Nursing is a complicated and multifaceted profession that sets high demands in preparing nursing students for the profession. In today's education, the emphasis is often on knowledge and skills, that is, epistemology. In caring science another approach is sought, an approach based on human sciences in which knowledge will serve a more profound understanding, that is, the ontology. Consequently, the question of what this ‘understanding’ in clinical education is and how it is promoted in clinical nursing education becomes important to (...) clarify. Therefore, the aim here is to explicate the phenomenon of understanding in clinical education as experienced by third‐year undergraduate nursing students ready for graduation. This study, with a hermeneutic approach, is based on a secondary analysis of focus group interviews with undergraduate nursing students. The analytical expansion of the original material suggests three interrelated themes that illuminate the phenomenon of understanding in clinical education. These findings are deepened and enriched through philosophical abstraction. In the process of understanding, episteme, techne and phronesis can be viewed as inherent parts of the structure of thought in nursing. The perspective advanced in this study adds new aspects to the phenomenon of understanding and its meaning and significance in the dynamic process of formation and becoming in clinical education. The focus in clinical nursing education should be on learning reflective, critical thinking and the ways of being a nurse, rather than drilling students on particular skills. In the rapidly changing world of the 21st century, an understanding‐based education is needed as a more meaningful and authentic approach. Therefore, an ontological turn in nursing education, through which the main focus shifts from a traditional epistemology to an epistemology in the service of ontology, is suggested. Further studies are needed in the development and implementation of an understanding‐based, interpretative education in nursing. (shrink)

Background Previous studies have shown that the rapid transition to emergency remote teaching due to the COVID-19 pandemic was challenging for healthcare teachers in many ways. This sudden change made them face ethical dilemmas that challenged their values and ethical competence. Research aim This study aimed to explore and gain a deeper understanding of the ethical dilemmas healthcare teachers faced during the COVID-19 pandemic. Research design This was an inductive qualitative study using a hermeneutic approach. Semi-structured interviews were conducted and (...) analysed thematically. Participants and research context Healthcare teachers ( n = 20) from eight universities and universities of applied sciences in the Nordic and Baltic countries participated. Ethical considerations This study was based on the research ethics of the Norwegian National Research Ethics Committee for Medicine and Health Sciences and approved by the Norwegian Agency for Shared Services in Education and Research. Findings Healthcare teachers faced several ethical dilemmas due to restrictions during the COVID-19 pandemic. The analysis revealed three main themes: How should I deal with students’ ill-being, and what can I as a teacher do?; What can I demand from myself and my students, what is good teaching?; How do I manage the heavy workload and everyone’s needs, and who gets my time? Conclusions This study highlights the importance of healthcare teachers’ continuous need for pedagogic and didactic education, especially considering new technology and ethical issues. During the pandemic, the ethical consequences of remote teaching became evident. Ethical values and ethical dilemmas should be addressed in healthcare education programmes at different levels, especially in teacher education programmes. In the coming years, remote teaching will grow. Therefore, we need more research on this issue from an ethical perspective on its possible consequences for students and healthcare teachers. (shrink)

Nudging is a concept in behavioural science, political theory and economics that proposes indirect suggestions to try to achieve non-forced compliance and to influence the decision making and behaviour of groups and individuals. Researchers in medical ethics are currently discussing whether nudging is ethically permissible in healthcare. In this article, we examine current knowledge about how different decisions are made and how this decision-making process pertains to patients. We view this knowledge in light of the nursing project and the ongoing (...) debate regarding the ethical legitimacy of nudging in healthcare. We argue that it is insufficient to discuss nudging in nursing and healthcare in light of free will and patient autonomy alone. Sometimes, nurses must take charge and exhibit leadership in the nurse–patient relationship. From the perspective of nursing as leadership, nudging becomes a useful tool for directing and guiding patients towards the shared goals of health, recovery and independence and away from suffering. The use of nudging in nursing to influence patients’ decisions and actions must be in alignment with the nursing project and in accordance with patients’ own values and goals. (shrink)

Background Interest in strengthening residents’ autonomy in nursing homes is intensifying and professional caregivers’ experience ethical dilemmas when the principles of beneficence and autonomy conflict. This increased focus requires expanded knowledge of how residents experience decision-making in nursing homes and how being subject to paternalism affects residents’ dignity. Research question/aim This study explored how residents experience paternalism in nursing homes. Research design This study involved a qualitative interpretive design with participant observations and semi-structured interviews. The interpretations were informed by Gadamer’s (...) hermeneutics. Participants and research context Eleven residents were interviewed after a period of participant observation in two nursing homes. Ethical considerations The study was performed in accordance with the Helsinki declaration. The Regional Ethics Committee (REK) permitted the researcher to perform participant observation in the nursing homes. The use of audio recordings of interviews was registered and supervised by Sikt - Norwegian Agency for Shared Services in Education and Research. The resident’s consent was assessed continuously. Three interviews were terminated for ethical reasons. Findings The resident interviews revealed that residents found it obvious for caregivers to possess the decision-making authority in nursing homes. When residents explained their views, three main themes emerged: (1) To be included even though caregivers make the decisions, (2) Surrender to dependency, and (3) Adherence to nursing home norms. Conclusions Residents submit to their caregivers and give caregivers the responsibility and function as leaders. Paternalism was experienced as dignifying in situations where it contributed to residents being able to live according to second order desires and values, and when it implied respect and appraisal of residents’ capabilities. Paternalism was experienced as debasing when residents felt left out, and when residents felt that their capabilities were underestimated. This also included their capability to withstand paternalistic influence. (shrink)

The emergence of key concepts in Reinhart Koselleck’s sense has been much discussed in conceptual history, but mainly for the eighteenth and nineteenth centuries. The article documents a post–World War II emergence of the concept of health, from relative anonymity to becoming a key concept, comparable to concepts such as politics, democracy, and culture. While previous research has emphasized conceptual mobility, this article focuses on conceptual aggregation, where the concept of health assembles and assimilates meanings, becoming essential to discourse. This (...) is explained with reference to the development of the welfare state and the political use of a positive, expanded health concept. The article utilizes a collocation analysis of Norwegian digitized newspapers 1950–2010, culled from the uniquely extensive database of the Norwegian National Library. (shrink)

The practice of nursing involves ongoing interactions between nurses' and clients' lived bodies. Despite this, several scholars have suggested that the “lived body” (Merleau‐Ponty, 1962) has not been given its due place in nursing practice, education or research (Draper, J Adv Nurs, 70, 2014, 2235). With the advent of electronic health records and increased use of technology, face‐to‐face assessment and embodied understanding of clients' lived bodies may be on the decline. Furthermore, staffing levels may not afford the time nurses need (...) to be as “present” with their clients in embodied ways. The failure to attend to the lived body may contribute to missed opportunities for care and decreased quality of life for both clients and healthcare practitioners. In this paper, we undertake an analysis of selected aspects of the work of Maurice Merleau‐Ponty. The aim is to advance understanding of the affordances this work may offer to enhancing client–nurse interactions within the practice of nursing. Merleau‐Ponty's notions of embodiment, intersubjectivity and intercorporeality as articulated in his seminal texts The Phenomenology of Perception (New York, NY: Routledge, 2012) and The Visible and the Invisible (Evanston, IL: Northwestern University Press, 1968) are examined. These three constructs are discussed as they relate to the lived body in client–nurse interactions in nursing practice and education. Finally, implications of how attention to “the lived body” could shape interactions and have the potential to foster increased quality of life of clients and nurses are considered. (shrink)

Our contribution in this paper is to highlight the ethical implications of workforce engagement strategies in an age of austerity. Hard or instrumentalist approaches to workforce engagement create the potential for situations where engaged employees are expected to work ever longer and harder with negative outcomes for their well-being. Our study explores these issues in an investigation of the enactment of an engagement strategy within a UK Health charity, where managers and workers face paradoxical demands to raise service quality and (...) cut costs. We integrate insights from engagement, paradox, and ethic of care literatures, to explore these paradoxical demands—illustrating ways in which engagement experiences become infused with tensions when the workforce faces competing requirements to do ‘more with less’ resources. We argue that those targeted by these paradoxical engagement strategies need to be supported and cared for, embedded in an ethic of care that provides explicit workplace resources for helping workers and managers cope with and work through corresponding tensions. Our study points to the critical importance of support from senior and frontline managers for open communications and dialogue practices. (shrink)

This essay explores the intersection of race science and plant taxonomy in the creation of evolutionary taxonomies (phylogenies) of populations of Zea mays, also known as maize or corn. Following recent work in the history and sociology of race, it analyzes maize taxonomy as technology. Through an analysis of successive attempts to classify diverse maize varieties, especially those originating in Mexico, it shows that taxonomy created possibilities for researchers to intervene in commercial agriculture, state development projects, biological conservation, and domestic (...) and international politics and policy. It further underscores that the modern science of maize taxonomy was distinct but never inseparable from assessments of maize’s human cultivators. Attending to particularities of this relationship is crucial, because it reveals the application of maize taxonomy as a technology for ordering human diversity and intervening in human lives, as well as managing the impressive diversity of Zea mays. (shrink)

Objective: Basic temporal dysfunctions have been described in patients with schizophrenia, which may impact their ability to connect and synchronize with the outer world. The present study was conducted with the aim to distinguish between interval timing and synchronization difficulties and more generally the spatial-temporal organization disturbances for voluntary actions. A new sensorimotor synchronization task was developed to test these abilities. Method: Twenty-four chronic schizophrenia patients matched with 27 controls performed a spatial-tapping task in which finger taps were to be (...) produced in synchrony with a regular metronome to six visual targets presented around a virtual circle on a tactile screen. Isochronous (time intervals of 500 ms) and non-isochronous auditory sequences (alternated time intervals of 300/600 ms) were presented. The capacity to produce time intervals accurately versus the ability to synchronize own actions (tap) with external events (tone) were measured. Results: Patients with schizophrenia were able to produce the tapping patterns of both isochronous and non-isochronous auditory sequences as accurately as controls producing inter-response intervals close to the expected interval of 500 and 900 ms, respectively. However, the synchronization performances revealed significantly more positive asynchrony means (but similar variances) in the patient group than in the control group for both types of auditory sequences. Conclusion: The patterns of results suggest that patients with schizophrenia are able to perceive and produce both simple and complex sequences of time intervals but are impaired in the ability to synchronize their actions with external events. These findings suggest a specific deficit in predictive timing, which may be at the core of early symptoms previously described in schizophrenia. (shrink)

Louise Antony draws a now well-known distinction between two explanatory models for researching and addressing the issue of women’s underrepresentation in philosophy – the ‘Different Voices’ (DV) and ‘Perfect Storm’ (PS) models – and argues that, in view of PS’s considerably higher social value, DV should be abandoned. We argue that Antony misunderstands the feminist framework that she takes to underpin DV, and we reconceptualise DV in a way that aligns with a proper understanding of the metaphilosophical framework that underpins (...) it. On the basis of that reconceptualisation – together with the rejection of her claim that DV posits ‘cognitive’ differences between women and men – we argue that Antony’s negative assessment of DV’s social value is mistaken. And, we argue, this conclusion does not depend on endorsing the relevant feminist metaphilosophical framework. Whatever our metaphilosophical commitments, then, we should all agree that DV research should be actively pursued rather than abandoned. (shrink)

This paper charts the history of the Rockefeller Foundation’s participation in the collection and long-term preservation of genetic diversity in crop plants from the 1940s through the 1970s. In the decades following the launch of its agricultural program in Mexico in 1943, the Rockefeller Foundation figured prominently in the creation of world collections of key economic crops. Through the efforts of its administrators and staff, the foundation subsequently parlayed this experience into a leadership role in international efforts to conserve so-called (...) plant genetic resources. Previous accounts of the Rockefeller Foundation’s interventions in international agricultural development have focused on the outcomes prioritized by foundation staff and administrators as they launched assistance programs and especially their characterization of the peoples and “problems” they encountered abroad. This paper highlights instead how foundation administrators and staff responded to a newly emergent international agricultural concern—the loss of crop genetic diversity. Charting the foundation’s responses to this concern, which developed only after agricultural modernization had begun and was understood to be produced by the successes of the foundation’s own agricultural assistance programs, allows for greater interrogation of how the foundation understood and projected its central position in international agricultural research activities by the 1970s. (shrink)

In an outline of a paper found amongst his philosophical papers and correspondence after his untimely death in 2001—“Nihil Obstat: An Analysis of Ability,” reproduced in this volume—David Lewis sketched a new compatibilist account of abilities, according to which someone is able to A if and only if there is no obstacle to their A-ing, where an obstacle is a ‘robust preventer’ of their A-ing. In this paper, we provide some background context for Lewis’s outline, a section-by-section commentary, and a (...) general discussion of the account’s main features. (shrink)

A new Clinical Ethics Advisory Group was created to contribute to NHS Trust policies and guidelines in response to ethical issues arising from the COVID-19 pandemic. An ethical analysis framework used in medical education, the CoRE-Values Compass and Grid, was adapted to form a step-wise ‘ABC’ decision-making process. CEAG members found the framework simple to understand and use and the model facilitated time-efficient decisions that were explicitly justifiable on moral, ethical, professional and legal grounds. The adapted CoRE-Values framework might help (...) facilitate decision-making processes for similar new clinical ethics advisory or support committees. (shrink)

Helen Beebee, Anne-Marie McCallion Download PDF.

Helen Beebee, Anne-Marie McCallion ABSTRACT: Louise Antony draws a now well-known distinction between two explanatory models for researching and addressing the issue of women’s underrepresentation in philosophy – the ‘Different Voices’ and ‘Perfect Storm’ models – and argues that, in view of PS’s considerably higher social value, DV should be abandoned. We argue ….

The western philosophical tradition, with its focus on universal concepts and a presumed neuter, but ultimately male subject, has only relatively recently become open to the question of alterity, in particular the alterity of woman as the other of man. The essays of this volume reflect in particular on the ethical implications of taking the feminine other into account. This necessitates a rethinking of the implicit structures of Western philosophy which continue to exclude women as subjects who contribute to the (...) conceptualization of world and society. This volume, which gives voice to women philosophers, is a contribution to that task. (shrink)

The H19 gene produces a non‐coding RNA, which is abundantly expressed during embryonic development and down‐regulated after birth. Although this gene was discovered over 20 years ago, its function has remained unclear. Only recently a role was identified for the non‐coding RNA and/or its microRNA partner, first as a tumour suppressor gene in mice, then as a trans‐regulator of a group of co‐expressed genes belonging to the imprinted gene network that is likely to control foetal and early postnatal growth in (...) mice. The mechanisms underlying this transcriptional or post‐transcriptional regulation remain to be discovered, perhaps by identifying the protein partners of the full‐length H19 RNA or the targets of the microRNA. This first in vivo evidence of a functional role for the H19 locus provides new insights into how genomic imprinting helps to control embryonic growth. (shrink)

This article introduces the 2012 Montréal FRAN-HOMA corpus, collected in the Francophone neighborhood of Hochelaga-Maisonneuve, and how it relates to the heritage corpora of Montréal French collected since the 1970s. We discuss the methodological choices made regarding the composition of this corpus including the historical and demo-linguistic information that led to the selection of the Hochelaga-Maisonneuve neighborhood for fieldwork. A presentation of the socially stratified sample and criteria for participant selection is followed by a discussion on data collection and the (...) sociolinguistic interview. After a brief review of the transcription protocol and the advantages of audio-aligned transcription, we provide two illustrations of the revival of research on linguistic variation made possible by this new corpus. (shrink)

Despite the growing interest in developing a micro-level understanding of strategy practices, there are few studies focusing on the official textual expression of these practices in the form of strategic plans. Using a large corpus of strategic plans from public and third sector organizations, this article examines the particular features of the strategic plan genre of communication. This corpus is systematically compared with nine other corpora derived from the same general domain or having similar expected characteristics. Our analysis combines linguistic (...) analysis with an analysis of the moves characteristic of the genre. The article seeks to advance a genre-based view of strategy practices to study the professional and institutional practices of strategists. (shrink)

Introduction.--Fragmenta: Aristaios. Aresas (Aisara). Boutheros. Brontinos. Ekphantos. Euryphamos. Eurytos. Hipparchos. Kleinias. Lysis. Onatas. Sthenidas.--Index fontium.

Within the rough ground that is the field of education there is a complex web of ethical obligations: to prepare our students for their future work; to be ethical as educators in our conduct and teaching; to the ethical principles embedded in the contexts in which we work; and given the Southern context of this work, the ethical obligations we have to this land and its First Peoples. We put out a call to colleagues whose work has been concerned with (...) the pedagogies of professional ethics, the ethical burdens of institutional injustice, and the application of ethical theory to education’s applied fields. In the responses we received it can be seen that ethical concerns in education are broad ranging, covering terrain varying from the preparation of preservice teachers, ethics in higher education, early childhood and care, educational leadership, relational and communicative ethics. Perhaps it could also be argued that this paper demonstrates Gibbon’s observation that ‘Assumptions about the particularity of this time as new and ripe with opportunity to make a difference through philosophy of education are not new and there’s much to learn from the persistence of wanting to imagine that they are’. However, while the field of ethics is perennially concerned with human relations and pedagogical interventions to improve these, the responses collected here show that educational ethics is far from static. Educational ethics is a field that continues to develop in response to changing contexts. (shrink)

Following the introduction of do-not-resuscitate orders in the 1970s, there was widespread misinterpretation of the term among healthcare professionals. In this brief report, we present findings from a survey of healthcare professionals. Our aim was to examine current understanding of the term do-not-attempt-resuscitate, decision-making surrounding DNAR and awareness of current guidelines. The survey was distributed to doctors and nurses in a university teaching hospital and affiliated primary care physicians in Dublin via email and by hard copy at educational meetings from (...) July to December 2014. A total of 519 completed the survey. The response rate in the hospital doctors group was 35.5%, 19.8% in the nurses group but 68.8% in the specialist nurses group and 40% in the primary care physician group.Alarmingly, our results demonstrate that 26.8% of staff nurses and 30% of primary care physicians surveyed believed that a patient with a DNAR order could not receive any/at least one of a list of simple treatments including antibiotics, physiotherapy, intravenous fluids, pain relief, oxygen, nasogastric feeding or airway suctioning, which were higher percentages compared to the other hospital doctors and experienced nurses groups with statistically significant differences. Furthermore, a higher percentage of staff nurses and primary care physicians believed that a patient with a DNAR order could not be referred to hospital from home/a nursing home, when compared with other healthcare groups. Our findings highlight continued misunderstanding and over-interpretation of DNAR orders. Further collaboration and information is required for meaningful Advance Care Plans. (shrink)

In this article, we present findings from a qualitative study examining how young women experience being long‐term bedridden with myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), during childhood and adolescence. The aim is to explore how young women who fell ill with ME/CFS during childhood and adolescence look back on their lived experience of being long‐term bedridden from the vantage point of being fully or partially recovered. Informed by a phenomenological theoretical perspective, the researchers applied a narrative (...) methodological approach involving the analysis of interviews with 13 women, aged 16–29 years at the time of the interview. Attention was particularly paid to how participants structured their narratives and to the events (telling moments) they identified as important. Four major storylines were developed: Ambivalent responses to the presence of others; A body on the edge of life; An eternity in the dark; and Recasting painful memories of being bedridden and alone. Based on our findings, we argue that the experience of being long‐term bedridden with ME/CFS during childhood and adolescence can be understood and communicated as a plot in which individuals find themselves pushed to the extreme limit of suffering and loneliness. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments (n=98; proportion of participation was (...) 99%) conducted in 2015 across publicly funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

In the context of long waiting time to access rehabilitation services, a large majority of settings use referral prioritization to help manage waiting lists. Prioritization practices vary greatly between settings and there is little consensus on how best to prioritize referrals. This paper describes the prioritization processes for physiotherapy services in Québec and its potential implications in terms of equity in access to services. This is a secondary analysis of a survey of outpatient physiotherapy departments conducted in 2015 across publicly (...) funded hospitals in Québec. In many settings, persons with acute orthopaedic conditions were prioritized while chronic conditions were given a lower priority. There were 72 different combinations of prioritization criteria used in outpatient physiotherapy departments. Variability was also observed in the type of personnel involved in the prioritization process, the number of priority levels used to rank the referrals and the source of information used to prioritize referrals. These results highlight potential issues regarding equity in access to physiotherapy services: the prioritization of persons with acute conditions to the detriment of those with chronic conditions, the lack of consensus on a fair prioritization process and the importance to adequately assess patients’ needs for treatment. Further research and interventions on prioritization criteria and processes are needed to ensure equitable access to physiotherapy services, especially in the public sector. (shrink)

This paper is part of a larger project designed to examine and ameliorate the underrepresentation of female-identified students in the philosophy department at Elon University. The larger project involved a variety of research methods, including statistical analysis of extant registration and grade distribution data from our department as well as the administration of multiple surveys. Here, we provide a description and analysis of one aspect of our research: focus groups. We ran three focus groups of female-identified undergraduate students: one group (...) consisted of students who had taken more than one philosophy class, one consisted of students who had taken only one philosophy class, and one consisted of students who had taken no philosophy classes. After analyzing the results of the focus groups, we find evidence that: one philosophy class alone did not cultivate a growth mindset among female-identified students of philosophy, professors have the potential to ameliorate students’ perceptions of philosophy; and students who have not taken philosophy are likely to see their manner of thinking as being at odds with that required by philosophy. We conclude by articulating a series of questions worthy of further study. (shrink)

Ce livre présente cinq entretiens avec des philosophes pionniers dans le champ de la bioéthique francophone, Anne Fagot-Largeault et Jean-Yves Goff i (France), Gilbert Hottois et Jean-Noël Missa (Belgique) et Marie-Hélène Parizeau (Québec), cinq personnalités de renom, connues pour leur trajectoire exceptionnelle. Les entretiens menés avec ces auteurs au sujet de leurs oeuvres, de leurs expériences dans des comités de bioéthique et des différents débats soulevés ces dernières années nous permettent de connaître leur travail, mais aussi de faire une incursion (...) dans le développement fulgurant de la bio-médecine et des biotechnologies des cinquante dernières années. Les conséquences de ces applications, les problèmes éthiques générés, les jugements favorables et défavorables à l'égard des changements sociaux qui se sont produits et le bouleversement d'idées qui s'en est suivi, sont autant d'aspects abordés dans ces entretiens. L'utilisation du langage courant exige un effort de synthèse important; aussi ces entretiens sous la forme d'une conversation, offrent-ils au lecteur une large vision panoramique, rigoureuse et concise de l'évolution de la bioéthique francophone. (shrink)

The use of psychometric tools to investigate the impact of school-based wellbeing programs raises a number of ethical issues around students’ rights, confidentiality and protection. Researchers have explicit ethical obligations to protect participants from potential psychological harms, but guidance is needed for effectively navigating disclosure of identifiable confidential information that indicates signs of psychological distress. Drawing on a large-scale study examining student, school, and system-based factors that impact the implementation of a school-based social and emotional learning program, we describe patterns (...) of distress attained from quantitative and qualitative questions and describe the process that we evolved to monitor and disclose sensitive mental health information, providing one example of how researchers might effectively address the responsibilities that emerge when collecting sensitive information from students within an education system. The patterns and processes that emerged illustrate that the inclusion of mental distress information can elicit important insights, but also brings responsibilities for minimising risks and maximising benefits. (shrink)