Background As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency (...) medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability. Methods A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis. Results Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting. Conclusions Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values. (shrink)

Background: Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses’ follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party – the (...) child – have attracted limited attention. Objective: The study explores challenges of confidentiality linked to a third party in nurse–patient relationships in a rural Tanzanian HIV/AIDS context. Study context: The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%. Methods: Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes. Ethical considerations: Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway. Findings and discussion: The material indicates a delicate balance between the nurses’ attempt to secure the HIV-free survival of the babies and the mothers’ desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient’s restricted disclosure came to light during follow-up of the HIV-positive women and the third party – the child who is at risk of HIV infection through mother’s milk. World Health Organization’s substantial focus on infant survival (Millennium Development Goal-4) and the strong calls for disclosure among the HIV-positive are reflected on in the discussion. (shrink)

Background:Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy and dignity of identity. While assistant nurses claim to support older persons’ wishes, older persons claim they have to adapt to assistant nurses' routines. The provider–receiver incongruence revealed here warrants investigation.Aim:To describe the elements of assisted bodily care, as performed in a nursing home.Research design:Data were collected through thirty-nine observations of (...) assisted bodily care, analyzed with qualitative content analysis.Participants and research context:Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home.Ethical considerations:The research was conducted in line with the Declaration of Helsinki, further approved by the regional ethics committee.Findings:Findings show that assisted bodily care consists of assistant nurses’ practical work, performed at a high tempo. Assistant nurses still attempt to adapt this work to the older persons’ wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care.Discussion:Assistant nurses try to promote older persons’ dignity of identity, but sometimes fail, possibly due to lack of time. They nevertheless seem to know the older persons well enough to adapt the assisted bodily care according to their preferences and to support self-determination. This indicates that openness to older persons’ lifeworlds may be more important than the amount of time available.Conclusion:Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could agree on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all. (shrink)

This article takes its point of departure in a research project studying the psychosocial problems of living with HIV. The project was intended to participate in changing practices dealing with these problems. It became a project including many differently situated and intersecting personal and generalized perspectives. The article researches the development of the HIV project as a contribution to discussions related to Participatory Action Research and Practice Research. In mainstream approaches methodological indications are often presented as rules to follow in (...) order to ensure the quality of the obtained knowledge. But situated historical and societal processes are involved in the effectuation of the HIV project, like they are in any other project. Researching the project heightens the awareness of the necessity of reflecting on situated and historical issues of power and marginalization and on the positions of the researcher in a given field of research. Methodological flexibility may also be necessary in order to encompass different perspectives. Such reflections and strategies are necessary precisely to ensure the development of knowledge and practice alike. (shrink)

We describe our clinical experience in treating patients with Tourette syndrome and other tic disorders using infra-low frequency neurofeedback, often in conjunction with cognitive behavior therapy. Following a narrative description of our approach, we present outcome data for 100 successive cases. Many of the children and adolescents that we have treated since 2005 did not derive sufficient benefit from standard treatment for Tourette syndrome and other tic disorders. In our clinical experience, based on extensive before- and after- testing and symptom (...) tracking, this patient group derived significant additive benefit from complementary neurofeedback treatment. The majority of trainees attained a higher level of functioning and were able to live up to their potential in a way they were not able to prior to neurofeedback treatment. (shrink)

The aim of this qualitative study was to gain an understanding of the meaning that community psychiatric nurses impart to their everyday interactions with patients in depot neuroleptic treatment situations. Nine experienced community psychiatric nurses were interviewed using semistructured, open-ended questions. Data analysis was by the phenomenological descriptive method according to Giorgi. Four themes were identified, highlighting aspects of the moral meaning of treating patients with depot neuroleptics: (1) ‘benevolent justification’ occurs when nurses perceive that the patient’s welfare is at (...) stake; (2) ‘inability to advocate the patients’ best interest’ occurs when nurses feel they are at a disadvantage; (3) ‘accommodative interactions’ occur when nurses are able to respond to a patient’s expressed needs; and (4) ‘acceptable advocacy’ occurs when physicians are sensitive to nurses’ suggestions on patients’ treatment. The findings indicate that treatment care planning involving both patients and nurses is essential to enhance patients’ autonomy, which is a precondition for satisfactory interactions. This phenomenological study describes the meaning that nurses give to administering depot neuroleptic injections to patients in the context of community psychiatric clinics. The phenomenon of concern was identified as the moral aspect in the interactions with individual patients in the treatment situation. (shrink)

In the past decades, narrative practices have been developed, and care has been conceptualized as being narrative in nature. More recently, narrative care has been developing both as a practice and a field of study. It is necessary to make the theoretical foundations of narrative care visible to avoid the risk of narrowly defining narrative care as a matter of storytelling and listening. In this article, we develop an understanding of narrative care grounded in early feminist pragmatist philosophy, with a (...) focus on social and political activism and experience. Pragmatism holds the possibilities to open spaces for realities that are constantly in flux and for emergent situations that must be considered across time, diverse places and social contexts. With the aid of Vera’s stories about her relationship with Tammy, we demonstrate the importance of recognizing that realities are multiple, complex and uncertain. Furthermore, we discuss how the stronghold of formula stories and issues of power, positioning and inequities, restrict people’s possibilities to be, become and co-author their stories. We also argue that the playfulness, imagination and world travelling of narrative care are in line with early feminist pragmatism, which draws on a wide and diverse range of experiences. Jane Addams linked democracy to dialogue, joint experiences and social equality. This calls for the development of ethical frameworks grounded in care that are more specifically focused on relational ethics and a commitment to dialogical and relational democracy and the prioritization of community. (shrink)

This article studies the mathematical properties of two systems that model Aristotle's original syllogistic and the relationship obtaining between them. These systems are Corcoran's natural deduction syllogistic and ?ukasiewicz's axiomatization of the syllogistic. We show that by translating the former into a first-order theory, which we call T RD, we can establish a precise relationship between the two systems. We prove within the framework of first-order logic a number of logical properties about T RD that bear upon the same properties (...) of the natural deduction counterpart ? that is, Corcoran's system. Moreover, the first-order logic framework that we work with allows us to understand how complicated the semantics of the syllogistic is in providing us with examples of bizarre, unexpected interpretations of the syllogistic rules. Finally, we provide a first attempt at finding the structure of that semantics, reducing the search to the characterization of the class of models of T RD. (shrink)

The affective turn -- Violence against women: perspectives and strategies -- Notes -- References -- PART III: Togetherness and its forms -- 7. Feminist visions and socio-political meanings of non-monogamous love -- Contemporary bonding, plurality of love -- Consensual plurality and sustainability of bonding -- Notes -- References -- 8. The invisible ties We share: A relational analysis of the contemporary loving couple -- The semantics of love and the We -- Love in situation: the WeLR in motion -- Enminded (...) bodies in the WeLR -- Final remarks: the bonds the WeLR creates -- Notes -- References -- 9. Silent love: On Irigaray's suggestion of cultivating sexual difference -- A culture of two subjects -- Listening -- The meaning of the word 'silence' -- Silence as a condition of love -- Cultivating silence -- Silent love -- Notes -- References -- 10. Love, feminism and dialectics: Repairing splits in theory and practice -- Dialectical critical realism -- Benjamin: from existential tension to oppressive contradiction -- Dialectics, necessity and redemptive critique -- The reparative turn and the issue of transformation -- In the pulse of now -- Closing words -- Notes -- References -- Index. (shrink)

When Gödel developed his functional interpretation, also known as the Dialectica interpretation, his aim was to prove consistency of first order arithmetic by reducing it to a quantifier-free theory with finite types. Like other functional interpretations Gödel’s Dialectica interpretation gives rise to category theoretic constructions that serve both as new models for logic and semantics and as tools for analysing and understanding various aspects of the Dialectica interpretation itself. Gödel’s Dialectica interpretation gives rise to the Dialectica categories , in: Contemp. (...) Math., vol. 92, Amer. Math. Soc., Providence, RI, 1989, pp. 47–62] and J.M.E. Hyland in [J.M.E. Hyland, Proof theory in the abstract, Ann. Pure Appl. Logic 114 43–78, Commemorative Symposium Dedicated to Anne S. Troelstra ]). These categories are symmetric monoidal closed and have finite products and weak coproducts, but they are not Cartesian closed in general. We give an analysis of how to obtain weakly Cartesian closed and Cartesian closed Dialectica categories, and we also reflect on what the analysis might tell us about the Dialectica interpretation. (shrink)

Drawing upon the literature on action research and case-study research, this paper discusses similarities and differences between these two forms of research practice. The paper also highlights some of the criticisms and challenges action researchers face. It suggests ways in which action researchers may enhance the discussability of action research by: (a) increasing the transparency of their research processes, (b) declaring the intellectual frameworks brought into action research projects, (c) discussing transferability of findings, and (d) defining accumulation of results. This (...) may require an extension to scientific discourse. In particular, the paper suggests that action researchers could change the ways in which action research results are reported to increase their reach among a wider audience. (shrink)

For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not (...) only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long‐term care, we show the possibilities of playfulness in the co‐composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times. (shrink)

Resumo: Este artigo busca compreender a situaçáo filosófica de alguns dos autores cujas vidas e cujos pensamentos estiveram entre Kant e Hegel. Romantismo alemáo foi como ficou conhecida esta época. Dentre seus primeiros autores, estiveram Friedrich Schlegel e Novalis, além de Hölderlin. Tais pensadores buscaram superar a crítica feita por Kant à pretensáo do conhecimento filosófico de alcançar a verdade absoluta, as coisas como sáo em si mesmas. Essa superaçáo, contudo, jamais conseguiu, para eles, completar-se – como aconteceria depois no (...) sistema de Hegel, para quem contradições só seriam aceitas como etapas do que chamou de dialética, cuja essência era, ao fim, solucioná-las na figura da síntese. Limitaçáo finita do homem diante do todo do ser, como firmara Kant, era o que ficava para trás com Hegel. Schlegel, Novalis e Hölderlin náo se contentam com a crítica de Kant, mas tampouco acreditam na síntese de Hegel. Parecem sugerir outro caminho para a modernidade ocidental, que náo se jogava na sanha hegeliana pelo saber absoluto sem despertá-la, toda vez, pela consciência crítica kantiana – e que náo se contentava com esta sem sonhar com aquela. Tal caminho é o que este artigo busca compreender. Palavras-chave: Hegel; Kant; Romantismo. (shrink)

Background: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in. Objective: To describe assistant nurses’ perspectives of providing care to older persons at the end of life in a nursing home. Research design: Data were collected (...) in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee. Results: Three main categories emerged; “Death a natural part of life”; “The older person’s well-being”; and “Care in the moment of death”; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons’ dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions. Discussion: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded. Conclusion: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development. (shrink)

Dissertação ANDRADE, Jackson Martins de. Religião, pluralismo e sociedade : uma análise do discurso paulino e sua contribuição para a comunidade cristã atual em seu diálogo com a sociedade de pluralismo religioso e Cultural. 2014. Dissertação – Pontifícia Universidade Católica de Minas Gerais, Programa de Pós-graduação em Ciências da Religião, Belo Horizonte.

This is not merely a theoretical problem, as Fernandes relates it to the very current crisis of nativist/multicultural identity in the West.

During the last ten years I have been working on the process of conversion to Protestantism of the indigenous people in Chimborazo province, Ecuador. Protestant evangelization in Ecuador started in the early twentieth century, but it is only in the last thirty years that the process of conversion of the indigenous people has become a large-scale one. During the first sixty years of evangelical activity North American missionaries from the Evangelical Missionary Union baptized only four natives in Chimborazo province. This (...) period was marked by strenuous resistance and rejection of the new religion. Accounts given by missionaries of the period describe the disasters and difficulties that the first evangelizing mission suffered. It was only the conviction that lost souls had to be saved that helped them overcome adversities and later achieve amazing results. (shrink)

Este ensayo analiza algunas semejanzas y diferencias entre la obra de Emmanuel Lévinas y la obra de Walter Benjamin . Se discute la crítica de ambos autores a la noción de totalidad, su cuestionamiento del historicismo y la exclusión de la alteridad que asocian con él, así como la propuesta de ambos autores de una noción de tiempo que rompa con la continuidad. Se discute de qué manera estas reflexiones se relacionan con la noción de responsabilidad hacia el otro.

This paper discusses the role of analogy in pre-theoretical experimental research, studying a particular historical case (the discovery and early investigation of X rays) and using the methodological ideas of William Stanley Jevons. The historical data and Jevons’ analysis suggest that the discovery of a completely new phenomenon is due to chance, but soon afterwards it is necessary that some assumptions provide a guidance to the research – otherwise, observations and experiments would occur at random, and that would sendom lead (...) to significant results. It is impossible to study all the factors that could possibly affect a give phenomenon, and hence the attention of the researcher must focus upon a small number of features. This choice, in a pre-theoretical context, must be guided by analogies. Contrary to tradicional analyses, this paper associates a peculiar epistemological status with analogies used in that kind of investigation: they are interpreted as originating desiderata, instead of probable hypotheses. RESUMO: A partir do estudo de um caso histórico particular (descoberta e investigação preliminar dos raios X), utilizando as concepções metodológicas de William Stanley Jevons, este artigo analisa o papel das analogias no processo de pesquisa experimental pré-teórica. A análise de Jevons e os dados históricos indicam que a descoberta de um fenômeno totalmente novo se dá ao acaso, porém logo em seguida é necessário que algumas suposições guiem a pesquisa, caso contrário as observações e experimentos seriam realizados totalmente ao acaso, o que dificilmente levaria a algum resultado. É impossível estudar todos os fatores que podem influenciar um fenômeno, e assim a atenção do pesquisador deve ser focalizada apenas sobre alguns aspectos, e essa escolha, em um contexto pré-teórico, deve ser guiada por analogias. Ao contrário das análises tradicionais, este artigo atribui um status epistemológico diferente às analogias empregadas nesse tipo de investigação, interpretando-as como geradoras de desiderata e não de hipóteses prováveis. (shrink)

Bribery has previously been viewed as a two-party transaction between the bribe-offerer and the bribe-taker. But there is a third party: the one who has a prior claim on the bribe-taker's loyalty. Breaking the first contract in response to the offer of a bribe is alienation of agency (a category that strictly includes bribes): alienation of agency is the additional immorality of bribery beyond any immorality of the act solicited by the bribe.

Compassion is often understood as central to nursing and as important to ensure quality nursing and healthcare. In recent years, there has been a focus on strategies in nursing education to ensure compassionate nurses. However, it is not always clear how the concept of compassion is understood. Theoretical conceptualisations that lie behind various understandings of compassion have consequences for how we approach compassion in nursing education. We present some ways in which compassion is often understood, their philosophical underpinnings and the (...) consequences these understandings can have for nursing education. We argue that it is useful for nursing education to understand compassion as a cognitive emotion and discuss how such an understanding can inform educational approaches to compassion. (shrink)

Departing from Anderson’s (2016) suggestion that there are three communities in Peirce’s thought corresponding to his three normative sciences of logic, ethics, and esthetics, I argue that these communities partake in a relationship of dependence similar to that found among the normative sciences. In this way, just as logic relies on ethics which relies on esthetics, so too would a logical community of inquirers rely on an ethical community of love, which would rely on an esthetic community of artists. A (...) community could conduct inquiry together only if it pursued the same goal; and it could pursue the same goal only if it first imaginatively construed it. Any logical or ethical community requires a shared imaginative repertoire of ideal ends. (shrink)

El trabajo como toda actividad del hombre debe insertarse en un mundo de sentido, que hoy pareciera ser el productivo, olvidando otras dimensiones del mismo, que enriquecen el vivir del hombre en su avance hacia un mundo más humano y humanizante.

O presente texto visa abordar a pertinência crítica da filosofia kantiana da história tentando assinalar o lugar transcendental da noçáo de fio condutor da natureza, para nós urn princípio regulativo passível de ser usado pelo discurso filosófico da história, que por isso náo se toma urn conhecimento teórico, mas nem por isso deixa de ser uma espécie de conhecimento, de cunho prático.

This article investigates the pervasive influence of the pharmaceutical industry in Pakistan and primarily the attitudes of the medical community toward such interactions. We used an inductive approach informed by grounded theory principles to analyze interviews and focus groups with consultants, residents, medical students, and a pharmaceutical industry representative in Karachi and Lahore, and participant-observation data from two biomedical conferences. Data were then analyzed through a deontological and teleological ethical theoretical framework. Findings highlight the reasons leading to the continuation of (...) norms including weak regulations, physicians’ expectations of receiving favors, and limited exposure to bioethics education. Recommendations for practice, policy, and research are discussed. (shrink)