Background Decisions regarding Cardio-Pulmonary Resuscitation (CPR) and Do Not Attempt Resuscitation (DNAR) orders remain demanding, as does including patients in the process. Objectives To explore physicians’ justification for CPR/DNAR orders and decisions regarding patient inclusion, as well as their reports of how they initiated discussions with patients. Methods We administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion. Results Justifications were provided for 59% of DNAR orders and included (...) severe comorbidity, patients and families’ resuscitation preferences, patients’ age, or poor prognosis or quality of life. Reasons to include patients in CPR/DNAR decisions were provided in 96% and 84% of cases, and were based on respect for autonomy, clinical assessment of the situation as not too severe, and the view that such inclusion was required. Reasons for not including patients were offered in 84% of cases for CPR and in 70% for DNAR. They included absent decision-making capacity, a clinical situation viewed as good (CPR) or offering little hope of recovery (DNAR), barriers to communication, or concern that discussions could be emotionally difficult or superfluous. Decisions made earlier in the patient's management were infrequently viewed as requiring revision. Residents reported a variety of introductions to discussions with patients. Conclusions These results provide better understanding of reasons for CPR/DNAR decisions, reasons for patient inclusion or lack thereof, and ways in which such inclusion is initiated. They also point to potential side-effects of implementing CPR/DNAR recommendations without in-depth and practical training. This should be part of a regular audit and follow-up process for such recommendations. (shrink)

Objective: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions.Design: Prospective clinical interventional study.Setting: Internal medicine department of the hospital of La Chaux-de-Fonds, Switzerland.Participants: Nine junior physicians in postgraduate training.Intervention: Information on the ethics of DNR and implementation of new DNR orders.Measurements and main results: Accurate understanding, interpretation, and use of DNR orders, especially with respect to the (...) patients’ involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% after the intervention and the patients’ involvement went from 17% to 48% . Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision.Conclusion: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

Violations of ethical conductThis article is about torture, power and the breach of ethical conduct among military doctors, nurses and medics in the “War on Terror”. Violations of ethical conduct have been widely recounted in academic and non-academic journals and reports.1 This paper is also a call to international boards of doctors and nurses to intervene directly to stop abuses undertaken by US military healthcare providers under the guise of the War on Terror. With evidence growing that US military and (...) security services are actively engaged in the ill treatment, torture and deaths of suspects, details about the participation of healthcare professionals in such unlawful and unethical activities remain for the most part timidly accounted for. But according to current literature on this topic, there is increasing evidence that US doctors, nurses and medics have been complicit in torture and other unethical activities in Afghanistan, Iraq and Guantanamo Bay .2–4The US government has inadequately dealt with these facts. Senior officials in the Bush administration who have played a major part in conducting the War on Terror have been either promoted or asked to remain in their posts. More seriously, despite worldwide condemnation of the reality behind the photos, allegations of torture continue at Guantanamo Bay, Cuba.5 The graphic and appalling nature of several photographs are by no means the only evidence of abuses conducted by the US on its own territory and abroad. But the complicity of healthcare professionals in many venues , such as in capital punishment procedures in the US, exacerbates the already disturbing extent of bio-political abuses by the US government.Doctors and nurses often top the polls as caring and trustworthy professionals.6 Indeed, so strong …. (shrink)

In this paper, I discuss nurses' ongoing difficulty in engaging with politics and address the persistent belief that political positioning is antithetical to quality nursing care. I suggest that nurses are not faced with choosing either caring for their patients or engaging with politics. I base my discussion on the assumption that such dichotomy is meaningless and that engaging with issues of relationships firmly grounds nursing in the realm of politics. I argue that the ethical merit of nursing care relies (...) instead on positioning nurses squarely at the centre of care activities, experiences, and functions. Such positioning makes possible what Foucault called ‘practices of self‐formation’, that is, micro‐level processes that balance out the ubiquitous economic, cultural, legal, and scientific technologies that steadily constitute subjects in this era of modernity. Nurses, then, become not a group that needs to be controlled and governed, but individuals who must care for their self before they may care for anyone else. (shrink)

Objective: To evaluate the effect of an intervention on the understanding and use of DNR orders by physicians; to assess the impact of understanding the importance of involving competent patients in DNR decisions. Design: Prospective clinical interventional study. Setting: Internal medicine department (70 beds) of the hospital of La Chaux-de-Fonds, Switzerland. Participants: Nine junior physicians in postgraduate training. Intervention: Information on the ethics of DNR and implementation of new DNR orders. Measurements and main results: Accurate understanding, interpretation, and use of (...) DNR orders, especially with respect to the patients’ involvement in the decision were measured. Junior doctors writing DNR orders had an extremely poor understanding of what DNR orders mean. The correct understanding of the definition of a DNR order increased from 31 to 93% (p<0.01) after the intervention and the patients’ involvement went from 17% to 48% (p<0.01). Physicians estimated that 75% of their DNR patients were mentally competent at the time of the decision. Conclusion: An intervention aimed at explaining the ethical principles and the definition of DNR orders improves understanding of them, and their implementation, as well as patient participation. Specific efforts are needed to increase the involvement of mentally competent patients in the decision. (shrink)

Change is inevitable, and increasingly rapid and continuous in healthcare as organizations strive to adapt, improve and innovate. Organizational change challenges healthcare providers because it restructures how and when patient care delivery is provided, changing ways in which nurses must carry out their work. The aim of this doctoral study was to explore frontline nurses’ experiences of living with rapid and continuous organizational change. A critical hermeneutic approach was utilized. Participants described feeling voiceless, powerless and apolitical amidst rapid and continuous (...) organizational changes which fuelled apathy, cynicism and disengagement from the organization. However, critical analysis of the data showed that nurses actively engaged with power, voice and politics through resistant and transgressive behaviours in micro‐ethical moments of practice. There is a need to reconceptualize the concepts of voice, power and politics in nursing as there is dissonance between nurses’ beliefs about these concepts and what they are enacting in practice. Recognizing their enactment of power, voice and political agency at the micro‐level may empower nurses. Empowerment would mitigate the high levels of reports of powerlessness experienced in practice during organizational changes. (shrink)

The purpose of this text is to tell the story of the implementation of the _Act Respecting End-of-Life Care,_ referred to hereafter as _Law 2_ (Gouvernement du Québec, 2014) with an emphasis on the ambiguous role of ethics in the Interdisciplinary Support Groups (ISGs), created by Quebec's _Ministère de la santé et des services sociaux_ (MSSS). As established, ISGs provide “clinical, administrative and ethical support to health care professionals responding to a request for Medical aid in dying (MAiD)” (Gouvernement du (...) Québec, 2015). It is suggested that their composition includes the participation of a person with an expertise in ethics. These ISGs represent an important innovation for stakeholders involved in MAiD. To date, no scientific research has specifically addressed ISGs and little research has been conducted in other jurisdictions on the roles, operations and practices of MAiD support structures, especially the implication of ethics. Several ISGs have certainly developed promising practices that could benefit all stakeholders in the wider field of ethics and end of life. We will explore the development of ISGs in Quebec as a support structure for MAiD by highlighting the role that ethics has played (and should play) in these morally and humanly challenging situations. (shrink)

Inner speech has been shown to vary in form along several dimensions. Along condensation, condensed inner speech forms have been described, that are supposed to be deprived of acoustic, phonological and even syntactic qualities. Expanded forms, on the other extreme, display articulatory and auditory properties. Along dialogality, inner speech can be monologal, when we engage in internal soliloquy, or dialogal, when we recall past conversations or imagine future dialogues involving our own voice as well as that of others addressing us. (...) Along intentionality, it can be intentional (when we deliberately rehearse material in short-term memory) or it can arise unintentionally (during mind wandering). We introduce the ConDialInt model, a neurocognitive predictive control model of inner speech that accounts for its varieties along these three dimensions. ConDialInt spells out the condensation dimension by including inhibitory control at the conceptualization, formulation or articulatory planning stage. It accounts for dialogality, by assuming internal model adaptations and by speculating on neural processes underlying perspective switching. It explains the differences between intentional and spontaneous varieties in terms of monitoring. We present an fMRI study in which we probed varieties of inner speech along dialogality and intentionality, to examine the validity of the neuroanatomical correlates posited in ConDialInt. Condensation was also informally tackled. Our data support the hypothesis that expanded inner speech recruits speech production processes down to articulatory planning, resulting in a predicted signal, the inner voice, with auditory qualities. Along dialogality, covertly using an avatar’s voice resulted in the activation of right hemisphere homologues of the regions involved in internal own-voice soliloquy and in cerebellar deactivation, consistent with internal model adaptation. Switching from first-person to third-person perspective resulted in activations in precuneus and parietal lobules. Along intentionality, compared with intentional inner speech, mind wandering with inner speech episodes was associated with greater bilateral inferior frontal activation and decreased activation in left temporal regions. This is consistent with the reported subjective evanescence and presumably reflects condensation processes. Our results provide neuroanatomical evidence compatible with predictive control and in favor of the assumptions made in the ConDialInt model. (shrink)

RACINE L and PERRON A. Nursing Inquiry 2012; 19: 190–201 Unmasking the predicament of cultural voyeurism: a postcolonial analysis of international nursing placementsThe growing interest in international nursing placements cannot be left unnoticed. After 11 years into this twenty‐first century, violations of human rights and freedom of speech, environmental disasters, and armed conflicts still create dire living conditions for men and women around the world. Nurses have an ethical duty to address issues of social justice and global health as (...) a means to fulfil nursing’s social mandate. However, international placements raise some concerns. Drawing on the works of postcolonial theorists in nursing and social sciences, we examine the risk of replicating colonialist practices and discourses of health in international clinical placements. Referring to Bakhtin’s notions of dialogism and unfinalizability, we envision a culturally safe nursing practice arising from dialogical encounters between the Self as an Other and with the Other as an Other. We suggest that exploring the intricacies of cultural and race relations in everyday nursing practice are the premises upon which nurses can understand the broader historic, racial, gendered, political and economic contexts of global health issues. Finally, we make suggestions for developing culturally safe learning opportunities at the international level without minimizing the impact of dialogical cultural encounters occurring at the local and community levels. (shrink)

Nurses have their own ways of talking about their experiences of injustice in healthcare organizations. The aim of this article is to describe how nurses talk about their work‐life experiences and discuss the discursive effects that arise from nurses' use of language regarding their political agency. To this end, we present the findings garnered from a study focused on exploring how nurses deploy their political agency to project their idea of social and political justice in public healthcare organizations and how (...) they face the challenges and uncertainties of (re)thinking their institutional order when it does not resonate with their professional ethos. We then discuss the implications that nurses' use of language has in relation to their ability to deploy their political agency to oppose the forms of injustice they face in their daily practice. We conclude by stating that careful attention should be placed on understanding the discursive implications of nurses' use of language on their individual and collective emancipation in healthcare organizations. (shrink)

The idea of agency has long been used in the nursing literature in the study of nurses' roles regarding the patients they take care of, but it has not often been used to study its relationship with nurses themselves and their status in the healthcare system. The purpose of this article is to analyze how the idea of agency is used in nursing research to better understand how we might advance our thinking around nurses' agency to shape nursing and healthcare (...) with an emancipatory intent. Based on the results of a literature review focused on the study of conceptions, treatments, and applications of the concept of agency in nursing, we present a critical discussion to reflect on the need to consistently define the idea of nurses' agency, to guide research concerned with this topic in theoretical frameworks with emancipatory and social change tenets, and to make a call to develop the idea of agency as a central one to rework nurses' relationship with themselves. The idea of agency provides a valuable analytical framework for the study of a wide range of issues around nurses' status in healthcare organizations and in the healthcare system while offering a means for nurses' emancipation. (shrink)

There are those who would argue that, recently, the profession of nursing has made a radical shift, while others believe that a schism has been created among both scholars and clinicians as a result of the emerging dominance of the evidence‐based nursing movement. This paper offers a philosophical critique of this movement using Gilles Deleuze and Felix Guattari’s concept of schizoanalysis. As a conclusion, the authors posit that nursing professionals maintain a stance of academic freedom of thought and scientific integrity (...) through the acceptance of multiplicity, diversity, and polyvocality, and by challenging with politically charged concepts the totalizing perspectives that often spread through the profession/discipline of nursing. (shrink)

In “Group Testimony” (2007) I argued that the testimony of a group cannot be understood (or at least cannot always be understood) in a summative fashion; as the testimony of some or all of the group members. In some cases, it is the group itself that testifies. I also argued that one could extend standard reductionist accounts of the justification of testimonial belief to the case of testimonial belief formed on the basis of group testimony. In this paper, I explore (...) the issue of group testimony in greater detail by focusing on one putative source of testimony, that of Wikipedia. My aim is to the answer the following questions: Is Wikipedia a source of testimony? And if so, what is the nature of that source? Are we to understand Wikipedia entries as a collection of testimonial statements made by individuals, some subset of individuals, or is Wikipedia itself (the organization or the Wikipedia community) the entity that testifies? If Wikipedia itself is a source of testimony, what resources do we have for assessing the trustworthiness of such an unusual epistemic source? In answering these questions I hope to further elucidate the nature of collective epistemic agency (Tollefsen 2006), of which group testimony is a paradigm example. When a mans Discourse begineth…at some saying of another, of whose ability to know the truth, and of whose honesty in not deceiving, he doubteth not; and then the Discourse is not so much concerning the Thing, as the Person; and the Resolution is called Beleefe, and Faith: Faith in the man. (1651/1991, Ch. 7; p. 48). (shrink)

This article aims to present the life and work of German thinker Hartmut Rosa as a philosopher of interest for nursing. Although his theoretical framework remains fairly unknown in the nursing domain, its main key concepts open up a philosophical and sociological approach that can contribute to the understanding of a wide range of study phenomena related to nurses, nursing, and healthcare. The concepts of social acceleration, alienation, and resonance are useful to explore healthcare organizations' performance by bringing the time (...) dimension of modernity to the center; to grasp nurses' experiences of caring for patients; and to understand nurses as agents endowed with the capacity to deploy their political agency to create alternative forms of relationship to themselves, to others, and the world, challenging the institutional order of healthcare organizations when it fails to resonate with their professional ethos. In this article, we propose Hartmut Rosa's theoretical framework as a new and inspiring phenomenological and critical lens that should be further explored to advance knowledge concerning phenomena that are found at the crossroads of the nursing domain and other fields of knowledge. (shrink)

Although there have been a number of recent discussions about the emotions that we bring with us to our epistemic endeavors, there has been little, if any, discussion of the emotions we bring with us to epistemic appraisal. This paper focuses on a particular set of emotions, the reactive attitudes. As Peter F. Strawson and others have argued, our reactive attitudes reveal something deep about our moral commitments. A similar argument can be made within the domain of epistemology. Our "epistemic (...) reactive attitudes" reveal our epistemic commitments. Reflection on the role they play in our practice of epistemic appraisal can contribute to a number of different debates in contemporary epistemology, including the nature of epistemic norms and epistemic responsibility. (shrink)

This article presents a novel theoretical approach to explore nurse executives’ paradoxical identity and agency of executive and nurse in homecare organizations. This complex phenomenon has yet to be well theorized or analyzed. Through a synthesis of literature, we demonstrate that Critical Management Studies, as informed by Foucault, and the Sociology of Ignorance, can create a different understanding of the complex interplay between knowledge and nonknowledge (ignorance) that positions nurse executives in both influential and precarious ways in homecare organizations. This (...) theoretical framework has the potential to allow for the explicit exploration of nurse executives’ strategic epistemic and discursive positioning and highlights hierarchal power structures within homecare organizations. We posit that this framework, that spans nursing, management and sociology disciplines, sets a different understanding of homecare organizations as epistemic landscapes, exposing institutional knowledge and ignorance dynamics that remain largely concealed and unchallenged, yet are integral to understanding nurse executives’ epistemic agency. (shrink)

In this paper we present a framework for the dynamic and automatic generation of novel knowledge obtained through a process of commonsense reasoning based on typicality-based concept combination. We exploit a recently introduced extension of a Description Logic of typicality able to combine prototypical descriptions of concepts in order to generate new prototypical concepts and deal with problem like the PET FISH (Osherson and Smith, 1981; Lieto & Pozzato, 2019). Intuitively, in the context of our application of this logic, the (...) overall pipeline of our system works as follows: given a goal expressed as a set of properties, if the knowledge base does not contain a concept able to fulfill all these properties, then our system looks for two concepts to recombine in order to extend the original knowledge based satisfy the goal. (shrink)

The debate surrounding the issue of collective moral responsibility is often steeped in metaphysical issues of agency and personhood. I suggest that we can approach the metaphysical problems surrounding the issue of collective responsibility in a roundabout manner. My approach is reminiscent of that taken by P.F. Strawson in "Freedom and Resentment" (1968). Strawson argues that the participant reactive attitudes - attitudes like resentment, gratitude, forgiveness and so on - provide the justification for holding individuals morally responsible. I argue that (...) the framework of the reactive attitudes extends to collectives and provides the justification for holding collectives morally responsible. (shrink)

Contemporary analytic epistemology exhibits an individualistic bias. The standard analyses of knowledge found in current epistemological discussions assume that the only epistemic agents worthy of philosophical consideration are individual cognizers. The idea that collectives could be genuine knowers has received little, if any, serious consideration. This individualistic bias seems to be motivated by the view that epistemology is about things that go on inside the head. In this paper I challenge this type of epistemic individualism by arguing that certain groups (...) are intentional agents and that cognition occurs at the level of groups. In section I, I extend a plausible and well-defended account of individual intentionality to organizations. In section II, I appeal to research on distributed cognition in order to challenge the view that cognition occurs exclusively in the individual mind-brain. Having established that groups can be believers and cognizers, I turn to the issue of the justification of group belief. In section III, consider whether a reliabilist account of justification can be extended to groups. (shrink)

In a collaborative work situation at a distance, the use of avatars to represent collaborators reduces collaborative effort. Also, animated avatars can help distant users to ground their relationship and facilitate their interaction because they materialise visual clues for the distant collaborators and their current activity. To check the validity of these hypotheses we set up an experiment based on the use of a collaborative virtual environment (CVE) synchronised for collective medical decision-making. Several teams of practitioners from different disciplines will (...) be required to deal with liver tumours displayed in Argonaute 3D. In this paper, we provide some evidence from existing studies for the hypotheses and select several measures to estimate the grounding process in CVEs. Next, we briefly describe the setup used to collect observable data with Argonaute 3D and we summarise first observations acquired with practitioners. (shrink)

Recent discussions of rational deliberation in science present us with two extremes: unbounded optimism and sober pessimism. Helen Longino (1990) sees rational deliberation as the foundation of scientific objectivity. Miriam Solomon (1991) thinks it is overrated. Indeed, she has recently argued (2006) that group deliberation is detrimental to empirical success because it often involves groupthink and the suppression of dissent. But we need not embrace either extreme. To determine the value of rational deliberation we need to look more closely at (...) the practice and practitioners of science. I offer a closer look here by exploring the joint agency of small research teams. Although there are factors that contribute to the suppression of dissent in group contexts, a closer look at the literature on group dynamics suggests that there are ways to mitigate the effects of groupthink. Thus, there is reason to be cautiously optimistic about the value of rational deliberation within certain scientific contexts. (shrink)

Despite changes to research and practice, that, to some degree, acknowledge that people are shaped by their contexts, the treatment of mental illness remains largely focused on interventions that take place at the level of the individual. Conceptualizing mental illness as something that resides in individuals can lead to reliance on neurobiological and psychotherapeutic solutions, and away from conversations about not only contextual causes of mental distress, but also sociopolitical solutions to mental distress. Further, it can lead to the use (...) of mental health interventions that focus on the biology of an individual without a consideration for how those interventions themselves may have psychological, social, or political consequences that act to shape an individual's identity, agency, and relationship to their community. This paper examines one medicolegal intervention, the community treatment order, using the philosophical work of Grosz and Foucault to consider how this intervention affects the experience and construction of identity, and the impact of this on an individual's sense of agential membership in a community. This discussion aims to increase understanding of the individual and social implications of interventions for mental illness, and provide a conceptualization of the relationship between identity, agency, and ethics which can inform critical research and nursing practice more broadly. (shrink)

Serious mental illness (SMI) has long posed a dilemma to society. The use of community treatment orders (CTOs), a legal means by which to deliver mandated psychiatric treatment to individuals while they live in the community, is a contemporary technique for managing SMI. CTOs (or a similar legal mechanism) are used in every province in Canada and in many jurisdictions around the world in the care and management of clients with severe and persistent mental illness (most frequently schizophrenia) who have (...) a history of treatment non‐compliance and subsequent relapse. Although there is ongoing controversy around CTOs, their use continues to be on the rise. René Girard's mimetic theory, in which he posits the social utility of the scapegoat mechanism, may shed some light on how established cultural patterns contribute to contemporary responses to SMI: how culture depends on the reproduction of certain narratives, and how these act to shape the identity of those involved. The CTO specifically can be seen to act as a scapegoating mechanism, wherein, by singling out and controlling individuals who appear to threaten social order, social order is restored. This paper reviews Girard's theory, looks at how it has been applied to SMI, and then considers how it may illuminate the social role of the CTO. This examination may provide mental health nurses with insight into the constructed identities of their patients, as well as the role of mental health care within broader cultural narratives. (shrink)

There is a small, but growing, number of philosophers who acknowledge the existence of plural subjects – collective agents that act in the world and are the appropriate subject of intentional state ascriptions. Among those who believe in collective agency, there are some who wish to limit the types of intentional state ascriptions that can be made to collectives. According to rejectionists, although groups can accept propositions, they cannot believe them. In this paper I argue that, given the centrality of (...) belief and the similarities between individual belief and collective attitudes, we ought to reject rejectionism. If one believes in collective agency, one must also believe in collective belief. (shrink)

AbstractmRNA stability is increasingly recognized as being essential for controlling the expression of a wide variety of transcripts during neuronal development and synaptic plasticity. In this context, the role of AU‐rich elements (ARE) contained within the 3′ untranslated region (UTR) of transcripts has now emerged as key because of their high incidence in a large number of cellular mRNAs. This important regulatory element is known to significantly modulate the longevity of mRNAs by interacting with available stabilizing or destabilizing RNA‐binding proteins (...) (RBP). Thus, in parallel with the emergence of ARE, RBP are also gaining recognition for their pivotal role in regulating expression of a variety of mRNAs. In the nervous system, the member of the Hu family of ARE‐binding proteins known as HuD, has recently been implicated in multiple aspects of neuronal function including the commitment and differentiation of neuronal precursors as well as synaptic remodeling in mature neurons. Through its ability to interact with ARE and stabilize multiple transcripts, HuD has now emerged as an important regulator of mRNA expression in neurons. The present review is designed to provide a comprehensive and updated view of HuD as an RBP in the nervous system. Additionally, we highlight the role of HuD in multiple aspects of a neuron's life from early differentiation to changes in mature neurons during learning paradigms and in response to injury and regeneration. Finally, we describe the current state of knowledge concerning the molecular and cellular events regulating the expression and activity of HuD in neurons. BioEssays 28: 822–833, 2006. © 2006 Wiley Periodicals, Inc. (shrink)

The extracellular‐signal regulated kinases 1/2 (ERK or ERKs) are involved in the regulation of important neuronal functions, including neuronal plasticity in normal and pathological conditions. We present findings that support the notion that the kinetics and localization of ERK are intrinsically linked, in that the duration of ERK activation dictates its subcellular compartmentalization and/or trafficking. The latter, in turn, dictates whether ERK‐expressing cells would enter a program of cell death, survival or differentiation. We summarize experimental data showing that chronic activation (...) of ERK plays a role in the mechanisms that trigger neurodegeneration. We also discuss how MKPs, members of the subclass of dual specificity phosphatases, might be the link between ERK kinetics and its subcellular localization. BioEssays 25:1085–1095, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

This article outlines the struggle between the power of the health care professional and the rights of the individual to choose freely a modality of treatment. Nurses are instrumental in assisting patients in making the best decision for a therapy they will have to assume for the rest of their lives. In guiding patients' decision, nurses must take into account these unavoidable contingencies: changes in lifestyle, nutritional restrictions, level of acceptance, compliance issues, ease of training and availability of support/facilities. Ensuring (...) that the patient makes an informed decision is therefore an ongoing challenge for nurses as they are taking part in a delicate balancing act between not directly influencing the patient's decision while making sure the patient is accurately informed. (shrink)

PERRON A and HOLMES D. Nursing Inquiry 2011; 18: 191–204Constructing mentally ill inmates: nurses’ discursive practices in correctionsThe concepts of discourse, subjectivity and power allow for innovative explorations in nursing research. Discourse take many different forms and may be maintained, transmitted, even imposed, in various ways. Nursing practice makes possible many discursive spaces where discourses intersect. Using a Foucauldian perspective, were explored the ways in which forensic psychiatric nurses construct the subjectivity of mentally ill inmates. Progress notes and individual (...) interviews constitute discursive spaces within which nurses construct patients’ subjectivities. Progress notes provide a written (and permanent) form of discourse, while interviews set the space for a more fluid and contextual form of discourse. We identified five types of subjectivities – the (in)visible patient, the patient as risk, the deviant patient, the disturbed patient and the disciplined patient. These subjectivities were rooted in various types of discourses circulating in the selected setting. Despite the multiple discursive dimensions of forensic psychiatric nursing, progress notes remain the main formal source of information regarding nursing care even though it is not representative of the care provided nor is it representative of nurses’ complex discursive practices in corrections. (shrink)

"Teaching after all is about knowing children well" -- from A Letter to Teachers "Perrone has given us a gift, a book worth reading over many times, an important reflection on his many years of close observation of schools and school people, parents, teachers, children, and their communities." -- Deborah W. Meier, principal, Central Park East Secondary School Simple, elegant and full of common sense, these reflections on the art of teaching address the deepest concerns teachers have for their work (...) with children and young people. (shrink)

Las prácticas teatrales contemporáneas se caracterizan por un fuerte coeficiente de hibridación. Esto conlleva un replanteo constante de las categorías que definen la teatralidad. En el marco de este problema, queremos pensar, a partir de los aportes de Gilles Deleuze, la intersección entre imagen y teatro, entendiendo que este cruce permite una modulación entre ambos. El aspecto fundamental de esta modulación es su desvinculación de la noción de representación mimética y su viraje hacia la presencia. A partir de la noción (...) de figura (analizada por Deleuze en su obra sobre Francis Bacon), vemos que la imagen se modula en un desajuste de la sensación, el cuerpo y su ritmo. Esto nos indica una operación teatral, de dislocación de la representación mimética y la puesta en escena de otros tipos de ritmo y otros tipos de corporalidad. Dado este vínculo, podemos establecer que la lógica de la sensación en la figura comparte el mismo esquema de variación que en el teatro. Por lo cual, establecemos el concepto de imagen teatral como un operador donde resuenan las nociones de presencia, imagen, cuerpo y desfiguración. (shrink)

MAPEDZAHAMA V, RUDGE T, WEST S and PERRON A. Nursing Inquiry 2012; 19: 153–164 [Epub ahead of print]Black nurse in white space? Rethinking the in/visibility of race within the Australian nursing workplaceThis article presents an analysis of data from a critical qualitative study with 14 skilled black African migrant nurses, which document their experiences of nurse‐to‐nurse racism and racial prejudice in Australian nursing workplaces. Racism generally and nurse‐to‐nurse racism specifically, continues to be under‐researched in explorations of these workplaces; when (...) racism is researched, the focus is nurse‐to‐patient racism and racial prejudice. Similarly, research on the experiences of migrant nurses from a variety of ethnicities in Australia has tended to neglect their experiences of the social dynamics of the workplace, thus reinforcing their racialisation. When racialised, the migrant nurse becomes ‘the problem’ through a focus on English language competency and ensuing communication barriers. This paper applies Essed’s framework of ‘everyday racism’ to theorise narratives of racism by black African migrant nurses in Australia. In so doing, it not only brings to the fore silenced discussions of nurse‐to‐nurse racism in Australia, but also exposes the subtle, mundane nature of contemporary racism. For this reason, while the data we present must be read within their context, that is, the Australian nursing workplace, it has significance for advancing a critical analysis of racialised minority groups’ experiences of racism within seemingly ‘race‐less’ nursing workplaces internationally. (shrink)

In everyday discourse we often attribute intentional states to groups. These attributions are found not only in colloquial speech but also in the context of legal, moral, and social scientific research. Contemporary accounts of group intentionality have attempted to analyze these ascriptions in terms of the intentional states of individuals in the group. Although these accounts acknowledge that group intentional ascriptions are something more than mere metaphors, they do not typically acknowledge groups as genuine intentional agents. I challenge these contemporary (...) accounts and individualistic intuitions by arguing that, given a plausible account of the nature of intentionality, certain groups are genuine intentional agents. ;Focusing on the work of Gilbert, Tuomela, Searle, and Bratman, I argue that there are significant explanatory reasons for countenancing groups as legitimate intentional agents, reasons that require that we reject the individualism to which each of these authors is committed. My account of collective intentional agency is grounded in interpretationism. Interpretationism is the view an agent is an intentional agent if and only if he or she is interpretable. I defend interpretationism by building on the work of Davidson and Dennett. In particular, I develop more fully the notion of a rational point of view and argue that an adequate interpretationism must accommodate it. A rational point of view is not simply a point of view from which one's own actions can be seen as intelligible, it is a point of view from which an agent engages in deliberation and it is a locus of authority and responsibility. I argue that organizations have a rational point of view and are, therefore, interpretable. Thus, organizations are genuine intentional agents. ;If groups can be believers, then group knowledge and justification are coherent notions. There is a pervasive individualistic bias in contemporary epistemology, however, that rejects the idea of group knowledge and justification. This bias is largely motivated by the assumption that cognition is a process that takes place only within the individual mind/brain. I challenge this bias by showing how the standard models of individual cognition and epistemic agency can be extended to groups. (shrink)

Cet article a pour objectif d’exposer les potentialités d’adaptation de la théorie de l’interpellation d’Althusser à un cadre phénoménologique, et ce à l’aide de ses récupérations par Judith Butler et Sara Ahmed. Non seulement leurs écrits aident à pallier plusieurs critiques émises à l’égard de la théorie althussérienne de l’idéologie – notamment son déterminisme latent et son universalisation du sujet –, mais ils nous aident aussi à mieux comprendre comment l’idéologie fonctionne au niveau du corps marginalisé. En effet, l’idéologie agit (...) comme une orientation discursive et corporelle du sujet dans le monde, et ce en limitant son espace, sa temporalité et les objets lui étant accessibles. En liant interpellation et corps, il nous sera également possible de pousser la théorie de l’émancipation butlérienne vers une performativité corporelle ayant pour objet le corps vécu. À cet effet, nous soulignerons que les écrits d’Ahmed sur l’interpellation bonifient ceux de Butler, car ils ouvrent la porte vers une résistance à l’idéologie ancrée dans le corps via le concept de désorientation. Bien que la désorientation puisse servir de mécanisme d’assujettissement, elle peut également, selon certaines phénoménologues, créer de nouvelles voies d’émancipation (et possibilités) pour le sujet marginalisé. (shrink)

L’article se propose de présenter l’éthique philosophique de Jean Ladrière comme une recherche de croisement entre ces deux dimensions constitutives de l’expérience éthique que sont les points de vue universel et existentiel. On couvrira pour ce faire toute l’étendue de la démarche éthique, telle que Ladrière la déploie depuis l’expérience pré-réflexive jusqu’à la détermination effective de l’action en regard d’une situation particulière. Dans cette perspective, l’éthique philosophique apparaît arc-boutée à la fois à l’universalité de la normativité immanente à l’action et (...) à la singularité existentielle d’une destinée unique. (shrink)

The concept of citizenship is becoming more and more prominent in specific fields, such as psychiatry/mental health, where it is constituted as a solution to the issues of exclusion, discrimination, and poverty often endured by the mentally ill. We argue that such discourse of citizenship represents a break in the history of psychiatry and constitutes a powerful strategy to counter the effects of equally powerful psychiatric labelling. However, we call into question the emancipatory promise of a citizenship agenda. Foucault's concept (...) of governmentality is helpful in understanding the production of the citizen subject, its location within the 'art of government', as well as the ethical and political implications of citizenship in the context of mental health. (shrink)

The study of Agrippa's works confirms his constant interest in the theory and practice of alchemy. The apparent contradiction between De occulta philosophia, which uses alchemical doctrines, and De vanitate scientiarum, where alchemy is harshly criticized, is to be resolved in the light of a moral and cultural reform founded on a Hermetic-Christian perspective on the relationship between faith and reason. The analysis of the alchemic passages in De occulta philosophia proves that Agrippa's transmutatory operations have no secondary role in (...) his 'restored' magic. Furthermore, these operations are oriented towards a utopia, where original unity is to be regained. (shrink)

In the mammalian brain dopamine systems play a central role in the control of movement, hormone release, emotional balance and reward. Alteration of dopaminergic neurotransmission is involved in Parkinson's disease and other movement disorders, as well as in some psychotic syndromes. This review summarises recent findings, which shed some light on signals and cellular interactions involved in the specification and maturation of the dopaminergic function during neurogenesis. In particular we will focus on three major issues: (1) the differentiation of dopaminergic (...) neurones triggered by direct contact with the midbrain floor plate cells through the action of sonic hedgehog; (2) the neurotrophic factors acting on dopaminergic neurones; and (3) the role of target striatal cells on the survival and the axonal growth of developing or grafted dopaminergic neurones. (shrink)

When restricted to proving $\Sigma _{i}^{q}$ formulas, the quantified propositional proof system $G_{i}^{\ast}$ is closely related to the $\Sigma _{i}^{b}$ theorems of Buss's theory $S_{2}^{i}$ . Namely, $G_{i}^{\ast}$ has polynomial-size proofs of the translations of theorems of $S_{2}^{i}$ , and $S_{2}^{i}$ proves that $G_{i}^{\ast}$ is sound. However, little is known about $G_{i}^{\ast}$ when proving more complex formulas. In this paper, we prove a witnessing theorem for $G_{i}^{\ast}$ similar in style to the KPT witnessing theorem for $T_{2}^{i}$ . This witnessing theorem (...) is then used to show that $S_{2}^{i}$ proves $G_{i}^{\ast}$ is sound with respect to $\Sigma _{i+1}^{q}$ formulas. Note that unless the polynomial-time hierarchy collapses $S_{2}^{i}$ is the weakest theory in the s₂ hierarchy for which this is true. The witnessing theorem is also used to show that $G_{i}^{\ast}$ is p-equivalent to a quantified version of extended-Frege for prenex formulas. This is followed by a proof that Gi p-simulates $G_{i+1}^{\ast}$ with respect to all quantified propositional formulas. We finish by proving that S₂ can be axiomatized by $S_{2}^{1}$ plus axioms stating that the cut-free version of $G_{0}^{\ast}$ is sound. All together this shows that connection between $G_{i}^{\ast}$ and $S_{2}^{i}$ does not extend to more complex formulas. (shrink)

La relación entre filosofía y teatro ocupa un lugar interesante y no siempre explorado en la filosofía de Gilles Deleuze. En el presente artículo exponemos la noción de teatro tal como aparece en la obra del autor vinculada al problema de una nueva imagen del pensamiento. Consideramos que el uso metodológico del teatro se encuentra diseminado a lo largo de todo su itinerario filosófico. Lo teatral funciona como una matriz de análisis que permite distinguir las fuerzas que dramatizan un concepto, (...) y esto se inscribe en el marco de una crítica a la representación en la filosofía de Deleuze. (shrink)