Despite over three decades of research into the sources and costs of what has become an “epidemic” of moral distress among healthcare professionals, spanning many clinical disciplines and roles, there has been little significant progress in effectively addressing moral distress. We believe the persistent sense of frustration, helplessness, and despair still dominating the clinical moral distress narrative signals a need for re-orientation in the way moral distress is understood and worked with. Most fundamentally, moral distress reveals moral investment and energy. (...) It is the troubled call of conscience, an expression of fidelity to moral commitments seen as imperiled or compromised.It is crucial that we find ways to empower clinicians in heeding this call—to support clinicians’ moral agency and voice, foster their moral resilience, and facilitate their ability to contribute to needed reform within the organizations and systems in which they work. These objectives must inform creative expansion in the design of strategies for addressing moral distress in the day-to-day of clinical practice. We include suggestions about promising directions such strategies might take in the hope of spurring further innovation within clinical environments. (shrink)

Undisputedly, the United States’ health care system is in the midst of unprecedented complexity and transformation. In 2014 alone there were well over thirty‐five million admissions to hospitals in the nation, indicating that there was an extraordinary number of very sick and frail people requiring highly skilled clinicians to manage and coordinate their complex care across multiple care settings. Medical advances give us the ability to send patients home more efficiently than ever before and simultaneously create ethical questions about the (...) balance of benefits and burdens associated with these advances. Every day on every shift, nurses at the bedside feel an intense array of ethical issues. At the same time, administrators, policy‐makers, and regulators struggle to balance commitments to patients, families, staff members, and governing boards. Ethical responsibilities and the fiduciary, regulatory, and community service goals of health care institutions are not mutually exclusive; they must go hand in hand. If they do not, our health care system will continue to lose valued professionals to moral distress, risk breaking the public's trust, and potentially undermine patient care. At this critical juncture in health care, we must look to new models, tools, and skills to confront contemporary ethical issues that impact clinical practice. The antidote to the current reality is to create a new health care paradigm grounded in compassion and sustained by a culture of ethical practice. (shrink)

Relationships are central to enacting person‐centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person‐centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long‐term care. The acute care setting is (...) characterized by archetypal constraints which differentiate it from long‐term care, in terms of acuity and haste, task‐orientated work patterns and influence from “the rule of medicine,” all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re‐interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re‐presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person‐centred care versus relationship‐centred care by arguing that these are complementary rather than mutually exclusive and can be brought together in one theoretical framework acknowledging personhood as relational in essence. (shrink)

Key commentators on person‐centred care have described it as a “new ethic of care” which they link inextricably to notions of individual autonomy, action, change and improvement. Two key points are addressed in this article. The first is that few discussions about ethics and person‐centred are underscored by any particular ethical theory. The second point is that despite the espoused benefits of person‐centred care, delivery within the acute care setting remains largely aspirational. Choices nurses make about their practice tend to (...) comply more often with prevailing norms than those championed by person‐centred care. We draw on elements of work by moral philosopher Løgstrup and Foucault to provide insight into nurses’ ethical conduct and ask why nurses would want to act otherwise, when what they think and do is viewed as normal, or think and act otherwise if doing so is seen within the organization as transgressive? To address these more specific questions, we discuss them in relation to the following constructs: the ethical demand, sovereign expressions of life and parrhêsia. We conclude by arguing that a ethical theoretical framework enables nurses to increase their perceptibility and appreciation of the ethical demand particularly those emanating from incommensurability between organizational norms and the norms invoked by person‐centred care. We argue that nurses’ responses to the ethical demand by way of parrhêsia can be an important feature of intra‐organizational reflexivity and its transformation towards the delivery care that is more person‐centred, particularly for older people with cognitive impairment. We conclude the article by highlighting the implications of this for nursing education and research. (shrink)

The aim of this analysis was to examine the concept of time to rejuvenate and extend existing narratives of time within the nursing literature. In particular, we hope to promote a new trajectory in nursing research and practice which focuses on time and person‐centred care, specifically of older people with cognitive impairment hospitalized in the acute care setting. We consider the explanatory power of concepts such as clock time, process time, fast care, slow care and time debt for elucidating the (...) relationship between ‘good care’ and ‘time use’. We conclude by offering two additional concepts of time, plurotemporality and person‐centred time (PCT) which we propose will help advance of nursing knowledge and practice. Nurse clinicians and researchers can use these alternative concepts of time to explore and describe different temporal structures that honour the patient's values and preferences using experiential, observation‐based nursing research approaches. (shrink)

The author proposes sustainability as the criterion for business ethics. The argument here is that in today’s world, business success depends on sustainability. This in turn depends on respect for the environment, employees, customers and stakeholders at large. Thinking about ethics in terms of sustainability involves thinking about ethics in strategic terms. Indeed sustainability could and should be raised to the status of a global ethic. There is evidence to show that corporate social responsibility pays; e.g. the Dow Jones sustainability (...) group index outperformed the Dow Jones index by 36% over the past three‐year period. This suggests that taking ethics seriously goes hand in hand with successful business. (shrink)

In this article, we sought reconciliation between the “body‐as‐representation” and the “body‐as‐experience,” that is, how the body is represented in discourse and how the body of older people with cognitive impairment is experienced. We identified four contemporary “technologies” and gave examples of these to show how they influence how older people with cognitive impairment are often represented in acute care settings. We argued that these technologies may be mediated further by discourses of ageism and ableism which can potentiate either the (...) repressive or productive tendencies of these technologies resulting in either positive or negative care experiences for the older person and/or their carer, including nurses. We then provided examples from research of embodied experiences of older people with dementia and of how nurses and other professionals utilized their inter‐bodily experiences to inform acts of caring. The specificity and individuality of these experiences were more conducive to positive care experiences. We conclude the article by proposing that the act of caring is one way nurses seek to reconcile the “body‐as‐representation” with the “body‐as‐experience” to mitigate the repressive effects of negative ageism and ableism. The act of caring, we argue, is the essence of caring enacted through the provision of person‐centred care which evokes nurses to respond appropriately to the older person's “otherness,” their “variation of being” while enabling them to enact a continuation of themselves and their own version of normality. (shrink)

Suffering is an unavoidable reality in health care. Not only are patients and families suffering but also the clinicians who care for them. Commonly the suffering experienced by clinicians is moral in nature, reflecting the increasing complexity of health care, their roles within it, and the expanding range of available interventions. Moral suffering is the anguish experienced in response to various forms of moral adversity including moral harms, wrongs or failures, or unrelieved moral stress. Confronting moral adversity challenges clinicians' integrity: (...) the inner harmony that arises when their essential values and commitments are aligned with their choices and actions. The most studied response to moral adversity is moral distress. The sources and sequelae of moral distress, one type of moral suffering, have been documented among clinicians across specialties. Recent interest has expanded to include a more corrosive form of moral suffering, moral injury. Moral resilience, the capacity to restore or sustain integrity in response to moral adversity, offers a path designing individual and system solutions to address moral suffering. It encompasses capacities aimed at developing self- regulation and self-awareness, buoyancy, moral efficacy, self-stewardship and ultimately personal and relational integrity. Moral resilience has been shown to be a protective resource that reduces the detrimental impact of moral suffering. Clinicians and healthcare organizations must work together to transform moral suffering by cultivating the individual capacities for moral resilience and designing a new architecture to support ethical practice. Used worldwide for scalable and sustainable change, the Conscious Full Spectrum Response, offers a method to solve problems to support integrity, shift patterns that undermine moral resilience and ethical practice, and source the inner potential of clinicians and leaders to produce meaningful and sustainable results that benefit all. (shrink)

Although a large body of literature exists propounding the importance of space in aged care and care of the older person with dementia, there is, however, only limited exploration of the ‘acute care space’ as a particular type of space with archetypal constraints that maybe unfavourable to older people with cognitive impairment and nurses wanting to provide care that is person‐centred. In this article, we explore concepts of space and examine the implications of these for the delivery of care to (...) older people who are cognitively impaired. Our exploration is grounded in theorisations of space offered by key geographers and phenomenologists, but also draws on how space has been constructed within the nursing literature that refers specifically to acute care. We argue that space, once created, can be created and that nursing has a significant role to play in the process of its recreation in the pursuit of care that is person‐centred. We conclude by introducing an alternative logic of space aimed at promoting the creation of more salutogenic spaces that invokes a sense of sanctuary, safeness, and inclusion, all of which are essential if the care provided to the older person with cognitive impairment is apposite to their needs. The concept of ‘person‐centred space’ helps to crystallize the relationship between space and person‐centred care and implies more intentional manipulation of space that is more conducive to caring and healing. Significantly, it marks a return to Nightingale's wisdom, that is, to put the person in the best possible conditions for nature to act upon them. (shrink)

When writing about cinema does Deleuze have a conception of cinema spectatorship? In New Philosophy for New Media, Mark Hansen argues that Deleuze does have a conception of cinema spectatorship but that the subjectivity central to that spectatorship is weak and impoverished. This article argues against Hansen's reductive interpretation of Deleuze. In doing so, it relies on the three syntheses of time developed in Difference and Repetition alongside an elaboration of Deleuze's notion of a ‘cinematographic Cogito’. In this way, the (...) article offers a way of understanding the processes of cinema spectatorship from a Deleuzian perspective. (shrink)

Early in the 20th century Bateson, Doncaster and Punnett formed a cooperative collective to share research findings on the chromosome theory of heredity (CTH). They cross-bred plants and animals to correlate behaviour of chromosomes and heredity of individual traits. Doncaster was the most enthusiastic proponent of the new theory and worked for years to convince Bateson and Punnett on its relevance to their own research. The two younger biologists collaborated with Bateson, the preeminent geneticist in England. As their own reputations (...) developed, their research findings allied with the consensus on the importance of the CTH by the broader scientific community. After Doncaster’s tragic death in 1920, major objections to the theory had been resolved; Bateson and Punnett then utilized the CTH to construct chromosome maps detailing locations of specific genes on particular chromosomes in several different species. The marriage of heredity and cytology enhanced confidence that the theory was an accurate mechanism to explain inheritance in both plants and animals. (shrink)

In this article, we report the outcome of a sociological inquiry into nursing knowledge of death and dying, specifically ‘the good death’. A genealogical approach informed by actor‐network theory and appreciative inquiry were used to compose a broad socio‐material account of how nurses concern themselves with the care of the dying and end‐of‐life care. Our enquiry revealed similarly to other studies, that there was no shared or overarching model of care. Key themes derived from nurses' translations of ‘the good death’ (...) were re‐presented pictorially as six pillars and two processes to comprise a new diagram of The Personalised Ideal Death. (shrink)

This narrative symposium illuminates the problem of clinician moral distress. NIB editorial staff and narrative symposium editors, Cynda Rushton, PhD, RN, FAAN and Renee Boss, MD, MHS, developed a call for stories, which was sent to several list serves and posted on Narrative Inquiry in Bioethics’ website. The request for personal stories from inter–professional healthcare providers asked them to: identify specific clinical situations that give rise to moral distress; discuss the sources of this distress; reflect on how they experienced (...) moral distress—physically, psychologically, socially, or spiritually; assess how they managed their situations; and offer suggestions for avoiding future problems of a similar nature. Twelve stories are found in the print version of the journal and an additional eight supplemental stories are published online only through Project MUSE. The clinicians describe a wide range of experiences with patients, other clinicians, and their own professional and personal identities. Embedded in each of the narratives are deeply felt emotions that accompany their experiences of moral distress. Katherine Brown-Saltzman (a nurse), Alisa Carse (a philosopher), Zhanna Bagdasarov and Shane Connelly (industrial–organizational psychologists), and Nancy Berlinger (a bioethicist) provided commentaries. (shrink)

In formulating a notion of filmic reality, The Reality of Film offers a novel way of understanding our relationship to cinema. It argues that cinema need not be understood in terms of its capacities to refer to, reproduce or represent reality, but should be understood in terms of the kinds of realities it has the ability to create. The Reality of Film investigates filmic reality by way of six key film theorists: André Bazin, Christian Metz, Stanley Cavell, Gilles Deleuze, Slavoj (...) Zizek and Jacques Rancière. In doing so, it provides comprehensive introductions to each of these thinkers, while also debunking many myths and misconceptions about them. Along the way, a notion of filmic reality is formed that radically reconfigures our understanding of cinema. This book is essential reading for film scholars, students and philosophers of film, while it will also appeal to graduate students and specialists in other fields. (shrink)

In 1891 Cambridge biologist William Bateson (1861–1926) announced his idea that the symmetrical segmentation in living organisms resulted from energy peaks of some vibratory force acting on tissues during morphogenesis. He also demonstrated topographically how folding a radially symmetric organism could produce another with bilateral symmetry. Bateson attended many lectures at the Cambridge Philosophical Society and viewed mechanical models prepared by eminent physicists that illustrated how vibrations affected materials. In his subsequent research, Bateson utilized analogies and metaphors based upon his (...) observations of nature to build a thought model on the effects of vibrations on living tissue, because he realized that the chemistry and biology of his day lacked technologies to perform actual experiments on the subject. He concluded the production of organic segmentation was both a chemical and mechanical phenomenon. By the time of his death Bateson had incorporated new ideas about embryonic organizer regions to suggest a center from which a rhythmic force emanated and then produced the observed repetitive segmentation as a common feature in living organisms. (shrink)

This article contrasts the notion of a Deleuzian imaginary with that articulated by various film theorists during the 1970s and 1980s. Deleuze offers us, I argue, a way to conceive of the imaginary in the cinema in a positive way; that is, as something which opens up new expressions of the real. By contrast, for film theorists of the 1970s and 1980s, the imaginary was primarily conceived as a negative concept, as something which offered merely escapes or fraudulent distortions of (...) the real. A Deleuzian imaginary for the cinema can be articulated, I argue, by way of the films of Jean Renoir. (shrink)

What questions does Deleuze's philosophy of cinema answer? -- The movement-image (I): Griffith, Eisenstein, Gance, Lang -- The movement-image (II): Ford and Kazan -- The movement-image (III): Hawks and Hitchcock -- The time-image (I): Italian neorealism and after -- The time-image (II): Ophüls and Fellini -- The time-image (III): Welles and Resnais -- Thought and cinema -- Cinema after Deleuze (I): the persistence of the movement-image -- Cinema after Deleuze (II): recent elements of the time-image.

This paper examines Stanley Cavell's theories from the perspective of a 'politics of cinema' and engages in a critical reading of Sofia Coppola's 2006 film, Marie Antoinette.

ABSTRACT In 1956 the biomedical world was surprised to hear a report that human cells each contained forty six chromosomes, rather than the forty eight count that had been documented since the 1920s. Application of available techniques to culture human cells in vitro, halt their division at metaphase, and disperse chromosomes in an optical plane permitted perception of visual images not seen before. Researchers continued to obtain the preconceived forty eight counts until reeducation with these novel epistemic ‘chromosomes’ convinced them (...) that they could confidently report forty six chromosomes per cell. Within only a few years, and virtually without dissent, the social community of human cytogeneticists agreed upon a shared visual culture of human chromosome count and morphology. The initial forty six count proved not to be an anomaly. A new comparison of historical and ethnomethodological studies has suggested a better understanding of how applied technologies coupled with altered human perceptions established a new science. Human cytogenetics then collaborated with medical genetics to correlate changes in the new human karyotype with disorders of clinical significance. (shrink)

An examination of Gilles Deleuze's writings on film and film theory and how these writings relate to Max Ophuls's 1955 film, Lola Montès.