BackgroundDecisions about limitations of life sustaining treatments are made for end-of-life patients in intensive care units. The aim of this research was to explore the professional and ethical attitudes and experiences of medical professionals on treatment of end-of-life patients in ICUs in the Republic of Croatia.MethodsA cross-sectional study was conducted among physicians and nurses working in surgical, medical, neurological, and multidisciplinary ICUs in the total of 9 hospitals throughout Croatia using a questionnaire with closed and open type questions. Exploratory factor (...) analysis was conducted to reduce data to a smaller set of summary variables. Mann–Whitney U test was used to analyse the differences between two groups and Kruskal–Wallis tests were used to analyse the differences between more than two groups.ResultsLess than third of participants stated they were included in the decision-making process, and physicians are much more included than nurses. Sixty two percent of participants stated that the decision-making process took place between physicians. Eighteen percent of participants stated that ‘do-not-attempt cardiopulmonary resuscitations’ orders were frequently made in their ICUs. A decision to withdraw inotropes and antibiotics was frequently made as stated by 22.4% and 19.9% of participants, respectively. Withholding/withdrawing of LST were ethically acceptable to 64.2% of participants. Thirty seven percent of participants thought there was a significant difference between withholding and withdrawing LST from an ethical standpoint. Seventy-nine percent of participants stated that a verbal or written decision made by a capable patient should be respected. Physicians were more inclined to respect patient’s wishes then nurses with high school education. Nurses were more included in the decision-making process in neurological than in surgical, medical, or multidisciplinary ICUs. Male participants in comparison to female, and physicians in comparison to nurses with high school and college education displayed more liberal attitudes about LST limitation.ConclusionsDNACPR orders are not commonly made in Croatian ICUs, even though limitations of LST were found ethically acceptable by most of the participants. Attitudes of paternalistic and conservative nature were expected considering Croatia’s geographical location in Southern Europe. (shrink)

STAJDUHAR K, FUNK L, JAKOBSSON E and ÖHLÉN J. Nursing Inquiry 2010; 17: 221–230A critical analysis of health promotion and ‘empowerment’ in the context of palliative family care-givingTraditionally viewed as in opposition to palliative care, newer ideas about ‘health-promoting palliative care’ increasingly infuse the practices and philosophies of healthcare professionals, often invoking ideals of empowerment and participation in care and decision-making. The general tendency is to assume that empowerment, participation, and self-care are universally beneficial for and welcomed by all individuals. (...) But does this assumption hold for everyone, and do we fully understand the implications of health-promoting palliative care for family caregivers in particular? In this study, we draw on existing literature to highlight potential challenges arising from the application of ‘family empowerment’ strategies in palliative home-care nursing practice. In particular, there is a risk that empowerment may be operationalized as transferring technical and medical-care tasks to family caregivers at home. Yet, for some family caregivers, a sense of security and support, as well as trust in professionals, may be equally if not more important than empowerment. Relational and role concerns may also at times take precedence over a desire for empowerment. The potential implications of ‘family empowerment’ are explored in this regard. ‘Family empowerment’ approaches need to be accompanied by a strong understanding of how to best support individual palliative family caregivers. (shrink)

Diverse beliefs about the nature and essence of scientific truth are pervasive in the nursing literature. Most recently, rejection of a more traditional and objective truth has resulted in a shift toward an emphasis on the acceptance of multiple and subjective truths. Some nursing scholars have discarded the idea that objective truth exists at all, but instead have argued that subjective truth is the only knowable truth and therefore the one that ought to govern nursing's disciplinary inquiry. Yet, there has (...) been relatively little critical debate or dialogue about the implications of adopting subjective and multiple truths as a maxim to govern the discipline. In this paper we examine what it might mean to adopt subjective forms of truth as the only knowable truths for nursing, and to accept the possibility of multiple co-existing realities. We understand the implications of such a philosophical stance for the epistemological basis of a practice science to be considerable, therefore we consider what it might mean for a practice-based discipline such as nursing to remain ambiguous on the question of truth, and examine the implications of failing to achieve consensus on what constitutes a truth claim. On the basis of this examination, we urge a cautious approach to the extremes of either position and argue for a more thoughtful and rigorous dialogue about ‘truth’ and knowledge in nursing practice, education, and research. (shrink)

Les vues philosophiques de Vladimir Jovanović : p.165-167.

The author analyses the second phase of the development of Husserl’s phenomenological egology and the transition from nonegological to egological phenomenology. Accepting the necessity of the pure I as a phenomenological residue of the transcendental epoché, a non-constituted transcendence in immanence and the source of the evidence of the ‘I am’, it is analysed in its main aspects – such as, among others, the I-pole and I-substrate of habitualities – and in its traits and roles it plays in the stream (...) of lived experiences of pure consciousness. Thus formulated, pure I will be incorporated into the late concepts of transcendental ego and transcendental intersubjectivity. The shortcomings of such an egological conception of consciousness will also be examined, to which the nonegological theories of Husserl’s followers will not offer an adequate solution, making the debate of the egological character of consciousness present also in contemporary philosophy. (shrink)

Die philosophischen und Gesellschafts-Politishchen Anschauungen Milan Kujundžić Aberdars (1842-1893).

The topic of this paper is the debate between political moralists and political realists. I will try to show that it is possible to find the middle ground that simultaneously satisfies the main demands of both camps while resisting objections directed against each. In the first part, I start with the view shared by both moralists and realists: that the main challenge lying before a political theory is solving the problem of legitimacy. I first sketch Rawls? moralist approach. I then (...) move to outline the realist criticisms of such moralism. I will mainly follow one of the most detailed recent theories - Sleat?s realist theory, although I will also draw from other well-known realists. In the second part, I outline objections against realism. They somewhat similar to the same criticisms they themselves direct against moralists. The main issue is, in short, the problem of underdetermination - that is, the insufficient determination of political action by facts. Since realists hold that a political theory has to be applicable, their view is thus considerably weakened by such criticism. In the third part of the paper, I point to deliberative theory as a view that can answer both realist criticism - because its main aspect is dealing with the way things work in actual politics of concrete societies - but it can also answer criticisms directed against realists themselves, because empirical research of deliberation suggests an actual and viable way to solve the problem of legitimacy - by raising the quality of deliberation. Moreover, a deliberative theory retains autonomy of the ethical, although it doesn?t do that, unlike moralism, by encroaching on the autonomy of politics. Thus, at the end of the paper, I claim that such a deliberative approach can be accepted by both realists and moralists. (shrink)

In this paper, I examine the view that, surprisingly, the more citizens deliberate about politics, the less likely they are to participate in the realm of the political, and vice versa. In the first part of the paper, I approach the problem from the perspective of the paradox of voting, the claim that voting itself is instrumentally irrational because of the very low probability that a single vote will make any difference at the elections. In the second part of the (...) paper, I argue that rather than analyzing voting instrumentally, it is better to view it as part of the civic commitments that constitute what it means to be a citizen in a democratic society. The act of voting is not primarily an individual?s attempt to decisively influence any particular outcome, but an affirmation of the key practice that upholds the democratic society in which citizens play a part. This reveals a meta-paradox of voting. Namely, to not vote is to exhibit a type of behavior that implies acceptance of democracy simultaneously with rejecting its defining component. Because of that, I will claim, not voting is itself irrational. In light of that conclusion, in the third part of the paper, I explore the extant divide between deliberation and participation by referring back to the analysis of civic commitments. Whereas participation without deliberating reveals ideological bias, deliberation without participation expresses a lack of understanding of what it means to be a citizen. The way to connect them is to engage in a process of attaining reflective equilibrium between the two, starting from the practice of deliberation that would be fully informed by the awareness of our democratic commitments and disconnected from ideologically motivated participation. (shrink)

knj. 1. Detinjstvo, đakovanje i studije (1875-1898).

Interpretations of family carer empowerment in much nursing research, and in home‐care practice and policy, rarely attend explicitly to families’ choice or control about the nature, extent or length of their involvement, or control over the impact on their own health. In this article, structural empowerment is used as an analytic lens to examine home‐care nurses’ interactions with families in one Western Canadian region. Data were collected from 75 hrs of fieldwork in 59 interactions (18 nurses visiting 16 families) and (...) interviews with 12 nurses and 11 family carers. Generally, nurses prioritized client empowerment, and their practice with families appeared oriented to supporting their role and needs as carers (i.e. rather than as unique individuals beyond the caring role), and reinforcing the caring role through validation and recognition. Although families generally expressed appreciation for these interactions, a structural empowerment lens illustrates how the broad context of home care shapes the interpretation and practice of empowerment in ways that can, paradoxically, be disempowering for families. Opportunities to effectively support family choice and control when a client is being cared for at home are discussed. (shrink)

Currently, much of the western world is experiencing a shift in the places where care is provided, namely from institutional settings like hospitals to diverse community settings such as the home. However, little is known about how language and the physical and social aspects of place interact to influence how health‐care is delivered and experienced in the home environment. Drawing on ethnographic participant observations of homecare nursing visits and semi‐structured interviews with Canadian family caregivers, care recipients and nurses, the intersection (...) of language, place and health‐care was explored in this secondary analysis. Our findings reveal four themes: homecare nurses view themselves as ‘guests’; home environments facilitate the development of nurse–client relationships; nurses adapt healthcare language to each home environment; and storytelling and illness narratives largely prevail during medical interactions in the home. These findings demonstrate the spatiality of language and how the home environment informs decisions regarding language use. Furthermore, these findings exemplify how language and place mutually influence the experiences and delivery of home health‐care. We conclude by discussing the importance of considering the language–place–healthcare intersection in order to gain a better understanding of medical exchanges in places and the associated implications for optimizing best nursing practice. (shrink)