This study focuses on investigating habits in perioperative nursing culture, which are often simply accepted and not normally considered or discussed. A hermeneutical approach was chosen as the means of understanding perioperative nurses' experiences of and reflections on operating theatre culture. Focus group discussions were used to collect data, which was analysed using hermeneutical text analysis. The results revealed three main categories of habits present in perioperative nursing culture: habits that promote ethical values (by temporary friendship with patients, showing respect (...) for each other, and spending time on reflection on ethics and caring); habits that hinder progress (by seeing the patient as a surgical case, not acknowledging colleagues, and not talking about ethics); and habits that set the cultural tone (the hidden power structure and achieving more in less time). (shrink)

This study presents findings from an ontological and contextual determination of the concept of dignity. The study had a caritative and caring science perspective and a hermeneutical design. The aim of this study was to increase caring science knowledge of dignity and to gain a determination of dignity as a concept. Eriksson’s model for conceptual determination is made up of five part-studies. The ontological and contextual determination indicates that dignity can be understood as absolute dignity, the spiritual dimension characterized by (...) responsibility, freedom, duty, and service, and relative dignity, characterized by the bodily, external aesthetic dimension and the psychical, inner ethical dimension. Dignity exists in human beings both as absolute and relative dignity. (shrink)

Background: Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation. Objective: To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care. Research design: The study had a qualitative approach. Method: Data were collected by Flanagan’s critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and (...) humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis. Ethical considerations: The study followed the ethical principles in accordance with the Declaration of Helsinki. Findings: The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient’s world and make professional decisions. The ambulance nurse respects the patient’s will and protects the patient’s body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient. Discussion: It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human. Conclusion: Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students’ ethical obligation results in the courage to see when a patient’s dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient. (shrink)

The aim of this study was to describe specialist ambulance nurse students’ experiences of ethical conflicts and dilemmas in prehospital emergency care. In the autumn of 2015, after participating in a mandatory lecture on ethics, 24 specialist ambulance nurse students reported experiences and interpretations concerning conflicts and ethical dilemmas from prehospital emergency care. The text consisted of 24 written critical incidents which were interpreted using hermeneutic text interpretation. The text revealed three themes: Not safeguarding a patient’s body and identity; Not (...) agreeing on the care actions; and Not treating the patient with dignity. The SANs experiences ethical dilemmas and conflict of values when they witness how others violate a patient’s dignity. Discussion and reflection is based on ethical conflicts and dilemmas experienced when students see how caregivers do not safeguard the patient’s body or identity. When caregivers have a conflicting will, it results in patients not being treated in an ethical manner. Also, seeing how caregivers put themselves in a power position over patients is described as an ethical dilemma that students experience when they choose not to intervene. (shrink)

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in (...) this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life. (shrink)

The aim of this study was to understand how nurses experience patients’ dignity in Swedish medical wards. A hermeneutic approach and Flanagan’s critical incident technique were used for data collection. Twelve nurses took part in the study. The data were analysed using hermeneutic text interpretation. The findings show that the nurses who wanted to preserve patients’ dignity by seeing them as fellow beings protected the patients by stopping other nurses from performing unethical acts. They regard patients as fellow human beings, (...) friends, and unique persons with their own history, and have the courage to see when patients’ dignity is violated, although this is something they do not wish to see because it makes them feel bad. Nurses do not have the right to deny patients their dignity or value as human beings. The new understanding arrived at by the hermeneutic interpretation is that care in professional nursing must be focused on taking responsibility for and protecting patients’ dignity. (shrink)

Background:The foundation of all nursing practice is respect for human rights, ethical value and human dignity. In perioperative practice, challenging situations appear quickly and operating theatre nurses must be able to make different ethical judgements. Sometimes they must choose against their own professional principles, and this creates ethical conflicts in themselves.Objectives:This study describes operating theatre nurses’ experiences of ethical value conflicts in perioperative practice.Research design:Qualitative design, narratives from 15 operating theatre nurses and hermeneutic text interpretation.Ethical consideration:The study followed ethical principles (...) in accordance with the Helsinki Declaration and approval was granted by the local university ethics committee.Findings:The result showed that value conflicts arose in perioperative practice when operating theatre nurses were prevented from being present in the perioperative nursing process, because of current habits in perioperative practice. The patient’s care became uncaring when health professionals did not see and listen to each other and when collaboration in the surgical team was not available for the patient’s best. This occurred when operating theatre nurses’ competence was not taken seriously and was ignored in patient care.Conclusion:Value conflicts arose when operating theatre nurses experienced that continuity of patient care was lacking. They experienced compassion with the patient but still had the will and ability to be there and take responsibility for the patient. This led to feelings of despair, powerlessness and of having a bad conscience which could lead to dissatisfaction, and even resignations. (shrink)

Introduction: Expressions of dignity as a clinical phenomenon in nursing homes as expressed by caregivers were investigated. A coherence could be detected between the concepts and phenomena of existence and dignity in relationships and caring culture as a context. A caring culture is interpreted by caregivers as the meaning-making of what is accepted or not in the ward culture. Background: The rationale for the connection between existence and dignity in relationships and caring culture is that suffering is a part of (...) existence, as well as compassion in relieving suffering, and ontological interdependency. Aim: To describe different expressions of dignity in relationships and existence in context of caring cultures from the perspective of the caregivers. Research design: The methodology and method are hermeneutic. The method used was to merge the theoretical preunderstanding as one horizon of understanding with empirical data. Participants and research context: Focus group interviews with caregivers in nursing homes. Ethical considerations: The principles of the Helsinki Declaration have been followed to, for example, preserve self-determination, integrity, dignity, confidentiality and privacy of the research persons. Findings: Data interpretation resulted in four themes: Encountering existential needs that promote dignity in a caring culture; To amplify dignity in relationships by the creative art of caring in a caring culture; Violation of dignity by ignorance or neglect in a non-caring culture and The ethic of words and appropriated ground values in a caring culture. Discussion: Dignity-promoting acts of caring, or dignity-depriving acts of non-caring are adequate to see from the perspective of dignity in relationships and existence and the caring culture. Conclusions: Dignity in relationships seems to touch the innermost existential life, as the existential life is dependent on confirmation from others. (shrink)

Background:In recent years, operating theatre nurse students’ education focused on ethics, basic values and protecting and promoting the patients' dignity in perioperative practice. Health professionals are frequently confronted with ethical issues that can impact on patient’s care during surgery.Objective:The objective of this study was to present what operating theatre nursing students perceived and interpreted as undignified caring in perioperative practice.Research design:The study has a descriptive design with a hermeneutic approach. Data were collected using Flanagan’s critical incident technique.Participants and research context:Operating (...) theatre nurse students from Sweden and Norway participated and collected data in 2011, after education in ethics and dignity. Data consisting of 47 written stories and the text were analysed with hermeneutical text interpretation.Ethical considerations:The study was approved by the Karlstad University's Research Ethics Committee.Findings:The findings show careless behaviour and humiliating actions among health professionals. Health professionals commit careless acts by rendering the patient invisible, ignoring the patient’s worry and pain and treating the patient as an object. They also humiliate the patient when speaking in negative terms about the patient’s body, and certain health professionals blame the patients for the situation they are in. Health professionals lack the willingness and courage to protect the patient’s dignity in perioperative practice.Discussion:In the discussion, we have illuminated how professional ethics may be threatened by more pragmatic and utilitarian arguments contained in regulations and transplant act.Conclusion:The findings reveal that patients were exposed to unnecessary suffering; furthermore, the operating theatre nurse students suffered an inner ethical conflict due to the undignified caring situations they had witnessed. (shrink)

Although the production and recognition of social actions have been central concerns for conversation analysis from the outset, it has recently been argued that CA is yet to develop a systematic analysis of ‘action formation’. As a partial remedy to this situation, John Heritage introduces ‘epistemic status’, which he claims is an unavoidable component of the production and recognition of social action. His proposal addresses the question how is social action produced and recognized? by reference to another question how is (...) relative knowledge recognized? Despite the importance placed on the latter question, it is not clear how it is to be answered in particular cases. We argue that the introduction of epistemic status builds on a reformulation of the action formation problem that unnecessarily de-emphasizes the importance of the sequential environment. Our re-analyses of key sequences cast doubts on the empirical grounding of the epistemic program, and question whether the fundamental role of epistemic status has been convincingly demonstrated. (shrink)

This study presents findings from an ontological and contextual determination of the concept of dignity. The study had a caritative and caring science perspective and a hermeneutical design. The aim of this study was to increase caring science knowledge of dignity and to gain a determination of dignity as a concept. Eriksson’s model for conceptual determination is made up of five part-studies. The ontological and contextual determination indicates that dignity can be understood as absolute dignity, the spiritual dimension characterized by (...) responsibility, freedom, duty, and service, and relative dignity, characterized by the bodily, external aesthetic dimension and the psychical, inner ethical dimension. Dignity exists in human beings both as absolute and relative dignity. (shrink)

From an aging research and life-course perspective, the transition to retirement marks a significant life-event and provides a unique opportunity to study psychological health and coping during a period of substantial change in everyday life. The aim of the present paper is to: (a) outline the rationale of the HEalth, Ageing and Retirement Transitions in Sweden (HEARTS) study, (b) describe the study sample, and (c) to present some initial results from the two first waves regarding the association between retirement status (...) and psychological health. The HEARTS study is designed to annually study psychological health in the years before and following retirement, and to examine change and stability patterns related to the retirement event. Among a representative Swedish population-based sample of 14 990 individuals aged 60 to 66 years, 5 913 completed the baseline questionnaire in 2015. The majority of the participants (69%) completed a web-based survey, and the rest (31%) completed a paper version. The baseline HEARTS sample represents the general population well in terms of gender and age, but is more highly educated. Cross-sectional findings from the first wave showed that retired individuals demonstrated better psychological health compared to those who were still working. Longitudinal results from the first and second waves showed that individuals who retired between waves showed more positive changes in psychological health compared with those still working or previously retired. (shrink)

This study takes an interest in instructions and instructed actions in the context of manual skills. The analysis focuses on a video recorded episode where a teacher demonstrates how to crochet chain stitches, requests a group of students to reproduce her actions, and then repeatedly corrects the attempts of one of the students. The initial request, and the students’ responses to it, could be seen as preliminary to the series of corrective sequences that come next: the request and the following (...) attempts make it possible for the teacher to launch instructional sequences specifically designed and addressed to the students who need further guidance. In the interaction between the teacher and the novice student, the reasoned character of the instructed actions is not explained so much as installed and tuned. The materiality of the project makes it possible for the two parties to methodically and meticulously adjust their actions in accordance with each other, and towards the gradual realization of the aimed-for results. In connection to this, a number of issues pertaining to the reproducibility and recognizability of manual skills are raised: how instructions-in-interaction orient towards the progression of the skill rather than the interaction itself; how attempts by and mistakes of the instructed party provide grounds for further instruction; and, consequently, how instructions in the form of corrections build on the instructor’s continuous assessments of the instructed actions. (shrink)

This paper is an analysis of a video clip of an interview between a reporter and ice hockey player following a game in which the player was involved in a hard collision with a member of the opposing team. The paper explores blame attribution and how participants claim and disclaim expertise in a way that supports or undermines assertions to have correctly seen and assessed the actions shown on tape. Our analysis focuses on the video of the interview, and it (...) also examines relevant video clips of the collision and various commentaries about the identities of the characters and their actions shown on the videos. In brief, the study is a third-order investigation of recorded-actions-under-analysis. It uses the videos and commentaries as “perspicuous phenomena” that illuminate and complicate how the members’ own action category analysis is bound up with issues of expertise, evidence, and blame. (shrink)

In the present work we investigated distinct sources of construct-relevant psychometric multidimensionality in two sport-specific measures of coaches’ need-supportive (ISS-C) and controlling interpersonal (CCBS) styles. A recently proposed bifactor exploratory structural equation modeling (ESEM) framework was employed to achieve this aim. In Study 1, using a sample of floorball players, the results indicated that the ISS-C can be considered as a unidimensional measure, with one global factor explaining most of the variance in the items. In Study 2, using a sample (...) of male ice hockey players, the results indicated that the items in the CCBS are represented by both a general factor and specific factors, but the subscales differ with regard to the amount of variance in the items accounted for by the general and specific factors. These results add further insight into the psychometric properties of these two measures and the dimensionality of these two constructs. (shrink)

The epistemological soundness of controlled clinical trials is questioned. It is argued that the real effect of therapies cannot be determined by such experiments because there is a significant interaction between the placebo effect and real effect created by the individual therapist and treatment situation which, however, is neglected in controlled clinical trials. This critical standpoint is supported by several pharmacological examples.

The epistemological soundness of controlled clinical trials is questioned. It is argued that the real effect of therapies cannot be determined by such experiments because there is a significant interaction between the placebo effect and real effect created by the individual therapist and treatment situation which, however, is neglected in controlled clinical trials. This critical standpoint is supported by several pharmacological examples.

This study explores questions posed by students in response to live video broadcasts of dental treatments. The aim of the study is to show and discuss the reflexive relationship between the questions, what they were occasioned by and how they are responded to. Procedures and anatomical features, that for the seminar leader are unproblematically seen in endodontic terms, repeatedly present problems for the students. Visible but unrecognized shifts in the dentist’s work, for instance, provide occasions for questions of the form (...) ‘What is he doing now?’. In the midst of an ongoing procedure, questions tend to be formulated as noticings that elicit instruction either about some detail of the dentist’s actions or about what a generic ‘one should’ or ‘should not do’, what ‘frequently’ happens and so on. It is shown, however, that the movement between specific here-and-now features on the one hand and more general issues on the other characterizes the entire scope of the relevant material, particularly because the seminar leaders’ answers tend to place even minute details within more general endodontic considerations. (shrink)

This comment provides an overview of the four articles by Lindwall, Lymer and Ivarsson; Lynch and Wong; Macbeth, Wong and Lynch; and Macbeth and Wong, which make up the kernel of this Special Issue of Discourse Studies on Epistemics; and it also examines the reasons for the assorted difficulties the authors of those articles have with the Epistemic Programme being proposed for conversation analysis. The legitimacy of their concerns is underscored by showing that the charge the EP makes, which (...) is that the CA developed by Sacks, Schegloff and Jefferson gives an incomplete account of linguistic interaction, is founded on a number of mistakes. The first mistake is the idea that CA cannot effectively address so-called action formation. The second is a misunderstanding of the idea of ‘proof procedure’ in CA. The third mistake is that conversation can better be understood through an abstract analytic construction, rather than an emphasis on participants’ analysis. And the fourth is that it is necessary to rely upon an imputed cognitive machinery that is asserted to underlie conversation. The systematicity and generative power of Sacks, Schegloff and Jefferson’s radical work on turn-taking in conversation is emphasised and a question that begs to be answered arises, which is how well the EP compares to that earlier and still-radical work, something that the kernel articles address in their return to key transcripts used in the EP. (shrink)