In the last decade, nurse scholars have focused extensively on the nature of nursing and its relationship to art and science. This emphasis has also been accompanied by an increasing literature on nursing ethics. In spite of this growing interest, the relationship of nursing art and nursing ethics has been left unclear. This paper proposes that nursing must be considered as a practical art because this conception explicates the relationship of nursing art and (...) nursing ethics. It is based on the thesis that nursing art is subordinated to nursing ethics and as such is a moral art. Different conceptions of nursing art (craft and fine art) will be explored to show their limits. This will be followed by the conception of nursing art as a practical art. (shrink)

This paper discusses a classic Aristotelian understanding of science, nature, and methods of inquiry and proof. It then discusses nursing as a practical science and provides some demonstrations through the application of classical methods. In the Aristotelian tradition an individual substance is a unity of form and matter: form being the intelligible universal that becomes the concept, while matter is the principle of individuation. Science is mediate intellectual causal knowledge. Inquiry uses hypothetical argument, and proof that is from (...) valid syllogistic reasoning with true premises provides necessity and certitude. This proof requires knowledge of the natural kind that gives origin to the attributes under investigation. The variability of nature is overcome by reasoning on the supposition of the end.Within the classical understanding of speculative and practical science, nursing is a practical science. As a science, nursing investigates the principles and causes of its subject, be that human beings, health or nursing behaviours as knowable nursing operations. The goal is knowledge of practice for the sake of practice, but nursing as a science is not operable. Nursing practice, that is nursing art or technologies, must complete the science. Reasoning on the supposition of the end, for example of cardiac compensation, allows one to identify necessary activities and physical states. Three causal demonstrations about decubiti show that demonstrations are possible. Classical science would teach us that the practical science of nursing studies human nature in order to identify principles and causes of health and principles and causes of nursing operations themselves. It also requires that the science ends in practical operation. Thus, proper decisions and individual actions in particular patient situations must complete nursing science. (shrink)

Accepted standards of parental decisional autonomy and child best interests do not address adequately the complex moral problems involved in the care of critically ill children. A growing body of moral discourse is calling for the recognition of `tragedy' in selected human problems. A tragic dilemma is an irresolvable dilemma with forced terrible alternatives, where even the virtuous agent inescapably emerges with `dirty hands'. The shift in moral framework described here recognizes that the form of conduct called for by tragic (...) dilemmas is the practice of phronesis. The phronetic agent has acquired a capacity to discern good agency in tragic circumstances. This discernment is practiced through the artful creation of moral narratives: stories that convey that which is morally meaningful in a particular situation; that is, stories that are `meaning making'. The phronetic agent addresses tragic dilemmas involving children as a narrator of contextualized temporal embodied human (counter)stories. (shrink)

BackgroundSerious ethical problems have been anecdotally identified in the care of children with osteogenesis imperfecta (OI), which may negatively impact their moral experiences, defined as their sense of fulfillment towards personal values and beliefs.Research aimsTo explore children’s actual and desired participation in discussions, decisions, and actions in an OI hospital setting and their community using art-making to facilitate their self-expression.Research designA focused ethnography was conducted using the moral experiences framework with data from key informant interviews; participant observations, semi-structured interviews, and (...) practice-based research (art-making) with 10 children with OI; and local documents.Participants and research contextThe study was conducted at a pediatric, orthopedic hospital.Ethical considerationsThis study was approved by McGill University Institutional Review Board.Findings/resultsChildren expressed desires to participate in their care, but sometimes lacked the necessary resources and encouragement from healthcare providers. Art-making facilitated children’s voice and participation in health-related discussions.ConclusionsHealthcare providers are recommended to consider the benefits of art-making and educational resources to reduce discrepancies between children’s actual and desired participation in care and promote positive moral experiences. (shrink)

Corporate and commercial values are inducing some healthcare organizations to prescribe a customer service model that reframes the provision of nursing care. In this paper it is argued that such a model is incommensurable with nursing conceived as a moral practice and ultimately places nurses at risk. Based upon understanding from ongoing research on compassion fatigue, it is proposed that compassion fatigue as currently experienced by nurses may not arise predominantly from too great a demand for compassion, but (...) rather from barriers to enacting compassionate care. These barriers are often systemic. The paradigm shift in which healthcare environments are viewed as marketplaces rather than moral communities has the potential to radically affect the evolution of nursing as a discipline. (shrink)

A collaborative undertaking between an artist and a philosopher, this monograph attempts to deepen our understanding of "contemplative seeing" by addressing the works of Plato, Thoreau, Heidegger, and more. The authors explore what it means to "see" reality and contemplate how viewing reality philosophically and artfully is a form of spirituality. In this way, by developing a new conception of active visual engagement, the authors propose a way of seeing that unites both critical scrutiny and spiritual involvement, as opposed to (...) simple passive reception. (shrink)

The spirit of nursing and its healing art: a Jungian perspectiveTimely change is in the air as interest grows in the riches of nursing literature and other creative arts of nursing. Using Jungian and sociological concepts, this article takes a personal look at the literature's contribution to the profession. As the image of contemporary nursing is redefined, the power of the creative is evident, both in its grounding effect on individual practice and its unifying and strengthening (...) potential for a changing profession. (shrink)

Collecting ethnographic items for the Estonian National Museum has been linked to the practice of buying objects during fieldwork. Often we can find metaphors or expressions connected with trading in the Komi fieldwork diaries. Comparing ethnographers with merchants is a stereotypical way of describing the activities of Estonian researchers in the field. If ethnographers use, in their diaries, metaphors and expressions connected to trading, it may be just a spontaneous phrasing or inter-textual play of words. Inside the community of Estonian (...) ethnologists there exists some kind of discourse style, which is followed in the fieldwork diaries, more or less consciously. This style of narration is also connected to the specific social and historical context in which ethnographers act. At the same time, even satiric inter-textual quotations do not exclude the possibility that some of this discourse is related to a deeper level of human consciousness. (shrink)

Collecting ethnographic items for the Estonian National Museum has been linked to the practice of buying objects during fieldwork. Often we can find metaphors or expressions connected with trading in the Komi fieldwork diaries. Comparing ethnographers with merchants is a stereotypical way of describing the activities of Estonian researchers in the field. If ethnographers use, in their diaries, metaphors and expressions connected to trading, it may be just a spontaneous phrasing or inter-textual play of words. Inside the community of Estonian (...) ethnologists there exists some kind of discourse style, which is followed in the fieldwork diaries, more or less consciously. This style of narration is also connected to the specific social and historical context in which ethnographers act. At the same time, even satiric inter-textual quotations do not exclude the possibility that some of this discourse is related to a deeper level of human consciousness. (shrink)

Background Making the right decisions, while simultaneously showing respect for patient autonomy, represents a great challenge to nursing home staff in the issues of life-prolonging treatment, hydration, nutrition and hospitalisation to dying patents in end-of-life. Objectives To study how physicians and nurses protect nursing home patients' autonomy in end-of-life decisions, and how they justify their practice. Design A qualitative descriptive design with analysis of the content of transcribed in-depth interviews with physicians and nurses. Participants Nine physicians and ten (...) nurses in 10 nursing homes in Norway. Results and interpretations Assessment of the patient's competence to consent to treatment is almost absent. The physicians build their practice on the principles of beneficence and nonmaleficence. Nurses tend to trust the patients' rejection of life support, even when the patients have difficulty speaking or suffer from dementia. Relatives were, according to the health personnel, included in decision-making processes to a very limited extent. However, futile life support is sometimes provided contrary to the physicians' judgement of what constitutes the patient's best interest on occasions when they are pressurised by next of kin. Conclusions The study reveals a need to improve decision-making routines according to ethical ideals and legislation. Conflicts between relatives and healthcare professionals in the decision-making process deflect the focus from searching for the best possible treatment for the terminal patient. Further discussion is required as to whether the concept of autonomy is applicable in situations in which the patient is impaired and dying. (shrink)

The increasing availability of passively observed data has yielded a growing interest in “data fusion” methods, which involve merging data from observational and experimental sources to draw causal conclusions. Such methods often require a precarious tradeoff between the unknown bias in the observational dataset and the often-large variance in the experimental dataset. We propose an alternative approach, which avoids this tradeoff: rather than using observational data for inference, we use it to design a more efficient experiment. We consider the case (...) of a stratified experiment with a binary outcome and suppose pilot estimates for the stratum potential outcome variances can be obtained from the observational study. We extend existing results to generate confidence sets for these variances, while accounting for the possibility of unmeasured confounding. Then, we pose the experimental design problem as a regret minimization problem subject to the constraints imposed by our confidence sets. We show that this problem can be converted into a concave maximization and solved using conventional methods. Finally, we demonstrate the practical utility of our methods using data from the Women’s Health Initiative. (shrink)

Moral strangerhood is due in part to competing worldviews. The profession of nursing is experiencing a paradigm shift which creates ethical dilemmas for both Christian nurses and Christian patients. Nursing's new focus on spirituality and spiritual care presents itself as broadly defining a desired state or patient outcome — spiritual integrity — supposed to be applicable to all patients of all faiths. Analysis of nursing's definition of spirituality reveals assumptions and values consistent with an Eastern/New Age worldview (...) which may cause hostility towards Christian patients stereotyped as dogmatic or noncompliant. (shrink)

Moral deliberation has been receiving more attention in nursing ethics. Several ethical conversation models have been developed. This article explores the feasibility of the so-called CARE (Considerations, Actions, Reasons, Experiences) model as a framework for moral deliberation in psychiatric nursing practice. This model was used in combination with narrative and dialogical approaches to foster discourse between various stakeholders about coercion in a closed admission clinic in a mental hospital in the Netherlands. The findings demonstrate that the CARE model (...) provides a substantial framework for structuring moral deliberations. Narratives and dialogue are useful tools for broadening issues in conversations, to engage various stakeholders (including patients), and to gain shared understandings. (shrink)

This article deals with nurses’ ethical concerns raised by the consequences of changes in governmental and institutional policies on nursing practice and patient care. The aims of this project were to explore perspectives of registered nurses who provide or manage direct patient care on policies that affect nursing and patient care, and to provide input to policy makers for the development of more patient-centred policies. Four focus groups were conducted with a total of 36 registered nurse participants. The (...) project team identified major themes that emerged in the analysis of transcripts of the focus group discussions. The four major themes were: effects of policy focused on cost containment, effects on quality of care, effects on patient education and access to needed services, and effects on nurses and nursing. The participants identified primarily negative effects of changes in national health policy and legislation that influence institutional policies on patient care and nursing practice. The effects of identified policy changes raised concerns about meeting nurses’ ethical obligations to patients and families. Participants specified key points for consideration by legislators and other policy makers. They viewed nurses who are involved in direct patient care as a critical resource for legislators and other policy makers in the development of public and institutional policies that affect nursing and patient care. (shrink)

The aspects of establishment of monosyllabism of the Turkic and Mongolian morpheme are directly connected with the characteristics regarding the dissoluble unit of mentioned root bases. In the present work the author uses the term ‘root bases‘ keeping in mind a big and transparent closeness of root morpheme to the base on the range of its features and structural accordance as in the Turkic as well as in Mongolian languages. As it is known in Turkic scientific researches in last two (...) decades of the leaving age division of monosyllabic root bases on to smaller lexical-grammatical ones are considered as relatively new statement of the problem that has been treated skeptically enough. The majority of scholars were convinced in the possibility of holding such operation of ‘splitting‘ for purposeful searching and ascertaining of convincing arguments. They came to conclusion that monosyllabic roofs represented the category of historical one. It is supposed that everything that nowadays has removed in the researched Turkic languages of Ural-Volga region into the ‘passive stock of lexical order‘ used to be active and viable. This phenomenon presents certain interest for studying the process of the historical development of root’s structure as in turkology, so in Altaic studies, in which all the researchers who systematically studied the structure of a root using big linguistic material recognize availability of ‘dead roots‘. At the same tune, some researchers consider ‘dead ones‘ those root elements that are not used in the linguistic practice self-dependently other ones the same root elements that cannot be removed from the derivative basis. (shrink)

Changes to practical nurse education (with expanded scopes of practice) align with the increasing need for nurses and assistive personnel in global acute care contexts. A case in point is this critical exploration of Canadian practical nursing literature, undertaken to reveal predominating discourses and relationships to nursing disciplinary knowledge. The objectives of this poststructural critical review were to identify dominant discourses in practical nurse education literature and to analyze these discourses to uncover underlying beliefs, constructed (...) truths, assumptions, ambiguities and sources of knowledge within the discursive landscape. Predominant themes in the discourses surrounding practical nurse education included conversations about the nurse shortage, expanded roles, collaboration, evidence‐based practice, role confusion, cost/efficiency, the history of practical nurse education and employer interests. The complex relationships between practical nursing and the disciplinary landscape of nursing are revealed in the analysis of discourses related to the purpose(s) of practical nurse education, curricula/educational programming, relationships between RN and PN education and the role of nursing knowledge. Power dynamics related to employer needs and interests, as well as educational silos and the nature of women's work, are also revealed within the intersection of various discourses. (shrink)

The proto-code of ethics and conduct for European nurse directors was developed as a strategic and dynamic document for nurse managers in Europe. It invites critical dialogue, reflective thinking about different situations, and the development of specific codes of ethics and conduct by nursing associations in different countries. The term proto-code is used for this document so that specifically country-orientated or organization-based and practical codes can be developed from it to guide professionals in more particular or situation-explicit reflection (...) and values. The proto-code of ethics and conduct for European nurse directors was designed and developed by the European Nurse Directors Association’s (ENDA) advisory team. This article gives short explanations of the code’ s preamble and two main parts: Nurse directors' ethical basis, and Principles of professional practice, which is divided into six specific points: competence, care, safety, staff, life-long learning and multi-sectorial working. (shrink)

The purpose of this qualitative study was to analyse nurses’ professional dignity in their everyday working lives. We explored the factors that affect nursing professional dignity in practice that emerge in relationships with health professionals, among clinical nurses working in hospitals and in community settings in central Italy. The main themes identified were: (i) nursing professional dignity perceived as an achievement; (ii) recognition of dignity beyond professional roles. These two concepts are interconnected. This study provides insights into professional (...) dignity in nursing being perceived as an achievement linked to the intrinsic dignity of every human being. The ‘nursing professional dignity perceived as an achievement’ was perceived as having declined in different social factors. Some factors of nursing professional dignity perceived as an achievement were attained more easily in community settings. ‘Recognition of dignity beyond professional roles’ underpins the intrinsic dignity as an expression of humanity, embedded in persons regardless of any profession, and values, such as: respect, moral integrity, humility, working conscientiously and kindness. (shrink)

Physicians, registered nurses and enrolled nurses engaged in geriatric and surgical care at a large hospital in Sweden gave 180 accounts of morally difficult care episodes. In total, the ENs gave 78, the RNs 55 and the physicians 47 accounts; there were 83 from geriatric care and 97 from surgical care. Forty-nine participants were male, and 59 were female; there were no differences in gender in the form and content of the moral reasoning disclosed in either morally difficult care episodes (...) or in the complete interviews when coded as mainly narrative or propositional, or as showing a care or a justice orientation. The ENs showed a care orientation, while RNs and physicians, to an equal degree, showed both a justice and a care orientation. The ENs also used narrative reasoning more often than RNs and physicians. No differences were seen between the two health care specialties. (shrink)

This article discusses the serious problem of the shortage of about 50 000 nurses in Japan today. If efficient measures to solve it are not adopted by administrators, it is clear that the shortage will become still more alarming in the future, in a society with more people in advanced years and in which the numbers in the younger generation will decrease from now on. The main factors behind the Japanese nursing labour shortage are, among others: a rapid increase (...) in the number of hospital beds between 1986 and 1989; poor working conditions; and nurses’ low social position in their places of work. Behind these factors, there has always been a contempt for the art of nursing in our society. Why has Japanese society made light of nursing? Three points can be identified: traditional discrimination against women; our disregard for a religious mentality; and our short history of hospital nursing. To overcome these problems, we must first of all change fundamentally our sense of values, such as love for one another and compassion. We must now reconstruct a caring culture in our society. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. (...) Research design and participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

Nurses working in outreach capacities frequently encounter disaffiliated or ‘hard to reach’ populations, such as those experiencing homelessness, those who use substances, and those with mental health concerns. Despite best efforts, nurses regularly fail to find meaningful engagement with these populations. Mobilizing the work of Deleuze and Guattari, this paper will critically examine conventional outreach nursing practices as rooted in the royal science of psychiatry, which many ‘survivors’ of psychiatric interventions reject. The field of Mad Studies offers an understanding (...) of patient resistance to outreach nursing interventions. Delueze and Guattari's concepts of packs and sorcerers provide a framework to envision alternative nursing practices as a form of resistance and creativity, where new alliances may be formed outside the coercive confines of traditional practices. In response to patient resistance, outreach nurses themselves must assemble packs and engage in acts of sorcery. (shrink)

The recent interest in wisdom in professional health care practice is explored in this article. Key features of wisdom are identified via consideration of certain classical, ancient and modern sources. Common themes are discussed in terms of their contribution to ‘clinical wisdom’ itself and this is reviewed against the nature of contemporary nursing education. The distinctive features of wisdom (recognition of contextual factors, the place of the person and timeliness) may enable their significance for practice to be promoted in (...) more coherent ways in nursing education. Wisdom as practical knowledge (phronesis) is offered as a complementary perspective within the educational preparation and practice of students of nursing. Certain limitations within contemporary UK nursing education are identified that may inhibit development of clinical wisdom. These are: the modularization of programmes in higher education institutions, the division of pastoral and academic support and the relationship between theory and practice. (shrink)

This article describes how an empirically supported theory of human behaviour, perceptual control theory, can be used to advance nursing practice and improve health outcomes for people who are accessing nursing care. Nursing often takes a pragmatic approach to the delivery of care, with an emphasis on doing what appears to work. This focus on pragmatism can sometimes take precedence over any consideration of the underlying theoretical assumptions that inform decisions to take one particular approach over another (...) or the mechanisms through which nursing interventions have their effects. For nursing to develop as a profession, there needs to be an increased focus on the core principles that underpin the delivery of care. In addition to understanding what works, nurses must develop their understanding of how and why particular approaches work or do not work. Understanding the fundamental principles that underpin nurses’ actions will lead to more efficient and effective approaches to the delivery of nursing care. It will also enable nurses to maximize those elements of their practice that are most beneficial for people and minimize other activities that either have little effect or actually lead to worse outcomes. In this article, we will propose that the phenomenon of control is fundamental to human health. Perceptual control theory provides a coherent theoretical framework that enables us to understand the phenomenon of control through a functional model of human behaviour. People are healthy when their neurochemical, physiological, biological, psychological and social states are all controlled satisfactorily. We will explain the implications of understanding health as control throughout the paper. From this perspective, we will argue that the aim of nurses and nursing should be to support people to maintain or recover control over those aspects of their lives that are important and meaningful to them. (shrink)

Care, we suspect, is initiated with an appeal. Something appeals to us which becomes a matter of concern. In accordance with this concern, we develop a volition: we want that which promotes the thriving – even to the smallest extent – of that which has appealed to us, regardless of how we may establish what that entails. Eventually we take practical action: we act according to our volition. Immediately after this has taken effect, as the case may be, we (...) release the source of the appeal from our care. As far as we can see, this quartet – appeal, concern, volition and practice – covers the four constitutive moments of care, although these moments are only theoretically separable from one another. The practice, as we have said, follows the volition. The volition, however, has arisen because we wanted to foster the wellbeing, however we may have recognised this, of the subject from which the initial appeal came. We have thus placed our volition in the service of this wellbeing, that is to say: we have subjected ourselves to an ought which we instantiated ourselves with the acceptance of the appeal. This seems to us to be the decisive point: in the act of caring, we instantiate an ought, a regulative element, which we then willingly follow. In the process of caring, we thus bring forth an ought, from our own being as it were – and as short-lived as this may be – to which we subject ourselves: in the process of caring, normativity only appears at all because we produce a will in the interest of the subject of the initial appeal to which we then dedicate ourselves, as if this were not our own will. Normativity is thus, as we further suspect, to be understood as a descriptive term of a phenomenology of care, or indeed a phenomenology of normativity. The phenomenon of caring provides the first indication that the ought arises directly from the practical experience of our lives. The phenomenology of care seems to us to be of eminent importance for health care ethics. To denote professional caring, we use the term nursing. The professional caregiver purposefully exposes him/herself to appeals, making him/herself receptive to such an appeal and reliably allowing the appeal to become a concern. The first fundamental principle of nursing ethics thus appears to us to be: to make known one’s receptiveness to an appeal – in a particular situation at a particular time – and to process this appeal reliably such that it becomes a concern. This encompasses the professionalism of care at its initiation. We believe that a precise phenomenology of care will provide, on the one hand, an exact understanding of the genesis of normativity, and on the other hand, in its practical application, a definition of the professional care that is nursing and an ethics of nursing for the care-giving professions. (shrink)

Background:A growing number of frameworks for the practice of clinical ethics are described in the literature. Among these, hermeneutical frameworks have helped highlight the interpretive and contextual nature of clinical ethics practice.Objectives:The aim of this article is to further advance this body of work by drawing on the ideas of Charles Taylor, a leading hermeneutical philosopher.Design/Findings:A Hermeneutical Rapprochement Framework is presented for clinical ethics practice, based on Taylor’s hermeneutical “retrieval” and “rapprochement.” This builds on existing hermeneutical approaches for the practice (...) of clinical ethics by articulating a framework with interpretive and reconciliatory scope that extends beyond the presenting “local” context. A Hermeneutical Rapprochement Framework considers broader socio-historical horizons and imaginaries grounded on Taylor’s expansive work in epistemological, ontological, political, and moral philosophy.Discussion:The framework is discussed in terms of how it can be operationalized for clinical practice as well as normative development. Implications for the educational preparation of clinical ethicists are also discussed. Although this work is directly relevant for clinical ethicists, it can also help inform the ethical practice of all clinicians. (shrink)

With its roots in clinical and educational psychology, school psychology is an ever-changing field that encompasses a diversity of topics. The Oxford Handbook of School Psychology synthesizes the most vital and relevant literature in all of these areas, producing a state-of-the-art, authoritative resource for practitioners, researchers, and parents.Comprising chapters authored by the leading figures in school psychology, The Oxford Handbook of School Psychology focuses on the significant issues, new developments, and scientific findings that continue to change the practical landscape. (...) The handbook's focuses include:allegiance to the reciprocal relationship between science and practice to promote problem-solving and enrichment modelsservice delivery designed to improve competencies of all studentsthe relationship between general cognitive ability and important life outcomesthe development of viable and enduring educational, family, and community systems to support studentsincreasing student diversity and the necessity of increased sensitivity to the influences of social, cultural, political, and legislative variables of schoolingoutlining tenable reasons why, since the end of World War II, children from kindergarten through the secondary grades have generally not been the recipients of a superior or efficient educational systemall relevant legislation, including the No Child Left Behind Act, and the ongoing question of who or what is responsible for the inadequate academic preparation of inner-city childrenbuilding a cumulative knowledge base to better facilitate students' academic, social, and personal competencies including the promotion of positive mental health and subjective well-beingThe scholarship compiled here is a must-read for practitioners, students, and faculty, and an ideal resource for parents seeking a scientific approach to the efficacy of school psychology practices. In both breadth and depth, this handbook promises to serve as the benchmark reference work for years to come. (shrink)

Philosophy, despite its typical attitude of detachment and abstraction, has for most of its long history been engaged with the practical and mundane-seeming question of whether there is a duty to obey the law. As Matthew Kramer has recently summarized: “For centuries, political and legal theorists have pondered whether each person is under a general obligation of obedience to the legal norms of the society wherein he or she lives. The obligation at issue in those theorists' discussions is usually (...) taken to be prima-facie, comprehensively applicable, universally borne, and content-independent.” This essay is a commentary on the current state of discussion of this perennial philosophical topic. (shrink)

Claims pertaining to understanding are made in a variety of contexts and ways. As a result, few in the philosophical literature have made an attempt to precisely characterize the state that is y understanding x. This paper builds an account that does just that. The account is motivated by two main observations. First, understanding x is somehow related to being able to manipulate x. Second, understanding is a mental phenomenon, and so what manipulations are required to be an understander must (...) only be mental manipulations. Combining these two insights, the paper builds an account (URM) of understanding as a certain representational capacity—specifically, understanding x involves possessing a representation of x that could be manipulated in useful ways. By tying understanding to representation, the account correctly identifies that understanding is a fundamentally cognitive achievement. However, by also demanding that which representations count as understanding-conferring be determined by their practical effects, URM captures the insight that understanding is vitally connected to practice. URM is fully general, and can apply equally well to understanding states of affairs, understanding events, and even understanding people and works of art. The ultimate test of URM is its applicability in actual scientific and philosophical discourse. To that end the paper discusses the importance of understanding in the philosophy of science, psychology, and computer science. (shrink)

Objectives: To assess French district nurses’ opinions towards euthanasia and to study factors associated with these opinions, with emphasis on attitudes towards terminal patients.Design and setting: An anonymous telephone survey carried out in 2005 among a national random sample of French district nurses.Participants: District nurses currently delivering home care who have at least 1 year of professional experience. Of 803 district nurses contacted, 602 agreed to participate .Main outcome measures: Opinion towards the legalisation of euthanasia , attitudes towards terminal patients (...) .Results: Overall, 65% of the 602 nurses favoured legalising euthanasia. Regarding associated factors, this proportion was higher among those who discuss end-of-life issues with terminal patients , who consider competent patients should always be told their prognosis and who value the role of advance directives and surrogates in end-of-life decision-making for incompetent patients . Women and older nurses were less likely to favour legalising euthanasia, as were those who believed in a god who masters their destiny.Conclusions: French nurses are more in favour of legalising euthanasia than French physicians; these two populations contrast greatly in the factors associated with this support. Further research is needed to investigate how and to what extent such attitudes may affect nursing practice and emotional well-being in the specific context of end-of-life home care. (shrink)

In this article, the nursing health history is revisited with a hermeneutic lens to uncover means by which this tool can better serve nursing practice. It is argued that further distanciation from the developmental and medical model is necessary to accurately uncover health and history in the nurse–client encounter. Based on the works of prominent hermeneutic philosophers, such as Heidegger, Gadamer, Merleau‐Ponty, Ricoeur, and Taylor, four orientations to health history and nursing are explored: orientation to caring, orientation (...) to narrative, orientation to time, and orientation to the body. The nursing health history is used as a vehicle for illuminating the usefulness of a hermeneutic perspective in everyday nursing practice. This article reveals views of health, history, and health history that are already known to nurses and the nursing milieu but are concealed by more dominant outlooks. The hermeneutical perspective presented in this article can help to reveal the important dimensions of everyday nursing practice and foster a richer attunement with the complex health experiences of individuals. (shrink)

Nurses and physicians may experience ethical conflict when there is a difference between their own values, their professional values or the values of their organization. The distribution of limited health care resources can be a major source of ethical conflict. Relatively few studies have examined nurses' and physicians' ethical conflict with organizations. This study examined the research question ‘What are the organizational ethical conflicts that hospital nurses and physicians experience in their practice?’ We interviewed 34 registered nurses, 10 nurse managers, (...) and 31 physicians as part of a larger study, and asked them to describe their ethical conflicts with organizations. Through content analysis, we identified themes of nurses' and physicians' ethical conflict with organizations and compared the themes for nurses with those for physicians. (shrink)

Abstract:This article conducts a close textual analysis of "A Painting of a Rice Cake (Gabyō)," a key fascicle in the Shōbōgenzō that reveals the significance of artistic creation as a metaphor for realizational practice. By analyzing the multiple meanings of "gabyō," it is shown that artistic creation can clarify the nonduality of practice and enlightenment in Dōgen's thought, inasmuch as enlightenment is a constant practice as if making an evanescent and cocreative painting of enlightenment with the entire world as Buddha-nature. (...) For Dōgen, enlightenment involves a deeply personal attunement to and a concrete actualization of the dharma that is not reducible to the purely theoretical understanding of Buddhist texts, and the metaphor of "painting rice cakes" demonstrates the importance of expressive activities in manifesting one's understanding of the dharma. (shrink)

Start your day with these peaceful, empowering words of wisdom. All of these words are interwoven with meditative, inspiring images of celebration. Each page is designed to increase positive thinking and improve your mental health. Life-changing mindful meditations. Strengthen your mindset with these empowering words of wisdom that are referenced as essential advice for how to grow spirituality and mentally strong. Meditation practices are essential to building mindfulness. Go Slowly, Breathe and Smile is a unique convergence of wisdom and art, (...) a beautiful tribute from a dedicated student to her teacher. Absorb Thich Nhat Hanh's words of wisdom and meditate on Rashani Réa's inspirational collages, and allow these pages to illuminate your heart and mind, inspire mindfulness, and reduce stress levels. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care (...) providers are confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:154, DAVID HUME'S PRACTICAL ECONOMICS As Professor Eugene Rotwein emphasized in his introduction to David Hume: Writings on Economics (Madison, 1955), the philosopher made his observations on the eve of the industrial revolution in a period of accelerating change. Very often — as in the latter half of the seventeenth century — times of flux and turmoil call forth Utopian thinkers, who propose the creation of hierarchical, communal, (...) authoritarian societies, often patterned after a supposed golden 2 age. Hume emphatically rejected Utopian schemes of this kind. "All plans of government which suppose great reformation in the manners of mankind," he said, 3 "are plainly imaginary." He repeatedly warned as well that "projectors" and visionaries would disrupt the balance in government between liberty and authority. Thus he could speak of or make reference to "the visionary system or ravings of Plato" (in The Republic), the ultimate impracticality of More's Utopia and James Harrington's The Commonwealth of Oceana, and the absurdity of Robert Wallace's theories on 4 population and the paper money schemes of John Law. Even the Utopian republics of Andrew Fletcher of Saltoun, the Scottish patriot whom Hume admired as "a man of undaunted courage and inflexible principles," were dismissed with the others on practical grounds. The key word we have extracted from Hume's economics is practicality. Much as Hume would have liked to have designed an empirical "science of man" — which, incidentally, would have permitted him to propose his own infallible scheme of political economy — he realized that his own attempts had fallen far short of his goal. Thus his nine essays devoted especially to economics: "Of Commerce," "Of Refinement 155. in the Arts," "Of Money," "Of Interest," "Of the Balance of Trade," "Of the Jealousy of Trade," "Of Taxes," "Of Public Credit," and "Of the Populousness of Ancient Nations," are cautious in approach and pragmatic in spirit. Most of these essays were specifically designed to challenge prevailing assumptions and Utopian grand schemes of one sort or another. In "Of Commerce," for example, Hume rejects the idea that a nation can achieve greatness as an agricultural utopia. In "Of Refinement in the Arts" he takes issue with certain religious thinkers who 7 denote luxury as evil. In "Of Money" he is critical of those who believe that an injection of money into O the economy will work long-term wonders, and in "Of Interest" he argues with those who reason that the 9 plenty of money leads to low interest rates. "Of the Balance of Trade" and "Of the Jealousy of Trade" are directed against the protectionist policies of the mercantilists, "Of Taxes" rejects the French physiocratic single tax on land, and "Of Public Credit" deplores the expedients of Lord Oxford's partisans to draw bills on posterity and imprudently 12 use public credit to create paper riches. Finally, he addressed his essay, "Of the Populousness of Ancient Nations" to a refutation of the doomsday thinking of 13 the Reverend Robert Wallace of Edinburgh. This is not to imply, however, that Hume's economic thought was merely negative, or that he believed governments could safely entrust their powers over the economy to an "invisible hand." Even Hume's advocacy of free trade (which his friend and pupil Adam Smith, of course, applied with less caution) left the government with room to maneuver. Hume was willing to employ both the market and authority in designs for human progress. In seeking his mix of "action, 156. consumption, liveliness and indolence," a contradictory, counter-poised economic actor, the individual, was not a simple pleasure maximizer, nor did the acquisition of wealth and luxury make him a villain. He was a person in whom the complex springs of action, the causes of labour, needed first one, now another counter-weight. Society benefited from both 14 free trade and from tariff. Hume believed that industrial development and the advancement of commerce were the springboards to progress and happiness. Less is less and more is more; Hume never got these simple verities mixed up. "The same age," he said, "which produces great philosophers and politicians, renowned generals and poets, usually abounds with skillful weavers, and ship-carpenters.... The spirit of the age... (shrink)

As the first President of the Royal Academy of Arts, Joshua Reynolds played a pivotal role in shaping the course of British art in the 18th century. In these discourses, Reynolds reflects on the nature of art, the role of the artist, and the importance of aesthetic education. With insightful commentary on the works of the Old Masters and a wealth of practical advice for aspiring artists, this volume is a must-read for anyone interested in the history of art (...) or art theory. This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work is in the "public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

This book challenges the traditional idea that religions can be understood primarily as texts to be interpreted, decoded, or translated. In More Than Belief, Manuel A. Vásquez argues for a new way of studying religions, one that sees them as dynamic material and historical expressions of the practices of embodied individuals who are embedded in social fields and ecological networks. He sketches the outlines of this approach through a focus on body, practices, and space. In order to highlight the centrality (...) of these dimensions of religious experience and performance, Vásquez recovers materialist currents within religious studies that have been consistently ignored or denigrated. Drawing on state-of-the-art work in fields as diverse as anthropology, sociology, philosophy, critical theory, environmental studies, cognitive psychology, and the neurosciences, Vásquez offers a groundbreaking new way of looking at religion. (shrink)

: Discussions of ethical approaches in nursing have been much enlivened in recent years, for instance by new developments in the theory of care. Nevertheless, many ethical concepts in nursing still need to be clarified. The purpose of this contribution is to develop a fundamental ethical view on nursing care considered as moral practice. Three main components are analyzed more deeply--i.e., the caring relationship, caring behavior as the integration of virtue and expert activity, and "good care" as (...) the ultimate goal of nursing practice. For the development of this philosophical-ethical interpretation of nursing, we have mainly drawn on the pioneering work of Anne Bishop and John Scudder, Alasdair MacIntyre, Lawrence Blum, and Louis Janssens. We will also show that the European philosophical background offers some original ideas for this endeavor. (shrink)

In this paper, it is argued that although data mining (DM) is being touted as a solution to many business problems and is basking in the glory of electronic business environments of today, as practiced currently, it reflects a preoccupation with short-run commercial applications and a neglect of the underlying theoretical issues. Although an argument can be made that theoretical precedence is not a necessary prerequisite for practical application or for commercial success, it can also be argued that an (...) exclusive reliance on data-driven and exploratory components of pattern recognition without a corresponding attention to the causal schemas underlying patterns is destined to limit the potential for DM to evolve into a long-term solution to business problems or into an intellectual discipline in its own right. This paper presents an overview of key features and assumptions in DM and examines some of the key practical, philosophical, and foundational issues in DM. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The University and Democracy: A Response to “Dewey, Implementation, and Creating a Democratic Civic University”Lee A. McBride IIIira harkavy has given us much to consider. His paper, “Dewey, Implementation, and Creating a Democratic Civic University,” invites us to critically assess our democracy and the role of colleges and universities in the propagation of our democratic way of life. Harkavy suggests that universities are failing to fulfill their function, that (...) is, “to educate students to be ethical, empathetic, engaged, democratic citizens, and advance knowledge for the continuous betterment of the human condition” (50). He suggests that universities are central societal institutions in the world, and research universities are most central—“they develop new ideas and technologies, incubate businesses, serve as cultural and artistic centers, and are engines of local, national, and global economics” (50). Our universities produce our teachers and our teachers’ teachers; they shape the learning, values, and the aspirations of students (Harkavy 50). But, again, universities are not fulfilling their social function of “creating and sustaining an inclusive, just democratic society” (Harkavy 51). Harkavy boldly asserts that a revolutionary change is required in higher education if it is to fulfill its democratic function.Closed LoopI have a concern about the role of Research 1 (R1) universities in this picture. I am led to believe that R1 universities, like the University of Pennsylvania, exist in rarefied air. Penn, for example, has a ridiculous endowment—more than $20 billion. Penn apparently accepts only 9% of its applicants. The resources and demographics of R1 institutions are unlike those at state schools and small liberal arts colleges. The various canons, the faculty, and the student body at elite R1 universities have historically represented the thoughts, [End Page 76] experiences, and perplexities of well-heeled white heteronormative men. The vast majority of the faculty and students at R1 universities are predominantly of Anglo-European descent and a higher socioeconomic status. This gives me pause. If R1 universities are placed as the central engines of democratic fomenting, I worry that the faculty and students at R1 universities will direct research and social amelioration projects in particular directions and retain particular presuppositions that will buttress the continued flourishing of elite R1 universities. A closed loop. I worry that both the material and the social capital needed to (re)shape social conditions will arise only from and circulate only between those who attend elite R1 universities. I mean, Harkavy suggests that the departments, programs, and institutes at R1 universities create and sustain those knowledges and skills that produce the scholars and thoughtful people who will drive our K–12 education, who will fashion new cooperatives and entrepreneurial ventures, and who will become our community activists and political leaders. As such, the knowledge and skills to implement a more just and inclusive democracy will be disseminated from the R1 university. Harkavy also explains that it is necessary that universities strive to be democratic civic universities, sites where university folk work alongside members of the surrounding communities to address and ameliorate the problems on the ground. This “would involve significant and ongoing engagement of an institution’s comprehensive assets (academic, human, cultural, and economic) in partnership with community members to produce knowledge and educate ethical students with the ability to help create and maintain just, anti-racist, democratic societies” (Harkavy 53). The democratic civic university would then nurture a culture of democracy that exceeds mere voting practices— democracy as a way of life (Dewey 226). Prima facie, this seems like a noble goal. And yet, I still worry that those university folks who do this work will be a small representative group of people who bear particular life experiences and perhaps phenotypic markers.I would suggest that other sites outside of the R1 university (e.g., the trade union meeting, the settlement house, the church, the community garden, etc.) will need to be taken as legitimate sites of knowledge creation or legitimate sites of communication and joint activity (Collins 269). This would at least bring differing life experiences to the table; that is, it would bring differing life experiences to the fore and recognize alternative non-academic sources of insight and wisdom. These sites and alternative... (shrink)

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

We use Homer and Sun Tzu as a background to better understand and reformulate confrontation, anger and violence in medicine, contrasting an unproductive ‘love of war’ with a productive ‘art of war’ or ‘art of strategy’. At first glance, it is a paradox that the healing art is not pacific, but riddled with militaristic language and practices. On closer inspection, we find good reasons for this cultural paradox yet regret its presence. Drawing on insights from Homer's The Iliad and The (...) Odyssey, we argue for better understanding of confrontation, anger, bullying, intimidation and violence in medicine in order to change the culture. For example, equating medicine with war is not a given condition of medicine but a convenient metaphor with historical origins and a historical trajectory. Other, non-martial metaphors, such as medicine as collaboration, may be more appropriate in an age of team-based care. Taking lessons from Homer, we suggest three key ways in which cold-hearted confrontation and anger in medicine can be transformed into productive, warm-hearted engagement: the transformation of angry impulse into reflection, moral courage and empathy. Thinking with Homer can offer an aesthetically and morally charged alternative to the current body of literature on topics, such as anger in doctors, and how this may be ‘managed’, without recourse to an instrumental economy where emotions are viewed as commodities, and emotional responses can be ‘trained’ through communication skills courses. (shrink)

SARGENT A. Nursing Inquiry 2012; 19: 134–143 [Epub ahead of print]Reframing caring as discursive practice: a critical review of conceptual analyses of caring in nursingThis study critically examines the way in which the concept of caring is presented in the nursing literature through conceptual analytic approaches. A critical reflection on the potential consequences of representing a concept of caring as vague and ambiguous, yet central to ontology and epistemology in professional nursing is presented drawing on comparisons between (...) the conceptual analyses of caring, and of structuralist perspectives of language, and how this potentially limits scholarship in this area. A search of the literature revealed nine conceptual papers. These papers highlight the self‐referential characteristics of the concept of caring, and of analytical methods in general. It is proposed that this is the result of a systematic adherence to a rigid, structuralist view of language, whereby stable relationships between words and their meanings are assumed. An alternative perspective is offered by viewing caring as a discursive practice rather than a fixed conceptual entity, calling into question the role that the concept plays in nursing practice. A poststructuralist perspective requires caring to be perceived as a discourse of nursing that is fluid and contingent, rather than a central and guiding concept, opening up a new orientation for nursing scholarship in caring research. (shrink)

Nursing is possible owing to a series of intricate systemic relations. Building on an established tradition of sociological research, we critically analysed the nursing profession in Chile, with an emphasis on its education system, in the light of social systems theory. The paper's aim was to explore basic characteristics of nursing education as a system, so as to outline its current evolution. Drawing on recent developments in nursing, we applied an empirical framework to identify and discuss (...) functionally differentiated systems that are relevant to nursing and observe communications between them. We found that the dynamics of nursing as a whole develop from communications with closely related systems, including the nursing profession and the education system more broadly. While the discipline (as a system of representations) strives to control the profession (as an applied occupational field), the necessities of practicing nurses imply other forces mediating the making of the profession, a process framed by market dynamics in education and health. (shrink)

The importance of patients taking an active role in their healthcare is recognized internationally, to improve safety and effectiveness in practice. There is still, however, some ambiguity about the conceptualization of that patient role; it is referred to interchangeably in the literature as engagement, involvement, and participation. The aim of this discussion paper is to examine and conceptualize the concepts of patient engagement, involvement, and participation within healthcare, particularly nursing. The concepts were found to have semantic differences and similarities, (...) although, from a nursing perspective, they can be summoned to illustrate the establishment of a mutual partnership between a patient and a nurse. The individualization of such processes requires the joint effort of engagement, involvement, or participation, represented by interactive actions of both the patient (asking questions, telling/speaking up, knowledge acquisition, learning, and decision‐making) and the nurse (recognizing, responding, information sharing, teaching, and collaborating). Suggesting that the concepts can be used interchangeably comes with some caution, requiring that nurses embrace patients playing a role in their health and healthcare. Further research and practice development should focus on how patients and nurses receive and respond to each other to establish patient engagement, involvement, and participation. (shrink)

It is argued that the current confusion about the role and purpose of the British nurse is a consequence of the modern rejection and consequent fragmentation of the inherited nursing tradition. The nature of this tradition, in which nurses were inducted into the moral virtues of care, is examined and its relevance to patient welfare is demonstrated. Practical suggestions are made as to how this moral tradition might be reappropriated and reinvigorated for modern nursing.