Background As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency (...) medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability. Methods A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis. Results Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting. Conclusions Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values. (shrink)

Background: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in. Objective: To describe assistant nurses’ perspectives of providing care to older persons at the end of life in a nursing home. Research design: Data were collected (...) in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee. Results: Three main categories emerged; “Death a natural part of life”; “The older person’s well-being”; and “Care in the moment of death”; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons’ dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions. Discussion: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded. Conclusion: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development. (shrink)

Background:Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy and dignity of identity. While assistant nurses claim to support older persons’ wishes, older persons claim they have to adapt to assistant nurses' routines. The provider–receiver incongruence revealed here warrants investigation.Aim:To describe the elements of assisted bodily care, as performed in a nursing home.Research design:Data were collected through thirty-nine observations of (...) assisted bodily care, analyzed with qualitative content analysis.Participants and research context:Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home.Ethical considerations:The research was conducted in line with the Declaration of Helsinki, further approved by the regional ethics committee.Findings:Findings show that assisted bodily care consists of assistant nurses’ practical work, performed at a high tempo. Assistant nurses still attempt to adapt this work to the older persons’ wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care.Discussion:Assistant nurses try to promote older persons’ dignity of identity, but sometimes fail, possibly due to lack of time. They nevertheless seem to know the older persons well enough to adapt the assisted bodily care according to their preferences and to support self-determination. This indicates that openness to older persons’ lifeworlds may be more important than the amount of time available.Conclusion:Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could agree on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all. (shrink)

When Gödel developed his functional interpretation, also known as the Dialectica interpretation, his aim was to prove consistency of first order arithmetic by reducing it to a quantifier-free theory with finite types. Like other functional interpretations Gödel’s Dialectica interpretation gives rise to category theoretic constructions that serve both as new models for logic and semantics and as tools for analysing and understanding various aspects of the Dialectica interpretation itself. Gödel’s Dialectica interpretation gives rise to the Dialectica categories , in: Contemp. (...) Math., vol. 92, Amer. Math. Soc., Providence, RI, 1989, pp. 47–62] and J.M.E. Hyland in [J.M.E. Hyland, Proof theory in the abstract, Ann. Pure Appl. Logic 114 43–78, Commemorative Symposium Dedicated to Anne S. Troelstra ]). These categories are symmetric monoidal closed and have finite products and weak coproducts, but they are not Cartesian closed in general. We give an analysis of how to obtain weakly Cartesian closed and Cartesian closed Dialectica categories, and we also reflect on what the analysis might tell us about the Dialectica interpretation. (shrink)

This article takes its point of departure in a research project studying the psychosocial problems of living with HIV. The project was intended to participate in changing practices dealing with these problems. It became a project including many differently situated and intersecting personal and generalized perspectives. The article researches the development of the HIV project as a contribution to discussions related to Participatory Action Research and Practice Research. In mainstream approaches methodological indications are often presented as rules to follow in (...) order to ensure the quality of the obtained knowledge. But situated historical and societal processes are involved in the effectuation of the HIV project, like they are in any other project. Researching the project heightens the awareness of the necessity of reflecting on situated and historical issues of power and marginalization and on the positions of the researcher in a given field of research. Methodological flexibility may also be necessary in order to encompass different perspectives. Such reflections and strategies are necessary precisely to ensure the development of knowledge and practice alike. (shrink)

Despite progress, discrimination in public health remains a problem. A significant aspect of this problem relates to how medical resources are allocated. The paradigm of quality-adjusted-life-year (QALY) dictates that medical resources should be allocated on the basis of units measured as length of life and quality of life that are expected after the implementation of a treatment. In this article, I discuss some of the ethical shortcomings of QALY, by focusing on some of its flawed moral aspects, as well as (...) the way it relates to discrimination on the basis of age, race, and disability status. I argue that while this approach seeks to maximize efficiency, it does not place sufficient value on the preservation of life itself. Even more concerning is the fact that the use of QALY disproportionately harms minorities. While QALY is a well-intentioned approach to the allocation of scarce healthcare resources, new alternatives must be sought. (shrink)

Drawing upon the literature on action research and case-study research, this paper discusses similarities and differences between these two forms of research practice. The paper also highlights some of the criticisms and challenges action researchers face. It suggests ways in which action researchers may enhance the discussability of action research by: (a) increasing the transparency of their research processes, (b) declaring the intellectual frameworks brought into action research projects, (c) discussing transferability of findings, and (d) defining accumulation of results. This (...) may require an extension to scientific discourse. In particular, the paper suggests that action researchers could change the ways in which action research results are reported to increase their reach among a wider audience. (shrink)

For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not (...) only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long‐term care, we show the possibilities of playfulness in the co‐composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times. (shrink)

Isometry hypotheses are propositions that assert the constancy of a specific physical magnitude of a system under prescribed conditions. This paper addresses the controversy concerning the conventionality of this type of hypotheses. It discusses several instances of isometry hypotheses and it is shown that experimental facts can be invoked to criticise (or "refute") isometry hypotheses, just as other types of hypotheses. This proves that isometry hypotheses, and the choices of measurement standards that are grounded in such hypotheses, are not merely (...) conventional. (shrink)

We describe our clinical experience in treating patients with Tourette syndrome and other tic disorders using infra-low frequency neurofeedback, often in conjunction with cognitive behavior therapy. Following a narrative description of our approach, we present outcome data for 100 successive cases. Many of the children and adolescents that we have treated since 2005 did not derive sufficient benefit from standard treatment for Tourette syndrome and other tic disorders. In our clinical experience, based on extensive before- and after- testing and symptom (...) tracking, this patient group derived significant additive benefit from complementary neurofeedback treatment. The majority of trainees attained a higher level of functioning and were able to live up to their potential in a way they were not able to prior to neurofeedback treatment. (shrink)

The purpose of this paper is to examine two hypothetical models: one in which job satisfaction acts as a mediator of the effects of overqualification on turnover intention and performance, and another in which job satisfaction acts as a mediator of the effects of overqualification on performance. Data were collected from 318 call center employees in Portugal. The relationships were tested using a multiple regression hierarchy with PROCESS. As hypothesized, job satisfaction mediates the relationship between overqualification and turnover intentions. It (...) appears that overqualification alone does not influence intention to quit, but rather does so via satisfaction. Job satisfaction also mediates the relationship between overqualification and job performance. However, perceptions of non-growth appear to be associated with a decline in contextual performance. The effects of overqualification on turnover intentions and job performance of call center employees have not been previously studied. Therefore, this study aims to fill this gap. Our study joins the small number of studies that analyze the mechanisms explaining the relationship between this mismatch between job demands and employees' perceived education, skills, experience, and work outcomes. (shrink)

This is not merely a theoretical problem, as Fernandes relates it to the very current crisis of nativist/multicultural identity in the West.

En este texto, presento a Lamarck, como un autor que debe ser considerado, no solo como uno de fundadores de la biología, sino uno de los precursores del positivismo. Se examinarán nociones de “fuerza vital”, organización, “plan de la naturaleza”, “sentimiento interior” y hábito, pilares de su teoría de la transformación. Esta teoría fusiona el determinismo inherente al “plan de la naturaleza” (PN) con el papel más flexible del “sentimiento interior” (SI) y el hábito en la modificación. Es así como, (...) Lamarck defendió un holismo materialista que justifica la imagen de una naturaleza que, al organizar la materia, da lugar a la generación espontánea de seres vivos simples que a lo largo del tiempo se transforman incrementando los grados de organización, culminando con la aparición del hombre. Idea que Comte extrapoló para justificar un progreso social atado a la aparición de las ciencias positivas. Este trabajo también evalúa la crítica de Comte a Lamarck acerca del papel del medioambiente, cuyo potencial de cambio estaría limitado por “la existencia de “obstáculos interiores” a la modificación, superados en los humanos mediante la emergencia de la sociedad. Ambos autores estuvieron influenciados por François Quesnay, quien propugnaba una sociedad regida por una ética basada en una ley natural biológica. Pero, mientras Lamarck anticipaba el riesgo de la autoextinción humana, Comte consideraba que el verdadero progreso se lograría al convertir esa ley natural en fundamento de una nueva religión secular. (shrink)

The affective turn -- Violence against women: perspectives and strategies -- Notes -- References -- PART III: Togetherness and its forms -- 7. Feminist visions and socio-political meanings of non-monogamous love -- Contemporary bonding, plurality of love -- Consensual plurality and sustainability of bonding -- Notes -- References -- 8. The invisible ties We share: A relational analysis of the contemporary loving couple -- The semantics of love and the We -- Love in situation: the WeLR in motion -- Enminded (...) bodies in the WeLR -- Final remarks: the bonds the WeLR creates -- Notes -- References -- 9. Silent love: On Irigaray's suggestion of cultivating sexual difference -- A culture of two subjects -- Listening -- The meaning of the word 'silence' -- Silence as a condition of love -- Cultivating silence -- Silent love -- Notes -- References -- 10. Love, feminism and dialectics: Repairing splits in theory and practice -- Dialectical critical realism -- Benjamin: from existential tension to oppressive contradiction -- Dialectics, necessity and redemptive critique -- The reparative turn and the issue of transformation -- In the pulse of now -- Closing words -- Notes -- References -- Index. (shrink)

This paper discusses the role of cultural anthropology in Cognitive Science. Culture is described as a very large pool of information passed along from generation to generation, composed of learned “programs” for action and understanding. These cultural programs differ in important ways from computer programs. Cultural programs tend to be unspecified and inexplicit rather than clearly stated algorithms learned through a slow process of guided discovery, and involve the manipulation of content based rather than formal symbol systems. Cultural symbol systems (...) often have affective as well as objective referents, giving them a strong directive effect. The argument is made that in the process of repeated social transmission and use, cultural programs come to take forms which have a good “fit” to the natural capacities and constraints of the human information processing system. (shrink)

Compassion is often understood as central to nursing and as important to ensure quality nursing and healthcare. In recent years, there has been a focus on strategies in nursing education to ensure compassionate nurses. However, it is not always clear how the concept of compassion is understood. Theoretical conceptualisations that lie behind various understandings of compassion have consequences for how we approach compassion in nursing education. We present some ways in which compassion is often understood, their philosophical underpinnings and the (...) consequences these understandings can have for nursing education. We argue that it is useful for nursing education to understand compassion as a cognitive emotion and discuss how such an understanding can inform educational approaches to compassion. (shrink)

Como he señalado en otras oportunidades, la obra de Santo Tomás de Aquino, aunque extensa y omniabarcante, se estructura a partir de algunos conceptos claves que sirven de fundamentos a la totalidad del ordenamiento de su pensamiento, lo que no lo simplifica, sino lo funda, haciendo de él un paradigma de reflexión también para nuestro tiempo, si sabemos comprenderlo desde la íntima profundidad de su sentido. La filosofía tomista es una filosofía esencialmente inclusiva que, a través de esas mismas ideas (...) matrices, presenta una cosmovisión filosófica y teológica, al mismo tiempo que refleja en ella una experiencia de vida. Así logra una síntesis que estructura una arquitectura reflexiva. Ello se puede ver en ideas como sabiduría, hábito y virtud, participación, analogía y otras. La connaturalidad como forma de conocimiento es una de esas ideas que estructuran su síntesis, siendo expresión de la congénita simpatía con el bien y de su concepción sobre la participación, mirada desde la realización cognoscitiva y afectiva de lo humano. El conocimiento por connaturalidad se muestra como simpatía que acerca afectivamente a un bien. Es así como, a través de él, presenta una visión casi sinóptica al abrirse a una amplia región de la doctrina tomista sobre Dios, el hombre, las cosas, desde un contexto que, aunque se puede analizar filosóficamente, es fundamentalmente teológico. En Santo Tomás la naturaleza se encuentra compenetrada por la gracia; su inteligencia no es sólo la del cultivar el don recibido, sino una inteligencia iluminada por la fe y purificada por la caridad. Por eso, la nobleza intelectual que transparece en sus escritos es, ante todo, el fruto de la santidad, de una santidad que no podía menos de expresarse en el orden del pensamiento. (shrink)

Sistencia surge como categoría ontológica que permite dar sustento a los entes y relacionarlos con el ser sin por ello perder la condición de cada uno de ellos. Dios se presenta como ser trascedente; y el humano y el mundo, como seres dependientes del ser en sí mismo. Palabras Clave: ontología, Dios, humano, mundo, existencia.

The elaborated intrusion (EI) theory of desire (Kavanagh, Andrade, & May, 2005) attributes the motivational force of cravings to cognitive elaboration, including imagery, of apparently spontaneous thoughts that intrude into awareness. We report a questionnaire study in which respondents rated a craving for food or drink. Questionnaire items derived from EI theory formed a single factor alongside factors for anticipated reward/relief, resistance, and opportunity. In a multiple regression predicting strength of craving, the first three factors accounted for 36% of (...) the variance. Opportunity did not enter the model. In a second study, the difference between individuals' strong and weak cravings to take part in a sporting activity was shown to be related to visual, auditory, and general imagery, and to anticipated reward or relief from engaging in the activity. Implications for treatment of craving-related disorders are discussed in the light of these results and of other research indicating that interference with imagery can reduce the strength of craving. (shrink)

During the last ten years I have been working on the process of conversion to Protestantism of the indigenous people in Chimborazo province, Ecuador. Protestant evangelization in Ecuador started in the early twentieth century, but it is only in the last thirty years that the process of conversion of the indigenous people has become a large-scale one. During the first sixty years of evangelical activity North American missionaries from the Evangelical Missionary Union baptized only four natives in Chimborazo province. This (...) period was marked by strenuous resistance and rejection of the new religion. Accounts given by missionaries of the period describe the disasters and difficulties that the first evangelizing mission suffered. It was only the conviction that lost souls had to be saved that helped them overcome adversities and later achieve amazing results. (shrink)

Resumo: Arthur Schopenhauer ficou conhecido como o pensador do “pessimismo filosófico”. Tratase de uma doutrina que, em linhas gerais, apresenta uma determinada interpretação acerca do valor do mundo, mas que, em seu sentido ainda mais básico, questiona a possibilidade de atribuição de valor ao todo da existência: há “justificação” para a existência? A partir da resposta a essa pergunta, o filósofo alemão desenvolve sua “metafísica da vontade” e, como seu desdobramento, sua teoria da “redenção”, ou soteriologia. Entretanto, o “filósofo do (...) pessimismo” também afirma, em sua obra, que há uma “ordenação moral de mundo” e um “significado moral da existência”, o que parece ir na direção oposta ao “pessimismo”. O presente artigo analisa o significado das noções de ordenação moral de mundo e justificação da existência no pensamento de Schopenhauer, a fim de demonstrar em que medida significado moral da existência e pessimismo filosófico se relacionam no pensamento do autor.: Arthur Schopenhauer is known as the thinker of “philosophical pessimism”. It means, in general lines, the doctrine that presents a certain worldview, but in its more basic sense, it questions the possibility of giving a meaning to the whole of existence: is there “justification” for the existence? By answering this question the German philosopher develops his “metaphysics of the will” and, as its unfolding, his theory of “redemption”, or soteriology. However, the “philosopher of pessimism” also asserts in his work that there is a “moral ordinance of world” and a “moral meaning of existence”, which seems to go on the opposite direction of what is claimed by the “pessimism”. The present paper analyses the sense of the notions of moral ordinance of world and justification of existence in Schopenhauer’s thought, in order to demonstrate how far moral meaning of life and philosophical pessimismo interact in his thought. (shrink)