Background: As frail older people might have difficulties in expressing themselves, their needs are often interpreted by others, for example, by significant others, whose information health care staff often have to rely on. This, in turn, can put health care staff in ethically difficult situations, where they have to choose between alternative courses of action. One aspect that might be especially difficult to express is that of existential loneliness. We have only sparse knowledge about whether, and in what way, the (...) views of frail older persons and their significant others concerning existential loneliness are in concordance. Objective: To contrast frail older persons’ experiences with their significant others’ perceptions of existential loneliness. Methods: A case study design was chosen for this study. Individual interviews with frail older persons and interviews with their significant others, as well as field notes, served as a basis for the study. A thematic analysis was used to interpret data. Ethical considerations: This study was conducted in accordance with the principles of research ethics. Findings: The findings showed three themes: Meaningless waiting in contrast to lack of activities, Longing for a deeper connectedness in contrast to not participating in a social environment and Restricted freedom in contrast to given up on life. Discussion: Knowledge about the tensions between older persons’ and their significant others’ views of existential loneliness could be of use as a basis for ethical reflections on the care of older people and in the encounter with their significant others. Conclusion: It is of importance that health care professionals listen to both the frail older person and their significant other and be aware of whose voice that the care given is based on, in order to provide care that is beneficial and not to the detriment of the older person. (shrink)

The aim of this study was to explore the relational aspects of the consent process for HPV vaccination as experienced by school nurses, based on the assumption that individuals have interests related to persons close to them, which is not necessarily to be apprehended as a restriction of autonomy; rather as a voluntary and emotionally preferred involvement of their close ones. Thirty Swedish school nurses were interviewed in five focus groups, before the school based vaccination program had started in Sweden. (...) The empirical results were discussed in light of theories on relational autonomy. The school nurses were convinced that parental consent was needed for HPV vaccination of 11-year-old girls, but problems identified were the difficulty to judge when a young person is to be regarded as autonomous and what to do when children and parents do not agree on the decision. A solution suggested was that obtaining informed consent in school nursing is to be seen as a deliberative process, including the child, the parents and the nurse. The nurses described how they were willing strive for a dialogue with the parents and negotiate with them in the consent process. Seeing autonomy as relational might allow for a more dialogical approach towards how consent is obtained in school based vaccination programs. Through such an approach, conflicts of interests can be made visible and become possible to deal with in a negotiating dialogue. If the school nurses do not focus exclusively on accepting the individual parent’s choice, but strive to engage in a process of communication and deliberation, the autonomy of the child might increase and power inequalities might be reduced. (shrink)

In nursing practice, awareness of ethical inner values and a common understanding of nursing and caring are needed. It is therefore important to highlight ideas of caring in nursing practice. The aim of this paper was to illuminate nursing, caring and ethical inner values in caring and caring in nursing practice. By being attentive, open, respectful and treating the patient as a person, nurses can enhance both their own and the patient's sense of personal meaning in the caring relationship. Nurses (...) can use self‐reflection to create an awareness of nursing, caring and ethical inner values in caring. (shrink)

Paediatric cancer care poses ethically difficult situations that can lead to value conflicts about what is best for the child, possibly resulting in moral distress. Research on moral distress is lacking in paediatric cancer care in Sweden and most questionnaires are developed in English. The Moral Distress Scale-Revised is a questionnaire that measures moral distress in specific situations; respondents are asked to indicate both the frequency and the level of disturbance when the situation arises. The aims of this study were (...) to translate and culturally adapt the questionnaire to the context of Swedish paediatric cancer care. In doing so we endeavoured to keep the content in the Swedish version as equivalent to the original as possible but to introduce modifications that improve the functional level and increase respondent satisfaction. The procedure included linguistic translation and cultural adaptation of MDS-R’s paediatric versions for Physicians, Nurses and Other Healthcare Providers to the context of Swedish paediatric cancer care. The process of adjustment included: preparation, translation procedure and respondent validation. The latter included focus group and cognitive interviews with healthcare professionals in paediatric cancer care. To achieve a Swedish version with a good functional level and high trustworthiness, some adjustments were made concerning design, language, cultural matters and content. Cognitive interviews revealed problems with stating the level of disturbance hypothetically and items with negations caused even more problems, after having stated that the situation never happens. Translation and cultural adaptation require the involvement of various types of specialist. It is difficult to combine the intention to keep the content as equivalent to the original as possible with the need for modifications that improve the functional level and increase respondent satisfaction. The translated and culturally adapted Swedish MDS-R seems to have equivalent content as well as improved functional level and respondent satisfaction. The adjustments were made to fit paediatric cancer care but it could be argued that the changes are relevant for most areas of paediatric care of seriously ill patients. (shrink)

BackgroundMoral distress has been described as an emotionally draining condition caused by being prevented from providing care according to one’s convictions. Studies have described the impact of moral distress on healthcare professionals, their situations and experiences. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) is a questionnaire that measures moral distress experienced by healthcare professionals at three levels: patient, system and team. The aim of this project was to translate and make a cultural adaption of the MMD -HP to (...) the Swedish context.MethodsThe questionnaire comprises 27 items, rated according to frequency and intensity on a five-point Likert scale (0–4). The procedure for translating MMD-HP followed WHO guidelines (2020). These entailed a forward translation from English to Swedish, a back translation, expert panel validation, pretesting and cognitive face-to-face interviews with 10 healthcare professionals from various professions and healthcare contexts.ResultsThe Swedish version of MMD-HP corresponds essentially to the concept of the original version. Parts of some items’ had to be adjusted or removed in order to make the item relevant and comprehensible in a Swedish context. Overall, the cognitive interviewees recognized the content of the items which generally seemed relevant and comprehensible.ConclusionThe Swedish version of MMD-HP could be a useful tool for measuring moral distress among healthcare professionals in a Swedish healthcare context. (shrink)

The paediatric Moral Distress Scale-Revised was previously translated and adapted to Swedish paediatric oncology. Cognitive interviews revealed five not captured situations among the 21 items, resulting in five added items: 22) Lack of time for conversations with patients/families, 23) Parents’ unrealistic expectations, 24) Not to talk about death with a dying child, 25) To perform painful procedures, 26) To decide on treatment/care when uncertain. The aim was to explore experiences of moral distress in the five added situations in the Swedish (...) paediatric MDS-R, among healthcare professionals in paediatric oncology. In this national cross-sectional survey, the Swedish paediatric MDS-R, including five added items, were used. Descriptive statistics, non-parametric analysis of differences between professions and a MDS-R score for each item were calculated. Internal consistency was tested using Cronbach’s alpha and inter-item correlation test. HCPs at all six Swedish paediatric oncology centres participated. The Regional Ethical Review Board had no objections. Consent was assumed when the survey was returned. Nursing assistants reported higher intensity and lower frequency on all added items; registered nurses reported a higher frequency on item 22–25; medical doctors reported higher MDS-R score on item 26. On item 22, intensity was moderate for RNs and MDs and high for NAs, and frequency was high among all. Item 22, had the second highest MDS-R score of all 26 for all professional groups. On item 23, the level of disturbance was low but it occurred often. The 26-item version showed good internal consistency for the overall sample and for all professional groups. However, item 22 and 24 could be viewed as redundant to two of the original 21. In accordance with other studies, the intensity was higher than the frequency, however, the frequency of the added items was higher than of the original items. In line with previous research, item 22 and 23 are important elements of moral distress. RNs experience the situations more often while NAs find them more disturbing. The results indicate that the added items are important in capturing moral distress in paediatric oncology. (shrink)

As the distance between science and society is collapsed with the growth of contemporary knowledge societies, so a range of different approaches to the democratic governance of science superseding its Enlightenment government is emerging. In light of these different approaches, this article focuses on the figure of the scientific citizen and the variable dimensions of a new scientific citizenship. Three models of democracy - advanced consumer, deliberative and radical/pluralist - are put forward as both partly competing and partly complementary frameworks (...) within which the new rights and responsibilities of the scientific citizen can be articulated and discussed. In each case the theory and practice of scientific citizenship are viewed against the background of contemporary developments within the field of science communication; the rise of the public understanding of science movement; the new enthusiasm for advancing public engagements with science, and the legitimate place of different forms of public protest and dissent within new designs for democratic governance. (shrink)

This study presents findings from an ontological and contextual determination of the concept of dignity. The study had a caritative and caring science perspective and a hermeneutical design. The aim of this study was to increase caring science knowledge of dignity and to gain a determination of dignity as a concept. Eriksson’s model for conceptual determination is made up of five part-studies. The ontological and contextual determination indicates that dignity can be understood as absolute dignity, the spiritual dimension characterized by (...) responsibility, freedom, duty, and service, and relative dignity, characterized by the bodily, external aesthetic dimension and the psychical, inner ethical dimension. Dignity exists in human beings both as absolute and relative dignity. (shrink)

The article is based on the argument that labour market segregation is an important factor contributing to women’s inequality in the labour market. Therefore, any equal opportunities policy has to be combined with a policy to reduce segregation. But up to now segregation has been extremely persistent, as is shown in a short empirical overview of segregation in the Austrian labour market. It is argued that the roots of this phenomenon lie in the assignment of men and women to the (...) market area and the reproduction area according to the breadwinner model. Labour market segregation by sex can be seen as a transformation and continuation of the asymmetrical gender relation in the family to the labour market. Most of the mechanisms and processes that occur every day in the labour market work together to preserve sex segregation. Strategies to reduce segregation should look at these historical roots of segregation and at the connection with the overall gender division of labour. Different perspectives on a reduction of labour market segregation are presented. (shrink)

(1998). A note on ‘The idea of the university in the global era: From knowledge as an end to the end of knowledge’. Social Epistemology: Vol. 12, Sites of Knowledge Production: The University, pp. 85-88. doi: 10.1080/02691729808578865.

Feeling old: being in a phase of transition in later life The aim of the study was to illuminate very old persons’ experiences of feeling old in order to get a nuanced understanding of the ageing process in later life. Fifteen persons 85–96 years of age, living in their own homes, were interviewed in‐depth. Data were analysed utilising a phenomenological‐hermeneutic approach. Eight persons reported that they felt old. The experience of feeling old entailed four characteristics: being able to date the (...) beginning of feeling old, fear of helplessness and of being unable to manage one’s life situation, not recognising one’s former self, and feeling different from others. These characteristics corresponded to the main properties of a transition process. The comprehensive understanding was that the very old persons who also felt old were in a phase of transition. The distinguishing qualities of those that felt old were also found to be in line with the dystonic dominance in the ninth stage designated by Joan Erikson of the previously described life cycle. Knowledge about transition processes and sensitivity to very old people’s experiences of feeling old are of great importance to nursing in order to provide adequate health care services and prevent unhealthy transitions. (shrink)

The paper describes a methodology to be used for analysis and design of human activity systems. The methodology is based on an analysis of the decision settings whereas most other decision analysis methodologies are analysing the process. The decision concept is analysed and discussed. A distinction between programmed and programmable as well as non-programmed and non-programmable decisions is proposed. A classification of different information types for decision making is presented. A methodology based on a systemic and systematic analysis of the (...) information requirements of an organization is proposed. This methodology also indicates organizational discrepancies and information imbalances. The methodology focuses the settings of the decisions on all levels of organizations. The methodology can be regarded as a dynamic, learning system. The author proposes further research on the individuals decision making abilities. (shrink)

The aim of this study was to understand how mothers experienced midwives' uncaring behaviour and actions during birth. Sixty-seven first-time mothers took part in the study, in which data were collected through interview. The interview text was analysed using hermeneutic text analysis. Nearly half of the mothers interviewed (n = 32) said that midwives did not care for them. The findings show that midwives' behaviour was humiliating when they ignored mothers and held them in contempt. The mothers felt further humiliated (...) when the midwives did not believe them, treated their bodies in a careless manner and tended to put blame on them. Through their behaviour and actions, some midwives have shown that they no longer have a caring attitude as an element of their professional practice and that they have ignored ethics by offending mothers' sense of dignity. (shrink)

Play and games are among the basic means of expression in intelligent communication, influenced by the relevant cultural environment. Games have found a natural expression in the contemporary computer era in which communications are increasingly mediated by computing technology. The widespread use of e-games results in conceptual and policy vacuums that must be examined and understood. Humans involved in design-ing, administering, selling, playing etc. computer games encounter new situations in which good and bad, right and wrong, are not defined by (...) the experience of previous generations. This article gives an account of the historical necessity of games, the development of e-games, their pros- and cons, threats and promises, focusing on the ethical awareness and attitudes of game developers. (shrink)

Background: Ethical climate and moral distress have been shown to affect nurses’ ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. Research aim: To investigate paediatric oncology nurses’ perceptions of ethical climate and moral distress. Research design: In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey–Shortened and the Swedish Moral Distress Scale–Revised. Data analysis includes descriptive statistics and non-parametric analyses. Respondents and research context: (...) Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. Ethical considerations: According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. Results: Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. Discussion: Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. Conclusion: Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses. (shrink)

An electronic poster from "Polarity from Different Perspectives," New York University, 2005. The authors present an experiment that investigated to what extent six negative polarity items (slept a wink, in ages, ever, much, at all, and yet) are licensed by 9 potential licensers.

This article analyses problem situations in the context of anaesthesia care. It considers what it means for nurse anaesthetists to be in problematic situations in the anaesthesia care of older patients. Benner’s interpretive phenomenological approach proved useful for this purpose. Paradigm cases are used to aid the analysis of individual nurses’ experiences. Thirty narrated problematic anaesthesia care situations derived from seven interviews were studied. These show that experienced nurse anaesthetists perceive anaesthesia care as problematic and highly demanding when involving older (...) patients. To be in problematic anaesthesia care situations means becoming morally distressed, which arises from the experience or from being prevented from acting according to one’s legal and moral duty of care. An important issue that emerged from this study was the need for an ethical forum to discuss and articulate moral issues, so that moral stress of the kind experienced by these nurse anaesthetists can be dealt with and hopefully reduced. (shrink)

There are two main ways of understanding the function of surrogate decision making in a legal context: the Best Interests Standard and the Substituted Judgment Standard. First, we will argue that the Best Interests Standard is difficult to apply to unconscious patients. Application is difficult regardless of whether they have ever been conscious. Second, we will argue that if we accept the least problematic explanation of how unconscious patients can have interests, we are also obliged to accept that the Substituted (...) Judgment Standard can be coherently applied to patients who have never been conscious at the same extent as the Best Interests Standard. We then argue that acknowledging this result is important in order to show patients respect. (shrink)

To study how populist sentiments have increasingly influenced businesses in society, we examine how German and Swedish corporations addressed the refugee situation in their 2015 and 2016 annual reports. We find that corporations changed their communication once refugee migration became subjected to populist political sentiments, but that they did so without subscribing to those sentiments. Although populism is based on such sharp oppositions as welcoming refugees or closing borders, our analysis shows that corporations have found ways to communicate about the (...) refugee migration beyond these oppositions. Rather than taking a political stance, the corporations studied have primarily articulated the refugee situation as it pertains to their business operations. We identify four modes of articulation: the refugee as someone needing international aid, as a factor for economic analysis, as a benefit recipient, or as a potential stakeholder. These findings help nuance our understanding of how corporations navigate contested political issues. (shrink)

The vocabulary for describing odors in English natural language is not well understood, as prior studies of odor descriptions have often relied on preselected descriptors and odor ratings. Here, we present a data-driven approach that automatically identifies English odor descriptors based on their degree of olfactory association, and derive their semantic organization from their distributions in natural texts, using a distributional-semantic language model. We identify 243 descriptors that are much more strongly associated with olfaction than English words in general. We (...) then derive the semantic organization of these olfactory descriptors, and find that it is captured by four clusters that we name Offensive, Malodorous, Fragrant, and Edible. The semantic space derived from our model primarily differentiates descriptors in terms of pleasantness and edibility along which our four clusters are positioned, and is similar to a space derived from perceptual data. The semantic organization of odor vocabulary can thus be mapped using natural language data (e.g., online text), without the limitations of odor-perceptual data and preselected descriptors. Our method may thus facilitate research on olfaction, a sensory system known to often elude verbal description. (shrink)

Online news sites have become an internet ‘staple’, but we know little of the forces driving the popularity of such sites in relation to what could be understood as the latest iteration of the web – social media services. This research in brief article discusses empirical results regarding the uses of Twitter for news sharing. Specifically, we present a comparative analysis of links emanating from the service at hand to a series of media outlets over a six-month period in two (...) countries; Sweden and Norway. Focusing on linking practices among highly active Twitter accounts, we problematize the assumption that online communication involves two or more humans by directing attention to more or less automated ‘bot’ accounts. In sum, it is suggested that such automated accounts need to be dealt with more explicitly by researchers as well as practitioners interested in the popularity of online news as expressed through social media activity. (shrink)

The quest for causes behind health and sickness proposes deeper causes like per- sonality and general view of life. Two such concepts have been shown to associate with health indicators in a systematic way, sense of coherence and view of life. Sense of coherence is defined as the sum of three factors, comprehensibility, manage- ability, and meaningfulness. View of life consists of three components, general theories of man and the world, a central value system, and a basic attitude. Two em- (...) pirical studies are summarized where the concepts are related to bereavement and health, respectively. It is concluded that there are many similarities between the two concepts. They both emphasize integration and coherence and connote basic struc- tures in belief systems. They can be related to personality structure and the coping process. The concepts differ in scope and depth. SOC can be considered as part of the connotation of VOL. SOC is quantitatively measurable while VOL presumes qualitative methods of assessment. In studies of health, where factors pertaining to world view or sense of coherence are not in focus, but studied rather as possible confoun- ders, methodological simplicity points to use of the SOC concept. In studies of health where the deeper causal structures are in focus, VOL should also be used, since it per- mits greater depth of analysis. Ideally, both concepts should be applied for a full un- derstanding between man's inner processes and health. (shrink)

The term gurlesque refers to an aesthetics that mixes feminism, femininity, the grotesque and the cute. This article explores how contemporary Swedish feminist comic books do gurlesque theory with the aim of contributing to the theoretical conversation about feminine aesthetics and gurlesque. The study focuses on two contemporary Swedish comic books, Jag är din flickvän nu by Nina Hemmingsson and Allt kommer bli bra by Lisa Ewald. The article views gurlesque as a queer aesthetics, as a form of wilful misinterpretation (...) and taunting of perceptions of femininity. The word gurlesque draws from the word ‘girl’, and questions the connection between girlhood and young age from a queer perspective. Although the gurlesque is rooted in images of girlhood, it has the potential to grasp femininities of all ages. (shrink)

Children’s school journeys have changed vastly during recent decades: More children are being driven to school in private cars instead of walking and cycling, with many who are entitled to a free school bus service still being driven. Earlier research into travel mode choice has often investigated how urban form impacts upon mode choice regarding school journeys – in particular how urban form hinders or enables the use of the active mode. This paper quantitatively explores parents’ stated reasons for choosing (...) the car and the relationship between these reasons and the decision to use the car to take their children to school. We additionally investigate the relationship between sociodemographic factors, distance, and both the stated reasons and the actual mode decision. A sample of 245 parents (194 women) of school children aged 10-15 in the County of Värmland in Sweden were included in the study. The results of PLS-SEM show that the factor Social convenience has a direct relationship with the frequency of car use indicating that the wish to accompany the child and the convenience of car impacts on car choice. If the child is not allowed to travel independently, the parents choose the car to take him/her to school. Sociodemographic factors had a direct relationship with the stated reasons, whereby parents with a higher level of education valued safety/security less. Quite surprisingly, distance (i.e. environmental factor) did not affect car use, indicating that parents drive their children to school regardless of distance. By isolating the particular reasons for choosing the car, this paper focuses on a potentially important missing piece as regards finding out what motivates the increasing car usage in children’s school journeys. An increased knowledge of what motivates the decision to take children by car is important for effective policies aimed at changing parents’ inclination towards choosing the car. (shrink)

In relation to semantics, “grounding” has two relevant meanings. “Symbol grounding” is the process of connecting symbols to perception and the world. “Communicative grounding” is the process of interactively adding to common ground in dialog. Strategies for grounding in human communication include, crucially, strategies for resolving troubles caused by various kinds of miscommunication. As it happens, these two processes of grounding are closely related. As a side-effect of grounding an utterance, dialog participants may adjust the meanings they assign to linguistic (...) expressions, in a process of semantic coordination. Meanings of at least some expressions include perceptual aspects which enable DPs to classify entities as falling under the expression or not based on their perception of those entities. We show how perceptual grounding of symbols can be achieved in a process of interactively adding to common ground. This requires that perceptual aspects of meaning can be updated as a result of participating in linguistic interaction, thereby enabling fine-grained semantic coordination of perceptually grounded linguistic meanings. A formal semantics for low-level perceptual aspects of meaning is presented, tying these together with the logical-inferential aspects of meaning traditionally studied in formal semantics. The key idea is to model perceptual meanings as classifiers of perceptual input. This requires a framework where intensions are represented independently of extensions, and structured objects which can be modified as a result of learning. We use Type Theory with Records, a formal semantics framework which starts from the idea that information and meaning are founded on our ability to perceive and classify the world, that is, to perceive objects and situations as being of types. As an example of our approach, we show how a simple classifier of spatial information based on the Perceptron can be cast in TTR. (shrink)

The Will Theory of Rights has commonly been criticized for excluding from the class of rights bearers all subjects who are incapable of agency. The Interest Theory of Rights faces the challenge of avoiding undue proliferation of the class of rights bearers. I advance a novel argument for a specific demarcation of the class of rights bearers. I then argue that this demarcation implies that the function of the moral rights of subjects incapable of exercising agency is to protect them (...) from being treated with illegitimate disregard in a certain sense. I advance reasons for holding that this theory is neither a Will Theory nor an Interest Theory, or a combination of these theories. The proposed account is significant also if it is interpreted as a version of the Interest Theory. It brings significant benefits in the form of cohesiveness, simplicity, and intuitive appeal. (shrink)

ABSTRACTColin Hay's constructivist institutionalism and Vivien A. Schmidt's discursive institutionalism are two recent attempts to theorize ideas as potential explanations of institutional change. This new attention to the causal role of ideas is welcome, but Hay and Schmidt do not take into consideration the constitutive and structural aspects of ideas. Instead they reduce ideas to properties of individual conscious minds, scanting the respects in which ideas are intersubjectively baked into the practices shared by individuals. This aspect of ideas—arguably, the institutional (...) side of ideas—is developed in post-structuralist thought, which therefore demands a place in ideational research. (shrink)

IntroductionRights-ethicists intensely debate what properties of an individual are necessary and sufficient in order for that individual to have moral rights. At the heart of this important debate is the issue of whether individuals such as human foetuses, infants, and unconscious adults have moral rights, and if so, what these rights are. This paper focuses on the moral status of unconscious adults, as well as human foetuses, which are potential agents in the sense that they follow a “normal” path of (...) development towards agency. Using Michael Tooley’s (Tooley 1983) and Jeff McMahan’s (McMahan 2002) influential discussions on this topic as a point of departure, this paper defends two claims. (1) Possession of the capacity for autonomous agency that is temporarily “blocked” by sleep or coma is sufficient in order for an individual to have intrinsic worth and thus, moral rights. (2) If possession of the blocked capacity for autonomous agency is sufficient in order for an individual to hav. (shrink)