Drawing on previous empirical research, we provide an exemplary narrative to illustrate how patients have experienced hospital care organized according to evidence‐based fast‐track programmes. The aim of this paper was to analyse and discuss if and how it is possible to include patients’ individual perspectives in an evidence‐based practice as seen from the point of view of nursing theory. The paper highlights two conflicting courses of development. One is a course of standardization founded on evidence‐based recommendations, which specify a set (...) of rules that the patient must follow rigorously. The other is a course of democratization based on patients’ involvement in care. Referring to the analysis of the narrative, we argue that, in the current implementation of evidence‐based practice, the proposed involvement of patients resembles empty rhetoric. We argue that the principles and values from evidence‐based medicine are being lost in the transformation into the current evidence‐based hospital culture which potentially leads to a McDonaldization of nursing practice reflected as ‘one best way’. We argue for reviving ethics of care perspectives in today's evidence practice as the fundamental values of nursing may potentially bridge conflicts between evidence‐based practice and the ideals of patient participation thus preventing a practice of ‘McNursing’. (shrink)

The present paper explores patients’ experience of lived space at the hospital and at home. To expand the understanding of the existential meaning of lived space the study revisited two empirical studies and a study of a meta-synthesis on health and caring. Phenomenological philosophy was chosen as a theoretical framework for an excursive analysis. The paper demonstrates that existential dimensions of lived space at the hospital and at home differ significantly. For the patients, the hospital space means alien territory as (...) opposed to the familiar territory of home. To some extent the experienced differences are due to the physical environment; however, as our analysis shows, other and more significant meanings are also involved. For patients, lived space at the hospital primarily concerns the influence of complex institutional power structures and specific cultural and social conventions, e.g. the role of the good patient and the ambiance of hospitals. Home, on the other hand, offers familiar lived space in which patients feel protected and safe. Further, the paper relates patients’ experience of lived space to a phenomenological view of lived space in order to illustrate the radical influence of illness on patients’ lifeworld and experience of lived space. The combination of illness and general discomfort may influence patients’ experience of home negatively; the former experience of home as a sanctuary changes into feelings of being left on one’s own and burdened by too much responsibility. Consequently, in the light of the increasing focus on patients’ self-monitoring at home, it is important for healthcare professionals to recognize the influence of spatial aspects on patients’ well-being both at the hospital and at home. (shrink)

Background: Nursing care is rapidly evolving due to the advanced technological and medical development, and also due to an increased focus on standardization and the logic of production, permeating today’s hospital cultures. Nursing is rooted in a holistic approach with an ethical obligation to maintain and respect the individual’s dignity and integrity. However, working within time limits and heavy workload leads to burnout and ethical insensitivity among nurses, and may challenge nurses’ options to act on the basis of ethical and (...) moral grounds in the individual care situation. Aim: The aim of this study is to describe and discuss ethical dilemmas described and experienced by nurses in clinical practice today. Method: The study was performed as a literature review following the matrix method allowing to synthesize literature across methodological approaches. A literature search was performed, including relevant studies published between 2011 and 2016. A total of 15 articles were included and analyzed focusing on their description of ethical dilemmas. Ethical consideration: We have considered and respected ethical conduct when performing a literature review, respecting authorship and referencing sources. Results: The analysis revealed three themes, relating to important aspects of nursing practice, such as the nurse–patient relationship, organizational structures, and collaboration with colleagues. The findings are summarized in the following three themes: (1) balancing harm and care, (2) work overload affecting quality, and (3) navigating in disagreement. Ethically difficult situations are evident across settings and in very diverse environments from neonatal care to caring for the older people. Organizational structures and being caught in-between professional values, standardization, and busyness was evident, revealing the complexity of nursing practice and the diversity of ethical dilemmas, concerns, and distress experienced by clinical nurses. Conclusion: Nursing practice is challenged by organizational structures and the development of the health care system, inhibiting nurses’ professional decision-making and forcing them to compromise basic nursing values. (shrink)

This essay introduces the massive redeployment hypothesis, an account of the functional organization of the brain that centrally features the fact that brain areas are typically employed to support numerous functions. The central contribution of the essay is to outline a middle course between strict localization on the one hand, and holism on the other, in such a way as to account for the supporting data on both sides of the argument. The massive redeployment hypothesis is supported by case studies (...) of redeployment, and compared and contrasted with other theories of the localization of function. (shrink)

Uncertainty and affect are fundamental and interrelated aspects of the human condition. Uncertainty is often associated with negative affect, but in some circumstances it is associated with positive affect. In this paper, we review different explanations for the varying relationship between uncertainty and affect. We identify “mental simulation” as a key process that links uncertainty to affective states. We suggest that people have a propensity to simulate negative outcomes, which results in a propensity towards negative affective responses to uncertainty. We (...) also propose the existence of several important moderators of this process, including context and individual differences such as uncertainty tolerance, as well as emotion regulation strategies. Finally, we highlight important knowledge gaps and promising areas for future research, both empirical and conceptual, to further elucidate the relationship between uncertainty and affect. (shrink)

A discussion of whiteness as an “ethos” or “relational category” in bioethics, drawing on examples from medical and historical research.

COVID-19 has truly affected most of the world over the past many months, perhaps more than any other event in recent history. In the wake of this pandemic are patients, family members, and various types of care providers, all of whom share different levels of moral distress. Moral conflict occurs in disputes when individuals or groups have differences over, or are unable to translate to each other, deeply held beliefs, knowledge, and values. Such conflicts can seriously affect healthcare providers and (...) cause distress during disastrous situations such as pandemics when medical and human resources are stretched to the point of exhaustion. In the current pandemic, most hospitals and healthcare institutions in the United States have not allowed visitors to come to the hospitals to see their family or loved ones, even when the patient is dying. The moral conflict and moral distress among care providers when they see their patients dying alone can be unbearable and lead to ongoing grief and sadness. This paper will explore the concepts of moral distress and conflict among hospital staff and how a system-wide provider wellness programme can make a difference in healing and health. (shrink)

This paper discusses the importance of local knowledge for institutional epistemology—the study of the epistemic capacities and dysfunctions of institutions, and the choice and design of institutions needed to discover, correct, and transmit the information needed to solve collective action problems. Local knowledge is knowledge of particulars held by individuals and communities with deep familiarity with those particulars. Political economists in anti-authoritarian traditions have long stressed the importance of local knowledge for solving many collective action problems. Institutions capable of deploying (...) such knowledge effectively must include the bearers of relevant local knowledge, recognize them as experts with respect to it, and respect their autonomy in deploying their local knowledge to solve such problems. I focus on mētis, a type of practical local knowledge of how to interact with particulars. I argue that the need for relevant mētis justifies three policies: (1) resisting the proletarianization of professionals; (2) taking affirmative action to include members of marginalized groups in research and the professions; and (3) recognizing the scientific status of certain types of Indigenous knowledge and incorporating it into science curricula. (shrink)

One of the most lasting contributions of Marr's posthumous book is his articulation of the different “levels of analysis” that are needed to understand vision. Although a variety of work has examined how these different levels are related, there is comparatively little examination of the assumptions on which his proposed levels rest, or the plausibility of the approach Marr articulated given those assumptions. Marr placed particular significance on computational level theory, which specifies the “goal” of a computation, its appropriateness for (...) solving a particular problem, and the logic by which it can be carried out. The structure of computational level theory is inherently teleological: What the brain does is described in terms of its purpose. I argue that computational level theory, and the reverse-engineering approach it inspires, requires understanding the historical trajectory that gave rise to functional capacities that can be meaningfully attributed with some sense of purpose or goal, that is, a reconstruction of the fitness function on which natural selection acted in shaping our visual abilities. I argue that this reconstruction is required to distinguish abilities shaped by natural selection—“natural tasks” —from evolutionary “by-products”, rather than merely demonstrating that computational goals can be embedded in a Bayesian model that renders a particular behavior or process rational. (shrink)

Coronavirus disease 2019 (COVID‐19) has placed significant strain on United States’ health care and health care providers. While most Americans were sheltering in place, nurses headed to work. Many lacked adequate personal protective equipment (PPE), increasing the risk of becoming infected or infecting others. Some health care organizations were not transparent with their nurses; many nurses were gagged from speaking up about the conditions in their workplaces. This study used a descriptive phenomenological design to describe the lived experience of acute (...) care nurses working with limited access to PPE during the COVID‐19 pandemic. Unstructured interviews were conducted with 28 acute care nurses via telephone, WebEx, and Zoom. Data were analyzed using thematic analysis. The major theme, emotional roller coaster, describes the varied intense emotions the nurses experienced during the early weeks of the pandemic, encompassing eight subthemes: scared and afraid, sense of isolation, anger, betrayal, overwhelmed and exhausted, grief, helpless and at a loss, and denial. Other themes include: self‐care, ‘hoping for the best’, ‘nurses are not invincible’, and ‘I feel lucky’. The high levels of stress and mental assault resulting from the COVID‐19 crisis call for early stress assessment of nurses and provision of psychological intervention to mitigate lasting psychological trauma. (shrink)

Nurse researchers engaged in qualitative interviews with patients and spouses in healthcare may often experience being in unforeseen ethical dilemmas. Researchers are guided by the bioethical principles of justice, beneficence, non-maleficence, respect for human rights and respect for autonomy through the entire research process. However, these principles are not sufficient to prepare researchers for unanticipated ethical dilemmas related to qualitative research interviews. We describe and discuss ethically challenging and difficult moments embedded in two cases from our own phenomenological interview studies. (...) We argue that qualitative interviews involve navigation between being guided by bioethics as a researcher, being a therapist/nurse and being a fellow human being or even a friend. The researchers’ premises to react to unexpected situations and act in a sound ethical manner must be enhanced, and there is a need for an increased focus on the researchers’ ethical preparation and to continually address and discuss cases from their own interviews. (shrink)

Volume 19, Issue 9, September 2019, Page 62-64.

In this article we present a new approach to practical artificial intelligence (AI) ethics in heavy industry, which was developed in the context of an EU Horizons 2020 multi partner project. We begin with a review of the concept of Industry 4.0, discussing the limitations of the concept, and of iterative categorization of heavy industry generally, for a practical human centered ethical approach. We then proceed to an overview of actual and potential AI ethics approaches to heavy industry, suggesting that (...) current approaches with their emphasis on broad high-level principles are not well suited to AI ethics for industry. From there we outline our own approach in two sections. The first suggests tailoring ethics to the time and space situation of the shop floor level worker from the ground up, including giving specific and evolving ethical recommendations. The second describes the ethicist’s role as an ethical supervisor immersed in the development process and interpreting between industrial and technological (tech) development partners. In presenting our approach we draw heavily on our own experiences in applying the method in the Use Cases of our project, as examples of what can be done. (shrink)

The purpose of this study was to examine the perceptions of Black African‐born nurses (BABN) with non‐native accents regarding their nursing career advancement in the United States. Data were collected using individual interviews. Fifteen nurses originally from three sub‐Saharan African countries were included in the study. The findings were reported under six themes: perceived low level of intelligence, not suitable to lead, making fun of/belittling, prejudging without evidence, downgrading, and accent modification. The finding indicated that participants believed that their race (...) and accent influenced their professional nursing opportunities. These results are relevant to BABNs, nurse educators, and healthcare organization leaders. BABNs are capable of participating in nursing leadership and education despite their non‐native accent. (shrink)

In this paper we provide an account of the structural underpinnings of self-awareness. We offer both an abstract, logical account.

The paper discusses various concepts of 'species equality' and 'species superiority' and the assumptions concerning intrinsic value on which they depend. I investigate what philosophers from the traditional deontological (Taylor and Lombardi) and utilitarian (Singer and Attfield) perspectives have meant by their claims for species equality. I attempt to provide a framework of intrinsic values that justifies one sense in which members of a species can be said to be superior to members of another species.

Volume 19, Issue 9, September 2019, Page 39-41.