The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile's (Practice‐based education: Perspectives and strategies, Rotterdam: Sense, 2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the healthcare assistant. In the British context, delegation and supervision are thought of as skills which are learnt (...) “on the job.” We suggest that learning “on‐the‐job” is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011 to 2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and healthcare assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the “invisible learning” which occurs as newly qualified nurses learn to delegate and supervise. (shrink)

In this article, I discuss the structural domination of whiteness as it intersects with the potential of individual critique and reflexivity. I reflect on my positioning as a white nurse researcher while researching international nurse migration. I draw on two large qualitative studies and one small focus group study to discuss my reactions as a white researcher to evidence of institutional racism in the British health services and my growing awareness of how racism is reproduced in the British nursing profession.

In conversation with the ethical-theological-philosophical role of love in the Abrahamic traditions and U.S. immigration, personal testimonies of refugee families seeking asylum join the witness of the interfaith community of greater San Antonio to explain the gift received when love of God is expressed as radical hospitality.

This paper develops previous work on theories of embodiment by drawing on empirical data from a study into the experiences of infertile women in the UK. I suggest experiences of embodiment shape the preferences of infertile women for a female nurse as chaperone during intimate medical procedures. I explore the impact of this role on the understandings and meanings of nursing in a highly gendered field of practice. I present data from an ethnographic study of infertile women who chose to (...) attend a British infertility clinic for investigation and fertility treatment cycles. Data were collected over 2 years using participant observation and semistructured interviews with 15 women and 20 members of staff in a British fertility unit. Data analysis was completed using a modified thematic analysis following Boyle and McEvoy. I discuss women's experiences of intimacy and bodily care and how these experiences might be understood by exploring the phenomenological concept of embodiment. I argue that women benefit from having a female nurse as chaperone because of their expectations of gender, nursing and caring. Women's expectations reinforce both notions of gendered caring and the gendered role of nursing. These data challenge notions of patriarchal professionalism prevalent in nursing, which seek to move away from the gendered role of the nurse (which traditionally included a chaperone role) towards a model of professional development based on a mind–body split. I suggest that these data offer a way of understanding the female embodied subject in the field of gendered caring, which is potentially transgressive because they suggest ways in which both mind and body can be integrated through the role of the female chaperone. (shrink)

We defend a set of acceptance rules that avoids the lottery paradox, that is closed under classical entailment, and that accepts uncertain propositions without ad hoc restrictions. We show that the rules we recommend provide a semantics that validates exactly Adams’ conditional logic and are exactly the rules that preserve a natural, logical structure over probabilistic credal states that we call probalogic. To motivate probalogic, we first expand classical logic to geologic, which fills the entire unit cube, and then we (...) project the upper surfaces of the geological cube onto the plane of probabilistic credal states by means of standard, linear perspective, which may be interpreted as an extension of the classical condition of indifference. Finally, we apply the geometrical/logical methods developed in the paper to prove a series of trivialization theorems against question-invariance as a constraint on acceptance rules and against rational monotonicity as an axiom of conditional logic in situations of uncertainty. (shrink)

Many assumptions are made about public willingness to participate in epidemiological research, yet few empirical studies have been conducted to ascertain whether such assumptions are correct. Our qualitative study of the public and of expert stakeholders leads us to suggest that people are generally prepared to participate in epidemiological research, particularly if it is conducted by a trusted public institution such as a government health department, charity, or university. However, there is widespread community distrust of research conducted or sponsored by (...) pharmaceutical companies. Individuals are prompted to take part if the study concerns an illness they or a family member or friend have personally experienced or if they believe the research will confer a widespread public benefit. Preferences vary about the mode of contact for the research to be conducted. Willingness to participate in telephone surveys has decreased in recent years, and this may be a consequence of an increase in calls to homes by telemarketers and market researchers. Participants also stressed the importance of knowing where their names and contact details were sourced and suggested that this information be available to prospective study participants as a matter of course in the first approach or letter. We provide valuable information to epidemiologists in designing studies. (shrink)

Objectives The objective of this research was to develop ethics accreditation standards for hospitals. Research design Our research methods included a literature review, an expert focus group, the Delphi technique and a hospital survey. The entire process was separated into two stages: (1) the development of a draft of hospital ethics accreditation standards; and (2) conducting a nationwide hospital survey of the proposed standards. Results This study produced a tentative draft of hospital ethics accreditation standards comprised of six chapters and (...) 62 standards based on the expert focus group and Delphi technique. The six chapters are: Medical ethics policies, regulations and leadership; The establishment and operation of a medical ethics committee; The establishment and operation of research-related ethics committees; Medical ethics education; Organisational ethical climate; and Respect for patients' rights and establishment of good hospital-patient relationships. The hospital survey indicated that the concept of an organisational ethical climate was new to most hospital managers, most hospitals disliked the idea of having a separate hospital ethics accreditation system, and small hospitals were concerned about their ability to comply with all of the standards. Conclusions Regardless of whether hospital ethics accreditation can be a stand-alone accreditation or just part of existing hospital accreditation programmes, we hope this draft can serve as a good reference for future endeavours by hospital accreditation authorities. (shrink)

The COVID-19 pandemic crisis has necessitated widespread adaptation of revised treatment regimens for both urgent and routine medical problems in patients with and without COVID-19. Some of these alternative treatments maybe second-best. Treatments that are known to be superior might not be appropriate to deliver during a pandemic when consideration must be given to distributive justice and protection of patients and their medical teams as well the importance given to individual benefit and autonomy. What is required of the doctor discussing (...) these alternative, potentially inferior treatments and seeking consent to proceed? Should doctors share information about unavailable but standard treatment alternatives when seeking consent? There are arguments in defence of non-disclosure; information about unavailable treatments may not aid a patient to weigh up options that are available to them. There might be justified concern about distress for patients who are informed that they are receiving second-best therapies. However, we argue that doctors should tailor information according to the needs of the individual patient. For most patients that will include a nuanced discussion about treatments that would be considered in other times but currently unavailable. That will sometimes be a difficult conversation, and require clinicians to be frank about limited resources and necessary rationing. However, transparency and honesty will usually be the best policy. (shrink)

Social context shapes negotiators’ actions, including their willingness to act unethically. We use a simulated negotiation to test how three dimensions of social context—dyadic gender composition, negotiation strategy, and trust—interact to influence one micro-ethical decision, the use of deception. Deception in all-male dyads was relatively unaffected by trust or the other negotiator’s strategy. In mixed-sex dyads, negotiators consistently increased their use of deception when three forms of trust were low and opponents used an accommodating strategy. However, in all-female dyads, negotiators (...) appeared to use multiple and shifting reference points in deciding when to deceive the other party. In these dyads, the use of deception increased when a competitive strategy combined with low benevolence-based trust or an accommodating strategy combined with high identity-based trust. Deception in all-female dyads decreased when a competitive strategy was used in the context of low deterrence-based trust. (shrink)

Ockham’s razor is the characteristic scientific penchant for simpler, more testable, and more unified theories. Glymour’s early work on confirmation theory eloquently stressed the rhetorical plausibility of Ockham’s razor in scientific arguments. His subsequent, seminal research on causal discovery still concerns methods with a strong bias toward simpler causal models, and it also comes with a story about reliability—the methods are guaranteed to converge to true causal structure in the limit. However, there is a familiar gap between convergent reliability and (...) scientific rhetoric: convergence in the long run is compatible with any conclusion in the short run. For that reason, Carnap suggested that the proper sense of reliability for scientific inference should lie somewhere between short-run reliability and mere convergence in the limit. One natural such concept is straightest possible convergence to the truth, where straightness is explicated in terms of minimizing reversals of opinion and cycles of opinion prior to convergence. We close the gap between scientific rhetoric and scientific reliability by showing that Ockham’s razor is necessary for cycle-optimal convergence to the truth, and that patiently waiting for information to resolve conflicts among simplest hypotheses is necessary for reversal-optimal convergence to the truth. (shrink)

Mindfulness and compassion meditation are thought to cultivate prosocial behavior. However, the lack of diverse representation within both scientific and participant populations in contemplative neuroscience may limit generalizability and translation of prior findings. To address these issues, we propose a research framework calledIntersectional Neurosciencewhich adapts research procedures to be more inclusive of under-represented groups. Intersectional Neuroscience builds inclusive processes into research design using two main approaches: 1) community engagement with diverse participants, and 2) individualized multivariate neuroscience methods to accommodate neural (...) diversity. We tested the feasibility of this framework in partnership with a diverse U.S. meditation center (East Bay Meditation Center, Oakland, CA). Using focus group and community feedback, we adapted functional magnetic resonance imaging (fMRI) screening and recruitment procedures to be inclusive of participants from various under-represented groups, including racial and ethnic minorities, gender and sexual minorities, people with disabilities, neuropsychiatric disorders, and/or lower income. Using person-centered screening and study materials, we recruited and scanned 15 diverse meditators (80% racial/ethnic minorities, 53% gender and sexual minorities). The participants completed the EMBODY task – which applies individualized machine learning algorithms to fMRI data – to identify mental states during breath-focused meditation, a basic skill that stabilizes attention to support interoception and compassion. All 15 meditators’ unique brain patterns were recognized by machine learning algorithms significantly above chance levels. These individualized brain patterns were used to decode the internal focus of attention throughout a 10-min breath-focused meditation period, specific to each meditator. These data were used to compile individual-level attention profiles during meditation, such as the percentage time attending to the breath, mind wandering, or engaging in self-referential processing. This study provides feasibility of employing an intersectional neuroscience approach to include diverse participants and develop individualized neural metrics of meditation practice. Through inclusion of more under-represented groups while developing reciprocal partnerships, intersectional neuroscience turns the research process into an embodied form of social action. (shrink)

Intentional change when viewed as making a risky or intertemporal choice with evolutionary relevance helps us understand its successes and its failures. To promote future-oriented ecological rationality requires establishing a linkage between nongenetic, cultural, and symbolic selections and genetic adaptations. Coupled with biophilic instinct, intentional conservation is more likely to prevail against evolved desires of environmental exploitation.

This article does not intend to actually valuate intangible assets but focuses to investigate the relative value distribution of corporate intangible assets, and this links closely to the concept and application of value drivers. This is because we believe that drivers or attributes of the value significantly determine how the virtual value of these intangibles can be created for companies. We apply the analytic hierarchy process (AHP) to the appraising process of intangible assets. The AHP method can mainly sort the (...) non-financial value drivers in order according to their weighted contributions. Therefore, the key purpose of this article is to develop a tentative model for the evaluation of intangible assets, which helps business to correctly appraise corporate value ratios and avoid bias due to mainly relying on financial statements when measuring an entity’s value. In addition, in view of the significant proportion of intangible assets over total assets in high-technology industries, this research, then, uses six industries in Hsinchu Science Park, Taiwan, as its research objects in order to test the applicability of its model, as well as exploring the value weights of intangible assets and its evaluation among different technology industries. Besides, the empirical result of this article is mainly to support business appraisal and thus improves the effectiveness of value-based management. (shrink)

The Ontology for Biomedical Investigations (OBI) is an ontology that provides terms with precisely defined meanings to describe all aspects of how investigations in the biological and medical domains are conducted. OBI re-uses ontologies that provide a representation of biomedical knowledge from the Open Biological and Biomedical Ontologies (OBO) project and adds the ability to describe how this knowledge was derived. We here describe the state of OBI and several applications that are using it, such as adding semantic expressivity to (...) existing databases, building data entry forms, and enabling interoperability between knowledge resources. OBI covers all phases of the investigation process, such as planning, execution and reporting. It represents information and material entities that participate in these processes, as well as roles and functions. Prior to OBI, it was not possible to use a single internally consistent resource that could be applied to multiple types of experiments for these applications. OBI has made this possible by creating terms for entities involved in biological and medical investigations and by importing parts of other biomedical ontologies such as GO, Chemical Entities of Biological Interest (ChEBI) and Phenotype Attribute and Trait Ontology (PATO) without altering their meaning. OBI is being used in a wide range of projects covering genomics, multi-omics, immunology, and catalogs of services. OBI has also spawned other ontologies (Information Artifact Ontology) and methods for importing parts of ontologies (Minimum information to reference an external ontology term (MIREOT)). The OBI project is an open cross-disciplinary collaborative effort, encompassing multiple research communities from around the globe. To date, OBI has created 2366 classes and 40 relations along with textual and formal definitions. The OBI Consortium maintains a web resource providing details on the people, policies, and issues being addressed in association with OBI. (shrink)

Animal welfare in livestock farming is a general concept that involves many concrete ethical issues for which solutions need to be developed. To avoid disturbing the internal market, the European Union encourages market players to develop harmonized solutions to such issues. One issue is the castration of piglets without pain relief, the practice of which causes pain to piglets. Although scientists have found alternatives to replace castration without pain relief, the process of solving the castration issue has stagnated. Questions remain (...) as to why this painful castration practice has still not been addressed after three decades, how it is likely to develop in the near future, and whether it will lead to a single harmonized solution for the EU. To answer these questions, this study examines the development of the castration issue using in-depth interviews and desk research. The results show that different countries have developed different solutions at different stages of the issue’s development. For a long period, the developments did not set a course toward a single solution; most EU pork producers waited for a castration ban in Germany. Such a situation was turbulent in solving the issue because the heterogeneous EU was unlikely to agree upon on a single alternative. With the EU now taking a market-based orientation, however, solving the issue now seems more likely. More attention is needed to understand market opportunities and chain integration in this area. (shrink)

© The Author 2016. Published by Oxford University Press on behalf of Japanese Society of Plant Physiologists. All rights reserved.Cell walls of grasses, including cereal crops and biofuel grasses, comprise the majority of plant biomass and intimately influence plant growth, development and physiology. However, the functions of many cell wall synthesis genes, and the relationships among and the functions of cell wall components remain obscure. To better understand the patterns of cell wall accumulation and identify genes that act in grass (...) cell wall biosynthesis, we characterized 30 samples from aerial organs of rice at 10 developmental time points, 3-100 d post-germination. Within these samples, we measured 15 cell wall chemical components, enzymatic digestibility and 18 cell wall polysaccharide epitopes/ligands. We also used quantitative reverse transcription-PCR to measure expression of 50 glycosyltransferases, 15 acyltransferases and eight phenylpropanoid genes, many of which had previously been identified as being highly expressed in rice. Most cell wall components vary significantly during development, and correlations among them support current understanding of cell walls. We identified 92 significant correlations between cell wall components and gene expression and establish nine strong hypotheses for genes that synthesize xylans, mixed linkage glucan and pectin components. This work provides an extensive analysis of cell wall composition throughout rice development, identifies genes likely to synthesize grass cell walls, and provides a framework for development of genetically improved grasses for use in lignocellulosic biofuel production and agriculture. (shrink)

The practice of respecting patients’ autonomy is rooted in the healthcare professionals’ empathy for patients’ situations, without which appropriate supports to the patients during the informed consent process may be remarkably moderated. The purpose of this study was to explore elective surgery patients’ experiences during their decision-making process. This research was conducted using a phenomenological approach, and the data analysis was guided by Colaizzi’s method. A total of 17 participants were recruited from a hospital in southern Taiwan. Two major themes (...) emerged from the analyses: (a) a voluntary yet necessary alternative—to undergo a surgery and (b) alternatives compelled by the unalterable decision—the surgery. It was concluded that unless healthcare professionals can empathize with the distressed situation of their patients who are facing elective surgery, the practice of informed consent may become merely a routine. Nurses can be the best advocates for patients and facilitators to enhance communication between patients and healthcare personnel. (shrink)

Approximately one in three adults has reported being abused or neglected by a caregiver during their childhood (i.e., they have experienced child maltreatment), though the exact prevalence differs...

Training of resident physicians is essential for the care of future patients. While surgical trainee involvement is necessary, its disclosure to patients can often be omitted or underplayed by surgeons. The informed consent process and the underlying ethical principles make evident that patients should be informed of trainee involvement. In this review we explore the importance of disclosure, current themes in practice, and the optimal discussion for which we should strive.

OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

Das Problem des Seinsglaubens in der Phänomenologie Husserls läßt sich zweifelsohne zu deren zentralen Themen wie Wahmehmung, Phantasie und Zeitbewußtsein zählen und steht auch in engem Zusammenhang mit diesen. Das Buch Seinsglaube in der Phänomenologie Edmund Husserls versucht dieses Problem zu klaren und zu zeigen, wie weit Husserl bei der Lösung dieses Problems gekommen ist und welche Fragen dabei offen blieben, die weiterer Lösungen bedürfen. Zudem werden die Gründe für das Gelingen bzw. Mißlingen bei Husserls Bemühungen herausgearbeitet. Die Einleitung erörtert (...) die verschiedenen Bedeutungen des Begriffs 'Seinsglauben' und zeichnet den Ort des Seinsglaubens im phänomenologischen System Husserls vor. Der erste Teil des Buches stellt sich als Hauptaufgabe die Strukturanalyse des Seinsglaubens aus verschiedenen Aspekten. In den ersten vier Kapiteln wird Husserls Exposition der verschiedenen Richtungen des Seinsglaubens, der Modalitäten, Modifikationen sowie der Eigentlichkeit und der Uneigentlichkeit des Seinsglaubens stufenweise behandelt. Das V. Kapitel, das den zweiten Teil einleitet, bildet den Wendepunkt der Arbeit, da es sich einerseits weiter mit Husserls Darstellung des Seinsglaubens, und zwar hier der verschiedenen Glaubensweisen, beschäftigt, andererseits schon Bezug auf die verschiedenen Weisen der Ausschaltung des Seinsglaubens nimmt, welche im VI. VII. und VIII. Kapitel das Hauptthema bilden: die eidetische Reduktion, Neutralitätsmodifikation und die transzendentale Reduktion. Der Schwerpunkt der vorliegenden Arbeit liegt auf den in der Forschungsliteratur bisher wenig beachteten Husserlschen Analysen zur Neutralitätsmodifikation (Kapitel VII) im Zusammenhang mit dem Problem des Seinsglaubens in der Vergegenwärtigung. Da die transzendentale Reduktion, eine andere wichtige Methode der Ausschaltung des Seinsglaubens im Sinne der Neutralitätsmodifikation, in der phänomenologischen Literatur bereits gründlich behandelt ist, wird sie hier nur in dem Maß in Betracht gezogen, insofern sie sich von der Neutralitätsmodifikation deutlich abhebt. Eine rückblickende Zusammenfassung der ganzen Untersuchung beschließt die Arbeit. (shrink)