Background Continued advances in human microbiome research and technologies raise a number of ethical, legal, and social challenges. These challenges are associated not only with the conduct of the research, but also with broader implications, such as the production and distribution of commercial products promising maintenance or restoration of good physical health and disease prevention. In this article, we document several ethical, legal, and social challenges associated with the commercialization of human microbiome research, focusing particularly on how this research is (...) mobilized within economic markets for new public health uses. Methods We conducted in-depth, semi-structured interviews (2009–2010) with 63 scientists, researchers, and National Institutes of Health project leaders (“investigators”) involved with human microbiome research. Interviews explored a range of ethical, legal, and social dimensions of human microbiome research, including investigators’ perspectives on commercialization. Using thematic content analysis, we identified and analyzed emergent themes and patterns. Results Investigators discussed the commercialization of human microbiome research in terms of (1) commercialization, probiotics, and issues of safety, (2) public awareness of the benefits and risks of dietary supplements, and (3) regulation. Conclusion The prevailing theme of ethical, legal, social concern focused on the need to find a balance between the marketplace, scientific research, and the public’s health. The themes we identified are intended to serve as points for discussions about the relationship between scientific research and the manufacture and distribution of over-the-counter dietary supplements in the United States. (shrink)

MOHAMMED SA, WALTERS KL, LAMARR J, EVANS‐CAMPBELL T and FRYBERG S. Nursing Inquiry 2012; 19: 116–127 [Epub ahead of print]Finding middle ground: negotiating university and tribal community interests in community‐based participatory researchCommunity‐based participatory research (CBPR) has been hailed as an alternative approach to one‐sided research endeavors that have traditionally been conducted on communities as opposed to with them. Although CBPR engenders numerous relationship strengths, through its emphasis on co‐sharing, mutual benefit, and community capacity building, it is often challenging as well. (...) In this article, we describe some of the challenges of implementing CBPR in a research project designed to prevent cardiovascular disease among an indigenous community in the Pacific Northwest of the United States and how we addressed them. Specifically, we highlight the process of collaboratively constructing a Research Protocol/Data Sharing Agreement and qualitative interview guide that addressed the concerns of both university and tribal community constituents. Establishing these two items was a process of negotiation that required: (i) balancing of individual, occupational, research, and community interests; (ii) definition of terminology (e.g., ownership of data); and (iii) extensive consideration of how to best protect research participants. Finding middle ground in CBPR requires research partners to examine and articulate their own assumptions and expectations, and nurture a relationship based on compromise to effectively meet the needs of each group. (shrink)

The article shows a comparison between two ideas or ‘models' of community, Tönnies Gemeinschaft, reworked by Schmitt, and the Latin American indigenous peoples' Comunidad. A comparison that starts from the respective origin myths and arrives at the reflections on the subject of rights and freedoms that these narratives still produce today, in contemporary intercultural societies. The study focuses in particular on how the element of identity and belonging to a community can be used to motivate policies and laws oriented to (...) the exclusion or inclusion, to discrimination or emancipation. (shrink)

KEY POINTS In Canada, commercial data brokers collect deidentified patient data from pharmacies, private drug insurers, the federal government and medical clinics without patient consent. Although pharmaceutical companies are the data brokers’ primary customers, academics and nonprofit and public entities also use commercial data sets, given the absence of a coordinated public approach to collecting these data across Canada. Risks of commercialized patient data include loss of anonymity, surveillance and marketing, discrimination and violation of Indigenous data sovereignty. Coordinated infrastructure for (...) the collection and coordination of health data across Canada and updated privacy legislation would protect individuals and communities and enable appropriate data uses. (shrink)

A growing literature examines the organizational factors that promote women’s access to positions of organizational power. Fewer studies, however, explore the implications of women in leadership positions for the opportunities and experiences of subordinates. Do women leaders serve to undo the gendered organization? In other words, is women’s greater representation in leadership positions associated with less gender segregation at lower organizational levels? We explore this question by drawing on Cohen and Huffman’s conceptual framework of women leaders as either “change agents” (...) or “cogs in the machine” and analyze a unique multilevel data set of workplaces nested within Fortune 1000 firms. Our findings generally support the “agents of change” perspective. Women’s representation among corporate boards of directors, corporate executives, and workplace managers is associated with less workplace gender segregation. Hence, it appears that women’s access to organizational power helps to undo the gendered organization. (shrink)

Inside this complete guide you will find: A guide to facilitate conversation with your family; How to create peace when war has been declared on your body; How to alleviate pain and suffering; How to choose your own end; How to use the dying process as a mechanism for personal and family growth. Filled with inspirational and helpful stories, Mortal Dilemmas... is a book that not only will prepare you for the inevitable, but will also give you a sense of (...) satisfaction and control."--P. [4] of cover. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

This article explores how ethics and religion interface in everyday life by drawing on a study examining the negotiation of religious and spiritual plurality in health care. Employing methods of critical ethnography, namely, interviews and participant observation, data were collected from patients, health care providers, administrators and spiritual care providers. The findings revealed the degree to which `lived religion' was intertwined with `lived ethics' for many participants; particularly for people from the Sikh faith. For these participants, religion was woven into (...) everyday life, making distinctions between public and private, secular and sacred spaces improbable. Individual interactions, institutional resource allocation, and social discourses are all embedded in social relationships of power that prevent religion from being a solely personal or private matter. Strategies for the reintegration of religion into nursing ethics are: adjusting professional codes and theories of ethics to reflect the influence of religion; and the contribution of critical perspectives, such as postcolonial feminism, to the understanding of lived ethics. (shrink)

IVF as lottery or investment: contesting metaphors in discourses of infertilityThis paper reports an aspect of a poststructural feminist study in which I explored the discursive formations within which women for whom in vitro fertilisation (IVF) was unsuccessful constitute themselves. In my exploration I draw on data from interviews with women who discontinued infertility treatment, print media material and infertility self‐help books. Specifically, I highlight a metaphor of lottery in discourses of infertility, arguing that it is hegemonic and showing how (...) when women are situated as gamblers, the metaphor is instrumental in polarising them into ‘winners’ or ‘losers’ in relation to the subjectivity of motherhood. I further deconstruct these subjectivities, showing how ‘winners’ are valorised and ‘losers’ are pathologised. But importantly, I show how infertile women who are not mothers resisted locating themselves as ‘losers’ in a metaphor of lottery and instead situated themselves in a contesting metaphor of investment as diligent ‘workers’ and as active agents in choosing the best employment of their bodily and monetary resources. This paper therefore amplifies the marginalised perspective of infertile women who are not mothers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:One Parable, Two Interpretations:Pope Francis and William Langland on the Good Samaritan*Sheryl OvermyerInterpretations of the parable of the Good Samaritan (Luke 10:25–37) focus on its theology, ethics, ecclesiology, and even moral psychology. The parable has much to say regarding holiness. It treats how to become holy and distinct acts of holiness, the exemplar of holiness, and the reality and effects of sin. In the history of interpretation, the (...) parable is taken to offer a model of the relationship between the fallen man and grace, the devil and the garment of virtue, the law and love, Christ and the Church. In short, the parable allegorizes salvation history.1I focus conversation about this parable through two interpretations-Pope Francis's Fratelli Tutti [FT], promulgated October 3, 2020, and William Langland's Piers Plowman [PP] circulating circa 1380. Some might hold that Francis's interpretation of the parable is ethical while Langland's is theological.2 Both interpretations of the parable are works of moral theology that intimate distinct understandings of what it means to embody [End Page 541] the Gospel and answer the universal call to holiness. In this essay, I outline the parable of the Good Samaritan as treated in Fratelli Tutti and Piers Plowman (first section), compare the major figures of the parable (second section), and compare their visions of charity (third section). In sum, I argue the encyclical sidelines crucial elements in the medieval figuration of the parable. Pope Francis elides critical issues of sin, agency, Christology, and the Church traditionally associated with this parable—all center on the Samaritan as Christ.Two Interpretations in OutlineFratelli Tutti's Parable of the Good SamaritanPope Francis's third encyclical, Fratelli Tutti, is unique in its genre. The encyclical includes all brothers and sisters in its scope of fraternity and social friendship and is addressed to all (§1). The inspiration for the encyclical includes St. Francis's visit to the Sultan some eight hundred years ago and the 2019 Document on Human Fraternity for World Peace and Living Together, a statement signed by Pope Francis and Sheikh Ahmed el-Tayeb, Grand Imam of Al-Azhar. Indeed, the joint document plays a critical role in the encyclical, sharing a common framework of a doctrine of creation and doctrine of God (FT §5). Because Pope Francis includes all of humanity in the audience of this encyclical and its sources of inspiration are broadly humanitarian, it is fair to raise a question about distinctively Catholic elements to the encyclical.The encyclical chapter devoted to the parable of the Good Samaritan (chapter 2 [§§56–86], treating Luke 10:25–37) intensifies these theological questions. Just as the encyclical is "addressed to all people of good will, regardless of religious convictions," likewise the parable is of universal relevance as it "is one that any of us can relate to and find challenging" (§56). Francis's interpretation of the parable encapsulates Fratelli Tutti's themes.The subject of the parable is, according to Pope Francis, the age-old problem of neighborly love (§57).3 The parable involves several figures: the wounded man lying on the wayside, the robbers, the passers-by, and the Samaritan.4 The wounded are the subject of the encyclical's first chapter. Francis characterizes the wounded as those members of weaker and poorer regions whom the global economy exploits; the poor, disabled, and elderly [End Page 542] who seem no longer useful; children, women, and men of all ages who live under contemporary forms of slavery such as trafficking; and victims of economically driven violence including war, terrorist attacks, and racial and religious persecution (§§§ 12, 18, 24–25). Francis admits that we feel like the wounded, "helpless because our institutions are neglected and lack resources, or simply serve the interests of a few" (§76). However, the primary identification of the wounded focuses on those pushed to the margins by profit-driven economic, technologically progressive, politically divisive, dehumanizing global forces (§76 briefly suggests our identification with the injured man).The parable of the Good Samaritan brings these vast forces to bear our everyday relationships—we all experience an interior struggle when we encounter anyone who suffers (§69... (shrink)

Today's conversations in virtue ethics are enflamed with questions of “pagan virtues,” which often designate non-Christian virtue from a Christian perspective. “Pagan virtues,” “pagan vices,” and their historied interpretations are the subject of Jennifer Herdt's book Putting On Virtue: The Legacy of the Splendid Vices (2008). I argue that the questions and language animating Herdt's book are problematic. I offer an alternative strategy to Herdt's for reading Thomas Aquinas's Summa Theologiae. My results are twofold: (1) a different set of conclusions (...) and questions regarding the moral life that lend a fresh perspective to “pagan virtues” and (2) corresponding methodological suggestions for improving Herdt's project that would, to my mind, reaffirm her normative conclusions regarding the most viable ways forward for contemporary discussions of virtue. (shrink)

This article seeks to advance ethical dialogue on choosing standards of prevention in clinical trials testing improved biomedical prevention methods for HIV. The stakes in this area of research are high, given the continued high rates of infection in many countries and the budget limitations that have constrained efforts to expand treatment for all who are currently HIV-infected. New prevention methods are still needed; at the same time, some existing prevention and treatment interventions have been proven effective but are not (...) yet widely available in the countries where they most urgently needed. The ethical tensions in this field of clinical research are well known and have been the subject of extensive debate. There is no single clinical trial design that can optimize all the ethically important goals and commitments involved in research. Several recent articles have described the current ethical difficulties in designing HIV prevention trials, especially in resource limited settings; however, there is no consensus on how to handle clinical trial design decisions, and existing international ethical guidelines offer conflicting advice. This article acknowledges these deep ethical dilemmas and moves beyond a simple descriptive approach to advance an organized method for considering what clinical trial designs will be ethically acceptable for HIV prevention trials, balancing the relevant criteria and providing justification for specific design decisions. (shrink)

Abstract The aim of this paper is to examine the propaganda power of Madison’s Solidarity Sing-Along. To do so, I will modify the Epistemic Merit Model of propaganda so that it can account for a broader spectrum of propaganda. I will show how this is consistent with other accounts of musical pragmatics and the potential political function of songs and music. This will provide the ground for a robust interpretation of the political meanings of the Solidarity Sing-Along. I will assume (...) the Madison protests and the Solidarity Sing-Along can be considered a paradigm case of peaceful protest as it has been claimed that the Madison protest and the role of art within those protests set the stage for the Occupy Movement protests later in the same year. (shrink)

Socrates, Sports, and Students involves a philosophical justification for the inclusion of physical education in the school system. This book will appeal to physical educators and administrators interested in justifying their activity, as well as philosophers and professors in the areas of education and sport.

Socrates, Sports, and Students involves a philosophical justification for the inclusion of physical education in the school system. This book will appeal to physical educators and administrators interested in justifying their activity, as well as philosophers and professors in the areas of education and sport.

Examples of propaganda abound in contemporary society. Even though propaganda is increasingly prevalent in modern society, this phenomenon has received scant philosophical attention. This is particularly true of philosophy of art even as art, from posters and murals to films and novels, has been instrumental in the dissemination of propaganda. My dissertation develops a new model of propaganda to account for the phenomenon of art propaganda. I call this model the epistemic merit model, because I argue that propaganda essentially lacks (...) epistemic merit. ;My project proceeds in four parts: offer a diagnosis of why propaganda has virtually escaped philosophical scrutiny, survey the field of propaganda studies in the disciplines of sociology, social psychology, and communication theory, perform a conceptual analysis of propaganda, and show how my new model is particularly well-suited to cases of art propaganda. (shrink)

This paper challenges the traditional account of vulnerability in healthcare which conceptualizes vulnerability as a list of identifiable subpopulations. This list of ‘usual suspects’, focusing on groups from lower resource settings, is a narrow account of vulnerability. In this article we argue that in certain circumstances middle-class individuals can be also rendered vulnerable. We propose a relational and layered account of vulnerability and explore this concept using the case study of cord blood (CB) banking. In the first section, two different (...) approaches to ‘vulnerability’ are contrasted: categorical versus layered. In the second section, we describe CB banking and present a case study of CB banking in Argentina. We examine the types of pressure that middle-class pregnant women feel when considering CB collection and storage. In section three, we use the CB banking case study to critique the categorical approach to vulnerability: this model is unable to account for the ways in which these women are vulnerable. A layered account of vulnerability identifies several ways in which middle-class women are vulnerable. Finally, by utilizing the layered approach, this paper suggests how public health policies could be designed to overcome vulnerabilities. (shrink)

This chapter contains sections titled: Pregnancy and the First Noble Truth: Pain is Inevitable The Second Noble Truth: Pain Arises from Cravings and Attachment The Third Noble Truth: The End of Suffering is Possible, or How to Be a Feminist Buddhist Mommy Mommy Meditations Notes.

This paper reviews and augments important work in philosophy of education on intrinsic aims for education, of knowledge, of knowledge of values, and of rationality. A contemporary conception of knowledge as ``rationality's `data-base''' is proposed and an in-depth section on the intrinsic value of rationality is incorporated.

Nursing, with its socially embedded theory and practice, inevitably operates in the realm of power and politics. One of these political sites is that of religion, which to varying degrees continues to shape beliefs about health and illness, the delivery of healthcare services and the nurse–patient encounter. In this paper, I attempt to complicate nursing's views on religion and politics in healthcare, with the intent of thinking critically and philosophically about questions that arise at the intersection of religion, politics and (...) nursing/healthcare. These questions include the following: What is the domain of religion and politics? How (non)religious are the contemporary societies in which nurses practice? What are the variations and implications of secularism? How is religion entangled with other intersecting social relations of power? How does a political reading of religion and politics matter to the concerns of nursing? (shrink)

The introduction of genomics and biobanking methodologies to the African research context has also introduced novel ways of doing science, based on values of sharing and reuse of data and samples. This shift raises ethical challenges that need to be considered when research is reviewed by ethics committees, relating for instance to broad consent, the feedback of individual genetic findings, and regulation of secondary sample access and use. Yet existing ethics guidelines and regulations in Africa do not successfully regulate research (...) based on sharing, causing confusion about what is allowed, where and when. In order to understand better the ethics regulatory landscape around genomic research and biobanking, we conducted a comprehensive analysis of existing ethics guidelines, policies and other similar sources. We sourced 30 ethics regulatory documents from 22 African countries. We used software that assists with qualitative data analysis to conduct a thematic analysis of these documents. Surprisingly considering how contentious broad consent is in Africa, we found that most countries allow the use of this consent model, with its use banned in only three of the countries we investigated. In a likely response to fears about exploitation, the export of samples outside of the continent is strictly regulated, sometimes in conjunction with regulations around international collaboration. We also found that whilst an essential and critical component of ensuring ethical best practice in genomics research relates to the governance framework that accompanies sample and data sharing, this was most sparingly covered in the guidelines. There is a need for ethics guidelines in African countries to be adapted to the changing science policy landscape, which increasingly supports principles of openness, storage, sharing and secondary use. Current guidelines are not pertinent to the ethical challenges that such a new orientation raises, and therefore fail to provide accurate guidance to ethics committees and researchers. (shrink)

Illness and trauma challenge self-narratives. Traumatized individuals, unable to speak about their experiences, suffer in isolation. In this paper, I explore Kristeva’s theories of the speaking subject and signification, with its symbolic and semiotic modalities, to understand how a person comes to speak the unspeakable. In discussing the origin of the speaking subject, Kristeva employs Plato’s chora (related to choreo , “to make room for”). The chora reflects the mother’s preparation of the child’s entry into language and forms an interior (...) darkroom, the reservoir of lived experience, from which self-narratives issue. Unable to speak of their suffering, traumatized individuals need someone to help them make room for a time of remembrance, someone who is a willing and capable listener. I call such a person a healing witness . Through the mediating presence of the healing witness, fragmented memories of trauma are recreated and incorporated into self-narratives that are sharable with others. Unfortunately, opportunities for witnessing are vanishing. In the last section, I examine the failure of modern media and communication technologies to bear (“hold,” “carry,” “transport”) acts of witnessing. I argue that they perturb the semiotic. According to Kristeva, meaning arises from the dialectical tension between the semiotic (drives and affects) and the symbolic (logic and rules) and is threatened by arid discourse, psychosomatic illnesses, and outbreaks of violence when the semiotic is not represented . Unless we open technology to the imaginary, we risk losing the capacity to bear witness to one another and to create narratives and connections that are meaningful. (shrink)

As the demand for human eggs for stem cell research increases, debate about appropriate standards for recruitment and compensation of women intensifies. In the majority of cases, the source of eggs for research is women undergoing fertility treatment requiring ovarian stimulation and egg retrieval. The principle of "just participant selection" requires that research subjects be selected from the population that stands to benefit from the research. Based on this principle, infertile women should be actively recruited to donate eggs for fertility-related (...) research only. It is unethical to exclusively or predominantly recruit infertile women to donate eggs for stem cell research that concerns general medical conditions. It is preferable to recruit women from the general population to donate eggs for such research, and these women should be viewed as healthy volunteers. To avoid exploitation, these donors should receive compensation for both the direct and indirect costs associated with their donation. (shrink)

During the past several years, numerous studies have been conducted regarding advance directives for health care). Studies have examined how many individuals have executed advance directives, who is more likely to execute such directives, and whether factors such as education, income, race, religiosity, or family status affect the likelihood of having executed an advance directive or one's willingness to do so. Studies have also investigated the effectiveness of different educational strategies aimed at increasing the number of individuals who execute these (...) documents. Finally, a number of researchers have looked at the implementation of advance directives.Although we now have a better understanding of some of these issues, one area that has been virtually ignored is the reliability, validity, and overall user friendliness of the advance directive forms themselves, and, in particular, of the statutory advance directive forms. (shrink)

During the past several years, numerous studies have been conducted regarding advance directives for health care). Studies have examined how many individuals have executed advance directives, who is more likely to execute such directives, and whether factors such as education, income, race, religiosity, or family status affect the likelihood of having executed an advance directive or one's willingness to do so. Studies have also investigated the effectiveness of different educational strategies aimed at increasing the number of individuals who execute these (...) documents. Finally, a number of researchers have looked at the implementation of advance directives.Although we now have a better understanding of some of these issues, one area that has been virtually ignored is the reliability, validity, and overall user friendliness of the advance directive forms themselves, and, in particular, of the statutory advance directive forms. (shrink)

As the demand for human eggs for stem cell research increases, debate about appropriate standards for recruitment and compensation of women intensifies. In the majority of cases, the source of eggs for research is women undergoing fertility treatment requiring ovarian stimulation and egg retrieval. The principle of "just participant selection" requires that research subjects be selected from the population that stands to benefit from the research. Based on this principle, infertile women should be actively recruited to donate eggs for fertility-related (...) research only. It is unethical to exclusively or predominantly recruit infertile women to donate eggs for stem cell research that concerns general medical conditions. It is preferable to recruit women from the general population to donate eggs for such research, and these women should be viewed as healthy volunteers. To avoid exploitation, these donors should receive compensation for both the direct and indirect costs associated with their donation. (shrink)

As the demand for human eggs for stem cell research increases, debate about appropriate standards for recruitment and compensation of women intensifies. In the majority of cases, the source of eggs for research is women undergoing fertility treatment requiring ovarian stimulation and egg retrieval. The principle of “just participant selection” requires that research subjects be selected from the population that stands to benefit from the research. Based on this principle, infertile women should be actively recruited to donate eggs for fertility-related (...) research only. It is unethical to exclusively or predominantly recruit infertile women to donate eggs for stem cell research that concerns general medical conditions. It is preferable to recruit women from the general population to donate eggs for such research, and these women should be viewed as healthy volunteers. To avoid exploitation, these donors should receive compensation for both the direct and indirect costs associated with their donation. (shrink)

Although spiritual practices such as prayer are engaged by many to support well‐being and coping, little research has addressed nurses and prayer, whether for themselves or facilitating patients' use of prayer. We conducted a qualitative study to explore how prayer (as a proxy for spirituality and religion) is manifest—whether embraced, tolerated, or resisted—in healthcare, and how institutional and social contexts shape how prayer is understood and enacted. This paper analyzes interviews with 21 nurses in Vancouver and London as a subset (...) of the larger study. Findings show that nurses' kindness can buffer the loneliness and exclusion of ill health and in this way support the “spirit” of those in their care. Spiritual support for patients rarely incorporated prayer, in part because of ambiguities about permission and professional boundaries. Nurses' engagement with prayer and spiritual support could become a politicized site of religious accommodation, where imposition, religious illiteracy, and racism could derail person‐centered care and consequently enact social exclusion. Spiritual support (including prayer) sustained nurses themselves. We propose that nursing's equity‐oriented knowledge encompass spirituality and religion as sites of exclusion and inclusion. Nurses must be supported to move past religious illiteracy to provide culturally and spiritually sensitive care with clarity about professional boundaries and collaborative models of spiritual care. (shrink)

In this paper we comment on the changes in the provision of fertility care in Australia, New Zealand and the UK to illustrate how different funding arrangements of assisted reproductive technologies (ART) shape the delivery of patient care and the position of fertility nursing. We suggest that the routinisation of in vitro fertilisation technology has introduced a new way of managing the fertility patient at a distance, the distal fertility patient. This has resulted in new forms of organisational routines in (...) ART which challenge both traditional forms of nursing and advanced nursing roles. We discuss the consequences of this increasingly globalised approach to infertility through the lens of three national contexts, Australia, New Zealand and the UK to unpack the position of nursing within the new forms of organisational routines. (shrink)

In many parts of sub-Saharan Africa, mothers impacted by the genetic condition of albinism, whether as mothers of children with albinism or themselves with albinism, are disproportionately impacted by a constellation of health-related stigma, social determinants of health, and human rights violations. In a critical ethnographic study in Tanzania, we engaged with the voices of mothers impacted by albinism and key stakeholders to elucidate experiences of stigma. Their narratives revealed internalized subjective stigma, social stigma such as being ostracized by family (...) and community, and structural stigma on account of lack of access to SDH. An analysis of health systems as SDH revealed stigmatizing attitudes and behaviours of healthcare providers, especially at the time of birth; a lack of access to timely quality health services, in particular skin and eye care; and a lack of health-related education about the cause and care of albinism. Gender inequality as another SDH featured prominently as an amplifier of stigma. The findings pose implications for research, policy, and practice. A concrete avenue to de-stigmatization of mothers impacted by albinism exists by the application of principles of human rights, particularly equality and non-discrimination; contextual analysis of cultural dynamics including relevant ontology; meaningful participation of rights-claimants, such as peer groups of mothers; and accountability of governments and their obligation to ensure access to health information as a key social determinant of the right to health. (shrink)

REIMER‐KIRKHAM S, SHARMA S, PESUT B, SAWATZKY R, MEYERHOFF H and COCHRANE M. Nursing Inquiry 2012; 19: 202–212 Sacred spaces in public places: religious and spiritual plurality in health careSeveral intriguing developments mark the role and expression of religion and spirituality in society in recent years. In what were deemed secular societies, flows of increased sacralization (variously referred to as ‘new’, ‘alternative’, ‘emergent’ and ‘progressive’ spiritualities) and resurgent globalizing religions (sometimes with fundamentalist expressions) are resulting in unprecedented plurality. These shifts (...) are occurring in conjunction with increasing ethnic diversity associated with global migration, as well as other axes of difference within contemporary society. Democratic secular nations such as Canada are challenged to achieve social cohesion in the face of growing religious, spiritual and ethnic diversity. These challenges are evident in the high‐paced, demanding arena of Health care. Here, religious and spiritual plurality enter in, sometimes resulting in conflict between medical services and patients’ beliefs, other times provoking uncertainties on the part of healthcare professionals about what to do with their own religiously or spiritually grounded values and beliefs. In this paper, we present selected findings from a 3‐year study that examined the negotiation of religious and spiritual pluralism in Health care. Our focus is on the themes of ‘sacred’ and ‘place’, exploring how the sacred – that which is attributed as special and set apart as it pertains to the divine, transcendence, God or higher power – takes form in social and material spaces in hospitals. (shrink)

In this discourse analysis of how memory acquires and is acquired in interview exchanges, we investigate remembering as a category-bound activity, both a tensional and collaborative process of moral ratification of `survivor' as membership category. We propose the term re-membering to mean piecing together possible versions of survivor experiences in talk; these versions, offered by respondents and elicited by interviewers through questioning strategies, are epistemic claims to acquire the Holocaust as memory, or institutional History. We explore the accounting dynamic of (...) interviewer and respondent, the relationship of ownership between survivors and memory, and the duties and moral obligations of the category `Holocaust survivor' that can be shown through the interviews of survivors and their adult daughters. (shrink)

BackgroundLow literacy of study participants in Sub - Saharan Africa has been associated with poor comprehension during the consenting process in research participation. The concerns in comprehension are far greater when consenting to participate in genomic studies due to the complexity of the science involved. While efforts are made to explore possibilities of applying genomic technologies in diseases prevalent in Sub Saharan Africa, we ought to develop methods to improve participants’ comprehension for genomic studies. The purpose of this study was (...) to understand different approaches that can be used to seek consent from individuals with low literacy in Sub-Saharan African countries in genomic research to improve comprehension.MethodsUsing qualitative study design, we conducted focus-group discussions, in-depth interviews and participant observations as data collection methods. This study was embedded in a hospital based genomic study on Sickle Cell Disease at Muhimbili National Hospital in Tanzania. Thematic content analysis was used to analyse the transcripts and field notes.ResultsFindings from this study show that literacy level has little influence on understanding the research details. According to the participants of this study, the methods used to provide information, the language, and time spent with the study participants were the key factors influencing understanding. The availability of group sessions held before individual consent to allow for a detailed questions and answers format was agreed to be the best method to facilitate the comprehension.ConclusionThe quality of the consenting process of participants will be influence by a number of factors. The type of research consented for, where the research will be implemented and who are the potential study participants are amongst the factors that need to be assessed during the consenting. Measures to improve participants’ comprehension need to be developed when consenting participants with low literacy level in genomic studies. (shrink)

While for decades nursing has advocated for theory‐informed practice, more recent attention has tended to focus on mid‐range theory rather than the earlier focus on developing grand theory to encompass all of nursing practice. However, there has been continued interest in the holistic nursing community on grand theory and, in particular, on Integral Theory. Although Integral Theory's four‐quadrant (AQAL) perspective is familiar in nursing, little is known about how it is being used by nurses in direct practice. The purpose of (...) this interpretive descriptive study was to provide a practice‐based perspective on Ken Wilber's Integral Theory in professional nursing practice. The following research question was investigated: How does Integral Theory assist nurses in describing and understanding their professional work? Nurses participating in this study used Integral Theory as a map or heuristic that gave structure to an inquiry process in professional nursing practice and in nursing education in a manner that was holonic, multiperspectival, and self‐reflective. Challenges constraining nurses’ use of Integral Theory included its intricacy, as well as contextual factors in practice environments. Implications for nursing practice and education for the use of Integral Theory's meta‐framework are described. (shrink)

The first-order theory of the lattice of recursively enumerable closed subsets of an effective topological space is proved undecidable using the undecidability of the first-order theory of the lattice of recursively enumerable sets. In particular, the first-order theory of the lattice of recursively enumerable closed subsets of Euclidean n -space, for all n , is undecidable. A more direct proof of the undecidability of the lattice of recursively enumerable closed subsets of Euclidean n -space, n ⩾ 2, is provided using (...) the method of reduction and the recursive inseparability of the set of all formulae satisfiable in every model of the theory of SIBs and the set of all formulae refutable in some finite model of the theory of SIBs. (shrink)

Cultural safety is a relatively new concept that has emerged in the New Zealand nursing context and is being taken up in various ways in Canadian health care discourses. Our research team has been exploring the relevance of cultural safety in the Canadian context, most recently in relation to a knowledge-translation study conducted with nurses practising in a large tertiary hospital. We were drawn to using cultural safety because we conceptualized it as being compatible with critical theoretical perspectives that foster (...) a focus on power imbalances and inequitable social relationships in health care; the interrelated problems of culturalism and racialization; and a commitment to social justice as central to the social mandate of nursing. Engaging in this knowledge-translation study has provided new perspectives on the complexities, ambiguities and tensions that need to be considered when using the concept of cultural safety to draw attention to racialization, culturalism, and health and health care inequities. The philosophic analysis discussed in this paper represents an epistemological grounding for the concept of cultural safety that links directly to particular moral ends with social justice implications. Although cultural safety is a concept that we have firmly positioned within the paradigm of critical inquiry, ambiguities associated with the notions of 'culture', 'safety', and 'cultural safety' need to be anticipated and addressed if they are to be effectively used to draw attention to critical social justice issues in practice settings. Using cultural safety in practice settings to draw attention to and prompt critical reflection on politicized knowledge, therefore, brings an added layer of complexity. To address these complexities, we propose that what may be required to effectively use cultural safety in the knowledge-translation process is a 'social justice curriculum for practice' that would foster a philosophical stance of critical inquiry at both the individual and institutional levels. (shrink)