An understanding of the nature and development of nursing intuition can help nurse educators foster it in young nurses and give clinicians more confidence in this aspect of their knowledge, allowing them to respond with greater assurance to their intuitions. In this paper, accounts from philosophy and neurophysiology are used to argue that intuition, specifically nursing intuition, is a valid form of knowledge. The paper argues that nursing intuition, a kind of practical (...) class='Hi'>intuition, is composed of four distinct aspects that include: embodied knowledge rather like that knowledge we have when we have learned to ride a bicycle; well‐trained sensory perceptions attentive to subtle details of complex, often rapidly changing situations; a significant store of pertinent conceptual knowledge; and a history of habitual actions intentionally directed towards achieving the best outcomes for our patients. Contemporary neurophysiology research strongly suggests that human persons experience other persons such that they directly understand the meaning of a variety of different human actions, intentions, emotions, and sensations in immediate, non‐reflective, and non‐conceptual perceptions. This research is supported by the philosophical theories of Jacques Maritain and Yves R. Simon found in their accounts of practical knowledge. Together, these accounts offer us a rich view of the reality of nursing intuition that helps us understand why we find intuitive actions in some but not all nurses and gives us some specific information about how to develop intuition in young nurses. Finally, this research shows us a path for further research. (shrink)

As a practicing clinical nurse, a phenomenon I experienced at times was the sudden acute sense that something was going wrong with a person in care at the sub‐critical unit in the hospital where I worked. In fact, many hospital nurses have their story of “something's not right” in relation to a person they were caring for/with, in that the day started with them on a coherent path to healing and then suddenly the nurse feels something is going very wrong, (...) and yet there is nothing observable that would justify such a feeling. This feeling would be called “intuition” by many nurses, a concept most notably theorized in nursing by Patricia Benner in her extensive program of scholarship. Benner defines intuition as “understanding without rationale.” Benner opposes embodied intuition and rational abstract reasoning and creates criteria for the use of each by nursing depending on whether the clinical situation is familiar or novel. The philosophical idea is that the new must be reasoned with a different mode of thought than the familiar. Charles Sanders Peirce was a philosopher of reasoning. He defined logic as the theory of reasoning, which by the end of his career he was declaring was only another name for semiotic. Peirce argued that all reasoning/semiosis is done through signs, or more accurately sign‐activity. Semiotic is the philosophical schema providing the concepts and methods by which semiosis ‐ reasoning ‐ happens. Importantly, semiotic does not oppose different modes of thought, and conceptualizes reasoning as a process that functions in familiar as well as novel situations. In this paper I describe Peirce's philosophy of semiotic. I then provide an example relevant to nursing by conducting a semiosis of the nursing scenario above to show how nursing “works chance,” or novelty, in a way that doesn't need to resort to rational abstract reasoning and yet is different than Benner's notion of intuition. (shrink)

This paper provides an analysis of nursing as a knowledgeable discipline. We examined ways in which knowledge operates in the practice of home care nursing and explored how knowledge might be fruitfully understood within the ambiguous spaces and competing temporalities characterizing contemporary healthcare services. Two popular metaphors of knowledge in nursing practice were identified and critically examined; evidence-based practice and the nurse as an intuitive worker. Pointing to faults in these conceptualizations, we suggest a different way of (...) conceptualizing the relationship between knowledge and practice, namely practice as being activated by contextualized knowledge. This conceptualization is captured in an understanding of the intelligent creation of context by the nurse for nursing practice to be ethical and effective. (shrink)

Nursing practice as bricoleur activity: a concept explored The debates concerning the nature of nursing practice are often rooted in tensions between artistic, scientific and magical/mythical practice. It is within this context that the case is argued for considering that nursing practice involves bricoleur activity. This stance, which is derived from the work of Levi‐Strauss, conceives elements of nursing practice as an embodied, bricoleur practice where practitioners draw on the ‘shards and fragments’ of the situation‐at‐hand to (...) resolve the needs of the individual patient for whom they care. This conceptualisation of nursing practice will be analysed with a particular emphasis on its implication for nursing epistemology, pedagogy and praxis. The evidence to support this argument is drawn from empirical work that investigated nurses’ use of intuition, the work of Levi‐Strauss, and issues in nursing epistemology and ontology. The paper itself is written from the perspective of a bricoleur who uses ‘bits and pieces’ from the domains of nursing, philosophy, psychology, education, sociology and anthropology. (shrink)

In this article, we clarify and describe the nature of nursing expertise and provide a framework to guide its identification and further development. To have utility and rigour, concept‐driven research and theories of practice require underlying concepts that are robust, valid and reliable. Advancing understanding of a concept requires careful attention to explicating its knowledge, metaphors and conceptual meaning. Examining the concepts and metaphors of nursing expertise, and how they have been interpreted into the nursing discourse, we (...) aimed to synthesise definitions and similarities between concepts and elicit the defining characteristics and properties of nursing expertise. In clarifying the concept, we sought to move beyond the ambiguity that currently surrounds expertise in nursing and unravel it to make explicit the characteristics of nursing expertise from published peer‐reviewed studies and structured literature synthesis. Findings indicate a lack of clarity surrounding the use of the term expertise. Traditional reliance upon intuition as a way of explaining expert performance is slowly evolving. Emerging from the analysis is a picture of expertise as the relationship between networks of contextual reasoning, understanding and practice. Striking absences in the discourse include limited explication of ethical reasoning and theorising a broader interpretation of expertise reflective of contemporary forms of nursing. (shrink)

The aim of this article is to explore the complex forms of knowledge involved in diagnostic and interventional decision making by comparing the processes in medicine and nursing, including nurse practitioners. Many authors assert that the practice of clinical decision making involves the application of theoretical knowledge (acquired in the classroom and textbooks) as well as research evidence, upon concrete particular cases. This approach draws on various universal principles and algorithms to facilitate the task. On the other hand, others (...) argue that this involves an intuitive form of judgement that is difficult to teach, one that is acquired principally through experience. In an exploration of these issues, this article consists of three sections. A clarification of terms commonly used when discussing decision making is provided in the first section. In the second section, an epistemological analysis of decision making is presented by examining several perspectives and comparing them for their use in the nursing and medical literature. Bunge's epistemological framework for decision making (based on scientific realism) is explored for its fit with the aims of medicine and nursing. The final section presents a discussion of knowledge utilization and decision making as it relates to the implications for the education and ongoing development of nurse practitioners. It is concluded that Donald Schön's conception of reflective practice best characterizes the skilful conduct of clinical decision making. (shrink)

This paper describes how an innocent venture outside the confines of academia to update my nursing skills completely changed the focus of my research. I was deeply involved in the theoretical development of my thesis, which I thought was a feminist exploration of the meaning of health for mid‐life women. I was immersed in feminist theory and was exploring the work of the French Feminists. I had written comprehensive draft chapters about nursing, women's bodies and science. While I (...) was absorbed in my theoretical exploration I decided to venture back into practice to improve my nursing skills. I am still unsure why I chose to do this; however, in hindsight, my theoretical exploration was inexorably pushing me in that direction. While my conscious thinking was focused on my stated topic, my subconscious (my intuition) turned me towards another. Being confronted with the reality of nursing practice through working with staff nurses in a gynaecological ward caused a major disjunction in every aspect of my research: the topic, my methodology and the setting, and the experience challenged my feelings about nurses and nursing. This inevitably led to a dramatic and fundamental change in my research. (shrink)

Nurses practising in mental health are faced with challenging decisions concerning confidentiality if a patient is deemed a potential risk to self or others, because releasing pertinent information pertaining to the patient may be necessary to circumvent harm. However, decisions to withhold or disclose confidential information that are inappropriately made may lead to adverse outcomes for stakeholders, including nurses and their patients. Nonetheless, there is a dearth of contemporary research literature to advise nurses in these circumstances. Cognitive Continuum Theory presents (...) a single‐system intuitive‐analytical approach to examining and understanding nurse cognition, analogous to the recommended single‐system approach to decision‐making in mental health known as structured clinical judgement. Both approaches incorporate cognitive poles of wholly intuition and analysis and a dynamic continuum characterised by a ‘common sense’ blending of intuitive and analytical cognition, whereby cues presented to a decision‐maker for judgement tasks are weighed and assessed for relevance. Furthermore, Cognitive Continuum Theory promotes the importance of determining pattern recognition and functional relations strategies, which can be used to understand the operationalisation of nurse cognition. (shrink)

Based on a Lived Experience Description written by an experienced nurse in Denmark, this article offers an ontological and existential‐phenomenological exploration of aesthetic dimensions of excellence in nursing. In the research of Patricia Benner and colleagues, excellence in nursing is described as a matter of intuitive pattern recognition based on clinical experience and narrative understanding. In this article, and based on phenomenological reflections and philosophical inspirations from the Danish philosopher Dorthe Jørgensen and the French philosopher Maurice Merleau‐Ponty, I (...) suggest an extended understanding of excellence in nursing, and I argue that the work and research of Benner seem to overlook ontological and aesthetic aspects of excellence in nursing. This article argues that aesthetic aspects of excellence in nursing can be comprehended as moments where nurses sense a surplus of meaning and moments where the nurse and the patient share and are subjected to communal and unfolding life phenomena. Aesthetic dimensions of being in nursing can, from an ontological approach, best be described as similar to the way human beings listen to a piece of music or to how artists try to give a voice to the world: as a resonant way of being and becoming within the moment. (shrink)

The aim of this discussion paper is to explore factors and contexts that influence how nurses might conceptualise and assign personhood for people with altered consciousness, cognition and behaviours. While a biomedical framing is founded upon a dichotomy between the body and self, such that the body can be subjected to a medical and objectifying gaze, relational theories of self, multiculturalism and technological advances for life‐sustaining interventions present new dilemmas which necessitate discussion about what constitutes personhood. The concept of personhood (...) is dynamic and evolving: where historical constructs of rationality, agency, autonomy and a conscious mind once formed the basis for personhood, these ideas have been challenged to encompass embodied, relational, social and cultural paradigms of selfhood. Themes in this discussion include: the right to personhood, mind–body dualism versus the embodied self; personhood as consciousness, rationality and narratives of self; social relational contexts of personhood and cultural contexts of personhood. Patricia Benner's and Christine Tanner's clinical judgement model is then applied to consider the implications for nursing care that seeks to reflexively incorporate personhood. Nurse clinicians are able to move between conceptions of personhood and act to support the body, as well as presumed autonomy and relational, social and cultural personhood. In doing so, they use analytical, intuitive and narrative reasoning which prioritises autonomous constructions of self. They also incorporate relational and social contexts of the person receiving care within the possibilities of technological advances and constraints of contextual resources. (shrink)

This study investigates what professional caregivers working in nursing homes consider to be a good life for residents suffering from dementia. Ten caregivers were interviewed; special attention was paid to the way in which they deal with conflicting values. Transcripts of the interviews were analysed qualitatively according to the method of grounded theory. The results were compared with those from a similar, earlier study on ideals found in mission statements of nursing homes. The concepts that were mentioned by (...) most interviewed participants as important for a good life were ‘peace and quiet’, ‘going along with subjective experience’ and ‘no enforcement: the way the resident wants it’. A considerable overlap was found between the interviews and the mission statements; however, when compared with the mission statements, the interviews put less emphasis on individuality and on giving meaning, and more on offering residents pleasant activities. When faced with conflicting values, caregivers tend to make pragmatic and more or less intuitive decisions. Although this has its merits, it may be desirable to stimulate conscious reflection regarding conflict between different values. (shrink)

Despite an abundance of theoretical literature on virtue ethics in nursing and health care, very little research has been carried out to support or refute the claims made. One such claim is that ethical nursing is what happens when a good nurse does the right thing. The purpose of this descriptive, qualitative study was therefore to examine nurses’ perceptions of what it means to be a good nurse and to do the right thing. Fifty-three nurses responded to two (...) open-ended questions: (1) a good nurse is one who...; and (2) how does a nurse go about doing the right thing? Three hundred and thirty-one data units were analysed using qualitative content analysis. Seven categories emerged: personal characteristics, professional characteristics, patient centredness, advocacy, competence, critical thinking and patient care. Participants viewed ethical nursing as a complex endeavour in which a variety of decision-making frameworks are used. Consistent with virtue ethics, high value was placed on both intuitive and analytical personal attributes that nurses bring into nursing by virtue of the persons they are. Further investigation is needed to determine just who the ‘good nurse’ is, and the nursing practice and education implications associated with this concept. (shrink)

In this paper, we argue that ‘good care’ in residential nursing homes is enacted through different care practices that are either inspired by a ‘professional logic of care’ that aims for justice and non-maleficence in the professional treatment of residents, or by a ‘relational logic of care’, which attends to the relational quality and the meaning of interpersonal connectedness in people’s lives. Rather than favoring one care logic over the other, this paper indicates how important aspects of care are (...) constantly negotiated between different care practices. Based on the intricate everyday negotiations observed during an ethnographic field study at an elderly nursing home in Germany, the paper puts forth the argument that care is always a matter of tinkering with different, sometimes competing ‘goods’. This tinkering process, which unfolds through ‘intuitive deliberation’, ‘situated assessment’ and ‘affective juggling’ is then theorized along the conceptualization of a ‘practical ethics of care’: an ethics which makes no a priori judgments of what may be considered as good or bad care, but instead calls for momentary judgments that are pliable across changing situations. (shrink)

Aim: To analyze the empathizing and systemizing profiles of Brazilian and Portuguese nursing undergraduates. Background: Empathy is a fundamental skill for nursing practice and should be analyzed during the student’s education. Methods: Descriptive study with cross-sectional design. Participants were 968 undergraduate students, including 215 (22.2%) Brazilians from a university in the state of São Paulo and 753 (77.8%) Portuguese students from a higher education institution in central Portugal. The Portuguese and Brazilian versions of the Empathizing/Systemizing Quotient have good (...) internal consistency and reliability. Ethical considerations: In Brazil, approval for the study was obtained from the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing (protocol 191/2016) and in Portugal, from the Ethics Committee of the Health Sciences Research Unit: Nursing, Coimbra Higher School of Nursing (protocol P362-09/2016). Results: Most (86%) participants were female and aged between 20 and 24 years. In the general profile analysis between both groups, the domains “Social Skills,” “Contents,” and “Processes” scored higher. Gender differences exist for the feeling of empathy and systemizing, as women scored better on the short version of the Empathy Quotient and men on the Systemizing Quotient. Conclusion: As demonstrated in the domain scores for “Social Skills,” “Contents,” and “Processes,” the undergraduate nursing students analyzed have the ability to deal intuitively and spontaneously with social situations; they are also characterized as methodical people, who like to follow rules, and experience practice better than theory, and the women have a higher empathetic level than men, who in turn are more systemizing. (shrink)

Phronesis, a popular Aristotelian concept that emphasizes deliberation and moral action, should replace the phrase ‘research‐based practice’ as the guiding light for nursing practice. Knowledge from research is still essential, of course, but is insufficient by itself for practice. In this paper, the author describes assumptions behind the apparent superiority of research‐based knowledge, and offers a critique of this position. One critique is that by automatically accepting the superiority of research‐based knowledge other types of knowledge (e.g. intuitive, ethical, personal) (...) are devalued. A second critique is that undeliberated, indiscriminate use of research findings may lead to inappropriate nursing practice.Phronesisis then described, and its application to nursing. For example,phronesisrequires that the context of the situation be considered very carefully before acting. Aristotle stated that the goal of personalphronesisis to reacheudaimonia, or genuine happiness or ‘human flourishing’. Infusing nursing practice withphronesismeans that an anthropomorphized discipline'seudaimoniawould be theeudaimoniaof patients. That is, nursing practice would be guided by a desire for patients' genuine happiness or human flourishing. The final section of the paper offers rebuttals to potential criticisms. (shrink)

The concept of equality is subject to many different interpretations, and it is closely connected to similar concepts such as equity, justice, fairness, and human rights. As an ideal, equality entails many aspects that are untenable. For instance, genetic and social inequalities may never be extinct, but they can both be ameliorated by proper distribution of society's resources. Likewise, within the context of health care, equality can be promoted by proper rationing of health resources, amongst which nursing care stands (...) out. In the field of nursing, the principle of equality presents itself in various forms of ethical and deontological mandates. However, beyond good intentions and abstract notions, there is a need to examine the ways in which nurses enforce this principle in practice, within the reality of modern health systems. Although there is scarcity of qualitative evidence in the nursing care rationing literature, existing studies suggest that fair treatment pertains to a largely intuitive sense of equality which involves subjective perceptions and judgements about rationing. Nurses’ initial predisposition is to view all patients as equal and treat them in an equal manner; yet, on an individual basis, each patient has a different starting point, different needs and different prospects that render rationing decisions complex and uncertain. Equality should be accepted with its unavoidable limitations in practice and be further examined within the context of nursing care rationing, in the hope that it can be advanced in a consistent way, despite the idealistic nature in many of its aspects. (shrink)

Background: An ethical, informed consent process requires that potential participants understand the study, their rights, and the risks and benefits. Yet, despite strategies to improve communication, many participants still lack understanding of potential risks and benefits. Investigating attitudes and practices of research nurses can identify ways to improve the informed consent process. Research question: What are the attitudes, practices, and preparedness of nurses involved in the informed consent process regarding communication of risks and benefits? Research design: A survey was developed (...) and administered online to a national purposive sample of 107 research nurses with experience obtaining informed consent for clinical trials. Survey responses stratified by selected work-related characteristics were analyzed. Ethical considerations: Participants were instructed they need not answer each question and could stop at any time. They consented by clicking “accept” on the email which linked to the survey. The study was approved by the Northeastern University Institutional Review Board, Boston, Massachusetts (NU-IRB Protocol #: 13-06-17). Findings: Most research nurses (87%) used a teach-back method to assess participant comprehension, while 72% relied on their intuition. About one-third did not feel prepared to communicate related statistics. About 20% did not feel prepared to tailor information, and half did not feel competent using supplemental materials to enhance risks and benefits comprehension. Only 70% had received training in the informed consent process which included in-person training (84%), case studies (69%), online courses (57%), feedback during practice sessions (54%), and simulation, such as role playing (49%) and viewing videos (45%). Perceived preparedness was significantly associated with greater informed consent experience and training. Conclusion: Research nurses may have inadequate training to encourage, support, and reinforce communication of risks and benefits during the informed consent process. Relevant purposeful education and training should help to improve and standardize the ethical informed consent process. (shrink)

Respect for autonomy is well known as a core element of normative views on good care. Most often it is interpreted in a liberal way, with a focus on independence and self-determination. In this article we argue that this interpretation is too narrow in the context of care in nursing homes. With the aim of developing an alternative view on respect for autonomy in this setting we described four interpretations and investigated the moral intuitions (i.e. moral judgements) of caregivers (...) regarding these approaches. We found that these caregivers seemed to value different notions relating to respect for autonomy under different circumstances. There was no significant difference in moral judgements between men and women or between doctors and nurses. We conclude that a multidimensional understanding of this principle would best fit this context. We end this article with a description of a modest theory of respect for autonomy in nursing homes. (shrink)

This paper explores the integral relationship between philosophy and nursing practice. The discussion begins by suggesting that philosophy is more than a set of abstract ideas or an intellectual activity; that it is a way of living and being in practice. The author contends that philosophical inquiry can improve the adequacy and relevance of family and nursing theories by promoting the examination and expansion of those theories in light of the experiences and intuitions of nurses. Offering a personal (...) example the author exemplifies how philosophical activity can directly and experientially enhance everyday nursing practice. (shrink)

Background: Reliance on moral principles and professional codes has given nurses direction for ethical decision-making. However, rational models do not capture the emotion and reality of human choice. Intuitive response must be considered. Research purpose: Supporting intuition as an important ethical decision-making tool for nurses, the aim of this study was to determine relationships between intuition, years of worked nursing experience, and perceived ethical decision-making ability. A secondary aim explored the relationships between rational thought to years of (...) worked nursing experience and perceived ethical decision-making ability. Research design and context: A non-experimental, correlational research design was used. The Rational Experiential Inventory measured intuition and rational thought. The Clinical Decision Making in Nursing Scale measured perceived ethical decision-making ability. Pearson’s r was the statistical method used to analyze three primary and two secondary research questions. Participants: A sample of 182 emergency nurses was recruited electronically through the Emergency Nurses Association. Participants were self-selected. Ethical considerations: Approval to conduct this study was obtained by the Adelphi University Institutional Review Board. Findings: A relationship between intuition and perceived ethical decision-making ability ( r =.252, p =.001) was a significant finding in this study. Discussion: This study is one of the first of this nature to make a connection between intuition and nurses’ ethical decision-making ability. Conclusion: This investigation contributes to a broader understanding of the different thought processes used by emergency nurses to make ethical decisions. (shrink)

This paper investigates the possibility of understanding the rudimentary elements of clinical sensitivity by investigating the works of Edmund Husserl and Emmanuel Levinas on sensibility. Husserl's theory of intentionality offers significant reflections on the role of pre-reflective and affective intuition as a condition for intentionality and reflective consciousness. These early works of Husserl, in particular his works on the constitution of phenomenological time and subjective time-consciousness, prove to be an important basis for Levinas’ works on an ethics of alterity (...) and infinite responsibility for the other person. In fact, it is difficult to understand the core of Levinasian ethics, of vulnerability as proximity, of ethical sensitivity as passivity and a suffering for the suffering of another, without understanding the influence from Husserl's work. Crucially, the paper will, on the basis of Levinasian ethics, establish an understanding of sensibility as vulnerability and receptivity that is fundamental also for understanding significant intuitions in clinical nursing. Clinical sensitivity and carefulness in nursing are shaped by the concrete and also bodily expressions of vulnerabilities in a receptivity that is pre-reflective and pre-ontological. (shrink)

In spite of the growing public awareness of those who would identify as transgender, very little has changed in attitudes that would accord such people full approbation. The author takes the reader on a 40‐year journey of discovery that has led her to an abiding interest in and dedication to the issues faced by people who do not fit within the gender binary of Western society. As well as describing a personal experience with someone who identifies as transsexual, the author (...) relates two troubling experiences from her nursing career. Included in the discussion are linguistics, sexuality, and vocabulary. A personal epistemology is explored that incorporates unknowing, intuition, and embodiment, and the difference this view can make to the care of those who identify as gender‐diverse. (shrink)

Declarations of the importance of dignity in health care are commonplace in codes of practice and other mission statements, yet these documents never clarify dignity’s meaning. Their vague aspirations are compared to comments from staff and patients about opportunities for and barriers against the promotion of dignity in elderly care institutions. These suggest that while nurses and health care assistants have an intuitive understanding of dignity, they either do not or cannot always bring it about in practice. Thus, despite stated (...) intentions to promote dignity, it appears that the circumstances of at least some elderly care institutions cause patients to experience avoidable indignities. Such institutions are “undignifying institutions” because they fail to acknowledge dignity’s basic components, focus excessively on quantifiable priorities, and have insufficient resources available to assure consistently dignifying care. As a partial solution, we argue that health workers should be taught to understand and specify the components of dignity, which will better prepare them to challenge undignifying practices and to recognise opportunities for dignity promotion. (shrink)

This paper will examine a claim that nursing is united by its moral stance. The claim is that there are moral constraints on nurses' actions as people practising nursing and that they are in some way different from both what for now can be called standard morality and also different from the person's own moral views who also happens to be a nurse, hence the defining and unifying factor for nursing. I will begin by situating the claim (...) within the broader area about the need for a definition to state features that are essential to all and only members of its class. This will highlight the fact that there are two distinct types of definition used by authors seeking to find a unity for nursing. One type of definition has to do with goals or purposes given to nursing and the other with ends discovered as nursing. But even if there are ends waiting to be discovered a particular practical concern is how we can have knowledge of them. I will suggest that knowledge by intuition is plausible but that as things currently stand in moral epistemology it will not provide the unifying ground for nursing. Then I will argue that in the latter approach to definition a certain account of human nature has been advanced in order to provide features that are there to be discovered and so not dependent on human beings for the definition or classification. However, such an attempt to define nursing cannot do what is wanted. Rather than the account of human nature grounding morality and doing so for nursing, the account of human nature itself relies upon a prior account of morality. Because of this it loses its supposed ground of unity for the profession. Nursing is not united by its moral stance especially if this is understood in a strong sense as unique moral stance, but as things currently stand in moral epistemology this is not necessarily a bad thing for practitioners or patients. (shrink)

Definition of the problemThe concept of privacy has been astonishingly absent in the discussion about dementia care. In general, questions of privacy receive a lot of attention in nursing ethics; however, when it comes to dementia care, hardly any systematic ethical debate on the topic can be found. It almost seems as though people with dementia had lost any comprehensible interest in privacy and no longer had any private sphere that needed to be considered or protected. However, this not (...) only contradicts widespread moral intuitions but also ignores the views and needs of those affected.ArgumentsWe first outline the origins and dimensions of the concept of privacy and point out problems and limitations in the context of dementia. Especially the prevalent liberal conceptions’ dependence on the idea of autonomy poses significant challenges to an adequate conceptualization of the moral significance of privacy for people with dementia. Therefore, we subsequently explore alternative ways of conceptualizing the “value of privacy” in the context of dementia care.ConclusionAutonomy-based concepts of privacy may still be valid in the early stages of dementia. However, in the further course of the syndrome, the relevance of other normative aspects comes to the fore, especially respect for remaining personal preferences as well as objective criteria of dignity and well-being. Thus, we outline in a differentiated manner how and to what extent privacy can be of normative importance beyond the purview of autonomy and should consequently be taken into consideration in dementia care. (shrink)

Background: On a day to day basis, nurses are facing more ethical dilemmas during end-of-life care resulting in not being able to actualize a good death for patients. Research objective: The purpose of this study was to explore how experienced hospice nurses resolve day to day ethical dilemmas during end-of-life care. Research design: The study used a qualitative narrative approach. Participants: Through purposeful sampling, a total of six experienced hospice nurse participated. Ethical considerations: Approval from the researcher’s university Institutional Review (...) Board for ethical review was obtained. Findings: Using core story creation, several different ethical dilemmas were identified divulging struggles with key stakeholders including family members and providers. Thematic analysis generated three main themes: Ethics within Practice, Ethical Knowledge, and Ethical Solutions. Discussion: The participants told their stories depicting a keen awareness of ethical conflicts situated by contextual factors including social, political, and personal issues. The nurses’ deliberations were informed through formal, experiential, and intuitive knowledge. Ethical predicaments were resolved by either following rules or choosing acts of resistance. Conclusion: A better understanding was obtained on how experienced hospice nurses successfully resolve ethical dilemmas culminating in better deaths for patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:To Cut or Not to Cut?That is the QuestionTracy WilsonWhat is circumcision? In simple terms, it is the removal or excision of the foreskin of the penis. Seems so simple, right? In some families, it is that simple. In other families, it is a religious exercise. I am a doctorally-prepared Family Nurse Practitioner and started my nursing career in the NICU. I have seen my fair share of (...) circumcisions. As a nurse, our role was to prep the room with whichever instrument the OB/GYNS preferred and then soothe the baby. Some OB/GYNS prescribed Sucrose, which is ultimately sugar water, for the babies to have while undergoing circumcision, while others wouldn't prescribe anything. What I learned in the NICU and by watching circumcisions being performed was that the doctor's preference determined the pain management protocol. Some doctors cared more about pain control, some cared [End Page 85] about presentation and ensuring the foreskin was cut properly, and some were just old school and had their preferences. I wanted to comfort the baby and make his world as comfortable as possible.Watching circumcisions being performed, I never formed an opinion about them. I really looked at circumcision like any other procedure. However, I did see some parents really toil over the decisions, especially fathers who did not want to "see their son tortured or mutilated like that" as one told me once. I didn't quite understand the comparison to mutilation, but I understood why he did not want his son to go through the procedure. It wasn't until years later that I understood the gravity of the decision when I became pregnant with our son and knew immediately it was a boy. Call it a mother's intuition, but I just knew. To circumcise my son was never a decision I had to deliberate very long because it was something I was accustomed to in my family. It wasn't until one of my relatives got married and had her first son that I became aware that this would ever be a weighty decision for someone in my family.I took it for granted all those years before working in the NICU because circumcision was superficial to me. I realized that it's not just a piece of foreskin to many people. For some circumcision is done for religious reasons, for others making the choice to circumcise is about sameness, or hygiene. For my extended family member, it happened to be about sameness. She didn't want her sons to look different from their dad. Since potty training was mostly going to be taught by their father, they wanted their sons to look like him. Many NICU parents told me they wanted their sons to look like their fathers, so this notion was familiar to me. After my extended family member explained why sameness mattered, I understood the reasons why some parents felt this way.There are other stories like this which we pondered upon when we got pregnant with our son, and I really began to reflect on whether we should circumcise or not. Then two additional frames of thoughts arose; one, I ensured that my husband and I jointly made the decision together, but I really leaned on him for his opinion because he was a male and most of the male teaching would come from him. Second, we considered if the decision to circumcise should come from him once he became an adult. His father and I discussed whether he should have a choice regarding being circumcised. He may have chosen a different decision than us and we didn't want to take away his right to choose. However, waiting to have a circumcision as an adult comes with its own sets of challenges, including the possibility of infection, increased pain, missed work, edema, etc. So, ultimately, we made the decision to go ahead with the circumcision.In our case, our pediatrician performed the circumcision. I asked him explicitly which instrument he used because I had my preference, and I was not going to allow my son to be circumcised by a healthcare professional that did not use my... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 45, no. 1. © 2019 by Feminist Studies, Inc. 235 Vivyan Adair Stigmata: A Memoir of Pain and Resistance For some of us poverty is not experienced from a distance or from the position of an audience member or critic, but as the most pressing truth of our existence, past or present and our core sense of identity. —Roxanne Rimstead, Remnants of Nation: On Poverty Narratives by (...) Women Shame My own mother—with four children under the age of seven by the time she was twenty five—taught, nurtured, and loved us ferociously but struggled and utterly failed to keep us fed, sheltered, and safe. We clung desperately to her fragile dignity, grace, and laughter, against all the forces of a cruel and indifferent world. Yet, in the end she was crushed by the weight of our shame and our raw, unrelenting pain as my brothers and sister and I were bent and broken and taken from her; with scars that never faded; injuries, infections, and ailments for which we found neither respite nor repair; with feet mangled by cheap, used Salvation Army shoes; the gnawing void of hunger and insecurity clawing at our tender backs; public indignities and humiliations for which I still can find no words. With access to neither medical insurance nor care, when my already fragile, toddling sister’s forehead was split open by a car door slammed in frustration, my brother and I had to pin her tiny body to the ground as 236 Vivyan Adair my mother sewed the angry gash together with needle and thread, practicing the meticulous dressmaker’s stitches for which she had received a modicum of acclaim, but so little reward. My sister somehow endured, but registered the pain, the terror, and the trauma with a brand, a stigmata, an angry and frightening scar as an indelible sign of our poverty, visually cleaving her very forehead in two, for the remainder of her life. In our school cafeteria “free lunchers” were reminded with a large and colorful sign to “line up last.” In that auditorium each fall we were coerced up onto a makeshift stage, with the promise of first dibs on free milk. There, our pristine school nurse sat upright and sucked air through her teeth as she donned surgical gloves to cautiously check only the hair of poor hungry children, one by one, for lice. I burned and choked and raged with shame, as our far more decent working-class colleagues and friends, in color-coordinated Sears sweater sets and matching tartan knee high socks, averted their eyes from our reluctant genuflections, while silently spooning their mac and cheese and sipping their Tree Top from tiny Dixie cups. In dilapidated and unsafe housing often without heat, hot water, or lights and with access to only public bathrooms, I developed a stubborn case of ringworm, scabies, and a series of painful urinary tract infections. When my second grade teacher would not excuse me every hour or so—because, as she said I was “willful”—I could not help but wet my pants in class. My schoolmates guffawed at my flea bitten legs, my ducttaped shoes, my crooked and ill-serviced teeth, and the way my siblings and I stank. Kids, teachers, and strangers stepped away from us intuitively and then, with great shows of distress, feigned concern and then outrage and disgust. Regularly our teachers excoriated us for our inability to concentrate in school and our refusal to come to class with proper school supplies, calling us out as greedy when we tried to take more than our share of free lunch. Whenever backpacks or library books came up missing, we were publicly interrogated and sent home to think about our offenses, often accompanied by notes that reminded my bewildered mother that she should be working twice as hard to make up for the discipline and order that had supposedly walked out the door with my father. And when occasionally we cried foul and lashed out, our behavior was used to justify even more elaborate punishment that exacerbated the effect of our growing anomie. Vivyan Adair 237 Guilt As children, our disheveled and unkempt bodies were produced as... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“It’s All Personal”Frances Rieth MaynardI was (am?) the mother of a full-term infant born in 1998 with hypoplastic left heart syndrome. This was my 3rd pregnancy; I had two prior pregnancies resulting in healthy children. Until that final week before birth, my pregnancy had been uneventful; my blood pressure, weight gain, and lab work charted normally. At my prenatal check (with a new physician as mine was away), my (...) measurements were off. That OB-GYN referred me to a perinatologist who was able to perform an ultrasound (checking for infant size) and advised that I should deliver soon because the infant was markedly growth retarded. I was induced two days later. My small daughter was born with skeletal leg deformities and brought to the neonatal intensive care unit (NICU). I was familiar with that NICU since I had worked there as an RN prior to this pregnancy. I was comfortable with the environment, the people, and the overall culture of the place. Indeed, I had been a pediatric nurse for the previous 10 years working primarily in intensive care.After my daughter’s birth, I was able to intuit meaning by the placement of her bassinet in the unit (e.g., it was not too close to the nurse’s station; she had no oxygen or tubing, and she was not in a private room). I believed that her journey home would be longer than I had planned but that it would occur. On that first day, a pediatric cardiolo-gist arrived to perform an ultrasound. I was familiar with this scene too; I did not view this process as anything more than routine. I was relieved to have [End Page 24] a physician who I knew and trusted to watch over my daughter. This allowed me to go back to my room to rest as I do not believe I had slept well (if at all) after being informed there was a potential problem a few days earlier.Less than two hours after returning to my room, my daughter had been intubated and begun on prostaglandins as the echocardiogram had revealed a hypoplastic left heart defect. The neonatologist started to discuss options for transport so my daughter could be treated at a larger hospital. I tried to catch my breath and process what I was being told. We spoke by phone with my husband who quickly deferred all decision-making responsibility to me because I was “the person with the medical expertise.” My thoughts raced with all these unforeseen circumstances, yet time seemed to slow down. I requested that an evaluation be made of other potential conditions before transfer since my daughter was also small for gestational age, something we had learned less than a week earlier, and she had some skeletal defects, an issue of which we were unaware until after she was born.A head ultrasound revealed an absent corpus callosum, the region of the brain that connects the two cerebral hemispheres and allows them to communicate by sending and receiving signals from each other.Given all the enormous medical issues my daughter was facing, I asked for her ventilator to be withdrawn and my husband concurred. We wanted our daughter to be baptized and to die a “natural death.” Our neonatologist indicated that our choices were reasonable. But, before the ETT could be withdrawn, I was advised that an ethics consult had been called by one of the nurses. I became angry, scared, and saddened at the thought of strangers (to me) deciding the fate of my daughter. The neonatologist told me not to be concerned, and I later learned that the ethics committee had “signed off” on the wishes of my husband and myself. My daughter was extubated and died 3 days later.This happened 25 years ago. In retrospect, it is interesting to me that I began to distrust the nurses, wondering which one had called the consult. I could not understand how anyone could doubt that I, as a mother, was not making the best possible decision, among bad alternative choices, for my daughter. I began to view the anonymous persons of the powerful ethics committee as a “them... (shrink)

In this essay we review a number of values and conflicts involved in human nutrition in order to clarify the sources of resistance to accepting a pump-fed patient on the part of nursing home nurses. The case illustrates the complexities of our feelings and values in the area of intrusion showing the need for continued reflection upon and revision of our intuitive reactions. The case also displays conflict resolution.

In lieu of an abstract, here is a brief excerpt of the content:Feminist Perspectives on Bioethics*Pat Milmoe McCarrick (bio) and Martina Darragh (bio)The literature of feminist bioethics has flourished in the last decade. Women’s health care, women’s role both as patient and health care professional, the many new reproductive technologies, the exclusion of women as research subjects, as well as the broader topic of feminist contributions to ethical theory itself, have all become topics of interest for feminist bioethical writers.Although feminism (...) is anything but a monolithic enterprise, Karen Lebacqz’ essay on feminism in the new, revised Encyclopedia of Bioethics (II A, 1995) says that “all feminists agree that women are oppressed and this oppression is wrong.” Rosemarie Tong refines this statement to include variations of feminism: “... feminist theory is not one, but many theories or perspectives and... each feminist theory or perspective attempts to describe women’s oppression, to explain its causes and consequences, and to prescribe strategies for women’s liberation” (VII, Tong 1989). She describes different feminist views in Feminine and Feminist Ethics (II A, 1993), labelling them liberal, Marxist, radical, psychoanalytic, socialist, existentialist, and postmodern. Alison Jaggar critiques these different forms of feminism in Feminist Politics and Human Nature, and Susan Sherwin applies these perspectives to the field of bioethics in No Longer Patient: Feminist Ethics and Health Care.One of the central activities in current feminist bioethics is a revisitation of ethical theory itself. There is a distinction between “feminine” and “feminist” ethics in this field (II A, Tong 1993). “A feminine approach to ethics consists of observations of how the traditional approaches to ethics fail to fit the moral experiences and intuitions of women. In contrast, a feminist approach to ethics applies a specifically political perspective and offers suggestions of how ethics must be revised if it is to get at the patterns of dominance and oppression as they affect women” (IV, Sherwin 1992). Carol Gilligan’s two books, In a Different Voice and Mapping the Moral Domain, Nel Noddings’s Caring: A Feminine Approach to Ethics and Moral Education, and Virginia Held’s Feminist Morality: [End Page 85] Transforming Culture, Society, and Politics can be thought of as feminine critiques of contemporary ethics.Gilligan’s notion of the “ethics of care” has served as a point of departure for a discussion of a type of relational ethics that focuses on concrete experiences, pairs emotions with reason, and balances justice with care. This “ethics of care” has been both celebrated and criticized. The concept of “care” in ethics dates back to the “cura” tradition of care in ancient Rome and was further developed by philosophers Soren Kierkegaard and Martin Heidegger and psychologists Rollo May and Erik Erikson. Nursing theorists have built on this tradition both in theory and in practice (II A, Reich, Care, Encyclopedia of Bioethics, 1995). “Care” often is discussed in opposition to the liberal notion of “justice” (III, Sterba, Justice, Encyclopedia of Bioethics, 1995).Gilligan’s theory was developed to provide a counter model to Lawrence Kohlberg’s six steps in the development of a human moral nature: (1) acting to avoid punishment, (2) acting to promote reciprocity, (3) conforming to get approbation, (4) respecting authority to maintain social order, (5) acting freely if others are not harmed, and (6) following self-legislated, self-imposed, universal principles of justice, reciprocity, and respect for the dignity of humans as individuals. In contrast, Gilligan holds that the moral self is an individual working with other individuals to identify mutually agreeable solutions to thorny human relations problems. Gilligan called Kohlberg’s the male moral point of view as an ethics of justice and hers the female moral view as an ethics of care. Her levels are (1) inward-directed care, (2) other-directed care subjugating personal wants and needs to others (eventually leading to anger), (3) a philosophy of care that balances egoism and altruism, recognizing the women’s connection to others and theirs to her.According to Jocelyn Downie and Susan Sherwin (IV, 1993), oppression, as used by feminists, is understood as an interlocking series of restrictions and barriers that reduce the options available to members of a group defined by morally insignificant characteristics, here gender. The literature itself can be... (shrink)

In the closed wards of mental health institutions, moral decisions are made concerning the use of forced seclusion. In this article we focus on how these moral decisions are made and can be improved. We present a case study concerning moral deliberations on the use of seclusion and its prevention among nurses of a closed mental health ward. Moral psychology provides an explanation of how moral judgments are developed through processes of interaction. We will make use of the Social Intuitionist (...) Model of Jonathan Haidt that emphasizes the role of emotions, intuitions and the social context in moral judgments and reasoning. We argue that this model can help to explain social dynamics in the context of enforced seclusion. In the discussion we explore how moral psychology can be complemented with the normative perspective of dialogical ethics to develop strategies for improving psychiatric practices. We conclude that social processes play an important role in moral deliberations and that moral development can be fostered by bringing in new perspectives in the dialogue. Moral case deliberation provides a practical tool to systematically organize moral reflections among nurses on the work floor. (shrink)

Negative prognostic communication is often delayed in intensive care units, which limits time for families to prepare for end‐of‐life. This descriptive study, informed by ethnographic methods, was focused on exploring critical care physician communication of negative prognoses to families and identifying timing influences. Prognostic communication of critical care physicians to nurses and family members was observed and physicians and family members were interviewed. Physician perception of prognostic certainty, based on an accumulation of empirical data, and the perceived need for decision‐making, (...) drove the timing of prognostic communication, rather than family needs. Although prognoses were initially identified using intuitive knowledge for patients in one of the six identified prognostic categories, utilizing decision‐making to drive prognostic communication resulted in delayed prognostic communication to families until end‐of‐life (EOL) decisions could be justified with empirical data. Providers will better meet the needs of families who desire earlier prognostic information by separating prognostic communication from decision‐making and communicating the possibility of a poor prognosis based on intuitive knowledge, while acknowledging the uncertainty inherent in prognostication. This sets the stage for later prognostic discussions focused on EOL decisions, including limiting or withdrawing treatment, which can be timed when empirical data substantiate intuitive prognoses. This allows additional time for families to anticipate and prepare for end‐of‐life decision‐making. (shrink)

_Winner of the 2010 Goethe Award for Psychoanalytic and Psychodynamic Scholarship!_ This book builds a key clinical bridge between attachment theory and psychoanalysis, deploying Holmes' unique capacity to weld empirical evidence, psychoanalytic theory and consulting room experience into a coherent and convincing whole. Starting from the theory–practice gap in psychoanalytic psychotherapy, the book demonstrates how attachment theory can help practitioners better understand what they intuitively do in the consulting room, how this benefits clients, and informs evidence-based practice. Divided into two (...) sections, theory and practice, _Exploring in Security_ discusses the concept of mentalising and considers three components of effective therapy – the therapeutic relationship, meaning making and change promotion – from both attachment and psychoanalytic perspectives. The second part of the book applies attachment theory to a number of clinical situations including: working with borderline clients suicide and deliberate self-harm sex and sexuality dreams ending therapy. Throughout the book theoretical discussion is vividly illustrated with clinical material, personal experience and examples from literature and film, making this an accessible yet authoritative text for psychotherapy practitioners at all levels, including psychoanalysts, psychiatrists, clinical psychologists, mental health nurses and counsellors. (shrink)

An outstanding feature of the study of nursing ethics is that it raises questions concerning moral virtue, conscience, consistency and character. A considerable section of the literature is devoted to ideas of how best to teach ethics to health professionals. It has been shown that when faced with ethical dilemmas nurses tended to rely on intuition and instinct to resolve them, with little systematic analysis to help the process. Nurses who have been in practice for a number of (...) years may experience particular difficulties in resolving ethical dilemmas, for although they may be able easily to identify ethical problems they may feel powerless to behave appropriately through lack of theoretical background and/or confidence in participating in informed debate. An educational programme was designed to meet the needs of mature registered nurses who were undertaking a post-qualification part-time honours degree in nursing studies. A variety of teaching methods were employed in teaching the nurses. These included discussion, student-led seminars, structured debate and role play. A session which dealt with sudden death and organ donation is described in some detail. Because the topic involved communication between professionals and patients and/or relatives and was linked with ethics, role play was used to explore the dynamics in these areas. The participants were invited to act out the situation as they felt it might occur. Role play highlighted the stress and shock attached to such an experience. Before working through the dynamics of a situation the nurses were conscious of being part of decision-making 'in the cold' and 'in isolation'. As a result of the experiential learning they felt more able to reflect analytically and to participate in discussions in an informed and articulate way. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:META-ONTOLOGY AND META-FICTION by Denis E. B. Pollard Peter van inwagen's attempt to explain the nature of fiction makes use of Quine's program in meta-ontology.1 This program comprises four basic theses: (i) that being is the same as existence, (ii) that being is univocal, (iii) that this univocal sense is best captured, for the purposes of formalization, by die existential quantifier, and (iv) that deciding what to believe about (...) what there is comes to a decision about what theories we should accept. As the aim of formalization is explicitness, then theories should be rendered into canonicalese and their commitments identified through those sentences which are prefaced with the existential quantifier. For Inwagen, as for his mentor Quine, acceptance of theory expressed in this canonical form entails acceptance of the ontology expressed in those quantified sentences. Bringing these considerations to bear on fiction, Inwagen asks, "What are theories about fiction?" and replies that they are "theories that treat stories as having an internal structure" (p. 72). The upshot of this is that such theories contain sentences which, when formally rendered, revead commitments to fictional objects. It is further claimed that such sentences can be vehicles of objective truth. Thus Inwagen finds he cannot wholeheartedly dismiss Sarah Gamp as a nonentity. In this respect, his view contrasts with two contemporary accounts, the "reductivist" one which denies Sarah Gamp's existence and her possession of any properties whatever, and the more recent "Meinongian" view which would agree that Sarah Gamp does not exist, but would nonetheless strenuously maintain that she is a nurse, fat, old, and decidedly the worse for drink. Inwagen's Sarah is neither ofthese: pace both these positions, she exists all right, but with properties such as being a theoretical entity of criticism, being a satiric villainess, not being a woman, and not being fond of gin. Inwagen's attempt to steer what seems to be a middle course has yielded, if anything, a more counterintuitive result than either ofthe other views. What is die explanation for this? 244 Denis E. B. Pollard245 To begin with, it is important to note a distinction, which Inwagen himself accepts, between two kinds of sentences. Let us take the following elementary examples: (1) "Sarah Gamp is a nurse," and (2) "Sarah Gamp is a character in a nineteenth-century novel." With specimens like (1), Inwagen sides with the reductivist: such sentences asefalse, and are not about anything. But it is with examples like (2) that ontology becomes a real issue, since sentences of this kind belong to literary theory. Neither authors nor critics who make use of sentences of the first kind are committed to the existence of fictional entities. So far, so good. But what is it that compels such commitment in the second case? Inwagen is sceptical about reductivist analyses which seek to paraphrase such sentences in order to remove any "misleading" implications. Such paraphrases he would regard as at best "messy," and more seriously, unlikely to preserve intuitive meaning without appearing to say that there are fictional characters. Unfortunately, he brushes this aside as a "narrow technical issue" at the very point where rather more argument is needed. However, on the issue of preservation of intuitive meaning, it might well be argued that his contention is somewhat question-begging, suggesting a rather literal reading of (2) above as a straightforward predication superficially akin to (3) "McEnroe is a seeded player in this year's Wimbledon tournament." So by a strange alchemy, the expression "Sarah Gamp" in (2) is accorded a referential status denied to it in (1). It is at this point that the notion of"theoretical entity" is introduced to supply the need for a referent dictated by the Quinean program. Inwagen's Sarah Gamp, in this theoretical disguise, can now literally satisfy predicates like "... is a character in a nineteenth-century novel," but not predicates like "... is a nurse." The parallel being exploited here is that with scientific theory. An ideal gas can satisfy Boyle's Law, but cannot literally be ignited, put into containers, or have an offensive smell. But there is more than a suspicion of equivocation over the term... (shrink)

This article will be concerned with the phenomenon of vitality, which emerged as one of the main findings in a larger grounded theory study about life and death decisions in hospitals' neonatal units. Definite signs showing the new-born infant's energy and vigour contributed to the clinician's judgements about life expectancy and the continuation or termination of medical treatment. In this paper we will discuss the normative importance of vitality as a diagnostic cue and will argue that vitality, as a sign (...) perceived by doctors and nurses, has moral significance and represents a legitimate contribution to clinical decision-making in difficult cases where the child's life is at stake. We will argue that these clinical intuitions can be justified on a moral basis but only with certain qualifications that accounts for a certain objectivity and intersubjective reliability in the therapeutic judgements. (shrink)

Most of us have two strong intuitions (or sets of intuitions) in relation to fairness in health care systems that are funded by public money, whether through taxation or compulsory insurance. The first intuition is that such a system has to treat patients (and other users) fairly, equitably, impartially, justly and without discrimination. The second intuition is that doctors, nurses and other health care professionals are allowed to, and may even in some cases be obligated to give preference (...) to the interests of their particular patients or clients over the interests of other patients or clients of the system. These two intuitions are in potential conflict. One of the most obvious ways in which to ensure impartiality in a health care system is to require impartiality of all actors in the system, i.e. to give health care professionals a duty to treat everyone impartially and to deny them the ‘right’ to give their patients preferential treatment. And one of the possible side-effects of allowing individual health care professionals to give preference to ‘their clients’ is to create inequality in health care. This paper explores the conflict and proposes that it can be right to give preference to ‘your’ patients in certain circumstances. (shrink)

This chapter contains sections titled: Childhood and Christmas Heaven is at Stake Moving around the Spiral Hecate at the Crossroads It's Not about Me? It's Not Me or You: It's Hallmark Spiraling Around the Christmas Tree.

The renowned Nobel Prize-winning scientist's elegant and concise explanation of the fundamental ideas in biology and their uses today. Hailed by Philip Pullman as "a great communicator" who is also "as distinguished a scientist as there could be," Paul Nurse writes with delight at life's richness and a sense of the urgent role of biology in our time. With What Is Life? he delivers a brief but powerful work of popular science in the vein of Carlo Rovelli's Seven Brief Lessons (...) in Physics. Nurse takes readers on a wondrous journey through five fundamental biological ideas-the Cell, the Gene, Evolution by Natural Selection, Life as Chemistry, and Life as Information-introducing the scientists who made the most important advances and taking us into his own lab to give us a sense of the thrill of scientific discovery. In a final chapter, Nurse addresses biology's most pressing ethical issues (including gene-editing, genetic testing, and genetically modified crops), and he concludes with a stirring encomium to biology's role in tackling infectious disease. (shrink)

In this article, I argue that the recent emphasis on compassion in healthcare practice lacks conceptual richness and clarity. In particular, I argue that it would be helpful to focus on a larger concept of empathy rather than compassion alone and that compassion should be thought of as a component of this larger concept of empathy. The first part of the article outlines a critique of the current discourse of compassion on three grounds. This discourse naturalizes, individualizes, and reifies compassion (...) leading to a decontextualized and simplified understanding of failures in healthcare practice. The second part uses resources from phenomenology and contemporary moral philosophy to construct a “hybrid” concept of empathy that includes both pre‐reflective/intuitive and cognitive/imaginative components. This “hybrid” concept of empathy leads to a more complex understanding of the multiple responses to others' distress. I conclude that there are no straightforward normative naturalistic responses to others' distress. Rather than conceptualizing compassion as a naturalistic impulse or a character‐based trait, we need to consider the complexity of our empathic recognition of vulnerable others. (shrink)

Background: Research Ethics Committees (RECs) or their equivalent review applications for prospective research with human participants. Reviewers use universally agreed principles i to make decisions about whether prospective health and social care research is ethical. Close attention to understanding how reviewers go about their decision-making work and consider principles in practice is limited. Objective: The study aimed to understand how reviewers made decisions in the contexts of meetings and to understand more about how reviewers approach their work. The purpose of (...) this article is to draw on data and findings and to show how reflective equilibrium as a theoretical frame can (1) deepen understanding of ethics review and (2) permit a reflexive examination of the habitual processes of review. Design and participants: Methods captured the day-to-day work of the RECs. Seventeen applications were heard during eight observations. There were 12 formal interviews with reviewers (n = 12) and with researchers (n = 8) which are not reported on in this article. Ethical considerations: Organisational permission for the study was given by the National Research Ethics Service (NRES) whose functions became part of the Health Research Authority (HRA) during the study. The study was given favourable opinion by the University of Salford's REC (Reference HSCR11/17). Findings: Data were analysed using constructed grounded theory resulting in eight themes which revealed attention to procedure and engagement with applications. Reflective equilibrium was used as a qualitative frame to interpret themes distilling them into three processes at work in review: emotion and intuition; imagination and creative thinking; and intuition and trust. Discussion: Reviewers went back and forth between universal principles and considered these in the contexts of each application using the above processes. Conclusions: Reflective equilibrium offers a coherent and grounded account of review work. Reflexivity in training for reviewers is essential for improving practices. The challenges reflexivity presents can be assisted by using reflective equilibrium as a tool to illuminate tacit review processes. (shrink)

Derek Nurse looks at variations in the form and function of tense and aspect in Bantu, a branch of Niger-Congo, the world's largest language phylum. Bantu languages are spoken in central, eastern, and southern sub-Saharan Africa south of a line between Nigeria and Somalia. By current estimates there are between 250 and 600 of them, as yet neither adequately classified nor fully described. Professor Nurse's account is based on data from more than 200 Bantu languages and varieties, a representative sample (...) of which is freely available on the publisher's website. He devotes substantial chapters to the analysis and comparison of the different tense and aspect systems found in Bantu. He also examines the verbal categories with which they interact, including negation and focus. Synchronic and diachronic perspectives are interwoven throughout the book. Following a brief history of Bantu over the last five thousand years, the final two chapters look systematically at the history of tense and aspect in Bantu. The first deals with the reconstruction of the earlier forms from which contemporary structures, morphemes, and categories are derived, and the second with the processes of change, including grammaticalization, by means of which older analytical structures and independent lexical items moved as they became incorporated as grammatical inflections and categories. (shrink)