Palliative care seeks to improve the quality of life for patients suffering from the impact of life‐limiting illnesses. Palliative care encompasses but is more than end‐of‐life care, which is defined as care during the final hours/days/weeks of life. Although palliative care policies increasingly require all healthcare professionals to have at least basic or non‐specialist skills in palliative care, international evidence suggests there are difficulties in realising such policies. This study reports on an action research project aimed at developing respiratory nursing (...) practice to address the palliative care needs of patients with advanced chronic obstructive pulmonary disease (COPD). The findings suggest that interlevel dynamics at individual, team, interdepartmental and organisational levels are an important factor in the capacity of respiratory nurses to embed non‐specialist palliative care in their practice. At best, current efforts to embed palliative care in everyday practice may improve end‐of‐life care in the final hours/days/weeks of life. However, embedding palliative care in everyday practice requires a more fundamental shift in the organisation of care. (shrink)

Using a quantitative methods approach, we examine the organisational drivers of cognitive workaholism and emotional exhaustion amongst a group of employees (N = 187) in a digital workplace based in Berlin, Germany. This study demonstrated that managers could influence cognitive workaholism through the pace of work and an employee’s perceived need to engage in off-hours work. Cognitive workaholism was also found to have a direct impact on emotional exhaustion, as did the relationship with one’s manager. Off-hours work was not found (...) to have a direct impact on emotional exhaustion. Instead, the data suggests that off-hours working hinders an employee’s ability to detach from their work, and therefore higher levels of cognitive workaholism are observed, which then leads to higher levels of emotional exhaustion. This study highlights how management’s distribution of workload can create a situation whereby employees have constant thoughts about work, leading to emotional exhaustion. This is an important topic, given the increasing use of digital technology in modern workplaces. Specifically, off-hours work is easily facilitated through the use of technology, and this study therefore unveils the double-edged sword of technology. Hence, this topic is important for modern organisations seeking to promote sustainable employee workplace wellbeing. (shrink)

This study employs a qualitative approach to investigate the factors influencing engagement in Irish employee wellbeing programmes. Two stages of data collection were conducted, involving 52 employees completing open-ended questionnaires in Stage 1 and 23 participants interviewed in Stage 2. Three themes emerged from the thematic analysis of the data: (1) communicating wellbeing initiatives; (2) creating and maintaining interest in wellbeing; and (3) challenges to employee wellbeing. The three themes and their subthemes provide qualitative evidence from employees on the barriers (...) to and drivers of workplace wellbeing initiative utilisation through the lenses of Resource utilisation Theory and Culture of Health. The findings underscore the importance of supportive environments and effective design in enhancing programme utilisation, along with the need to offer targeted initiatives addressing secondary and tertiary wellbeing issues. By addressing shortcomings in Irish workplaces, this research contributes to advancing the effectiveness and impact of workplace wellbeing initiatives at multiple levels: organisational, individual, and governmental. (shrink)

O presente artigo tem por objetivo apontar a relação entre a III Conferência Geral do Episcopado Latino Americano celebrada no final de janeiro e início de fevereiro de 1979 em Puebla de Los Angeles e os Bispos do Brasil. Apontando quem foram os Bispos do Brasil que de Puebla tomaram parte e em quais aspectos eles contribuíram. Tal colaboração será externada em duas vertentes. De um lado, a contribuição dos Bispos do Brasil enquanto Conferência Episcopal Nacional; De outro, a colaboração (...) pessoal de prelados especialmente Aloísio Lorscheider e Luciano Mendes de Almeida que ou por sua liderança natural no episcopado Latino Americano ou por suas opções e testemunhos eclesiológicas, influíram profundamente em posições assumidas no Documento Final. (shrink)

Some commentators have worried that Descartes‘s ontological proof is a kind ofafterthought, redundancy, or even embarrassment. Descartes has everythingneeded to establish God as the ground of certainty by Meditation Three, so whybother with yet another proof in Meditation Five? Some have even gone so far asto doubt his sincerity.1Past literature on this topic is of daunting variety andmagnitude, dating back to the seventeenth century.2The current discussion hasfocused on Descartes‘s premises in relation to the coherence of his concept ofGod.3I wish to (...) take up this issue from a somewhat different tack, showing that Descartes‘s ontological proof actually involves a subtle change in the direction ofhis argument from a reflective to a recollective theory of innateness. In the FifthMeditation, Descartes does not simply expand on his previous discussion of God,which arose out of reflection on his self; rather, the ontological proof depends ona kind of recollection of God‘s being that could only be based on the causalpositivity, or ―power,‖ of His existence. God is the structural cause of our idea ofhim and thereby restricts the way in which we may think of Him, in the sameway as the essence of a triangle structurally determines the ways we must thinkof it.4We are not free to construct such ideas in any way we want, so there mustbe a cause, or a reason, that restricts such construction.The specific argument of Meditation Five, however, must be understoodin its larger context, for part of the structurally determined idea of God containsnecessary existence, which Descartes interprets in terms of causal power. In theprocess of explaining this causal power, first to Caterus and, later to Arnauld,Descartes develops a way of interpreting God‘s causal relationship to himself, interms of a scholastic distinction between God as causa sui and ens a se, whichpreserves the universality of the causal principle and allows us to understand whyGod can be considered as the formal cause of His own being—the self-groundingground of all existence—an idea of subsequent importance to Malebranche andSpinoza, among others. Understanding this position on God and cause allows usto see a complementarity between Mediations III and V that has previously beenoverlooked.5While the principle of eminent causality found in Meditation Threeis central to the structural causation argument of Meditation Five, it is God‘spower, the positivity of His causal relationship to himself, that allows theargument from his effects to his existence in the first place.The dualistic structure to Descartes‘s arguments for God‘s existence inMeditations Three and Five mirrors Anselm‘s approach in the Monologion andthe Proslogion. Appreciating this stylistic debt is crucial for understandingDescartes‘s attempts to improve on Anselm‘s arguments, as well as his attempt totruly ground all knowledge in the certainty of God‘s existence. Yet whileAnselm‘s dual argument is ultimately based on a negative intuition of God‘sbeing, described in the Monologion as that without which the world cannot be,Descartes‘s dual argument in Meditations Three and Five is based on a positiveintuition or recollection of God‘s being as a necessary structural restriction on our concepts of the world. The ontological proof is primarily based on thisrecollective theory of innateness. It is God as causa sui, recollected as thenecessary ground of all things, that is the sole efficient cause of the existence ofevery finite, limited thing—especially human beings and their clear and distinctideas. (shrink)

Through discussions of Locke, Behn, Shaftesbury, Hume, and Richardson, this book traces the idea of romance as, in the process of engendering resistance, it comes nonetheless to define the empiricist mind as the reading mind.

Machine generated contents note: -- Acknowledgements Introduction: From Passions to Language: The Transformation of the ImaginationLocke: Metaphorical Romances Behn: Romance from the Stage to the Letter Shaftesbury: Conversation and the Psychology of Romance Hume: Reading Romances, Writing the Self Richardson: How to Read Romance NotesBibliographyIndex.

A Charter on Medical Professionalism (CMA) has just recently been developed internationally, and the Canadian Medical Association is calling for public dialogue on medical professionalism now that reforms in the Canadian system of health care are imminent. We posit that good practices are at issue; we outline the essence of these in general and also specifically in the knowing, teaching and intervening components of practice. We also see challenges not to, but in, medical professionalism – first and foremost in the (...) profession's definition of good practices and the payer's confinement of insurance coverage to these. (shrink)

For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re-clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for (...) use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care. (shrink)

Can work-family policies promote greater gender equity in family roles? Using interviews with couples from upstate New York, we examine the role of work-family policies in the decisions dual-earner married couples make about paid work during the transition to parenthood. During the period immediately around a birth, differences in mothers’ and fathers’ access to paid time off from work interacted with their parenting role ideologies to influence gender differences in paid work arrangements. After the initial transition, employed women used and (...) created more flexibility in their work arrangements than their husbands, often reducing their husbands’ need to use available work-family policies. (shrink)

Somewhere between use and mere whim there is a place for the expressivity of affect as a concept. This paper raises the question of how the concept of affect might be mobilized without reducing its expressions to the logic of work. We suggest that the very attempt to put affect to work in order to solve pressing problems may be symptomatic of an anxiety to master the events of the world. With this in mind, we make a case for the (...) importance of Georges Bataille's critique of an instrumentalist form of thinking, which reduces events to objects of human sensemaking. Bataille's “general economy” opens onto all that the restricted economy of use negates; namely, that which exceeds our efforts as humans to make sense of, and thus appropriate, events. Ultimately, Bataille's antihumanist thought limits the potential of the gift economy, by rendering it the negative of the social order. We argue that a more posthumanist thought can realize the immanent potential of affect and apprehend its gift to thinking. (shrink)

Transcultural comparisons taking the differences and commonalities into consideration in the fields of mental health and ill mental health have always been a focus of scientific interest. The ‘East’ and ‘West’ comparisons in this regard, could be the one most widely deliberated. ‘East and West’, as a human-made conceptual construct, has evolved to signify many social, cultural, political, economic and psychological realities and meanings, beyond its geographical references. Such conceptualizations both reflect and re-construct our realities. -/- Beyond the inequalities and (...) discrepancies in resources, the ‘East and West’ dualism has an impact on mental health theory and praxis in a many different ways. The range, content, patterns and expression of psychopathology and psychiatric symptomatology; the explanatory models of mental disorders; the diagnostic and classification systems; the psychopharmacological and psychotherapeutical interventions; the role of family and psychosocial support systems; basic conceptualizations of mental health and disease are some of the main areas of diversity. -/- This chapter, after briefly discussing the historical roots of the conceptualization of ‘East and West’, will be focused on the relations of mental health and ill mental health with this and related conceptualizations. It is concluded that, in this day of globalization, to improve the quality of psychiatric theory and praxis within a framework of high ethical standards, a paradigm focusing on the unity in diversity and embracing a non-dualistic, non-categorical, and non-hierarchical humanistic approach to cultural differences would bring all the colours of humanity and therefore psychiatry onto the canvas. (shrink)

Obese people consume significantly greater amounts of health resources. This study set out to determine if health resource utilization by obese people decreases after losing weight in a comprehensive medically supervized weight management programme. Four hundred and fifty-six patients enrolled in a single-centred, multifaceted weight loss programme in a universal health care system were studied. Patient information was anonymously linked with administrative databases to measure health resource utilization for 1 year before and after the programme. Mean body mass index (BMI) (...) decreased by more than 15%. The mean annual physician visits (pre = 9.6, post = 9.4) did not change significantly after the programme. However, patients saw a significantly fewer number of different physicians per year following the programme (pre = 4.5, post = 3.9; P < 0.001). Mean annual number of emergency visits (pre = 0.2; post = 0.2) and hospital admissions (pre = 0.05; post = 0.08) did not change. Neither baseline BMI, nor its change during the programme, influenced changes in health resource utilization. Our study suggests that weight loss in a supervized weight management programme does not necessarily decrease short-term health resource utilization. Further study is required to determine if patients who maintain their weight loss experience a decrease in health utilization. (shrink)