Se presenta una revisión bibliográfica en la que se valora la implementación de las estrategias curriculares en la Licenciatura en Enfermería, a partir de las asignaturas impartidas en el segundo año de la carrera. Se destaca la importancia de estos recursos pedagógicos en la formación de los estudiantes, su desarrollo y contribución a la solución de situaciones relacionadas con el cuidado, la calidad de la atención de salud, la disminución de eventos adversos y la seguridad del paciente. Las estrategias curriculares (...) vinculadas a la carrera de Enfermería constituyen una forma particular de desarrollar el proceso docente, caracterizadas por una direccionalidad coordinada que responde al perfil de salida del egresado, en la que se imbrican los contenidos y métodos teóricos y prácticos de las unidades curriculares correspondientes al plan de estudio, a partir de una estructura metodológica que garantiza su funcionamiento. Ello contribuye a la formación integral de un profesional competente. A bibliographic revision is presented in order to assess the implementation of curricular strategies in Nursing 2nd year subjects. The importance of teaching aids in students' training, their development and contribution to solve issues related to care and quality of the health system, the lowering of adverse events and the patient´s safety are pointed out. Curricular strategies related to Nursing represent a particular way to develop the teaching process, characterized by a coordinated direction which responds to the graduate's experience, in which theoretical and practical methods and contents of the curricular units that belong to the syllabus are interwoven, starting from a methodological structure that ensures these strategy functions. It contributes to the comprehensive formation of a competent professional. (shrink)

Con el objetivo de diseqar una propuesta de modificacisn al programa de la formacisn de enfermeros y sugerir la inclusisn de temas sobre la discapacidad infantil, que permitan instruir al personal en formacisn, se realizs un estudio descriptivo cualitativo, en dos etapas, en la primera, mediante entrevistas se recogis la opinisn del claustro de profesores de la Licenciatura en Enfermerma de la Universidad de Ciencias Midicas de Camag|ey, en una segunda etapa se aplics el mitodo de Panel de Expertos, en (...) el que participaron diez expertos seleccionados de manera intencional a partir de su prestigio, experiencia y vinculacisn a la docencia, en lo referido al tema. Se analizaron los programas rectores de la carrera de formacisn en Enfermerma. El analisis de los mismos permitis apreciar aspectos tan importantes como el trabajo con la familia del discapacitado, o los procedimientos propios del manejo en el domicilio del discapacitado, los cuales no son objeto de estudio en la carrera. Se diseqs una estrategia curricular teniendo en cuenta los objetivos pedagsgicos a cumplimentar con las modificaciones propuestas. Se impone la necesidad de incluir en los programas de estudios aspectos relacionados con esta compleja tematica. Constituye un reto entonces para la universidad continuar desarrollando estrategias que permitan el desarrollo del proceso docente educativo y garanticen calidad en el egresado. In order to design a modification proposal to the nurses training program and suggest the inclusion of topics on the child disability, enabling to instruct staff in training, a qualitative descriptive study was carried out in two stages. In the first stage, opinions through interviews to the staff of the Nursing Faculty of the University of Medical Sciences of Camag|ey were collected. In the second stage, the method of Experts Panel was applied. Ten experts were chosen intentionally taking into account their prestige, experience and links to teaching in regard to the subject. Guiding programs of the career of nursing training were analyzed. This analysis gave the possibility to appreciate important aspects, such as the work with the family of disabled children, and management procedures in their home, which are not the object of study in the career. A curricular strategy was designed taking into account the educational objectives to be fulfilled with the proposed modifications. It is necessary to include those aspects related to this complex subject in the programs. To continue developing strategies that allow improving the educational teaching process and ensuring the quality of graduated students represents a challenge to the University. (shrink)

RESUMEN La discapacidad que afecta a la población infantil constituye un problema emergente; diagnosticarla y tratarla de manera integral es parte del trabajo diario del profesional de Enfermería en la atención primaria de salud. Durante el estudio se identificaron carencias en las habilidades profesionales de los licenciados en Enfermería respecto a este saber. Se aplicó un entrenamiento encaminado al desarrollo de habilidades profesionales especializadas para la atención integral a la discapacidad infantil en este personal. Por ello el objetivo del presente (...) trabajo está dirigido a exponer los resultados del entrenamiento. Los métodos y técnicas empleados incluyeron la observación científica, encuesta, entrevista, la técnica de grupo focal y el criterio de expertos. El entrenamiento se sometió al criterio de expertos. Se corroboró su impacto positivo como una vía importante para la preparación y desarrollo de habilidades profesionales en la muestra seleccionada. ABSTRACT The disability that affects the children population constitutes an emergent problem; to diagnose it and to treat it as an integral way is a part of the daily work of the professional of Infirmary in the primary health care. During the study, lacks in the professional skills of the Bachelors of Infirmary with regard to this know ledge were identified. There was applied a training directed to the development of specialized professional skills for the integral attention to the infant disability in this personnel. That is why the objective of the present work is directed to exhibit the results of the training. The methods and techniques used included the scientific observation, polls, interviews, the technique of focal group and the experts' criteria. The training was surrendered to the experts' criteria. It was corroborated its positive impact as an important route for the preparation and development of professional skills in the chosen sample. (shrink)

BackgroundRespect for confidentiality is important to safeguard the well-being of patients and ensure the confidence of society in the doctor-patient relationship. The aim of our study is to examine real situations in which there has been a breach of confidentiality, by means of direct observation in clinical practice.MethodsBy means of direct observation, our study examines real situations in which there has been a breach of confidentiality in a tertiary hospital. To observe and collect data on these situations, we recruited students (...) enrolled in the Medical Degree Program at the University of Cordoba. The observers recorded their entries on standardized templates during clinical internships in different departments: Internal Medicine; Gynecology and Obstetrics; Pediatrics; Emergency Medicine; General and Digestive Surgery; Maxillofacial Surgery; Plastic Surgery; Orthopedics and Traumatology; Digestive; Dermatology; Rheumatology; Mental Health; Nephrology; Pneumology; Neurology; and Ophthalmology.ResultsFollowing 7138 days and 33157 h of observation, we found an estimated Frequency Index of one breach per 62.5 h. As regards the typology of the observed breaches, the most frequent were related to the consultation and/or disclosure of clinical and/or personal data to medical personnel not involved in the patient’s clinical care, as well as people external to the hospital. As regards their severity, severe breaches were the most frequent, accounting for 46.7 % of all incidents. Most of the reported incidents were observed in public areas, such as corridors, elevators, the cafeteria, stairs, and locker rooms.ConclusionsIn addition to aspects related to hospital organization or infrastructure, we have shown that all healthcare personnel are involved in confidentiality breaches, especially physicians. While most are committed unintentionally, a non-negligible number are severe, repeated breaches, thus suggesting a certain carelessness, perhaps through ignorance about certain behaviors that can jeopardize patient confidentiality. (shrink)

In recent years, supported by new scientific evidence, the conceptualization of cognitive reserve has been progressively enriched and now encompasses not only cognitive stimulating activities or educational level, but also lifestyle activities, such as leisure physical activity and socialization. In this context, there is increasing interest in understanding the role of psychological factors in brain health and cognitive functioning. In a previous study, we have found that these factors mediated the relationship between CR and self-reported cognitive functioning. In this study, (...) we have confirmed an association between two important constructs included in the psychological wellbeing and salutogenic models, “purpose in life” and “sense of coherence,” CR, as assessed using a questionnaire, and cognitive functioning, as evaluated using a comprehensive neuropsychological battery. Results from 888 middle-aged healthy participants from the Barcelona Brain Health Initiative indicate that both sense of coherence and CR were positively associated with verbal memory, reasoning and attention, working memory, and global cognition. Moreover, the relation between CR and cognitive functioning in the different domains is partially mediated by SoC. When we controlled for brain integrity, introducing into the model neurofilament light chain measures, the mediator role of SoC was confirmed for reasoning and attention and global cognition. However, purpose in life was not associated with cognitive functioning. These results reveal the central role of the SoC construct, which mediates the association between classic CR estimates and cognitive functions, potentially representing a modifiable target for interventions that aim to promote brain health. (shrink)

It is a matter of fact that Europe is facing more and more crucial challenges regarding health and social care due to the demographic change and the current economic context. The recent COVID-19 pandemic has stressed this situation even further, thus highlighting the need for taking action. Active and Assisted Living technologies come as a viable approach to help facing these challenges, thanks to the high potential they have in enabling remote care and support. Broadly speaking, AAL can be referred (...) to as the use of innovative and advanced Information and Communication Technologies to create supportive, inclusive and empowering applications and environments that enable older, impaired or frail people to live independently and stay active longer in society. AAL capitalizes on the growing pervasiveness and effectiveness of sensing and computing facilities to supply the persons in need with smart assistance, by responding to their necessities of autonomy, independence, comfort, security and safety. The application scenarios addressed by AAL are complex, due to the inherent heterogeneity of the end-user population, their living arrangements, and their physical conditions or impairment. Despite aiming at diverse goals, AAL systems should share some common characteristics. They are designed to provide support in daily life in an invisible, unobtrusive and user-friendly manner. Moreover, they are conceived to be intelligent, to be able to learn and adapt to the requirements and requests of the assisted people, and to synchronise with their specific needs. Nevertheless, to ensure the uptake of AAL in society, potential users must be willing to use AAL applications and to integrate them in their daily environments and lives. In this respect, video- and audio-based AAL applications have several advantages, in terms of unobtrusiveness and information richness. Indeed, cameras and microphones are far less obtrusive with respect to the hindrance other wearable sensors may cause to one’s activities. In addition, a single camera placed in a room can record most of the activities performed in the room, thus replacing many other non-visual sensors. Currently, video-based applications are effective in recognising and monitoring the activities, the movements, and the overall conditions of the assisted individuals as well as to assess their vital parameters. Similarly, audio sensors have the potential to become one of the most important modalities for interaction with AAL systems, as they can have a large range of sensing, do not require physical presence at a particular location and are physically intangible. Moreover, relevant information about individuals’ activities and health status can derive from processing audio signals. Nevertheless, as the other side of the coin, cameras and microphones are often perceived as the most intrusive technologies from the viewpoint of the privacy of the monitored individuals. This is due to the richness of the information these technologies convey and the intimate setting where they may be deployed. Solutions able to ensure privacy preservation by context and by design, as well as to ensure high legal and ethical standards are in high demand. After the review of the current state of play and the discussion in GoodBrother, we may claim that the first solutions in this direction are starting to appear in the literature. A multidisciplinary debate among experts and stakeholders is paving the way towards AAL ensuring ergonomics, usability, acceptance and privacy preservation. The DIANA, PAAL, and VisuAAL projects are examples of this fresh approach. This report provides the reader with a review of the most recent advances in audio- and video-based monitoring technologies for AAL. It has been drafted as a collective effort of WG3 to supply an introduction to AAL, its evolution over time and its main functional and technological underpinnings. In this respect, the report contributes to the field with the outline of a new generation of ethical-aware AAL technologies and a proposal for a novel comprehensive taxonomy of AAL systems and applications. Moreover, the report allows non-technical readers to gather an overview of the main components of an AAL system and how these function and interact with the end-users. The report illustrates the state of the art of the most successful AAL applications and functions based on audio and video data, namely lifelogging and self-monitoring, remote monitoring of vital signs, emotional state recognition, food intake monitoring, activity and behaviour recognition, activity and personal assistance, gesture recognition, fall detection and prevention, mobility assessment and frailty recognition, and cognitive and motor rehabilitation. For these application scenarios, the report illustrates the state of play in terms of scientific advances, available products and research project. The open challenges are also highlighted. The report ends with an overview of the challenges, the hindrances and the opportunities posed by the uptake in real world settings of AAL technologies. In this respect, the report illustrates the current procedural and technological approaches to cope with acceptability, usability and trust in the AAL technology, by surveying strategies and approaches to co-design, to privacy preservation in video and audio data, to transparency and explainability in data processing, and to data transmission and communication. User acceptance and ethical considerations are also debated. Finally, the potentials coming from the silver economy are overviewed. (shrink)

The diagnosis of idiopathic short stature refers to children who are considerably shorter than average without any identified medical reason. The US Food and Drug Administration authorised marketing of recombinant human growth hormone for ISS in 2003, while the European Medicines Agency refused it in 2007. This paper examines the arguments for these decisions as detailed in selected FDA and EMA documents. It combines argumentative analysis with an approach to policy analysis called ‘What’s the problem represented to be’. It argues (...) that the FDA presents its approval as an argument for equity of access to the treatment, describing short stature as a potential disadvantage, and assuming that height normalisation is a clinically meaningful result. The EMA, instead, refuses marketing authorisation with an argument that there is an imbalance of risks and benefits, describing ISS as a healthy condition, and arguing that hGH should provide some psychosocial and/or quality of life benefits to children with ISS other than height gain. This paper then discusses how these arguments could be read through different models of disability, particularly through the medical model of disability and the relational, experiential, and cultural understandings of disability. (shrink)

This study explores the intra-organizational antecedents of sustainable governance by examining the impact of female presence at the corporate apex. Drawing upon the upper echelon theory, we investigate whether women in top positions influence sustainable governance practices. Our research focuses on a sample of companies operating within two distinct market economies: liberal market economies (LMEs) and coordinated market economies (CMEs). The United States, represented by the S&P100, and the United Kingdom, represented by the FTSE100, serve as examples of LMEs. Conversely, (...) Germany (DAX30), France (CAC40), Spain (IBEX35), and Switzerland (SMI) are illustrative of CMEs. Analyzing archival data spanning from 2010 to 2019, we confirm that the presence of a critical mass of women on the board of directors significantly increases the likelihood of establishing a sustainability committee within organizations. This relationship holds true across both LMEs and CMEs, highlighting the universal importance of gender diversity in driving sustainable governance initiatives. Interestingly, we observe that the impact of women with structural power on sustainability committee formation is specific to LMEs, suggesting the context-dependent nature of female leadership in sustainable governance. (shrink)

Most studies investigating the relationship between cultural constructs and ethical perception have focused on individual- and societal-level values without much attention to other type of cultural constructs such as social beliefs. In addition, we need to better understand how social beliefs are linked to ethical perception and the level of analysis at which social beliefs may best predict ethical perceptions. This research contributes to the cross-cultural ethical perception literature by examining the relationship of individual-level social cynicism belief, one of five (...) universally endorsed social beliefs, together with individual social dominance orientation and the perception of unethical behavior. By means of two studies, we examine these relationships across societies that significantly differ on societal-level social cynicism belief. Using 371 business students from Russia and the U.S. in Study 1 and 268 professionals from Portugal and the U.S. in Study 2, we found that individual-level social cynicism belief was positively associated with social dominance orientation. Social dominance orientation, in turn, mediated the relationship between individual social cynicism belief and the perception of unethical behavior. Although we found significant societal-level differences in social cynicism belief in both studies, the relationships between individual-level social cynicism belief, social dominance orientation, and the perception of unethical behavior were structurally equivalent across societies in both studies, suggesting that societal-level differences did not significantly affect these relationships. Implications for cross-cultural business ethics research and practice are discussed. (shrink)

In the ongoing pandemic, death statistics influence people’s feelings and government policy. But when does COVID-19 qualify as the cause of death? As philosophers of medicine interested in conceptual clarification, we address the question by analyzing the World Health Organization’s rules for the certification of death. We show that for COVID-19, WHO rules take into account both facts and values.

La filosofía tiene una tarea fundamental que es dialogar y pensar sobre algo particular, la moda es uno de ellos; tiene un tiempo, un espacio y un lugar en el que se despliega, en la base de su estructura está la exclusión social y tiene como fin la hiperrealidad. Esto es posible analizarlo bajo la mira de distintos autores como Walter Benjamin, Georg Simmel, Jean Baudrillard, los cuales me permiten visibilizar algunos elementos de la moda que perduran en el modo (...) en el que vivimos cotidianamente. (shrink)

The general definition of mental disorder stated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders seems to identify a mental disorder with a harmful dysfunction. However, the presence of distress or disability, which may be bracketed as the presence of harm, is taken to be merely usual, and thus not a necessary requirement: a mental disorder can be diagnosed as such even if there is no harm at all. In this paper, we focus on the (...) harm requirement. First, we clarify what it means to say that the harm requirement is not necessary for defining the general concept of mental disorder. In this respect, we briefly examine the two components of harm, distress and disability, and then trace a distinction between mental disorder tokens and mental disorder types. Second, we argue that the decision not to regard the harm requirement as a necessary criterion for mental disorder is tenable for a number of practical and theoretical reasons, some pertaining to conceptual issues surrounding the two components of harm and others pertaining to the problem of false negatives and the status of psychiatry vis-à-vis somatic medicine. However, we believe that the harm requirement can be maintained among the specific diagnostic criteria of certain individual mental disorders. More precisely, we argue that insofar as the harm requirement is needed among the specific diagnostic criteria of certain individual mental disorders, it should be unpacked and clarified. (shrink)

El artículo tiene como objetivo fundamental presentar el concepto de repetición bajo tres aspectos. El primero es su ubicación en el contexto de la existencia individual; el segundo, su carácter de exigencia de búsqueda de la libertad; y, finalmente, la consideración de la repetición como acontecimiento de la existencia. El recorrido del artículo revela así el tránsito que se emprende desde la importancia de la figura del lector en su profunda soledad; lector de la vida, de la prueba, de la (...) circunstancia, de lo ineludible; hasta la revelación de la existencia revestida en un acto mimético. Este recorrido aparece evidenciado porque se pone de relieve la preocupación humana no sólo por la existencia, sino por el sentido que ella adquiere frente a la posibilidad del mal desde lo particular, desde lo individual. En este orden de ideas, tras un seguimiento del concepto de repetición se pretende hacer evidente un interés que puede llamarse interés existencial y por ello filosófico: volver la cara hacia el individuo. (shrink)

This study sets out the main points in Leonardo Polo’s theory of moral development, which systematically articulates goods, norms, and virtues. To make them easier to understand, each point has been compared with Kohlberg’s theory of moral development, which is well known to specialists and radically different to it. We have chosen three aspects of Kohlberg’s theory of moral development to highlight the uniqueness of Polo’s theory: a) Kohlberg does not account for the specificity of voluntary acts, particularly the act (...) of deciding; b) The options that solve Kohlberg’s dilemmas are isolated from potential prior and subsequent decisions, so his moral development ignores any internal biographical storyline to the decisions themselves; and c) The Kohlbergian morality is an ethics of justice and duty, thereby relegating the friendship, which to Polo is the culmination of ethics, to a morally irrelevant level. (shrink)

Este artículo trata de mostrar el espíritu más agustiniano y humanista de la fenomenología de Husserl, que ahonda en la subjetividad humana buscando un sentido no mundano a su existencia. Con el fin de destacar este aspecto de la filosofía de Husserl se establece una comparación entre la reducción fenomenológica transcendental y el método conocido como «vichara», enseñado por los maestros de la escuela advaita de la India.

Background Only a few studies have been conducted to assess physicians’ knowledge of legal standards. Nevertheless, prior research has demonstrated a dearth of medical law knowledge. Our study explored physicians’ awareness of legal provisions concerning informed consent and confidentiality, which are essential components of the physician-patient relationship of trust. -/- Methods A cross-sectional study assessed attending physicians’ legal knowledge of informed consent and confidentiality regulations. The study was conducted in nine hospitals in Dolj County, Romania. Physicians were given a questionnaire (...) with ten scenarios and instructed to select the response that best reflected their practice. We assessed the responses of physicians who claimed their practice to be entirely legal. Their legal knowledge was evaluated by comparing their answers to applicable laws. We also calculated a score for the physicians who admitted to committing a legal breach. -/- Results Of the 305 respondents, 275 declared they never committed any law violation. However, their median correct answer score was 5.35 ± 1.66 out of 10. The specialty was the strongest predictor of legal knowledge, with emergency physicians rating the lowest and non-surgical physicians scoring the highest. Physicians who worked in both private and public sectors were better knowledgeable about legal issues than those who worked exclusively in the public sector. Results indicate that physicians are aware of the patient’s right to informed consent but lack comprehensive understanding. While most physicians correctly answered simple questions, only a tiny minority identified the correct solution when confronted with ethical dilemmas. The physicians who acknowledged breaching the law, on the other hand, had a slightly higher knowledge score at 5.45 ± 2.18. -/- Conclusion Legal compliance remains relatively low due to insufficient legal awareness. Physicians display limited awareness of legal requirements governing patient autonomy, confidentiality, and access to health data. Law should be taught in all medical schools, including undergraduate programs, to increase physicians’ legal knowledge and compliance. (shrink)

Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease and for who may be accorded the social privileges and personal responsibilities associated with being sick. In this article, we consider an ideal diagnostic test for coronavirus disease 2019 infection with respect to four groups of people—positive and asymptomatic; positive and symptomatic; negative; and (...) untested—and show how different concepts of disease impact on the disease and sickness judgements for these groups. The suggestion is that sickness judgements and social measures akin to those experienced during the current COVID-19 outbreak presuppose a concept of disease containing social harm as a component. We indicate the problems that arise when adopting this kind of disease concept beyond a state of emergency. (shrink)

Esses escritos compartilham experiências de entrada em campo etnográfico com pesquisas com crianças ciganas do acampamento Mathias, no município de Quissamã, estado do Rio de Janeiro. O estudo, ainda em andamento, se justifica pela urgência em respeitar o povo cigano e compreender suas demandas. Pretendemos também, como nossa pesquisa e através de nossa fotoetnografia miúda, ampliar espaços nos chamados Estudos das Infância. Urge que os grupos ciganos sejam vistos pelos seus valores, seus modos de vida e suas narrativas, incluindo as (...) narrativas das crianças. (shrink)

Reason and rationality represent crucial elements of the self-image of human beings and have unquestionably been among the most debated issues in Western philosophy, dating from ancient Greece, through the Middle Ages, and to the present day. Many words and thoughts have already been spent trying to define the nature and standards of reason and rationality, what they could or ought to be, and under what conditions something can be said to be rational. This volume focuses instead on the relationships (...) of reason and rationality to some relevant specific topics, i.e., science, knowledge, gender, politics, ethics, religion, aesthetics, language, logic, and metaphysics, trying to uncover and clarify both the connections and differences in their various characterisations and uses. (shrink)

Qual é o objeto da lógica? Seria a arte de bem conduzir o discurso? Mas conduzí-lo para onde, com que finalidade? Haveria uma normatividade independente, que definisse o racional independente do real? É Lacan que pergunta e nos responde no sem. XIX: “eu proponho definir o objeto da lógica como aquilo que produz a necessidade de um discurso. E afirmo que o simbólico, o imaginário e o real se afirmam nos impasses da lógica. ” (LACAN, 2011, p. 40). Muitos comentadores (...) encaram os recursos lógicos de Lacan como uma provocação, mas entendo que não, pois são muito coerentes com seus princípios, tanto lógicos, quanto linguísticos, antropológicos e principalmente matemáticos. (shrink)

Most of the epidemiological models of the Covid-19 pandemic contain the reproduction number as a parameter. In this article we focus on some shortcomings regarding its role in driving health policies and political decisions. First, we summarize what R is and what it is used for. Second, we introduce a three-question matrix for the evaluation of any construct or parameter within a model. We then review the main literature about R to highlight some of its shortcomings and apply to them (...) our three-question matrix. Finally, we argue that these shortcomings are important for an epistemic and political evaluation of R. (shrink)

In 2003, the Food and Drug Administration approved the use of growth hormone treatment for idiopathic short stature children, i.e. children shorter than average due to an unknown medical cause. Given the absence of any pathological conditions, this decision has been contested as a case of medicalisation. The aim of this paper is to broaden the debate over the reasons for and against the treatment, to include considerations of the sociocultural phenomenon of the medicalisation of short stature, by means of (...) a critical understanding of the concept of medicalisation. After defining my understanding of medicalisation and describing both the treatment and the condition of idiopathic short stature, I will problematise two fundamental issues: the medical/non-medical distinction and the debate about the goals of medicine. I will analyse them, combining perspectives of bioethics, medical sociology, philosophy of medicine and medical literature, and I will suggest that there are different levels of normativity of medicalisation. Ultimately, this study shows that: the definition of idiopathic short stature, focusing only on actual height measurement, does not provide enough information to assess the need for treatment or not; the analysis of the goals of medicine should be broadened to include justifications for the treatment; the use of growth hormone for idiopathic short stature involves strong interests from different stakeholders. While the treatment might be beneficial for some children, it is necessary to be vigilant about possible misconduct at different levels of medicalisation. (shrink)

Background: The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses’ involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of (...) a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. Objective: To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. Research design: Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. Participants and research context: Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse’s experience in exercising autonomy relating to end-of-life decision-making. Ethical considerations: Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. Findings: The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. Conclusion: Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude that inserts them into the decision-making process. (shrink)

Exemplos, relatos e anedotas históricas são recorrentes nos Ensaios e revelam a maneira original de Montaigne se apropriar da história: como estudo do passado e das ocorrências particulares; como alimento moral; como referência fictícia ou real; através da relação da história com a retórica e a prova argumentativa; como história contemporânea e a crítica da mentalidade cultural; como história de vida. Em todas essas articulações da narrativa histórica, que podemos sintetizar ao modo de uma conversação com os homens do passado (...) e do presente, encontramos o alvo de Montaigne: ir das ações às intenções, do outro para o conhecimento de si, do diverso para o discernimento. A história, sobretudo aquela à maneira plutarquiana, constitui matéria prima indispensável para o exercício do julgamento de Montaigne. Examples, reports and historical anecdotes are not hard to find in Les Essais and reveal Montaigne's original way of approaching history: as a study of the past and particular events; as moral nourishment; as fictitious or real reference; by relating history to rhetoric and argumentative proof; as contemporary history and criticism of cultural mentality; as life story. In all these articulations of historical narrative, which we can synthesize as a conversation with men of the past and present time, we find Montaigne's target: to go from actions to intentions, from the other to the knowledge of oneself, from diversity to discernment. History, mainly the one that follows Plutarch's style, composes the raw material indispensable to Montaigne's exercise of judgment. (shrink)