Nursing

The COVID-19 pandemic put immense pressure on healthcare systems globally, including those of highly developed countries like the United States and United Kingdom. During the pandemic, professional nursing organizations were the first to call attention to the disproportionate pandemic-related deaths among Filipino nurses. These organizations played a central role in addressing the various crises Filipino nurses faced due to their vulnerabilities as frontliners, ethnic minorities, and migrants in their host countries. Using the Volatile, Uncertain, Complexity, and Ambiguous (VUCA) framework, this (...) monograph assesses the pandemic-response actions and strategies of PNAA and PNAUK, two Filipino nursing associations in the US and UK. The major themes suggest that the two organizations are multifunctional entities with the capacity to act as lobbyists, research organizations, and decision-makers when adapting, strategizing, and coping with VUCA conditions. These findings corroborate previous findings on the potentiality of diasporic nursing organizations in addressing the gaps in government support for migrant workers in the healthcare industry. (shrink)

Phenomenology has been adapted for use in qualitative health research, where it’s often used as a method for conducting interviews and analyzing interview data. But how can phenomenologists study subjects who cannot accurately reflect upon or report their own experiences, for instance, because of a psychiatric or neurological disorder? For conditions like these, qualitative researchers may gain more insight by conducting observational studies in lieu of, or in conjunction with, interviews. In this article, we introduce a phenomenological approach to conducting (...) this kind of observational research. The approach relies on conceptual grounding to focus a study on specific aspects of the participants’ experiences. Moreover, the approach maintains the openness to novel discoveries that qualitative research requires while also providing a structured framework for data collection and analysis. To illustrate its practical application, we use examples of hemispatial neglect—a neurologic disorder in which patients characteristically lack awareness of their own illness and bodily capacities. However, the approach that we describe can be applied more broadly to the study of complex illness experiences and other experiential alterations. (shrink)

Background: The time before surgery is a traumatic period for patients. Despite this fact, no research has been conducted on nurses’ preoperative patient education in Ethiopia. This study aimed to assess preoperative patient education practices and associated factors among nurses working in East Amhara comprehensive specialized hospitals, Ethiopia, 2022. Methods: A hospital-based cross-sectional study was conducted with 416 nurses. Pretested, structured questionnaires were used to collect the data. Bivariable analysis was performed for each independent variable with a P-value < 0.25 (...) on the data imported to multivariate logistic regression analysis. AOR with a 95% CI and a P-value < 0.05 at a 5% level of significance were considered. Results: Only 38.5% of nurses were found to have good practices for preoperative patient education, with a response rate of 98%. Nurses with 6 years of work experience (AOR = 3.15, 95% CI: 1.692– 5.874), adequate time (AOR = 2.33, 95% CI: 1.119– 4.889), training (AOR = 4.27, 95% CI: 1.548– 11.796), age 25– 29 (AOR = 0.15, 95% CI: 0.070– 0.331), age 30– 34 (AOR = 0.25, 95% CI: 0.137– 0.479), and knowledge (AOR = 3.73, 95% CI: 2.222– 6.273) were significantly associated. Conclusion: Preoperative patient education practices among nurses were poor. Work experience, knowledge, training, and adequate time were found to be significant. Organize preoperative patient education programs for nurses that share experiences and provide ongoing training. (shrink)

- First book to describe what pain means in vulnerable or special groups of people - Clinical applications described in each chapter - Provides insight into the nature of pain experience across the lifespan -/- This book, the third and final volume in the Meaning of Pain series, describes what pain means to people with pain in “vulnerable” groups, and how meaning changes pain – and them – over time. -/- Immediate pain warns of harm or injury to the person (...) with pain. If pain persists over time, more complex meanings can become interwoven with this primitive meaning of threat. These cognitive meanings include thoughts and anxiety about the adverse consequences of pain. Such meanings can nourish existential sufferings, which are more about the person than the pain, such as loss, loneliness, or despair. -/- Although chronic pain can affect anyone, there are some groups of people for whom particular clinical support and understanding is urgently needed. This applies to “vulnerable” or “special” groups of people, and to the question of what pain means to them. These groups include children, women, older adults, veterans, addicts, people with mental health problems, homeless people, or people in rural or indigenous communities. Several chapters in the book focus on the lived experience of pain in vulnerable adults, including black older adults in the US, rural Nigerians, US veterans, and adults with acquired brain injury. The question of what pain experience could mean in the defenceless fetus, neonate, pre-term baby, and child, is examined in depth across three contributions. -/- This book series aspires to create a vocabulary on the “meanings of pain” and a clinical framework with which to use it. It is hoped that the series stimulates self-reflection about the role of meaning in optimal pain management. -/- Meanings of Pain is intended for people with pain, family members or caregivers of people with pain, clinicians, researchers, advocates, and policy makers. Volume I was published in 2016; Volume II in 2019. (shrink)

Introduction: Agricultural workers perform intense labor outside in direct sunlight and in humid environmental conditions exposing them to a high risk of heat-related illness (HRI). To implement effective cooling interventions in occupational settings, it is important to consider workers’ perceptions. To date, an analysis of agricultural workers’ experience and perception of cooling devices used in the field while working has not been published. -/- Methods: Qualitatively data from 61 agricultural workers provided details of their perceptions and experiences with cooling interventions. (...) -/- Results: The participants in the bandana group reported the bandana was practical to use at work and did not interfere with their work routine. Cooling vest group participants agreed that the vest was effective at cooling them, but the practicality of using the vest at work was met with mixed reviews. -/- Conclusion: The findings of this qualitative study support and extend existing research regarding personal cooling and heat prevention research interventions with vulnerable occupational groups. Personal cooling gear was well received and utilized by the agricultural workers. Sustainable heat prevention studies and governmental protection strategies for occupational heat stress are urgently needed to reduce the risk of heat-related morbidity, mortality, and projected climate change health impacts on outdoor workers. (shrink)

This short peer-reviewed text is a concise overview of neurodiversity, the natural diversity of human brain functioning including ways that are currently pathologized as disorders. The concept is essential to understanding humans and societies.

In this paper, I bring together Jewish and Buddhist philosophical resources to develop a notion of radical responsibility that can confront a complicity within nursing and health care between empathy and (neo)liberal white supremacist hegemony. My inspiration comes from Angela Davis's call for building coalitions to advance struggles for peace and justice. I proceed as follows. First, I note ways phenomenology clarifies empathy's seeming foundational role in nursing care, and how such a formulation can be complicit with assumptions about private (...) individualism. Second, I turn to the Jewish philosophies of Martin Buber and Emmanuel Levinas, and their advocacy for a kind of responsibility that precedes the constitution of individuality as this can provide a resource for action and practice circumventing liberal influenced empathy. I note critical reservations about direct and practical application of Levinasian ethics in nursing care, and turn to engaged Buddhist philosophies of interdependence—such as in Thich Nhat Hanh and the Dalai Lama—as a corrective. Third, I conclude by indicating ways interreligious radical responsibility can reorient us toward housekeeping habits of character and away from exceptional crisis management, noting specific examples and actions in health care, nursing education and nursing scholarship. (shrink)

Today, many philosophers write on topics of contemporary interest, such as emerging technologies, scientific advancements, or major political events. However, many of these reflections, while philosophically valuable, fail to contribute to those who may benefit the most from them. In this article, we discuss our own experience of engaging with nursing researchers and practicing nurses. By drawing on the field of philosophical phenomenology, we intervene in a longstanding debate over the meaning of “empathy” in nursing, which has important implications for (...) nursing research, training, and practice. However, our intention is not only to introduce and discuss this philosophical intervention. Rather, we present this intervention as a model for how philosophers might successfully engage with the field of nursing, and perhaps with other fields as well, with the aim of effecting positive change in research or practice. The article proceeds in five parts. First, we introduce the problem of conceptual clarity in nursing and explain why many nursing concepts are still in need of refinement. Second, we discuss the origins of the concept of empathy in nursing and outline the challenges associated with borrowing theory from other fields. Third, we explain how nurses tend to conceptualize empathy today, drawing upon the psychological distinction between cognitive and emotional empathy. Fourth, we discuss our intervention in this debate and explain how we attempt to resolve existing conceptual confusions by developing the concept of empathy from the ground up. Fifth, we conclude by briefly reflecting upon some of the challenges of interdisciplinary engagement and providing some recommendations based upon our own experience. (shrink)

Is it possible to train empathy? We suggest a new way, based on insights from phenomenology.

Highlights: -/- • Breastfeeding and breastfeeding support can contribute to mitigating climate change. • Achieving global nutrition targets will save more emissions than fuel-switching. • Breastfeeding support programmes support a just transition. • This work can support the expansion of mitigation options in energy system models. -/- Abstract: -/- Renewable gas has been proposed as a solution to decarbonise industrial processes, specifically heat demand. As part of this effort, the breast-milk substitutes industry is proposing to use renewable gas as a (...) substitute for fossil natural gas. However, decarbonising the industrial processing of breast-milk substitutes can increase social license for these products, potentially undermining breastfeeding. World Health Organisation nutrition targets aim to increase exclusive breastfeeding to at least 50% globally by 2025 to improve maternal, infant, and young child health and nutrition. This target will have implications for the energy transition. A weakness of existing energy models is that demands for end-use products such as breast-milk substitutes are typically not considered explicitly. This paper develops an analytical framework for explicitly representing infant feeding methods in energy systems models. We compare the emissions saved in Ireland from decarbonising the industrial processing of breast-milk substitutes with renewable gas with the emissions saved by an increase in exclusive breastfeeding to 50% in both Ireland and a key export market, China. We demonstrate that the emissions saved from achieving the minimum global breastfeeding target are greater than when renewable gas is used to displace natural gas in the production of breast-milk substitutes in Ireland. We discuss the decarbonisation of breast-milk substitutes in relation to the principle of justice as non-maleficence, a principle based on the commitment to avoid harm, a novel application of a principle of justice. We conclude that breastfeeding support can be considered a demand-side measure for mitigating climate change by reducing the demand for energy services to produce breast-milk substitutes. A key recommendation is to position breastfeeding support as both a public health and a climate justice issue that is relevant for a just transition. The framework developed for this paper could be applied to support the inclusion of a wider range of mitigation options with social justice outcomes in energy system models. [Open access]. (shrink)

When decisionally incapable patients need a surrogate to make medical decisions for them, sometimes the patient has not appointed a healthcare agent and there is intractable disagreement among potential surrogates of equal priority, legal rank, or relation to the patient (e.g., child vs. child, sibling vs. sibling). There is no ethical, legal, or professional consensus about how to identify the appropriate surrogate in such circumstances. This article presents a case study involving an elderly female patient whose four children disagree about (...) whether to continue life-sustaining treatment for their mother, along with an ethical analysis of various strategies for selecting the appropriate surrogate in cases of conflicting equal-rank family members. It critically examines three different strategies—chance, majority rules, and quality of relationship with the patient—and defends the third approach. (shrink)

Taiwan and Vietnam have taken successful measures to combat the spread of COVID-19 at the early stages. Many authors attributed the successful policies to the lessons learned by these countries during the severe acute respiratory syndrome (SARS) pandemic in 2002.(Ohara, 2004) This manuscript provides a summary of recent early-stage policies that were successful in mitigating the spread and creating resilience against the negative consequences of COVID-19 in Taiwan and Vietnam. Crucially, these policies go beyond and complement social isolation. As social (...) isolation is expected to have a negative socio-economic impact on the population and adherence is likely to decrease with time(Armitage and Nellums, 2020; Weems et al., 2020), it is important to consider a broad range of policies to promote a steady control of the COVID-19 spread. Initially, we provide a brief introduction to some general concepts related to COVID-19. Thereafter, we introduce a concise review of policies and their dates relative to the first detection case in Taiwan and Vietnam as well as doing a comparative analysis. (shrink)

The COVID -19 is one of the most contagious and fatal diseases known today, which had spread in communities very fast. This deadly virus affecting the lives of many people and causing fatalities. Besides the strong practice of praying and putting trust in Allah for the cure of disease, Islam also recommends taking medications and adopt sufficient precautions for the safety and well-being of the community. Before 1400 years ago, the Prophet Muhammad (peace be upon Him) introduced the quarantining and (...) hygiene practice, at a time there was very little known to combat the contagious diseases. Currently, modern societies are emphasizing on hand hygiene, social distancing, quarantining, and social isolation to combat COVOD-19. Islam has superseded modern societies by establishing the idea of quarantines and hygienic practice for contagious and fatal diseases. The commandments to prevent the spread of COVID-19 by worldwide public health organizations are almost in line with the teachings of Islam. (shrink)

L’épidémie de Covid-19 aurait pu y faire des ravages. Pourtant, ce 11 avril, le Vietnam ne comptait que 258 cas déclarés et aucun décès selon l’université américaine Johns Hopkins. Des chiffres observés avec moins de méfiance que ceux du voisin chinois, avec qui il partage 1 280 kilomètres de frontière. Le résultat est surprenant pour ce pays de 96 millions d’habitants, qui ne consacre que peu de moyens à la santé. À Hô-Chi-Minh-Ville, seuls 900 lits d’hôpitaux sont équipés pour les (...) soins intensifs, soit 1 pour près de 9 000 habitants. (shrink)

Background The purpose of this systematic review is to examine cooling intervention research in outdoor occupations, evaluate the effectiveness of such interventions, and offer recommendations for future studies. This review focuses on outdoor occupational studies conducted at worksites or simulated occupational tasks in climatic chambers. -/- Methods This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. PubMed, Embase, and Web of Science were searched to identify original research on intervention studies published (...) in peer‐reviewed journals that aimed at reducing heat stress or heat‐related illness from January 2000 to August 2020. -/- Results A systematic search yielded a total of 1042 articles, of which 21 met the inclusion criteria. Occupations with cooling intervention studies included agriculture (n = 5), construction (n = 5), industrial workers (n = 4), and firefighters (n = 7). The studies focused on multiple types of cooling interventions cooling gear (vest, bandanas, cooling shirts, or head‐cooling gel pack), enhanced heat dissipation clothing, forearm or lower body immersion in cold water, water dousing, ingestion of a crushed ice slush drink, electrolyte liquid hydration, and modified Occupational Safety and Health Administration recommendations of drinking water and resting in the shade. -/- Conclusion Current evidence indicates that using multiple cooling gears along with rest cycles may be the most effective method to reduce heat‐related illness. Occupational heat‐related illnesses and death may be mitigated by targeted cooling intervention and workplace controls among workers of vulnerable occupational groups and industries. (shrink)

This book offers a philosophically-based, yet clinically-oriented perspective on current medical reasoning aiming at 1) identifying important forms of uncertainty permeating current clinical reasoning and practice 2) promoting the application of an abductive methodology in the health context in order to deal with those clinical uncertainties 3) bridging the gap between biomedical knowledge, clinical practice, and research and values in both clinical and philosophical literature. With a clear philosophical emphasis, the book investigates themes lying at the border between several disciplines, (...) such as medicine, nursing, logic, epistemology, and philosophy of science; but also ethics, epidemiology, and statistics. At the same time, it critically discusses and compares several professional approaches to clinical practice such as the one of medical doctors, nurses and other clinical practitioners, showing the need for developing a unified framework of reasoning, which merges methods and resources from many different clinical but also non-clinical disciplines. In particular, this book shows how to leverage nursing knowledge and practice, which has been considerably neglected so far, to further shape the interdisciplinary nature of clinical reasoning. Furthermore, a thorough philosophical investigation on the values involved in health care is provided, based on both the clinical and philosophical literature. The book concludes by proposing an integrative approach to health and disease going beyond the so-called “classical biomedical model of care”. (shrink)

Since the “last day” of 2019, a new virus emerged in Asia, which in Feb./2020 was called by the World Health Organization (WHO, 2020) as Coronavirus disease (Covid-19). Due to its fast transmission, after eight months since the first global official case, at 23:59 (GMT) on August 31, 2020, the world has accounted for about 25,620,737 new confirmed cases with 854,222 deaths and 17,921,063 recovered cases (WORLDOMETERS, 2020). The pandemic is the newest challenge for all nations, most of them eager (...) to learn from countries that are successful against the virus. However, until now, no methodology was developed to identify them by taking into account a holistic approach with international rankings concerned to health, innovation, sustainability, image, and competitiveness, as well as the estimated real number of fatal cases by one million population during the first 180 days of facing the pandemic. Thus, the main objective is to develop a holistic methodology to identify twenty benchmark countries that are saving people's lives against Covid-19. The research is applied, as its results and recommendations are useful for academy, government policymakers and authorities. It is descriptive, with a qualitative and quantitative approach, based on bibliographic and documentary research, involving the study of official sites, articles, reports, manuals, and other technical documents related to 13 international rankings. As a result, the fifteen phases of the methodology, far from perfect, shows that among 108 well-evaluated countries, the top six benchmark countries are from Asia (1) Vietnam; 2) Taiwan; 3) Thailand; 4) China; 5) Malaysia; 6) Singapore), which suffered from fatal cases from first SARS-CoV in 2002/2003, followed by 7) South Korea; 8) New Zealand; 9) Australia; 10) Japan; 11) Hong Kong; 12) Cyprus; 13) Greece; 14) Latvia; 15) Iceland; 16) the United Arab Emirates; 17) Czech; 18) Lithuania; 19) Norway, and 20) Estonia. (shrink)

Aims and Objectives. This article uses the concept of embodiment to demonstrate a conceptual approach to applied phenomenology. -/- Background. Traditionally, qualitative researchers and healthcare professionals have been taught phenomenological methods, such as the epoché, reduction, or bracketing. These methods are typically construed as a way of avoiding biases so that one may attend to the phenomena in an open and unprejudiced way. However, it has also been argued that qualitative researchers and healthcare professionals can benefit from phenomenology’s well-articulated theoretical (...) framework, which consists of core concepts, such as selfhood, empathy, temporality, spatiality, affectivity, and embodiment. -/- Design. This is a discursive article that demonstrates a conceptual approach to applied phenomenology. -/- Method. To outline and explain this approach to applied phenomenology, the Discussion section walks the reader through four stages of phenomenology, which progress incrementally from the most theoretical to the most practical. -/- Discussion. Part one introduces the philosophical concept of embodiment, which can be applied broadly to any human subject. Part two shows how philosophically trained phenomenologists use the concept of embodiment to describe general features of illness and disability. Part three illustrates how the phenomenological concept of embodiment can inform empirical qualitative studies and reflects on the challenges of integrating philosophy and qualitative research. Part four turns to phenomenology’s application in clinical practice and outlines a workshop model that guides clinicians through the process of using phenomenological concepts to better understand patient experience. -/- Conclusion and Relevance to Clinical Practice. A conceptual approach to applied phenomenology provides a valuable alternative to traditional methodological approaches. Phenomenological concepts provide a foundation for better understanding patient experience in both qualitative health research and clinical practice, and therefore provide resources for enhancing patient care. (shrink)

Empathy is a topic of continuous debate in the nursing literature. Many argue that empathy is indispensable to effective nursing practice. Yet others argue that nurses should rather rely on sympathy, compassion, or consolation. However, a more troubling disagreement underlies these debates: There’s no consensus on how to define empathy. This lack of consensus is the primary obstacle to a constructive debate over the role and import of empathy in nursing practice. The solution to this problem seems obvious: Nurses need (...) to reach a consensus on the meaning and definition of empathy. But this is easier said than done. Concept analyses, for instance, reveal a profound ambiguity and heterogeneity of the concept of empathy across the nursing literature. Since the term “empathy” is used to refer to a range of perceptual, cognitive, emotional, and behavioral phenomena, the presence of a conceptual ambiguity and heterogeneity is hardly surprising. Our proposal is simple. To move forward, we need to return to the basics. We should develop the concept from the ground up. That is, we should begin by identifying and describing the most fundamental form of empathic experience. Once we identify the most fundamental form of empathy, we will be able to distinguish among the more derivative experiences and behaviors that are addressed by the same name and, ideally, determine the place of these phenomena in the field of nursing. The aim of this article is, consequently, to lay the groundwork for a more coherent concept of empathy and thereby for a more fruitful debate over the role of empathy in nursing. In Part 1, we outline the history of the concept of empathy within nursing, explain why nurses are sometimes warry of adapting concepts from other disciplines, and argue that nurses should distinguish between adapting concepts from applied disciplines and from more theoretical disciplines. In Part 2, we show that the distinction between emotional and cognitive empathy—borrowed from theoretical psychology—has been a major factor in nurses’ negative attitudes toward emotional empathy. We argue, however, that both concepts fail to capture the most fundamental form of empathy. In Part 3, we draw on and present some of the seminal studies of empathy that can be found in the work of phenomenological philosophers including Max Scheler, Edmund Husserl, and Edith Stein. In Part 4, we outline how their understanding of empathy may facilitate current debates about empathy’s role in nursing. (shrink)

Being a parent advocate of the rights of children with autism, I have witnessed how the Vietnamese news media perpetuate misrepresentation, misinformation and disinformation about autism. As the first media study of its kind in Vietnam, this thesis set out to describe, interpret and explain the issue of misrepresentation, misinformation and disinformation about autism in the Vietnamese online news media between 2006 and 2016.

An Islamic approach from its theological sources to address the spiritual pain related to palliative care of terminally ill patients can be established on attaining a spiritual stage of soul or spirit termed as reassured soul. The attainment of such stage is based on hope of the patient to receive mercy and forgiveness of God. And the way of attainment of hope is possible by doing the repentance, praying, and patience. In combating the pain and suffering, the patient is supposed (...) to understand that the life in its reality is a test and facing such a test is possible by two ways, one is patient centric by building patience within to endure the suffering and second is seeking help from God by praying. For the spiritual wellbeing, the patient should understand that his suffering is in fact expiation for his sins. On the other hand, the visitors and caregivers of patients have certain responsibilities that contribute to enhancing of the spiritual well-being of the patient, including comforting them by giving hope to the patients and at the same time praying for their recovery. These all elements enhance the spiritual well-being of patients and help in prevention of suffering by spiritual means. (shrink)

When talking about sexual abuse of children we can understand culture as one of the leading determinants of child health. As a public health problem, sexual abuse has different causes, from which we can distinguish the silence and secrecy that is kept by third parties. In every single abuse there is a person or people that are present at the moment of the abuse, or without being present know that the abuse is in progress, or even help in any way (...) the perpetrator to commit the abuse. In order to work consistently in this type of abuse of children, we need to work in adding values to a culture that contribute to freely and openly talk about sexuality and to teach how to gain transparency in communities that could help disclose sexual abuses. (shrink)

Objectives The study aims to evaluate the impact of the Revised Health Insurance Law 2014 on the utilisation of outpatient and inpatient care services, healthcare services utilisation at different levels of providers, types of providers and types of visits across different entitlement groups. Design/setting Secondary data from two waves of the Vietnam Household Living Standard Survey (VHLSS) 2016, VHLSS 2014 were used. A cross-sectional study applying propensity score matching was conducted. Participants A total of 4900 individuals who reported using healthcare (...) services are analysed. Outcomes measure Numbers of outpatient and inpatient visits, frequency of healthcare service utilisation at commune health stations, district hospitals, provincial hospitals, public and private health facilities, number of visits at health facility for medical treatment and health checks per year. Results The result indicates that health insurance (HI) policy increased the number of outpatient visits for the enrolled between 0.87 and 1.29. The greatest impact was found on participants of heavily subsidised health insurance (HSHI) programmes with 1.29 visits per person per year. Similarly, an increase between 0.08 and 0.16 in the number of inpatient admissions was because of participation in HI. With regard to type of healthcare providers, the study found that participation in HI has the most effect on the use of healthcare services at district hospitals. However, the study demonstrated that the impacts of HI on the increase in the frequency of visiting commune health stations, number of visits at the provincial hospital for HSHI groups, and number of visits at health facilities for health check and consultation were sensitive to unobserved characteristics. Conclusion Our findings imply that policy-makers in Vietnam could continue expanding health insurance coverage to increase access to healthcare services for citizens, especially vulnerable groups. In addition, the government should draw more attention to primary healthcare level. (shrink)

I have been reading Nursing Philosophy since its inception in 2000. Indeed, the journal has played an important role in the development of my thinking—from a doctoral student in philosophy to the pres‐ent day. The invitation to write an article commentary as an editorial board member presented an opportunity to look over previous issues (including well‐worn paper copies from the years before it became a digital‐only publication), a task I have relished over the first months of 2019. Despite my long (...) relationship with the journal, selecting a focus for my commentary was not difficult; two articles on spiritual‐ity in nursing, by John Paley (2008a) and Barb Pesut (2008a), respec‐tively, are touchstones to which I have returned many times in the 11 years since their publication. In this commentary, I present a brief summary of the articles followed by a reflection on their value for nurses and philosophers of nursing. (shrink)

Key Points -/- ◆ Nurses are ideally suited to advocate for patients and families due to their professional orientation, education, and role in patient care. ◆ Six components constitute a model of advocacy in palliative nursing: clinical competency, relational care, communication skills, bio-psycho-social-spiritual orientation, interdisciplinary collaboration, and a combination of confidence and humility. ◆ Nurse advocates respond to the strengths as well as the vulnerabilities of patients and families, building empowering relationships to support care decisions that respect the values and (...) personhood of patients. ◆ Seven functional elements facilitate effective advocacy in palliative nursing: specific documentation, careful observation of patient and family interactions, assessing understanding, building rapport, eliciting care preferences, privileging patient values and preferences, teaching and sharing information. ◆ Advocacy is an approach to palliative nursing care, one which emphasizes careful attention to process over outcome. (shrink)

Counselling y cuidados paliativos es el título del libro escrito por la doctora Esperanza Santos y el profesor José Carlos Bermejo. En esta obra, de fácil lectura y con consejos muy prácticos y útiles, se presentan elementos fundamentales para brindar un acompañamiento de óptima calidad en el cuidado paliativo, así como la posibilidad de hacer un autoexamen de cómo los cuidadores de los pacientes prestan sus servicios e incluso para no caer en burnout. Este libro es de gran utilidad, tanto (...) para los profesionales de la salud que trabajan en las unidades de cuidados paliativos, como para personas que dedican gran parte de su tiempo al cuidado de familiares con enfermedades terminales, o que pasan por procesos prolongados de enfermedad. Con ejemplos de conversaciones de la vida real entre cuidadores y pacientes, la lectura del libro se hace, a la vez, agradable, divertida y profundamente reflexiva. (shrink)

This paper is a study about Philadelphia’s comprehensive user engagement sites (CUESs) as the authors address and examine issues related to the upcoming implementation of a CUES while seeking solutions for its disputed questions and plans. Beginning with the federal drug schedules, the authors visit some of the medical and public health issues vis-à-vis safe injection facilities (SIFs). Insite, a successful Canadian SIF, has been thoroughly researched as it represents a paradigm for which a Philadelphia CUES can expand upon. Also, (...) the existing criticisms against SIFs are revisited while critically unpackaged and responded to in favor of the establishment. In the main section, the authors propose the layout and services of the upcoming CUES, much of which would be in congruent to Vancouver’s Insite. On the other hand, the CUES would be distinct from Insite, as the authors emphasize, in that it will offer an information center run by individuals in recovery and place additional emphasis on early education for young healthcare professionals by providing them a platform to work at the site. The paper will also briefly investigate the implementation of a CUES site under an ethical scope of the Harm Reduction Theory. Lastly, the authors recommend some strategic plans that the Philadelphia City government may consider employing at this crucial stage. (shrink)

In Ecological Thinking, Lorraine Code argues that advocacy “often makes knowledge possible” and without it “certain kinds of knowing are impossible.” By acknowledging the value of subjectivity and testimony in knowledge creation, I argue that ecological thinking serves as an appropriate framework for engagement with individuals who are living with mental illnesses. Contrasted with the dominant Anglo-American epistemologies that involve excessive degrees of mastery and control (with the tendency to silence the voices of Others), I argue that ecological thinking facilitates (...) healthy advocacy practices precisely because of its inclusivity and receptivity towards different perspectives in knowledge creation. (shrink)

This article is about a new definition of health and how this relates to transition processes. It focuses on the practical translation of the new concepts into challenges for mental health nurses. To that aim the Engagement Model is examined and operationalized. We did so as nurse researcher and lecturer involved in training nurse practitioners.

In society, human vulnerability is associated with multiple causes such as poverty, injustice, discrimination and illnesses, among others. In the midst of this panorama of external agents that lead human beings to situations of vulnerability, some clearly see – although others not so much – a vulnerability proper to the human person, simply because they exist. This approach to vulnerability is considered to be a conditio humana that affects everyone. Precisely because it is a conditio humana, vulnerability is closely related (...) to autonomy. For this reason, in this article we have attempted to deepen in the interrelationship between autonomy and vulnerability, focusing on an anthropological vulnerability, and determining whether vulnerability constitutes an impediment for autonomy, as vulnerability and autonomy seem to be the representatives of polar opposites: one that is limited and can do nothing or very little, and the other that can do everything and has no limits. -/- La vulnerabilidad humana está asociada en la sociedad a múltiples causas, tales como la pobreza, la injusticia, la discriminación, las enfermedades, entre otras. En medio de este panorama de agentes externos que lleven a los seres humanos a situaciones vulnerables, se deja ver, para unos claramente, para otros no tanto, una vulnerabilidad propia a la persona humana por el simple hecho de existir. Uno de los enfoques de la vulnerabilidad es considerarla como una conditio humana que nos afecta a todos, asunto que ha sido insistentemente ratificado por el pensamiento contemporáneo. Justamente, por ser una conditio humana, la vulnerabilidad se encuentra en estrecha relación con la autonomía. Es así que en este trabajo nos hemos propuesto ahondar en ese entramado de autonomía y vulnerabilidad, tomando el enfoque de la vulnerabilidad antropológica con el fin de describir la interrelación entre dichos principios y determinando si la vulnerabilidad constituye un “freno” o no para la autonomía, pues vulnerabilidad y autonomía parecen ser los representantes de dos polos opuestos, el del que se encuentra limitado y no puede hacer nada o hace poco, y el del que puede hacerlo todo sin ningún límite. (shrink)

If the health sciences are to be humanized, health professionals must first humanize themselves. This investigation deepens in the paradigmatic aspects that enrich and form the foundation of being compassionate, a key element in this process of humanization. For this reason, an emphasis has been placed on the sensibility that is found at the base of a compassionate attitude. It is proposed that this sensibility involves wonder as a starting point, which allows one to connect with reality and to encounter (...) the reality of the human person, who in turn discovers himself called to communion with another like to himself. In this way, compassion is considered as a movement of heart and the particularities and consequences of this movement are determined in order to respond to objections to compassion, principally those of the German philosopher Friedrich Nietzsche. It is determined that his critiques are directed toward a compassion understood as pity, while compassion understood as a movement of heart distances itself from falling into the sentimentalization of pity and helps highlight once again the positive dimension of compassion. -/- Si se quiere humanizar las ciencias de la salud, han de comenzar a humanizarse los profesionales de la salud. Por esta razón, en esta investigación se profundiza en aspectos paradigmáticos que fundamentan y enriquecen el ser compasivo, considerado como un elemento clave en dicho proceso de humanización. Para ello, se ha puesto énfasis en la sensibilidad que se encuentra al fondo de la actitud compasiva. Se ha planteado que dicha sensibilidad involucra el asombro como punto de partida, que conecta con la realidad y que permite encontrarse con la realidad de la persona humana, que a su vez se descubre llamada a la comunión con el otro semejante a ella. De esta manera, se llega a considerar la compasión como un movimiento del corazón, y a partir de allí, se determinan las particularidades y consecuencias de este movimiento para responder a las objeciones que se le hacen a la compasión, principalmente las del filósofo alemán Friedrich Nietzsche. Se ha determinado que sus críticas están dirigidas a una compasión entendida como lástima, mientras que la compasión entendida como movimiento del corazón, se aleja de caer en la sentimentalización de la lástima y da luces para retomar la dimensión positiva que posee la compasión. (shrink)

This chapter offers an explanation of, and approach to, respecting confidentiality as an ethical obligation in the practice of hospice and palliative medicine. Understood in the context of coincident ethical obligations to maximize clinical benefit, avoid preventable harm, and restore moral agency, respecting confidentiality is embedded in the most basic philosophical precepts that define hospice and palliative care. How to respect confidentiality in everyday practice, however, can be a matter of unusual complexity. As such, following a brief conceptual framework, the (...) chapter explores ways to employ the framework in the service of patients and families in clinical practice. While various regions and nationalities will have legal and regulatory requirements informing the definition and practice of respecting confidentiality, this chapter focuses instead on respecting confidentiality as an ethical value. Readers are encouraged to supplement the content of this chapter with the relevant requirements that apply in their practice location. (shrink)

Paul Ricoeur argues that narration is lived life. Therefore, human experience has a narrative dimension, ie, it has a narrative structure and every effort you want to make for the human need to consider the narrative. For this reason, the text theory is converted to Ricoeur in a general model for the study of human action, since this is conceived as an open work to anyone who can read it. Given this general framework for discussion, we have deepened the notion (...) of the patient as “text”, and described their richness for reflection of bioethics and medical act, rescuing the value of listening, prudence, responsibility and rediscovering a place for the principle of autonomy and casuistry. -/- Paul Ricoeur sostiene que la narración es vida vivida. Por lo tanto, la experiencia humana posee una dimensión narrativa, es decir, tiene una estructura narrativa y todo esfuerzo que quiera dar cuenta de lo humano tendrá que contar con lo narrativo. Por esta razón, la teoría del texto se convierte para Ricoeur en un modelo general para el estudio de la acción humana, pues esta es concebida como una obra abierta a cualquiera que pueda leer. Teniendo en cuenta este marco general de reflexión, hemos profundizado en la noción del paciente como “texto”, y describimos su riqueza para la reflexión de la bioética y el actuar médico, rescatando el valor de la escucha, la prudencia, la responsabilidad y redescubriendo un lugar para el principio de autonomía y la casuística. (shrink)

By the early 2000s, it was already being mentioned that one of the issues affecting bioethics was a lack of wonder or amazement. Today, we see the patient, the weak and the helpless have become clients or objects placed at the disposal of personal, community and entrepreneurial whims based on functionality or utility that can take on a life of its own. Accordingly, the authors of this article propose wonder or amazement as an attitude that not only makes it possible (...) to place the human being at the center and starting point of bioethical reflection, but it is those who suffer the most, the weak and the defenseless, who are predominantly at that center or starting point. -/- A comienzos de la década del 2000 ya se mencionaba que una de las cuestiones que aquejaba la Bioética era la falta de asombro. En la actualidad vemos que el paciente, el débil y el indefenso han pasado a ser clientes u objetos puestos a disposición de caprichos personales, comunitarios o empresariales basados en la funcionalidad o utilidad que pueda tener una vida en particular. Es por eso que en este trabajo proponemos el asombro como una actitud que permite no solo situar a la persona humana como centro y punto de partida de la reflexión bioética, sino que en dicho centro esté de manera preponderante el que más sufre, el débil y el indefenso. (shrink)

This chapter explains the interrelationship between a clearly formulated philosophy of hospice care and the possibility of ethical reflection and analysis in hospice care. In so doing, it proposes that the reader consider the care given by hospices to be a special kind of practice that contains and infers its own ethics. Terminal care given by hospices is also situated in a larger society, and therefore its internal values interact with a broad set of social values; the practice of hospice (...) care interacts with many other social practices, some that support hospice and some that are in tension with it. This situation of internal ethical coherence within a context of social and cultural plurality provides an important orientation and framework for ethical decision making in, and about, hospice care. (shrink)

Introduction/Background: Moral distress and related concepts surrounding morality and ethical decision-making have been given much attention in nursing. Despite the general consensus that moral distress is an affective response to being unable to act morally, the literature attests to the need for increased clarity regarding theoretical and conceptual constructs used to describe precisely what the experience of moral distress involves. The purpose of this study is to understand how student nurses experience morally distressing situations when caring for patients with different (...) values and beliefs than their own in the clinical environment -/- Methods: This study is based on secondary analysis of participant data. The stories of eight student nurses who completed the original study were reviewed following Yin’s multiple-case study design. -/- Results: Findings suggest there is a subtle form of moral distress that has been under appreciated in the literature and differs from Jameton’s classic definition. While traditional institutional triggers to moral distress are pervasive, personal conflict as a result of differing value systems may be a moral challenge faced by nursing students working with culturally diverse patients. -/- Conclusion: Ethics education is needed in nursing school to reduce moral distress in the clinical environment. Nursing students need opportunities to develop moral reasoning skills in addition to their clinical skills. A philosophical approach to ethics education may be needed to prevent and alleviate moral distress. (shrink)

We can say that it is necessary for every human being to walk towards the comprehension of the contingent and limited reality of the human person, starting with those whose work involves dealing with patients, as well as those who dedicate themselves to bioethical reflection, and even the patients themselves. In this way, at the time when these people face a situation of pain and suffering, they will be able to assume it with integrity and strength, always choosing to protect (...) the valuable gift of human life, and not simply looking for it. to make the pain disappear as it may, tearing it up at the root, often ending up with a human life, be it at the moment of conception, as an embryo, with disabilities, sick or aging. -/- Podemos decir que es necesario que todo ser humano camine hacia la comprensión de la realidad contingente y limitada de la persona humana, empezando por aquellos cuyo trabajo involucra el trato con pacientes, así como quienes se dedican a la reflexión bioética, e incluso los mismos pacientes. De esta manera, en el momento en que estas personas se enfrenten a una situación de dolor y sufrimiento, podrán asumirla con entere-za y fortaleza, optando siempre por proteger el valioso don de la vida humana, y no simplemente buscando hacer desaparecer el dolor a como dé lugar, arrancándolo de raíz, muchas veces terminando con una vida huma-na, sea en el momento de la concepción, como embrión, con discapacidades, enferma o envejecida. (shrink)

The professional situation is considered a major interface of practicum training, here conceived as a School of conjunction, a school where one learns to make links, a foundation for the engineering of professionalization. The notion of situation is here developed based on the study of a data corpus elaborated during an experience with a practicum training model centred on writing and the construction of the professional situation by a subject-actor-author of the situation, in interaction with others, in the context of (...) nurse training. The analysis and interpretation of data brings to light a complex and unique unit, constructed in the space-time of a professional practice, a process during which several states succeed one another. The critical moment in action characterizes this unit; it is central to the process, mobilizing reflection in action, internal deliberation, and action-related decision. La situation professionnelle est identifiée comme interface majeure de la formation en alternance conçue ici comme une Ecole de la conjonction, une école où l’on apprend à relier, fondement d’une ingénierie de professionnalisation. La notion de situation est approfondie à partir de l’étude d’un corpus de données constitué au fil de l’expérimentation d’un modèle de formation en alternance centrée sur l’écriture et la construction de la situation professionnelle par un sujet-acteur-auteur de la situation, en interaction avec autrui, dans le contexte de la formation en soins infirmiers. L’analyse et l’interprétation des données permettent de mettre en évidence une unité singulière complexe, construite dans l’espace-temps d’une pratique professionnelle, un processus au cours duquel plusieurs états se succèdent. Le moment critique dans l’action la caractérise ; il occupe la place centrale du processus, mobilisant réflexion dans l’action, délibération intérieure et décision d’action. (shrink)

The professional situation is considered a major interface of practicum training, here conceived as a School of conjunction, a school where one learns to make links, a foundation for the engineering of professionalization. The notion of situation is here developed based on the study of a data corpus elaborated during an experience with a practicum training model centred on writing and the construction of the professional situation by a subject-actor-author of the situation, in interaction with others, in the context of (...) nurse training. The analysis and interpretation of data brings to light a complex and unique unit, constructed in the space-time of a professional practice, a process during which several states succeed one another. The critical moment in action characterizes this unit; it is central to the process, mobilizing reflection in action, internal deliberation, and action-related decision. La situation professionnelle est identifiée comme interface majeure de la formation en alternance conçue ici comme une Ecole de la conjonction, une école où l’on apprend à relier, fondement d’une ingénierie de professionnalisation. La notion de situation est approfondie à partir de l’étude d’un corpus de données constitué au fil de l’expérimentation d’un modèle de formation en alternance centrée sur l’écriture et la construction de la situation professionnelle par un sujet-acteur-auteur de la situation, en interaction avec autrui, dans le contexte de la formation en soins infirmiers. L’analyse et l’interprétation des données permettent de mettre en évidence une unité singulière complexe, construite dans l’espace-temps d’une pratique professionnelle, un processus au cours duquel plusieurs états se succèdent. Le moment critique dans l’action la caractérise ; il occupe la place centrale du processus, mobilisant réflexion dans l’action, délibération intérieure et décision d’action. (shrink)

This important new book provides a philosophical and historical analysis of the subject, looking at a review of sociological and political theories concerning ...

One of the many proposals put forth recently in the revival of bioethics concerns solidarity, which is part of the agenda for the discipline in the twenty-first century. In this article, solidarity is proposed as a bioethical value, inasmuch as it cannot be achieved without considering the person towards whom one shows solidarity and without taking into account his or her environment. It is not possible to make bioethical judgments or to accomplish in-depth biological thinking when forgetting the person who (...) is at the source or heart of the matter. Based on a study of the experience of a group of health volunteers in Medellin (Colombia), this research found evidence of the existence of three elements that, together, serve as a hinge between solidarity and bioethics. -/- Entre las muchas propuestas que se han hecho recientemente en ese resurgir de la bioética se encuentra la solidaridad, consti­tuyéndose parte de la agenda del siglo XXI sobre esta disciplina. Proponemos la solidaridad como un valor bioético puesto que así como no se puede ser solidario sin tener en cuenta a la persona con quien soy solidario y su entorno, no se pueden emitir juicios bioéticos o hacer una reflexión bioética de fondo olvidando a quien se tiene en frente. A partir de un estudio de la expe­riencia de una población de voluntarios del sector salud en Medellín, Colombia, se logró evidenciar que existen tres elementos que, en conjunto, sirven de bisagra entre la solidaridad y la bioética. (shrink)

The purpose of this article is to illustrate moral learning in persons with a psychiatric disability who participated in a nursing intervention, called the photo-instrument. This intervention is a form of hermeneutic photography. The findings are based on a multiple case study of 42 patients and additional interviews with eight of them. Photo groups were organized within three settings of psychiatric services: ambulatory as well as clinical, all situated in the Netherlands. Data were analysed according to hermeneutic and semiotic principles. (...) Two cases are presented. Findings show that voice and face are concepts that help to identify elements of moral learning in the rehabilitation process of persons with a psychiatric disability. During the process patients become more aware of their responsibilities towards themselves and others. (shrink)