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)

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)

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)

The sport of wheelchair rugby is the subject of a recent film Murderball, which tells the story of the apparently intense rivalry between the Canadian and United States men's teams. In part, the story is told through the lives of some of the game's leading players and coaches. Murderball deals with a series of ethical and political questions concerned with conceptions of disability, articulations of sporting bodies, and the value attached to sporting performance. In this paper we offer a critique (...) of Murderball and explore a number of themes including: (1) What can disabled bodies do?; (2) This is not the Special Olympics; and (3) ?Hot? and disabled. We conclude that these themes offer us new intellectual challenges for thinking about the physical education experiences of young disabled people and progression in disability sport. Indeed, we argue that Murderball moves disability issues into new intellectual terrain, thus increasing the ways in which people who work with young people and sport might need to take account of disability. (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)

This article introduces a symposium that aims to identify and critically assess the legal strategies of the tobacco, alcohol, and food and beverage industries which rest on freedom of expression arguments.

We extend Tomasello's discussion of children's developing sense of obligation to testimonial learning. First, we review a battery of behaviors in testimonial exchanges that parallel those described by Tomasello. Second, we explore the variable ways in which children hold others accountable, suggestive that children's evaluations of moral and epistemic responsibilities in joint collaborative activities are distinct.

Based upon a brief outline of existential-phenomenological ontology we present a theoretical and practical understanding of humanbeing, which is suited for a methodologically reflected approach to qualitative research. We present the phenomenological distinction between threedimensions of corporeal intentionality(structural, generative and dialectic intentionality) that form elementary events and structures of meaning. Various aspects of human being are better scrutinized with these concepts of intentionality, such as the association of individual being or collective being (e.g. groups) with the less differentiated anonymity of (...) human being. The aim of our framework is to support the qualitative researcher in grasping the experience of the human life in closer accord with how this being actually unfolds and is lived. Application of the presented framework is illuminated with empirical examples from educational, health and psychological contexts. Finally, we discuss the methodological implications that our approach has for qualitative investigations of human being. (shrink)

Si les figures continuent à faire l'objet de l'attention des linguistes, c'est dans le cadre toujours restreint de l'élocution, en dépit d'ouvertures vers la pragmatique, qui minimisent le détail du fait grammatical. Cette étude les aborde dans une perspective non seulement de rhétorique générale mais aussi de linguistique et de philosophie du langage, ce qui conduit à soulever la question même de leur définition. Elle s'appuie sur une conception souple du langage, considéré non comme un code, mais comme un processus (...) qui admet le flou et l'approximation. Les figures ne constituent pas un écart repérable par rapport à une norme, au demeurant introuvable, mais des agencements de faits grammaticaux qui prennent leur sens dans le contexte où ils se trouvent. On passe ainsi de la notion de figure à celle de configuration, ce qui est loin d'être une simple question de terminologie. Il ne s'agit donc pas de proposer une énième liste de figures aux noms savants, mais de mettre en évidence le jeu de mécanismes inscrits dans le logos, qui, en liaison avec l'ethos du locuteur et le pathos de l'interlocuteur, contribuent à la négociation de la distance entre individus à propos d'une question, où Michel Meyer voit l'essentiel de la rhétorique. C'est une nouvelle théorie des figures qui est proposée : loin d'en faire des écarts, elle les inscrit dans le fonctionnement ordinaire du langage. (shrink)

This paper considers the role of physicaleducation researchers within current publicconcerns about body shape and weight. UsingUlrich Beck's notion of `risk' it examines howcertainty about children, obesity, exercise andhealth is produced in the contexts of `expert'knowledge and recontextualised in the academicand professional physical education literature.It is argued that the unquestioning acceptanceof the obesity discourses in physical educationhelps to construct anxieties about the body,which are detrimental to students and silencesalternative ways of thinking and doing physicaleducation.

When adopted in 1991, the French Loi Evin was pioneering as one of the first in the world to regulate alcohol marketing as extensively. This short contribution assesses whether it remains fit for purpose over 30 years later. To this effect, it assesses its main provisions, considers the legislative amendments that have ensued as well as the extensive interpretation French courts have given of its scope, before concluding that the prospects for its revisions are limited in the near future.

This contribution considers the case law of European Court of Human Rights (ECtHR) and focuses on the extent to which the Contracting Parties to the European Convention on Human Rights (ECHR) can regulate the tobacco, alcohol, and food industries in a manner compatible with their ECHR obligations. After briefly presenting the two key cases dealing specifically with tobacco advertising, this contribution considers the main factors that the ECtHR takes into account when balancing competing concerns, and in particular freedom of commercial (...) expression and public health protection. It concludes that none of these factors is absolute, as the Court considers the strength of each one of them on the facts of each case. Nevertheless, it is clear from its case law that States have a wide margin of appreciation to regulate marketing practices that are inimical to public health and the prevention of non-communicable diseases more specifically, to the extent that even extensive advertising restrictions can be compatible with Article 10 of the ECHR. (shrink)

Excessive alcohol consumption can have adverse effects on health, and patients who suffer from alcohol use disorders are subject to much stigmatization. Nurses are often the first point of contact when patients enter the acute medical unit, and it is pivotal that this contact establishes the basis for future collaboration. The aim of this study is to elucidate nurses’ lived experience of providing care to patients suffering from alcohol use disorders. This present study has a qualitative research design, anchored in (...) phenomenological and hermeneutical methodology as described in reflective lifeworld research. Ten in‐depth, open‐ended interviews with nurses working in an acute medical unit were conducted. The analysis showed that providing care to patients suffering from alcohol use disorders was a highly complex task to accomplish. This required the nurse to engage with the patient in a sensitive cooperation in order to be dealing with the intricacy of the patient's life situation and balancing care between standardized procedures and the complexity of the patients. Further, a two‐sided feeling of responsibility emerged: a professional responsibility and a personal responsibility causing the provision of care as being caught between feelings of despondency and resignation. Nurses lack opportunities for being creative in determining how to provide care; instead, patients' perspectives of well‐being should be taken into account and should guide the provision of a meaningful care. Nurses must call for opportunities to deviate from the firmly established procedures restraining the care of this population. (shrink)

I debatten om fastlegers adgang til reservasjon mot henvisning til abort hevdet noen at reservasjonslegenes ønske er selvmotsigende og utilstrekkelig begrunnet. Det ble hevdet at reservasjonslegenes foreslåtte balansegang – å nekte henvisning til abort, men i stedet legge til rette for at en kollega henviser – er etisk inkonsistent og innebærer et særegent etisk hykleri, som har blitt kalt «de rene henders etikk». Ved nærmere ettersyn viser det seg at denne viktige kritikken har brodd mot noen måter å praktisere reservasjon (...) på, men ikke mot alle. Selv om den konkrete saken fikk en løsning som ikke innebærer reservasjonsadgang, er anklagen om «de rene henders etikk» prinsipielt interessant og kan anspore en diskusjon om samvittighetsfrihetens og toleransens grenser, et tema som vil vende tilbake til offentlighetens søkelys i stadig nye former.Nøkkelord: medisinsk etikk, naturrett, reservasjonsrett, samvittighetsfrihetEnglish summary: Conscientious objection for general practitioners – hypocritical or well-justified?In the Norwegian debate about General Practitioners’ right to conscientious objection to referrals for abortion, some claimed that the GPs’ request was self-contradictory and inadequately justified. It was claimed that the GPs’ suggested balancing act, that is, refusing referral for abortion, while instead facilitating referral by a colleague, is ethically inconsistent and implies a particular kind of ethical hypocrisy, termed ‘the ethics of clean hands’. Upon closer inspection, however, it turns out that this important critique applies to some ways of practicing conscientious refusal, but not to all. Even though this particular case was resolved in a way that does not involve toleration of conscientious objection, the charge of ‘ethics of clean hands’ is fundamentally interesting, and may spur a discussion of freedom of conscience and the limits of tolerance, a topic that will be recurring in the public square in ever new shapes. (shrink)

There is an increasing demand for ethical and Corporate Social Responsibility practices by companies. This competence has to be introduced in students’ training in business degree programs, and a check must then be done to determine if the students have come to appreciate the importance of CSR commitments. Using the framework of Stakeholders Theory, this work aims to examine students’ perceptions of ethical and CSR practices and commitment to different stakeholders, as well as the factors that lead students to act (...) in a socially responsible way. Furthermore, we hope to identify how the perception of CSR can be improved when Web 2.0 and social media tools that have proven effective in transmitting emotions and values are used in classrooms to teach these ideas. To this end, a survey was carried out in the year 2019 with 1,030 first-year students; it was administered at the beginning of the semester and also at the end of the semester after the training activities had been carried out. The main finding of the research is that students start with the belief that ethics and CSR are developed for reasons of image and legitimacy; however, after receiving training on these topics through tools that take into account emotions and values, they start to value the importance of the company as an agent of social change. The main practical and managerial implication is that methods based on Web 2.0 and social media tools are useful to teach ethics and CSR; the theoretical contribution is that students take into account the welfare of others. This finding contributes to Stakeholder Theory in a higher education context. (shrink)

Soft X‐ray tomography (SXT) is an imaging technique capable of characterizing and quantifying the structural phenotype of cells. In particular, SXT is used to visualize the internal architecture of fully hydrated, intact eukaryotic and prokaryotic cells at high spatial resolution (50 nm or better). Image contrast in SXT is derived from the biochemical composition of the cell, and obtained without the need to use potentially damaging contrast‐enhancing agents, such as heavy metals. The cells are simply cryopreserved prior to imaging, and (...) are therefore imaged in a near‐native state. As a complement to structural imaging by SXT, the same specimen can now be imaged by correlated cryo‐light microscopy. By combining data from these two modalities specific molecules can be localized directly within the framework of a high‐resolution, three‐dimensional reconstruction of the cell. This combination of data types allows sophisticated analyses to be carried out on the impact of environmental and/or genetic factors on cell phenotypes. (shrink)

Despite an increasingly growth of professional guidelines, textbooks and research about ethics in health care, awareness about ethics in Danish physiotherapy private practice seen vague. This article explores how physiotherapists in Danish private practice, from an ethical perspective, perceive to practice physiotherapy. The empirical data consists of interviews with twenty-one physiotherapists. The interviews are analysed from a hermeneutic approach, inspired by Ricoeur’s textual interpretation of distanciation. The analysis follows three phases: naïve reading, structural analysis and comprehensive analysis. Four main themes (...) are constructed: Beneficence as the driving force; Disciplining the patient through the course of physiotherapy; Balancing between being a trustworthy professional and a businessperson; The dream of a code of practice. Private practice physiotherapy is embedded in a structural frame directed by both political and economical conditions that shape the conditions for practicing physiotherapy. It means that beneficence in practice is a balance between the patient, the physiotherapists themselves and the business. Beneficence towards the patient is expressed as an implicit demand. Physiotherapeutic practice is expressed as being an integration of professionalism and personality which implies that the physiotherapists also have to benefit themselves. Private practice seems to be driven by a paternalistic approach towards the patient, where disciplining the patient is a crucial element of practice, in order to optimise profit. Physiotherapists wish for a more beneficent practice in the future by aiming at bridging ‘to be’ and ‘ought to be’. (shrink)