A large proportion of nursing home residents in developed countries come from ethnic minority groups. Unmet care needs and poor quality of care for this resident population have been widely reported. This systematic review aimed to explore social conditions affecting ethnic minority residents' ability to exercise their autonomy in communication and care while in nursing homes. In total, 19 studies were included in the review. Findings revealed that ethno‐specific nursing homes create the ideal social condition for residents to (...) express their care needs and preferences in a language of choice. In nonethno‐specific nursing homes, staff cultural competence and nursing home commitment to culturally safe care are crucial social conditions that enable this group of residents to fulfil their autonomy in communicating and in participating in their care. In contrast, social conditions that undermine residents' ability to express their care needs and preferences include low levels of staff cultural awareness and cultural desire, negative attitudes towards residents and limited organisational support for staff to improve culturally responsive and culturally safe care. In conclusion, it is important to optimise the social conditions to support ethnic minority residents to communicate their care needs and preferences. (shrink)

Social inclusion/exclusion involves just/unjust social relations and social structures enabling or constraining opportunities for participation and health. In this paper, social inclusion/exclusion is explored as a dialectic. Three discourses – discourses on recognition, capabilities, and equality and citizenship – are identified within Canadian literature. Each discourse highlights a different view of the injustices leading to social exclusion and the conditions supporting inclusion and social justice. An Integrated Framework for Social Justice that incorporates the (...) three discourses is developed and used to critique the dominant focus on distributive justice within foundational Canadian nursing documents. We propose a broader conceptualization of social (in)justice that includes both relational and structural dimensions. Opportunities for multilevel interventions to promote social justice are identified. This framework is congruent with nursing's moral imperative to promote health equity and with the multiple roles played by nurses to promote social justice in everyday practice. (shrink)

Certified nursing assistants (CNAs) provide the majority of direct care to nursing home residents in the United States and, therefore, are keys to ensuring optimal health outcomes for this frail older adult population. These diverse direct care workers, however, are often not recognized for their important contributions to older adult care and are subjected to poor working conditions. It is probable that social‐based discrimination lies at the core of poor treatment toward CNAs. This review uses perspectives from critical (...) class='Hi'>social theory to explore the phenomenon of social‐based discrimination toward CNAs that may originate from social order, power, and culture. Understanding manifestations of social‐based discrimination in nursing homes is critical to creating solutions for severe disparity problems among perceived lower‐class workers and subsequently improving resident care delivery. (shrink)

Nurse practitioners (NPs) are increasingly called on to provide high‐quality health‐care particularly for people who face significant barriers to accessing services. Although discourses of social justice have become relatively common in nursing and health services literature, critical analyses of how NP roles articulate with social justice issues have received less attention. In this study, we examine the role of NPs from a critical social justice perspective. A critical social justice lens raises morally significant questions, for example, (...) why certain individuals and groups bear a disproportionate burden of illness and suffering; what social conditions contribute to disparities in health and social status; and what social mandate NPs ought to develop in response to these realities. In our analysis, we draw on lessons learned from the initial Canadian experience with the introduction of NPs in the 1970s to consider the renewed and burgeoning interest in NPs in Canada, Australia and elsewhere. As we argue, a critical social justice perspective (in addition to the biomedical foci of NP practice) will be essential to sustaining long‐term, socially responsive NP roles and achieving greater equity in health and health‐care. (shrink)

This volume provides a critical introduction to contemporary attempts to base nursing ethics on a feminine 'ethics of care'.

Philosopher Judith Butler has influenced how people talk about vulnerable bodies and sees vulnerability as universal, existential, and relational. Being vulnerable is part of the human condition. The main theoretical areas that run across Butler’s work; power, knowledge and subjectivity, performativity, and ethics—are of particular relevance to nursing practice. This review aims to explore how Butler’s theoretical work is reflected in research literature within a nursing context. We conducted a scoping review guided by Arksey and O’Malley’s methodological framework. A systematic (...) literature search of CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Web of Science identified 15 papers. Butler’s theoretical work was applied at an individual and social level in research literature within a nursing context. Nurses need to reflect on their clinical practice and role as health professionals in relation to power and performativity in encounters with patients who are marginalized. Nurses’ working conditions, recognition, and understanding are strongly influenced by society, and calling nurses heroes undermines their capacity to challenge and resist the hero identity. The healthcare system’s impact on patient-nurse encounters challenges patients’ and nurses’ subjectivity, performativity, and power relations. The review allowed us to describe how Butler’s theoretical work can facilitate a reflection on nursing practice which is a prerequisite for caring, ethical relationships, and working conditions within a nursing context. Butler’s concepts can provide useful perspectives on how nurses understand, communicate with, and care for patients, as well as a nuanced understanding of the nursing role and power relations and structures. (shrink)

Rationale, aims and objectives This randomized controlled trial was designed to evaluate the 2-year costs and effects of a proactive, public health nursing case management approach compared with a self-directed approach for 129 single parents (98% were mothers) on social assistance in a Canadian setting. A total of 43% of these parents had a major depressive disorder and 38% had two or three other health conditions at baseline. Methods Study participants were recruited over a 12 month period and randomized (...) into two groups: one receiving proactive public health nursing and one which did not. Results At 2 years, 69 single parents with 123 children receiving proactive public health nursing (compared with 60 parents with 91 children who did not receive public health nursing services) showed a slightly greater reduction in dysthymia and slightly higher social adjustment. There was no difference between the public health and control groups in total per parent annual cost of health and support services. However, costs were averted due to a 12% difference in non-use of social assistance in the previous 12 months for parents in the public health nursing group. This translates into an annual cost saving of $240 000 (Canadian) of costs averted within 1 year for every 100 parents. Conclusions In the context of a system of national health and social insurance, this study supports the fact that it is no more costly to proactively service this population of parents on social assistance. (shrink)

Background Cardiopulmonary resuscitation and subsequent care are subject to various ethical and legal issues. Few studies have addressed ethical and legal issues in post-resuscitation care. Objective To explore nurses’ experiences of ethical and legal issues in post-resuscitation care. Research design This qualitative study adopted an exploratory descriptive qualitative design using conventional content analysis. Participants and research context In-depth, semi-structured interviews were conducted in three educational hospital centers in northwestern Iran. Using purposive sampling, 17 nurses participated. Data were analyzed (...) by conventional content analysis. Ethical considerations The study was approved by Research Ethics Committees at Tabriz University of Medical Sciences. Participation was voluntary and written informed consent was obtained. For each interview, the ethical principles including data confidentiality and social distance were respected. Findings Five main categories emerged: Pressure to provide unprincipled care, unprofessional interactions, ignoring the patient, falsifying documents, and specific ethical challenges. Pressures in the post-resuscitation period can cause nurses to provide care that is not consistent with guidelines, and to avoid communicating with physicians, patients and their families. Patients can also be labeled negatively, with early judgments made about their condition. Medical records can be written in a way to indicate that all necessary care has been provided. Disclosure, withdrawing, and withholding of therapy were also specific important ethical challenges in the field of post-resuscitation care. Conclusion There are many ethical and legal issues in post-resuscitation care. Developing evidence-based guidelines and training staff to provide ethical care can help to reduce these challenges. (shrink)

Variability in the symptom experience in patients diagnosed with chronic conditions may be related to social determinants of health (SDoH). The purpose of this critical review was to (1) summarize the existing literature on SDoH and symptom clusters (i.e., multiple, co‐occurring symptoms) in patients diagnosed with common chronic conditions, (2) evaluate current variables and measures used to represent SDoH, (3) identify gaps in the evidence base, and (4) provide recommendations for the incorporation of SDoH into future symptom cluster research. (...) We identified 118 articles including information on SDoH in chronic condition symptom cluster research. Articles primarily focused on cancer populations. Few articles had the explicit purpose of investigating relationships between SDoH and symptom clusters, and the inclusion of SDoH was often limited to variables used to describe samples. Future studies should be designed to “move beyond Table 1” in their utilization of SDoH as variables and examine relationships between SDoH and symptom clusters. Attention should be paid to the appropriateness of measures being used to collect information on SDoH, and analysis methods that estimate causal connections between variables should be considered. Research regarding the relationship of SDoH with symptom clusters in patients with chronic conditions has the potential to reveal mechanisms of symptom disparities and guide changes to alleviate these disparities. (shrink)

For more than 15 years Professor Per Nortvedt has been arguing the case for moral realism in nursing and the health‐care context more generally. His arguments focus on the clinical contexts of nursing and medicine and are supplemented by a series of persuasive examples. Following a description of moral realism, and the kinds of considerations that support it, criticisms of it are developed that seem persuasive. It is argued that our moral responses are explained by our beliefs as opposed to (...) moral realities. In particular, two key arguments presented by Nortvedt are challenged: the so‐called argument from convergence and the argument from clinical sensitivity. Both of these key planks in the case for moral realism are rejected, and an alternative ‘social conditioning’ account briefly sketched, which, it is claimed, has the same explanatory power as Nortvedt's thesis but does not rest on an appeal to independently existing moral properties. (shrink)

This article discusses the serious problem of the shortage of about 50 000 nurses in Japan today. If efficient measures to solve it are not adopted by administrators, it is clear that the shortage will become still more alarming in the future, in a society with more people in advanced years and in which the numbers in the younger generation will decrease from now on. The main factors behind the Japanese nursing labour shortage are, among others: a rapid increase (...) in the number of hospital beds between 1986 and 1989; poor working conditions; and nurses’ low social position in their places of work. Behind these factors, there has always been a contempt for the art of nursing in our society. Why has Japanese society made light of nursing? Three points can be identified: traditional discrimination against women; our disregard for a religious mentality; and our short history of hospital nursing. To overcome these problems, we must first of all change fundamentally our sense of values, such as love for one another and compassion. We must now reconstruct a caring culture in our society. (shrink)

This article explores and examines the fundamental need for nurses to include the promotion of the spiritual dimension of the health of human beings as well as the physical, mental and social facets if they truly wish to engage in holistic care. The author attempts to define the phenomenon of spirituality, aware of the dilemma that many individuals face when thinking and reflecting on this very personal and intangible issue. To be spiritual is to become fully human, the (...) article argues, and the reverse is also true. Spirituality in health is inextricable in each person’s search for the discovery of the truth about self and the meaning and purpose of life. Healthy communities are the product of healthy individuals who sow spiritual seeds such as unconditional positive regard, acceptance, respect and dignity for the benefit and advancement of individuals and humankind as a whole. The global nature of the phenomenon of spirituality is also shown by using examples of people who demonstrate compassion and communion with other human beings, in other countries in times of suffering, war and disaster. Compassion and empathy is expressed and experienced for victims of earthquakes that happen miles from home and far removed from personal or religious beliefs. Yet at such times we are all connected in the tapestry of life by our own human spirituality and earthiness.themes like compassion and justice are treated in the text within the context of spirituality. The author argues that being just and fair means that all patients have the right to achieve spiritual healing regardless of their belief systems, culture or creed. The works of some spiritual philosophers are used to reflect on this integral aspect of human caregiving. Historical symbols of spirituality are examined. The need for nurses to explore and reflect on the paradoxical concepts involved in their own spirituality is highlighted. Nurses are the essential providers of care and, therefore, the paper argues, guardians of that essential humanity that ensures that patients never become less than full human beings, whatever their condition, faith, culture or belief, or whoever they may be. The author contends that this responsibility is uniquely essential to being a nurse. (shrink)

This article explores and examines the fundamental need for nurses to include the promotion of the spiritual dimension of the health of human beings as well as the physical, mental and social facets if they truly wish to engage in holistic care. The author attempts to define the phenomenon of spirituality, aware of the dilemma that many individuals face when thinking and reflecting on this very personal and intangible issue. To be spiritual is to become fully human, the (...) article argues, and the reverse is also true. Spirituality in health is inextricable in each person’s search for the discovery of the truth about self and the meaning and purpose of life. Healthy communities are the product of healthy individuals who sow spiritual seeds such as unconditional positive regard, acceptance, respect and dignity for the benefit and advancement of individuals and humankind as a whole. The global nature of the phenomenon of spirituality is also shown by using examples of people who demonstrate compassion and communion with other human beings, in other countries in times of suffering, war and disaster. Compassion and empathy is expressed and experienced for victims of earthquakes that happen miles from home and far removed from personal or religious beliefs. Yet at such times we are all connected in the tapestry of life by our own human spirituality and earthiness.themes like compassion and justice are treated in the text within the context of spirituality. The author argues that being just and fair means that all patients have the right to achieve spiritual healing regardless of their belief systems, culture or creed. The works of some spiritual philosophers are used to reflect on this integral aspect of human caregiving. Historical symbols of spirituality are examined. The need for nurses to explore and reflect on the paradoxical concepts involved in their own spirituality is highlighted. Nurses are the essential providers of care and, therefore, the paper argues, guardians of that essential humanity that ensures that patients never become less than full human beings, whatever their condition, faith, culture or belief, or whoever they may be. The author contends that this responsibility is uniquely essential to being a nurse. (shrink)

Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric‐driven competency‐based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing students at two Canadian Baccalaureate programs to understand how nursing's educational context, including its hidden curriculums, impacted student writing activities. We viewed this qualitative data through the lens of activity theory. Students spoke about navigating a rigid writing context. This resulted in a hyper‐focus on “figuring out” the teacher (...) with minimal focus on the act of writing. Students used a form of behavioral “code‐switching” to maximize their grade while considering how their “valuing” of the assignment fit within their writing motives. Hidden curriculum messages taught students that academic success was assured whether their writing mirrored instructor preferences. Instructional practices of rigidity reinforced unequal social conditions for some minority students. Faculty can counteract the impact of the hidden curriculum through encouragement of choice and independent thinking about writing activities. Acknowledging power relationships and their influence on how students navigate writing assignments and nursing discourse may relieve pressures on students who fear penalties for countering norms and result in a more flexible learning environment. (shrink)

At the bedside, nurses are expected to be precise when they read indications on screens and on the bodies of patients and decide on the meaning of words framed by the context of acute care. In academia, although there is no incident report to fill when we misread or misrepresent complex philosophical ideas, the consequences of inaccurate reading include misplaced epistemological claims and poor scholarship. A long and broad convention of nursing phenomenological research, in its various forms, claims a (...) philosophical grounding in the ideas of Husserl, Heidegger, and other thinkers. But for nearly two decades, nurse phenomenologists' knowledge claims have been challenged by well‐informed criticisms, most notably by John Paley. At the heart of criticism lies an observation that Continental phenomenological thought is misrepresented in many nursing sources and that nursing phenomenology, both descriptive and interpretive, cannot appeal to the authority of either Husserl or Heidegger. Taking these criticisms seriously, I am asking, Is phenomenology after Paley possible? If misreading seems to be an issue, how can – or should – we read rigorously? My thinking through these questions is influenced by the ideas of Jacques Derrida. Under a condition of a play of language, of Derridian différance, when meaning is never self‐identical and never fully arrives, I suggest that one has to negotiate meanings through reading for differences. I develop this idea in relation to the methodological conventions of phenomenological nursing research and argue for a careful rereading of the whole field of phenomenological nursing research. Such rereading presupposes and necessitates interdisciplinary engagement between nursing and the humanities and interpretive social sciences. Greater familiarity with research practices of those disciplines that stress theoretical and writing rigour might make visible the limits of nursing research approaches and their quality criteria. An understanding of philosophical and theoretical works – a condition of quality scholarship – depends on our reading of both originary texts and contemporary literature from the humanities and the social sciences. This understanding, far from obliging researchers to always trace (often erroneously) their work to its philosophical roots, opens other, often more sound, methodological possibilities. (shrink)

To enhance patient care in the inevitable conditions of complexity that exist in contemporary healthcare, collaboration among healthcare professions is critical. While each profession necessarily has its own primary focus and perspective on the nature of human healthcare needs, these alone are insufficient for meeting the complex needs of patients (and potential patients). Persons are inevitably contextual entities, inseparable from their environments, and are subject to institutional and social barriers that can detract from good care or from accessing healthcare. (...) These are some of the reasons behind current movements to develop competency frameworks that can enhance cross‐disciplinary communication and collaboration. No single profession can claim the big picture. Effective teamwork is essential and requires members of diverse professions to understand the nature of each other's knowledge, skills, roles, perspectives, and perceived responsibilities so that they are optimally utilized on behalf of patients and their families. Interdisciplinary approaches to care permit different aspects of a person's needs to be addressed seamlessly and facilitate the removal of obstacles by engaging the range of resources exemplified by the different professions. Additionally, collaborative efforts are needed to influence policy changes on behalf of individual and social good and to address root causes of poor health especially as these impact society's most vulnerable. Here, we explore both the benefits and the risks of an uncritical acceptance of competency frameworks as a way to enhance interdisciplinary communication. We highlight the importance of anchoring proposed competency domains in the reason for being of a given profession and exemplify one way this has been accomplished for advanced practice nursing. Additionally, we argue that having this mooring, permits integration of the various competencies that both enhances professional moral agency and facilitates interdisciplinary collaboration to further the mutual goals of the healthcare professions on behalf of quality patient care. (shrink)

American Indian/Alaska Native (AI/AN) populations in the United States continue to experience overall health inequity, despite significant improvement in health status for nearly all other racial‐ethnic groups over the past 30 years. Nurses comprise the bulk of healthcare providers in the U.S. and are in an optimal position to improve AI/AN health by transforming both nursing education and practice. This potential is dependent, however, on nurses’ ability to recognize the distinct historical and political conditions through which AI/AN health (...) inequities have been produced and sustained. Nurse providers, educators, and leaders must in turn recognize how the sustained conditions of marginalization and expropriation that underpin current AI/AN health inequities continue to shape contemporary AI/AN health outcomes. This manuscript builds upon the extant literature of AI/AN historical health policy and utilizes decolonial theorizations of nursing and a cultural safety framework to propose a series of immediately actionable steps for nursing intervention into AI/AN health inequity. Ultimately, we suggest that it is crucial for nurses to collaborate with AI/AN individuals and communities across educational and clinical settings to further refine these approaches in alignment with the disciplinary obligation of promoting social justice within healthcare. (shrink)

The notion of mutual aid, which Peter Kropotkin introduced in the 19th century, goes against the logic of competition as a natural condition, and instead shows how mutual aid is a more important factor to consider for the survival and flourishing of a group. The best cooperation strategies allow organisms to adapt to different types of changes in their environment—and we have witnessed a lot of these changes since the start of the COVID‐19 pandemic. This propensity towards cooperation is not (...) a foreign concept, despite how it seems to be overshadowed by individualism in Western societies. These reflections then lead us to believe it is possible to apply the anarchist philosophical principle of mutual aid to our social organizations, rather than giving priority, again and again, to competition and professional hierarchies, especially in healthcare systems, and particularly in hospitals were the majority of nurses work. For us, anarchist philosophical precepts, including but not limited to mutual aid, can be the key to a more adequate functioning of healthcare institutions. Anarchism can help to imagine the first steps needed to take to gradually move away from ideologies that encourage competition, professional hierarchies, and illegitimate authority. In this paper, we will first explore some anarchist philosophical precepts before turning to mutual aid as it is currently conceptualised, then highlight several concrete ways it is visible in nursing, as well as ways it can be applied in hospitals, and healthcare systems. (shrink)

The aim of this study was to examine physicians' and nurses' preferences regarding the use of life-sustaining treatments for severely ill elderly patients, and the patient- and social-centered factors that influence them. Physicians and nurses working in Israeli general hospitals completed structured questionnaires referring to their preferences for using LST in three severe health conditions. The participants were also asked about factors influencing these preferences, including patients' wishes, quality of life, religiosity and the current law. Both physicians (...) and nurses indicated that they would use less LST for patients with metastatic cancer than with those suffering from the other two health conditions. Our findings indicate that the attitudes of professionals involved in these processes are influenced not only by the patient's condition but also by their professional orientations and personal values. Open communication among professionals for clarifying the various beliefs, as well as the antecedents of these beliefs, is important for the benefit of professional teams, patients and families. (shrink)

The nurse–patient relationship is of great significance for both nurses and patients. The purpose of this article is to gain an understanding of how the individual is constituted through a focus on the execution of the patient’s and nurse’s role in the joint relationship. The article represents a social-constructionist consideration using Kenneth Gergen’s concept of multi-being. Gergen’s notions of the self as a multi-being focuses on the individual’s relational character through former relationships and social interactions. Gergen’s concept (...) is applied onto nurses and patients as individuals to gain an understanding of the broader institutional and social context of each role and their interactions within the nurse–patient relationship. The article focuses on the nurse–patient relationship in general with regard to specific challenges in the home care setting. Various demands and experiences from a myriad of past relationships merge as potential actions for nurses and patients during the forming of a relationship. Nurses as multi-beings see themselves confronted with guidelines and legal conditions, their own as well as the patients’ expectations and the actual possible forming of a relationship in the light of daily nursing care. Patients as multi-beings experience an extended social environment that comprises the nurse–patient relationship while simultaneously having to cope with illness and increasing care dependency within their own homes. Discrepancies can be observed in the relationship with regard to the inherent human qualities, the demands of forming a relationship, and the actual relationship arising due to framework conditions. (shrink)

Since the 1960s, it has been recognized that “medical ethics,” the area of inquiry about the obligations of practitioners of medicine, is inadequate for capturing and addressing the complexities associated with modern medicine, human health, and wellbeing. Subsequently, a new specialty emerged which involved scholars and professionals from a variety of disciplines who had an interest in healthcare ethics. The name adopted is variously biomedical ethics or bioethics. The practice of bioethics in clinical settings is clinical ethics and its primary (...) aim is to resolve patient care issues and conflicts. Nurses are among these clinical ethicists. They are drawn to the study and practice of bioethics and its applications as way to address the problems encountered in practice. A significant number are among the ranks of clinical ethicists. However, in the role of bio- or clinical ethicist, some retained the title of their original profession, calling themselves nurse ethicists, and some did not. In this article, we explore under which conditions it is permissible or preferable that one retains one’s prior profession’s nomenclature as a prefix to “ethicist,” under which conditions it is not, and why. We emphasize the need for transparency of purpose related to titles and their possible influence on individual and social good. (shrink)

With the accelerating aging of the population and the worsening psychological conditions of older people, the traditional mode of family support for the elderly in China does not always meet the physical and psychological needs of the elderly, and more social support modes for the elderly are needed. Based on 3,513 valid questionnaires on the long-term care and protection needs of Chinese residents, this paper uses a logit regression model to analyze the factors influencing the willingness of the elderly (...) to choose nursing care. The results show that intergenerational family support for the elderly is a significant psychological driver on the willingness of the elderly to choose nursing care. Compared with the elderly living with family, empty nesters or older people living alone are more inclined to select nursing care when they have difficulties taking care of themselves. The physical health of the elderly affects their willingness to choose nursing care, and elderly individuals with more hospitalizations are less likely to select nursing care. In addition, elderly females who are relatively young, have a high level of education, have a high income, have a nursing home near the residence, and are already covered by medical insurance are more willing to choose nursing care. The results of this study are of great importance for improving the medical services and aging care services for the elderly and providing theoretical support for alleviating the psychological and social pressure brought by population aging. (shrink)

RACINE L and PERRON A. Nursing Inquiry 2012; 19: 190–201 Unmasking the predicament of cultural voyeurism: a postcolonial analysis of international nursing placementsThe growing interest in international nursing placements cannot be left unnoticed. After 11 years into this twenty‐first century, violations of human rights and freedom of speech, environmental disasters, and armed conflicts still create dire living conditions for men and women around the world. Nurses have an ethical duty to address issues of social justice and global health (...) as a means to fulfil nursing’s social mandate. However, international placements raise some concerns. Drawing on the works of postcolonial theorists in nursing and social sciences, we examine the risk of replicating colonialist practices and discourses of health in international clinical placements. Referring to Bakhtin’s notions of dialogism and unfinalizability, we envision a culturally safe nursing practice arising from dialogical encounters between the Self as an Other and with the Other as an Other. We suggest that exploring the intricacies of cultural and race relations in everyday nursing practice are the premises upon which nurses can understand the broader historic, racial, gendered, political and economic contexts of global health issues. Finally, we make suggestions for developing culturally safe learning opportunities at the international level without minimizing the impact of dialogical cultural encounters occurring at the local and community levels. (shrink)

The development of nursing began in Poland much later than it did elsewhere, for instance in the United Kingdom, the United States, or Germany, and it came up against difficult conditions. After a brief twenty‐year period of development between 1918 and 1939, it almost stalled during the war (1939–45), only to be followed by nearly twenty years of chaos. Nursing started to come out of this difficult period at the beginning of the 1960s. The turn of the 21st century saw (...) the emergence of extensive professional development and training opportunities for nurses. This change was brought about as much by political, social and economic issues, health care requirements, and the advancement of science, medicine, the birth of humanitarism, the growth of the feminist movement, the European Agreement on the Instruction and Education of Nurses, the WHO European Strategy for Nursing and Midwifery Education, the Bologna declaration, as well as the activities undertaken by the European Union, the International Council of Nurses, the American and Polish Red Cross, the Rockefeller Foundation, the Polish Association of Nurses, and the professional self‐governing body. The transformation of nursing into an independent profession was further boosted by physicians deeply involved in the issue and female pioneers of nursing. (shrink)

BackgroundMoral distress is a phenomenon that can lead to an imbalance of the mind and body. There are many coping strategies to overcome the obstacles that lead the subject to this condition. Some coping strategies are capable of being achieved through the cultivation of moral resilience.AimThe aim is to identify the strategies of moral resilience in the nursing management of University Hospitals in Brazil.Research designThe research design is the qualitative study with discursive textual analysis.Participants and research context: 44 nurse managers (...) and nurses in leadership positions participated in a total of 30 University Hospitals in Brazil. Data were collected online, using a questionnaire with open questions.Ethical considerationsThe Ethics Committee approved the study. Participants received information about the research, agreed to respond to the questionnaire, and were guaranteed anonymity.FindingsPersonal adaptive strategies (intrapersonal and interpersonal) and organizational collaborative strategies (intrinsic and transformational management) emerged from this process. The intrapersonal strategies involved elements of rationality, flexibility, rebalancing practices, moral courage, and detachment. The interpersonal strategies addressed support networks, team involvement, and dialog. Organizational strategies dealt with actions which reorient ethical infrastructure, ethical education, and psychological protection, as well as fostering dialogical relationships, empowerment, and cooperation.ConclusionFrom the perspective of social historical construction, it is understood that developing personal and organizational strategies is essential to cultivating moral resilience. (shrink)

Background Nurses frequently face situations in their daily practice that are ethically difficult to handle and can lead to moral distress. Objective This study aimed to explore the phenomenon of moral distress and describe its work-related predictors and individual consequences for home-care nurses in Germany. Research design A cross-sectional design was employed. The moral distress scale and the COPSOQ III-questionnaire were used within the framework of an online survey conducted among home-care nurses in Germany. Frequency analyses, multiple (...) linear and logistic regressions, and Rasch analyses were performed. Participants and research context The invitation to participate was sent to every German home-care service ( n = 16,608). Ethical considerations The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. Results A total of 976 home-care nurses participated in this study. Job characteristics, such as high emotional demands, frequent work-life-conflicts, low influence at work, and low social support, were associated with higher disturbance caused by moral distress in home-care nurses. Organizational characteristics of home-care services, such as time margin with patients, predicted moral distress. High disturbance levels due to moral distress predicted higher burnout, worse state of health, and the intention to leave the job and the profession, but did not predict sickness absence. Conclusions To prevent home-care nurses from experiencing severe consequences of moral distress, adequate interventions should be developed. Home-care services ought to consider family friendly shifts, provide social support, such as opportunities for exchange within the team, and facilitate coping with emotional demands. Sufficient time for patient care must be scheduled and short-term takeover of unknown tours should be prevented. There is a need to develop and evaluate additional interventions aimed at reducing moral distress, specifically in the home-care nursing sector. (shrink)

This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could (...) ‘see’ neither their role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for ‘things’ such as cost‐effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice. (shrink)

To understand power relations, it is important to consider that power is an attribute, and whoever has it at a given moment is in the condition of dominant and whoever is under its exercise is dominated. Moreover, we must consider that these positions are interchangeable, changing when relations of force change. Power relations represent the pursuit of supremacy through knowledge, with struggles for better positioning in the social structure. In this study, we analyze the effects of disciplinary power on (...) daily practices of nurses and physicians in the hospital environment, more specifically in intensive care units. From the perspective of disciplines, power is exercised in a discreet, modest, calculated and permanent way, through the establishment of rules and norms. In this context, despite the strong appreciation of a medical‐centered model, it is observed that nurses gain visibility through knowledge and the defense of institutional norms and rules, which can generate tensions in daily professional practices. (shrink)

This study seeks to understand, in the context of intersectional theory, the roles of family members in nursing home care. The unique social locus at which each person sits is the result of the intersection of gender, status, ethnicity and class; it is situational, shifting with the context of every encounter. A content analysis of 15 qualitative interviews with relatives of nursing home residents in Sweden was used to gain a perspective on the relationships between relatives and residents, relatives (...) and the nursing home as an institution, and relatives and the nursing home staff. We sought to understand these relationships in terms of gendered notions of the family and the residents, which are handed down from generation to generation and thus condition who and how relatives should be involved in care, and the ways in which relationships change as care moves from home to nursing home. It requires knowledge and awareness that the nursing home culture is based on intersectional power structures in order for relatives to be involved in nursing home care in alternative and individual ways. (shrink)

It is fundamental assumption in nursing theory that it is important for nurses to understand how patients experience states of ill health. This assumption is often related to aims of empathic understanding, but normative principles of social interpretation can have an important action‐guiding role whenever nurses seek to understand patients’ subjective horizons on the basis of active or passive expressions of meaning. The aim of this article is to present a philosophical theory of concept possession and to (...) argue that it can shed light on how nurses should seek to understand patients’ subjective perspectives on the meaning of illness. The two basic ideas in the theory are that patients’ beliefs and thoughts about their experiences involve concepts and that concepts can be communicated on the basis of shared implicit conceptions of what they mean. These conditions of understanding have a striking application: nurse‐patient communication is limited by many contextual factors, but it is often possible for nurses to detect shared implicit conceptions of the meaning of concepts of disease and illness. Furthermore, by acting as sympathetic linguistic experts and creating an atmosphere for dialogue, nurses can make patients feel comfortable about deferring to medical explanations of meaning that can constitute a communicative platform. The last part of the article uses a number of cases studies to show how these implications can be implemented as conceptual tools for securing meaningful communication about illness experiences in patient dialogue. (shrink)

The purpose of this study was to develop and empirically test a model for predicting the key factors affecting nurses’ behavioral intention to use mobile learning. We explored behavioral intention from users’ perspectives by applying an extended unified theory of acceptance and use of technology model with the addition of information quality, system quality, technostress, and satisfaction. We conducted a survey of the district and regional hospitals in central Taiwan. Data were derived from 434 respondents. Structural equation modeling was (...) applied to analyze the causal effects of 15 hypothesized predictive factors. We determined that satisfaction, social influence, performance expectancy, facilitating conditions, and effort expectancy positively impacted nurses’ behavioral intention to use m-learning. In addition, technostress was a negative antecedent of effort expectancy. Information quality and system quality had significantly positive effects on satisfaction, performance expectancy, and effort expectancy. This study provides hospital managers with a reference when assessing future developments and informs approaches to promote m-learning. (shrink)

Burnout is characterized by emotional exhaustion and caused by exposure to excessive and prolonged stress related to job conditions. Moreover, burnout is highly prevalent among health care professionals. The aim of this study is, first, to examine the mediating role of social support over the effect of burnout in health care professionals and, second, to explore potential gender differences. A convenience sample of 1,035 health professionals from Ecuador, including 608 physicians and 427 nurses, was surveyed using the Maslach (...) Burnout Inventory, Social Support Survey, and General Health Questionnaire as measures of burnout, social support, and general health, respectively. Social support was found to mediate the negative effects of burnout on health regardless of gender. Differences across the three dimensions of burnout and health are further discussed, along with their implications for designing effective burnout interventions for health care professionals in Ecuador. (shrink)

End-of-life issues have become an urgent problem in Japan, where people are among the longest lived in the world and most of them die while connected to high-technology medical equipment. This study examines a sensitive end-of-life ethical issue that concerns patients, families and nurses: the withdrawal of artificial food and fluid from terminally ill patients. A sample of 160 Japanese nurses, who completed a questionnaire that included forced-choice and open-ended questions, supported this act under only two specific conditions: (...) if the patient requested it, and if it relieved the patient’s suffering. They considered that the doctor’s orders, the family’s request, or the patient’s advanced age did not ethically justify this act. A small number of people who had recently lost a relative took part in semistructured interviews focusing on their experiences of their terminally ill relatives being given artificial food and fluid. Ethical, social and cultural factors surrounding this issue are discussed. (shrink)

Death and dying are natural phenomena embedded within complex political, cultural and social systems. Nurses often practice at the forefront of this process and have a fundamental role in caring for both patients and those close to them during the process of dying and following death. While nursing has a rich tradition in advancing the palliative and end‐of‐life care movement, new modes of care for patients with serious and irremediable medical conditions arise when assisted death is legalized in (...) a particular jurisdiction. In early 2015, the Supreme Court of Canada released its landmark decision Carter v. Canada (Attorney General) (‘Carter’), which legalized physician‐assisted suicide in particular clinical situations. The new law provided the broad national framework for Medical Assistance in Dying (MAiD) in Canada but, once the law was passed, provincial and territorial governments and health professional regulatory bodies each had to undertake a process of developing policies, procedures and processes to guide MAiD‐related practice specific to their jurisdiction. In this paper, we begin to examine the political ramifications and professional tensions arising from MAiD for nurses and nursing, focusing specifically upon the impacts for registered nurses. We identify how variations in the provincial and territorial literature and regulatory guidelines across Canada have given rise to role confusion and uncertainty among some registered nurses and how this may potentially impact patient care. We then continue to highlight the need for greater political activism among nurses to foster greater clarity in nursing roles in MAiD and to advocate for improved supports for patients and those close to them. (shrink)

From the state to the family: reconfiguring the responsibility for long‐term nursing care at homeThis paper discusses the implications of the shift in the location of the provision of healthcare services from healthcare institutions to the home, which has occurred or is projected to occur in coming years. It is argued that the responsibility for the provision of care and assistance needed by the elderly living at home and people with long‐term conditions living at home has shifted from public services (...) to the family. Studies of care‐givers have shown that in many situations they experience tremendous burdens, financial difficulties and health problems. Their social lives have been confined to the home, and contacts with friends and neighbors have been significantly reduced. This situation needs to be addressed by nurses, who in many cases serve as the bridge between the home and the official healthcare system. Using Foucault’s exploration of power, particularly his idea of governmentality, a genealogy of care‐giving in the home in Iceland’s health‐care has been constructed. The main findings were that, although this is occurring somewhat later than in many other countries, the state is withdrawing from its previously defined responsibility for the health and well‐being of the nation. At the same time the citizen’s responsibility for maintaining health is emphasized. Based on these findings, the argument is made that nurses in Iceland can have a profound influence on policy‐making in relation to the organization of services provided in those homes. Suggestions are made as to how this can be done, which may be of interest to nurses in other countries. (shrink)

The conceptual and investigative tools for the analysis of social behavior can be expanded by integrating biological theory, control systems theory, and Pavlovian conditioning. Biological theory has focused on the costs and benefits of social behavior from ecological and evolutionary perspectives. In contrast, control systems theory is concerned with how machines achieve a particular goal or purpose. The accurate operation of a system often requires feed-forward mechanisms that adjust system performance in anticipation of future inputs. Pavlovian conditioning is (...) ideally suited to subserve this function in behavioral systems. Pavlovian mechanisms have been demonstrated in various aspects of sexual behavior, maternal lactation, and infant suckling. Pavlovian conditioning of agonistic behavior has been also reported, and Pavlovian processes may likewise be involved in social play and social grooming. Several further lines of evidence indicate that Pavlovian conditioning can increase the efficiency and effectiveness of social interactions, thereby improving their cost/benefit ratio. We extend Pavlovian concepts beyond the traditional domain of discrete secretory and other physiological reflexes to complex real-world behavioral interactions and apply abstract laboratory analyses of the mechanisms of associative learning to the daily challenges animals face as they interact with one another in their natural environments. Key Words: aggression; biological theory; control theory; feed-forward mechanisms; learning theory; nursing and lactation; Pavlovian conditioning; sexual behavior; social behavior; social grooming; social play. (shrink)

Social determinants of health are a subject of growing interest, yet criticisms have emerged about the way determinants are conceptualized in nursing. A tendency to focus on readily observable living conditions and measurable demographic characteristics can divert attention, it has been said, from the less visible underlying processes which shape social life and health. To illustrate how the analytic perspective determines what becomes visible or invisible as a “determinant” in health, this paper presents a case exemplar. Drawing from (...) news reports and research in real estate economics and urban policy analysis, it explores a single local infectious illness outbreak through a series of progressively more abstract units of inquiry, considering mechanisms of lending and debt financing, housing supply, property valuation, tax policy, change in the structure of the financial industry, and international patterns of migration and capital flow, among other factors, which contributed in various ways to creating unsafe living conditions. An analytic exercise calling attention to dynamism and complexity in social processes, the paper offers a political‐economy‐based approach that serves as a cautionary note against oversimplification in discussions of health causality. (shrink)

Advances in cloning technology and successful cloning experiments in animals have raised concerns about the possibility of human cloning in recent years. Despite many objections, this is not only a possibility but also a reality. Human cloning is a scientific revolution. However, it also introduces the potential for physical and psychosocial harm to human beings. From this point of view, it raises profound ethical, social and health related concerns. Human cloning would have an impact on the practice of nursing (...) because it could result in the creation of new physiological and psychosocial conditions that would require nursing care. The nursing profession must therefore evaluate the ethics of human cloning, in particular the potential role of nurses. This article reviews the ethical considerations of reproductive human cloning, discusses the main reasons for concern, and reflects a nursing perspective regarding this issue. (shrink)

This article aimed to explore issues of concern related to quarantine, its social consequences and influences, challenging its effects on human behavioral expressions during social isolation. The advent of the coronavirus disease 2019 (COVID-19) pandemic impacted human lives in multifarious ways, threatening the meaning of normalcy. Quarantine, lockdown, isolation, and other terms reflecting conditions limiting human freedoms have become synonymous in importance to safety, security, and survival. To understand human defiance in the face of maintaining limited mobility during (...) the COVID-19 pandemic, reimagining situations of “unfreedoms” is explained as thinking of changes to inspire and improve the meaning of living lives meaningfully. During the pandemic, issues regarding healthcare practices and social behaviors focused much attention on interactive challenges that enhance ways to mitigate the spread of contagious diseases. Illuminating these issues, discussing concerns and highlighting recommendations to engage in alternative approaches and practices, heightens the declaration of efficiency of quarantine outcomes and effectiveness. Implications are proposed with the hope that they may lead the way forward in exercising contemporary healthcare practices. (shrink)

Approaches to self‐management traditionally focus upon individual capacity to make behavioural change. In this paper, we use Bourdieu's concepts of habitus and capital to demonstrate the impact of structural inequalities upon chronic illness self‐management through exploring findings from 28 semi‐structured interviews conducted with people from a lower socioeconomic region of Adelaide, South Australia who have type 2 diabetes. The data suggests that access to capital is a significant barrier to type 2 diabetes self‐management. While many participants described having sufficient cultural (...) capital to access and assess health information, they often lacked economic capital and social capital in the form of support networks who promote health. Participants were often involved in social networks in which activities which are contrary to self‐management have symbolic value. As a consequence, they entered relationships with health professionals at a disadvantage. We conclude that structural barriers to self‐management arising from habitus resulting in the performance of health behaviours rooted in cultural and class background and limited access to capital in the form of economic resources, social networks, health knowledge and prestige may have a negative impact on capacity for type 2 diabetes self‐management. (shrink)

Health systems in Africa have been widely studied in the social sciences. Several aspects have been addressed in particular: the provision of and access to care, working conditions, the human resources crisis, and patient–provider relations, for example. In this respect, the idea of an “attitude problem,” with health-care providers offering different services for different patients, has been suggested. Recently, researchers have studied the impact of global health initiatives on local health systems, mainly in the fight against HIV/aids. Others have (...) explored why some health issues have attracted more attention than others. Despite this wealth of studies, one point remains insufficiently addressed: the materiality of care and its impact on interactions within hospital settings. In this article, I consider the heuristic value of the uses of a maternity ward in a resource-limited country to understand health workers’ so-called attitude problem, specifically, the tension characteristic of patient–provider interactions. I suggest that this tension is related to a continuous process of translation and anticipation to adapt the maternity ward’s space to everyday activities. Drawing on Akrich’s description of technical objects, and Lussault’s pragmatics of space, I attempt to show that in this context, care is also an art of tinkering with unpredictable bodies in unstable hospitals’ spaces. (shrink)

In this article, the production of knowledge in the context of socially excluded people exposed to inequality, oppression, and exploitation is problematized. The analysis follows Enrique Dussel's philosophical exegesis of the politics of power and corruption and his vision of a critical transformation of the social political order. The argument is also informed by the work of critical educator Paulo Freire, who elucidates the conditions of oppression and marginalization and highlights the importance of conscientization to develop a critical awareness (...) of these conditions. Hannah Arendt's work on the politics of understanding totalitarianism also assists in the elucidation of the machinery that operates behind oppression to sustain power and inequality. The article emphasizes the need to recognize the inequality of conditions that exists between the producer of knowledge and those who live through inequality and oppression in their lived corporality. A critical transformation of the process of production of knowledge is needed to both acknowledge the conditions that sustain this endeavour in the first place and avoid the corruption of knowledge. A work of conscientization is also necessary among knowledge producers to undertake a critical analysis of inequality that exposes the corruption of power. This analysis needs to examine and unmask the hidden mechanisms that perpetuate inequality and oppression and serve only the interests of a few. The abysmal gaps between the wealthy and the poor within and among countries bespeak a degree of human indifference that reflects a most serious and complex phenomenon that perverts something profoundly human in our societies. (shrink)

Background During the pandemic, social and health care professionals operated in ‘crisis conditions’. Some existing rules/protocols were not operational, many services were closed/curtailed, and new ‘blanket’ rules often seemed inappropriate or unfair. These experiences provide fertile ground for exploring the role of virtues in professional life and considering lessons for professional ethics in the future. Research design and aim This article draws on an international qualitative survey conducted online in May 2020, which aimed to explore the ethical challenges experienced (...) by social workers during Covid-19. Participants and research context 607 social workers responded from 54 countries, giving written online responses. This article first summarises previously published findings from the survey regarding the range of ethical challenges experienced, then develops a new analysis of social workers’ accounts of ethically challenging situations from a virtue ethics perspective. This analysis took a narrative ethics approach, treating respondents’ accounts as stories featuring the tellers as moral agents, with implicit or explicit implications for their professional ethical identity and character. The article is illustrated with accounts from the 41 UK respondents, drawing particularly on two case examples. Ethical considerations Ethical approval was gained from Durham University and anonymity was ensured for participants. Findings/results This article explores the nature of the ethical space created during the pandemic showing how practitioners were able to draw more on ‘inner resources’ and professional discretion than usual, displaying virtues such as professional wisdom, care, respectfulness and courage as they took account of the specific contexts of their work, rather than simply adhering to blanket rules. Conclusion Exploring practice through a virtue ethical lens provides valuable lessons for ‘building back better’ in social and health care professions. (shrink)

Background:Since 2010, the United States has experienced 228 disasters, affecting over 86 million people. Because of population shifts, the growing number of people living with chronic conditions or disabilities, and the growing number of older citizens living independently, access and service gaps often exist for those without money or other transferable resources. There is a lack of evidence regarding individual community members’ capacity to prepare for emergencies.Research objective:The purpose of this study is to highlight participant experiences in becoming better prepared (...) for emergencies and provide insight from a social justice perspective.Research design:This is a descriptive qualitative study, staying very close to the data as an end product rather than a beginning for interpretation.Participants and research context:A total of 13 low-income, uninsured, or under-insured attendees at a medical outreach clinic were interviewed.Ethical considerations:Institutional Review Board approval was obtained from the University of Texas at Tyler.Findings:Four themes emerged from the interview data: (a) evaluation of the emergency-preparedness education, (b) making emergency plans, (c) challenges in preparing for emergencies, and (d) facilitators of emergency preparedness.Discussion:Identifying the potential challenges to individual emergency preparedness among vulnerable populations is the first step in overcoming them. The capacity to comply with such measures, especially the ability of those with limited incomes and other vulnerable populations, must be considered.Conclusion:Synchronized, well-ordered assistance will close gaps in recovery and enhance efficiency in pre- and post-event aid. Theoretically, doing so will promote engaged and resilient members of society who are better able to withstand adverse events. The importance of the relationship between individual preparedness levels and the resiliency of nations supports the social justice imperative to address the needs of vulnerable populations in the mitigation and planning phase of the emergency management cycle. (shrink)

Complexity of the changes taking place in modern societies makes it is necessary to deepen the analysis of the impact of social inequality on the activity of old people. Dissemination of new technologies and organizational forms allows solving many social problems and improving the quality of human life. At the same time broadens the range of areas in which old people are losing their authority and differ in expertise required for the achievement of socially valued goods. Article aims (...) to highlight the importance of inequality for the activity of the elderly and its relationship to social capital in conditions of shaping social dispersion space order. Study brings closer chosen results of empirical studies portraying the dimensions of internal diversity of seniors. ** Złożoność przemian zachodz¸a}cych we współczesnych społeczeństwach sprawia, iż niezbȩdne staje siȩ pogłȩbienie analiz oddziaływania nierówności społecznych na aktywność ludzi starych. Upowszechnianie siȩ nowych technologii i form organizacyjnych pozwala na rozwi¸a}zanie wielu problemów społecznych i podniesienie jakości życia ludzkiego. Jednocześnie poszerza siȩ zakres dziedzin, w których ludzie starzy trac¸a} swój autorytet oraz różni¸a} siȩ miȩdzy sob¸a} kompetencjami wymaganymi do osi¸a}gania społecznie cenionych dóbr. Celem artykułu jest zwrócenie uwagi na znaczenie nierówności dla aktywności ludzi starych oraz jej zwi¸azków z kapitałem społecznym w warunkach kształtowania siȩ w polskiej przestrzeni społecznej ładu rozproszonego. Opracowanie przybliża wybrane wyniki badań empirycznych, które ukazuj¸a wymiary zróżnicowania kategorii społecznej ludzi starych. (shrink)

_Psychopathology at School_ provides a timely response to concerns about the rising numbers of children whose behaviour is recognised and understood as a medicalised condition, rather than simply as poor behaviour caused by other factors. It is the first scholarly analysis of psychopathology which draws on the philosophers Foucault, Deleuze, Guattari and Arendt to examine the processes whereby children’s behaviour is pathologised. The heightened attention to mental disorders is contrasted with education practices in the early and mid-to-late twentieth century, and (...) the emergence of a new conceptualization of childhood is explored. Taking education as a central component to the contemporary experience of growing up, the book charts the ways in which mental disorders have become commonplace in childhood and youth, from birth through to college and university, but also offers examples of where professionals have refused to pathologise children’s behaviour. The book examines the extent of the influence of psychopathology on the lives of children and young people, as well as the practices that infiltrate education and the possibilities for alternative educational responses that negate the diagnosis of mental disorder. Psychopathology at School is a must read for anyone concerned about the growing influence of psychopathology in education and will be of particular interest to educated readers and to scholars, students and professionals in education, psychiatry, psychology, child studies, youth studies, nursing, social work and sociology. (shrink)

Though the impetus for psychoanalytic and group analytic in-patient psychotherapy largely came from Britain, it is in Germany that this work has been supported, developed and researched to a greater extent than elsewhere. In _Psychoanalytic Therapy in the Hospital Setting_ Paul Janssen describes the different models which have been tried and evaluated and explains his own integrative model in detail, illustrating it with vivid clinical vignettes. The author also shows that in-patient groups are particularly effective in the treatment of severe (...) personality disorders, borderline conditions and psychosomatic illness. Not previously available in the English language, this book will be invaluable reading to psychiatrists, psychotherapists, nurses, social workers and anyone working in health care. (shrink)

As a third-year medical student, I have the job of being the first person from the medical team to check in on patients in the morning, follow up on consults that they may need, and communicate with people from other services who are involved with patients’ care. Because third-year medical students have the most time of anyone on the medical team, we are encouraged to get to know our patients. We are encouraged to take time to understand our patients’ conditions (...) on both a medical and personal level, that is, both to read about their complex diseases and to talk about their preferences, goals, families, and lives outside the hospital. As best we can, we then communicate their personal needs and preferences to the medical team of doctors, nurses, social workers and others. What could be wrong with that? (shrink)

Recent estimates indicate that over 40,000 children die annually in the United States and a majority have life-limiting conditions. Children at end of life require extensive healthcare resources, including multiple hospital readmissions and emergency room visits. Yet, many children still suffer from symptoms at end of life—including fatigue, pain, dyspnea, and anxiety—with less than 10% of these children utilizing hospice care services. A critical barrier to pediatric hospice use was the original federal regulations associated with the hospice care that required (...) a diagnosis of 6 months to live and the discontinuation of all curative treatments. The Concurrent Care Provision of the United States’ Affordable Care Act eliminated the need to forgo curative therapies in order to enroll in hospice for children in Medicaid or Children’s Health Insurance Program. Concurrent care for children can help mitigate the tension families experience in choosing between essential forms of care, as well as contribute to improved end-of-life outcomes for the child and possibly bereavement outcomes for the family. Understanding concurrent care for children from a social justice perspective has important advocacy and research implications for hospice and palliative care clinicians providing care for children and their families. We apply Powers and Faden’s theory of social justice “as the moral foundation of public health and health policy” to the provision of concurrent care to children near end of life and families in the United States. The goals of applying this theory are to explore additional insights and perspectives into concurrent care policy may provide and to assess the usefulness of this theory when applied to end-of-life health policy. We argue that concurrent care policy is socially just since it has potential to promote well-being in vulnerable children and families and can limit the inequity children at end-of-life experience in access to high-quality hospice care. (shrink)