BackgroundDecision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a result helps determine the (...) range of influences on these decisions.MethodsMedline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence.Results53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care.ConclusionsThere is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside ‘end-of-life’ care. This review provides a sound basis for empirical research into the important influences on a child’s potential technology dependence. (shrink)

For most nurses world-wide, activities are centred around working directly with patients and so the nurse-patient relationship is of the greatest importance. Ethnocentrism on the part of the health care community has led to misdiagnosis, mistreatment and undertreatment of culturally diverse individuals world-wide. This author discusses a tool, Greipp's Model of Ethical Decision-Making, which can be used to assist nurses in analysing the effects of culture, beliefs and diversity upon the caregiver and care recipient within an ethical framework.

This paper presents three interpretations of the infamous “sailor / ship” sentence that concludes Aristotle’s De Anima II.1. The first two interpretations represent the ones most popular in contemporary scholarship; the final is the author’s original. The interpretations are then evaluated with respect to grammatical plausibility and explanatory strength. The paper makes a case that the new reading answers to both points of evaluation and contributes to an interpretive approach to Aristotle that values the coherence and cogency of his De (...) Anima as a whole. (shrink)

At the end of Book III, chapter 4 of Aristotle’s Politics, Aristotle identifies the virtue peculiar to the excellent ruler as prudence. The ruled’s complementary virtue is true opinion. All the other virtues are held in common, albeit in different forms. Why these habits? The answer to this question lies in Aristotle’s discussion of the good man and the serious citizen in III.4, and of the rule of law in III.16.

Aborder l’exposition comme média implique de considérer le point de vue du producteur (commissaire), celui du récepteur (visiteur) et celui de l’exposition (à travers les moyens employés et l’aspect de l’architecture communiqué). Deux manières d’envisager la communication de l’architecture au musée sont abordées. Pour la première, et selon nous la plus ancienne, le terme architecture est pris au sens de bâtiment. Les commissaires tentent alors de transmettre à la fois l’expérience et la matérialité du bâtiment. Pour la seconde manière, apparue (...) ces vingt dernières années, c’est plutôt le projet architectural (idée, processus, bâtiment et représentations) que l’on communique. La communication de l’idée et du processus semble être une tendance forte qui cible la pratique architecturale. Cette réflexion critique mène au constat suivant : d’un point de vue communicationnel, l’exposition d’architecture oublie trop souvent de considérer son destinataire, et les commissaires n’utilisent donc pas son plein potentiel comme média. (shrink)

This comparative study shows biases relative to client age, gender and behaviour demon strated by 268 female nurse subjects. A repeated measures design was utilized. All three main effects were significant (p < 0.001) for how respondents predicted that they would react to various clients and also how they predicted that their colleagues would react. Most two-way and three-way interaction effects were significant. Subjects demonstrated more favourable reactions to nice, young, male clients and least favourable reactions to not nice, old, (...) male clients. Study subjects predicted more favourable self-reactions to simulated clients than for their colleagues. What should be important to every professional as a result of this study is the need to be aware of self-biases, which may cause errors in decision-making and nursing care interventions and lead to ethical violations with clients. (shrink)

Spirituality in Nursing: Standing On Holy Ground, Sixth Edition explores the relationship between spirituality and the practice of nursing.

In recent years, scholars have begun to give greater attention to the 14th-century political writer, Ptolemy of Lucca, mostly on account of his avid defense of republican government in the treatise, De regimine principum. Educated in the scholastic curriculum at the University of Paris, Ptolemy has typically been identified by scholars as one of the most thoroughly Aristotelian medieval thinkers. Ptolemy, like many of his contemporaries, peppered his writing with citations from Aristotle's major works. This article, however, examines the sources (...) employed in Ptolemy's republican arguments, finding that the legacy of Republican Rome played a far more critical role in shaping his republicanism than could be attributed to Aristotle's moral or political works. Though conversing fluently in an Aristotelian language system, Ptolemy's arguments in De regimine principum are derived, at their core, from his reading of Roman Republican sources, not from Aristotelian influence. This discovery reveals Ptolemy to be an even more artful and original writer than was previously assumed, and should add to, rather than detract from, his place as a key figure in the development of western political thought. (shrink)

Recent research has emphasized the continuities in European republican political thought from the late Middle Ages until well into the Renaissance and even beyond. Two of the central figures in the story of the persistence of republicanism are Ptolemy of Lucca, who is commonly viewed as the quintessential late medieval republican, and Niccolò Machiavelli, whose work is generally regarded as the classic statement of early modern republicanism. We argue that these two remain conceptually at considerable remove from one another, a (...) claim we illustrate by analyzing the impact of the reception, Latin translation and transmission of the Histories of Polybius, and especially the theory of constitutional change proposed in Book 6. The unavailability of the Histories to Ptolemy and its rather ample use by Machiavelli at the beginning of the Discourses signal an important divergence in the theoretical principles underlying the defense of republican institutions. In turn, this variation captures one facet of the distinct qualities of republican thought that separated the intellectual terrain of the early fourteenth century from that of the sixteenth century. (shrink)

Spirituality in Nursing: Standing on Holy Ground addresses the relationship between spirituality and nursing practice across a variety of settings and broad perspectives related to caring for the ill and infirm, from care of special population like children, families and older adults to spiritual care during disaster situations. The current edition examines both historical and contemporary issues pertaining to the spiritual needs and care of the sick and includes topical discussions of areas such as the nurse's role in spiritual care, (...) the nurse-patient relationship, spiritual needs of special populations, and spiritual needs in areas such as mass casualty disasters and parish leadership. The author brings her considerable experience as a parish nurse to each discussion, lending a unique perspective to each of the issues addressed in this text. (shrink)

A veteran nurse researcher and educator provides a spiritual perspective on the professional nurse's vocation of caring. Grounding each chapter in Scripture, O'Brien explores the Christian nurse's call to love as Jesus loved: without discrimination, reserve and, sometimes, reward.

Having a serious illness like breast cancer is a calamity for individuals and families. Along with the pain, discomfort, and dislocation comes the issue of how to pay the medical expenses for the care and treatment of the disease. If the seriously ill person has inadequate or no insurance, these problems are aggravated.Stories abound about seriously ill people losing private health insurance following diagnosis with a catastrophic disease, remaining in jobs just to maintain health insurance, or facing financial hardship because (...) of gaps in coverage. Yet surprisingly little research has focused on the problems that people with serious illness face with health coverage and, in particular, how concerns about access to health insurance coverage shape their lives.Further, despite profoundly moving anecdotes of cancer victims and other seriously ill people about their problems with health insurance and despite recent federal and state efforts to reform the private health insurance market in ways discussed below, neither the federal government, states, nor the private sector has crafted comprehensive strategies to enhance health coverage for the seriously ill. (shrink)

Having a serious illness like breast cancer is a calamity for individuals and families. Along with the pain, discomfort, and dislocation comes the issue of how to pay the medical expenses for the care and treatment of the disease. If the seriously ill person has inadequate or no insurance, these problems are aggravated.Stories abound about seriously ill people losing private health insurance following diagnosis with a catastrophic disease, remaining in jobs just to maintain health insurance, or facing financial hardship because (...) of gaps in coverage. Yet surprisingly little research has focused on the problems that people with serious illness face with health coverage and, in particular, how concerns about access to health insurance coverage shape their lives.Further, despite profoundly moving anecdotes of cancer victims and other seriously ill people about their problems with health insurance and despite recent federal and state efforts to reform the private health insurance market in ways discussed below, neither the federal government, states, nor the private sector has crafted comprehensive strategies to enhance health coverage for the seriously ill. (shrink)

Recent arguments claim that behavioral science has focused – to its detriment – on the individual over the system when construing behavioral interventions. In this commentary, we argue that tackling economic inequality using both framings in tandem is invaluable. By studying individuals who have overcome inequality, “positive deviants,” and the system limitations they navigate, we offer potentially greater policy solutions.

_Russian Philosophy in the Twenty-First Century: An Anthology_ presents a variety of contemporary philosophic problems found in the works of prominent Russian thinkers, ranging from social and political matters and pressing cultural issues to insights into modern science and mounting global challenges.

The COVID‐19 pandemic has placed extraordinary stress on frontline healthcare providers as they encounter significant challenges and risks while caring for patients at the bedside. This study used qualitative research methods to explore nurses and respiratory therapists' experiences providing direct care to COVID‐19 patients during the first surge of the pandemic at a large academic medical center in the Northeastern United States. The purpose of this study was to explore their experiences as related to changes in staffing models and to (...) consider needs for additional support. Twenty semi‐structured interviews were conducted with sixteen nurses and four respiratory therapists via Zoom or by telephone. Interviews were transcribed verbatim, identifiers were removed, and data was coded and analyzed thematically. Five major themes characterize providers' experiences: a fear of the unknown, concerns about infection, perceived professional unpreparedness, isolation and alienation, and inescapable stress and distress. This manuscript analyzes the relationship between these themes and the concept of moral distress and finds that some, but not all, of the challenges that providers faced during this time align with previous definitions of the concept. This points to the possibility of broadening the conceptual parameters of moral distress to account for providers' experiences of treating patients with novel illnesses while encountering institutional and clinical challenges. (shrink)

The development and use of large and dynamic health data repositories designed to support research pose challenges to traditional informed consent models. We used semi-structured interviewing to elicit diverse research stakeholders' views of a model of consent appropriate to participation in initiatives that entail collection, long-term storage, and undetermined future research use of multiple types of health data. We demonstrate that, when considering health data repositories, research stakeholders replace a concept of consent as informed with one in which consent is (...) engaged. In engaged consent, a participant's ongoing relationship with a repository serves as a substitute or adjunct to information exchange at enrollment. We detail research stakeholders' views of the risks of engaged consent and suggest questions for further study about engagement and consent procedures in initiatives that aim to store data for future unspecified research purposes. (shrink)

Discusses the fundamental question of how life can continue to evolve on Earth.

We argue that critiques of political process theory are beginning to coalesce into new approach to social movements--a "multi-institutional politics" approach. While the political process model assumes that domination is organized by and around one source of power, the alternative perspective views domination as organized around multiple sources of power, each of which is simultaneously material and symbolic. We examine the conceptions of social movements, politics, actors, goals, and strategies supported by each model, demonstrating that the view of society and (...) power underlying the political process model is too narrow to encompass the diversity of contemporary change efforts. Through empirical examples, we demonstrate that the alternative approach provides powerful analytical tools for the analysis of a wide variety of contemporary change efforts. (shrink)

Background:Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives, setting, and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether research nurses experience unique ethical challenges distinct from those experienced (...) by nurses in traditional patient-care settings.Research objectives:The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice.Research design:The study utilized a qualitative descriptive design with individual interviews.Participants and research context:Participating nurses self-identified as having experienced ethical challenges during screening. The majority were Caucasian, female, and worked in outpatient settings. Approximately 50% had > 10 years of research experience.Ethical considerations:The human subjects review board approved the study. Written informed consent was obtained.Findings:Predominant themes were revealed: the inability to provide a probable good, or/do no harm, and dual obligations. The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship.Discussion:Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science.Conclusion:Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

The epigrams of the Carmina Priapea comically celebrate the exploits of the ithyphallic god Priapus, most often seen lording over his garden threatening would-be thieves with rape. In so doing, they promote a phallocentric sex-gender ideology whose valorized position was reserved for the active man who could control himself and dominate others. But the physical experience of reading these poems runs counter to the codes of masculinity their content upholds. Their rhythms and sounds immerse the reader in a range of (...) all-over pleasures that undermine the bodily comportment championed and embodied by Priapus himself. They thereby invite their readers to experience what I call the touch of the cinaedus, an expansive sensuality associated with this maligned sexual type. The Carmina Priapea's ongoing suggestion that entering this garden of verse will turn its readers into cinaedi might, then, be read as a promise as well as a threat. This promise is no less than the promise of poetry itself, a form of linguistic organization that invites all readers to revel in the cinaedus' liberating touch. (shrink)