes reductio, it comes with substantive commitments of its own. In particular, we will see that it forces us to deny the existence of any essentially intentional actions. We go on to argue that this consequence should be embraced. On the resulting picture, intentional action is not luminous. But it still entails practical knowledge. (shrink)

Doing Practical Ethics supports the deliberate practice of philosophical skills relevant to understanding, evaluating, and developing arguments in forms commonly used in the field of practical ethics. Each chapter includes an explanation of a specific moral reasoning skill, demonstration exercises with sample solutions that offer students immediate feedback on their initial practice attempts, and extensive sets of practice exercises. It is suitable for any ethics course that centrally features argument from principle, argument from analogy, or inference to (...) the best explanation. It may be used as a standalone text in a debate-focused course. Paired with an anthology in a readings-focused course, it will help students develop the skills they need to understand and evaluate the arguments in the assigned readings. (shrink)

Defenders of pragmatic encroachment in epistemology (or what I call practicalism) need to address two main problems. First, the view seems to imply, absurdly, that knowledge can come and go quite easily—in particular, that it might come and go along with our variable practical interests. We can call this the stability problem. Second, there seems to be no fully satisfying way of explaining whose practical interests matter. We can call this the “whose stakes?” problem. I argue that both problems can (...) be addressed in roughly the same terms. More exactly, I argue that by first clarifying the whose stakes? problem an answer to the stability problem naturally falls out. (shrink)

The paper has two aims. The first is to propose a general framework for organizing some central questions about normative practical reasons in a way that separates importantly distinct issues that are often run together. Setting out this framework provides a snapshot of the leading types of view about practical reasons as well as a deeper understanding of what are widely regarded to be some of their most serious difficulties. The second is to use the proposed framework to uncover and (...) diagnose what I believe is a structural problem that plagues the debate about practical reasons. A common move in the debate involves a proponent of one type of view offering what she and others proposing that type consider to be a devastating criticism of an opposing type of view, only to find that her criticism is shrugged off by her opponents as easy to answer, misguided, or having little significance for their view. This isn’t due to conceptual blindness or mere slavish devotion to a theory but something fundamental about the argumentative structure of a debate over genuinely shared issues. Hence, the debate about practical reasons suffers from argumentative gridlock. The proposed framework helps us to see why this is so, and what we might do to move beyond it. (shrink)

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?

This chapter presents two contemporary pictures of practical reasoning. According to the Rule-Guidance Conception, roughly, practical reasoning is a rule-guided operation of acquiring (or retaining or giving up) intentions so as to meet synchronic requirements of rationality. According to the Reasons-Responsiveness Conception, practical reasoning is a process of responding to reasons we take ourselves to have, and its standards of correctness derive from what we objectively have reason to do, if things are as we suppose them to be. I argue (...) that a version of the latter has some significant advantages. This has some surprising consequences for how we should conceive of the structure of instrumental reasoning in particular. (shrink)

According to an attractive and widely held view, all practical reasons are explained in terms of the (instrumental or final) value of the action supported by the reason. I argue that this theory is incompatible with plausible assumptions about the practical reasons that correspond to certain moral rights, including the right to a promised action and the right to an exclusive use of one’s property. The argument is an explanatory rather than extensional one: while the actions supported by the relevant (...) reasons (e.g. keeping a valid promise or respecting property) can be argued to have a certain kind of value, I argue that this value presupposes a moral right, and therefore cannot explain the reason. Reflection on such cases suggest the conclusion that reasons that are subject to normative powers are generally not value-based. This also has important implications for the dialectic between ‘value-first’ and ‘reasons-first’ approaches to normativity. (shrink)

In this chapter, we compare Kant and James’ accounts of freedom. Despite both thinkers’ rejecting compatibilism for the sake of practical reason, there are two striking differences in their stances. The first concerns whether or not freedom requires the possibility of an open future. James holds that morality hinges on the real possibility that the future can be affected by our actions. Kant, on the other hand, seems to maintain that we can still be free in the crucial sense, even (...) if none of our actions can have any effect on the future. The second difference between them is related, and concerns the location of freedom. Kant views experience as determined by natural necessity, and locates freedom outside of it, in things-in-themselves. James, on the other hand, has a richer conception of experience than Kant, and holds that we can locate our freedom within experience alone. In the end, we contend that James has a better account of how freedom relates to our experience, but this comes at a cost. For while Kant's account struggles with the relationship between freedom and experience, it has the advantage of insulating our freedom from potential empirical challenges. (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)

Why did such highly abstract ideas as truth, knowledge, or justice become so important to us? What was the point of coming to think in these terms? This book presents a philosophical method designed to answer such questions: the method of pragmatic genealogy. Pragmatic genealogies are partly fictional, partly historical narratives exploring what might have driven us to develop certain ideas in order to discover what these do for us. The book uncovers an under-appreciated tradition of pragmatic genealogy which cuts (...) across the analytic-continental divide, running from the state-of-nature stories of David Hume and the early genealogies of Friedrich Nietzsche to recent work in analytic philosophy by Edward Craig, Bernard Williams, and Miranda Fricker. However, these genealogies combine fictionalizing and historicizing in ways that even philosophers sympathetic to the use of state-of-nature fictions or real history have found puzzling. To make sense of why both fictionalizing and historicizing are called for, the book offers a systematic account of pragmatic genealogies as dynamic models serving to reverse-engineer the points of ideas in relation not only to near-universal human needs, but also to socio-historically situated needs. This allows the method to offer us explanation without reduction and to help us understand what led our ideas to shed the traces of their practical origins. Far from being normatively inert, moreover, pragmatic genealogy can affect the space of reasons, guiding attempts to improve our conceptual repertoire by helping us determine whether and when our ideas are worth having. (shrink)

This article considers the question ‘What makes hope rational?’ We take Adrienne Martin’s recent incorporation analysis of hope as representative of a tradition that views the rationality of hope as a matter of instrumental reasons. Against this tradition, we argue that an important subset of hope, ‘fundamental hope’, is not governed by instrumental rationality. Rather, people have reason to endorse or reject such hope in virtue of the contribution of the relevant attitudes to the integrity of their practical identity, which (...) makes the relevant hope not instrumentally but intrinsically valuable. This argument also allows for a new analysis of the reasons people have to abandon hope and for a better understanding of non-fundamental, ‘prosaic’ hopes. (shrink)

This paper introduces constitutivism about practical reason, which is the view that we can justify certain normative claims by showing that agents become committed to these claims simply in virtue of acting. According to this view, action has a certain structural feature – a constitutive aim, principle, or standard – that both constitutes events as actions and generates a standard of assessment for action. We can use this standard of assessment to derive normative claims. In short, the authority of certain (...) normative claims arises from the bare fact that we are agents. This essay explains the constitutivst strategy, surveys the extant attempts to generate constitutivist theories, and considers the problems and prospects for the theory. (shrink)

Regulation by design (RBD) is a growing research field that explores, develops, and criticises the regulative function of design. In this article, we provide a qualitative thematic synthesis of the existing literature. The aim is to explore and analyse RBD's core features, practices, limitations, and related governance implications. To fulfil this aim, we examine the extant literature on RBD in the context of digital technologies. We start by identifying and structuring the core features of RBD, namely the goals, regulators, regulatees, (...) methods, and technologies. Building on that structure, we distinguish between three types of RBD practices: compliance by design, value creation by design, and optimisation by design. We then explore the challenges and limitations of RBD practices, which stem from risks associated with compliance by design, contextual limitations, or methodological uncertainty. Finally, we examine the governance implications of RBD and outline possible future directions of the research field and its practices. (shrink)

In defending his interest-relative account of knowledge in Knowledge and Practical Interests (2005), Jason Stanley relies heavily on intuitions about several bank cases. We experimentally test the empirical claims that Stanley seems to make concerning our common-sense intuitions about these bank cases. Additionally, we test the empirical claims that Jonathan Schaffer seems to make in his critique of Stanley. We argue that our data impugn what both Stanley and Schaffer claim our intuitions about such cases are. To account for these (...) results, one must develop a better conception of the connection between a subject's interests and her body of knowledge than those offered by Stanley and Schaffer. (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)