FEX A, FLENSNER G, EK A‐C and SÖDERHAMN O. Nursing Inquiry 2011; 18: 336–347 Living with an adult family member using advanced medical technology at homeAn increased number of chronically ill adults perform self‐care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self‐care (...) at home, either using long‐term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent‐care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent‐care and transition, which may have an influence on the self‐care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context. (shrink)

Our goal was to explore self‐care practices among men who have sex with men in the context of Mpox in Brazil. This study used qualitative research methods, including interviews and thematic analysis, to collect and analyze data from male participants across the Brazilian territory. The narratives unveil men's perspectives on self‐care, risk reduction, and health beliefs during the Mpox pandemic. Our findings highlight a multifaceted approach to self‐care among men, encompassing hygiene, physical contact management, (...) mask usage, skin lesion vigilance, and adherence to official guidelines. Men's attitudes toward sexual behaviors emphasize the importance of reducing sexual partners, practicing safe sex, and combating misinformation through accurate information dissemination. The development of these behaviors and self‐care practices can be facilitated by nurses guided by Dorothea Orem's Self‐Care Theory, supported by patient‐centered care, with strategies to address and confront the stigma associated with the disease and provide emotional support. Thus, the study underscores the pivotal role of self‐care in mitigating infection risks, especially in the context of emerging infectious diseases. It acknowledges the impact of socio‐cultural factors and healthcare policies on men's preventive measures. However, it also recognizes limitations, such as potential bias due to stigma concerns and a nonrepresentative sample. Ultimately, the research advocates for tailored education, promotion of gender equity, and healthcare empowerment to effectively manage health risks in such contexts. (shrink)

IntroductionPalliative care is an emotionally and spiritually high-demanding setting of care. The literature reports on the main issues in order to implement self-care, but there are no models for the organization of the training course. We described the structure of training on self-care and its effects for a Hospital Palliative Care Unit.MethodWe used action-research training experience based mostly on qualitative data. Thematic analysis of data on open-ended questions, researcher’s field notes, oral and written (...) feedback from the trainer and the participants on training outcomes and satisfaction questionnaires were used.ResultsFour major themes emerged: “Professional role and personal feelings”; “Inside and outside the team”; “Do I listen to my emotions in the care relationship?”; “Death: theirs vs. mine.” According to participants’ point of view and researchers’ observations, the training course resulted in ameliorative adjustments of the program; improved skills in self-awareness of own’s emotions and sharing of perceived emotional burden; practicing “compassionate presence” with patients; shared language to address previously uncharted aspects of coping; allowing for continuity of the skills learned; translation of the language learned into daily clinical practices through specific facilitation; a structured staff’s support system for emotional experiences.DiscussionSelf-care is an important enabler for the care of others. The core of our intervention was to encourage a meta-perspective in which the trainees developed greater perspicacity pertaining to their professional role in the working alliance and also recognizing the contribution of their personal emotions to impasse experienced with patients. (shrink)

This article argues that standard models of person-centred care (PCC) and shared decision making (SDM) rely on simplistic, often unrealistic assumptions of patient capacities that entail that PCC/SDM might have detrimental effects in many applications. We suggest a complementary PCC/SDM approach to ensure that patients are able to execute rational decisions taken jointly with care professionals when performing self-care. Illustrated by concrete examples from a study of adolescent diabetes care, we suggest a combination of moral (...) and psychological considerations to support the claim that standard PCC/SDM threatens to systematically undermine its own goals. This threat is due to a tension between the ethical requirements of SDM in ideal circumstances and more long-term needs actualized by the context of self-care handled by patients with limited capacities for taking responsibility and adhere to their own rational decisions. To improve this situation, we suggest a counseling, self-care, adherence approach to PCC/SDM, where more attention is given to how treatment goals are internalized by patients, how patients perceive choice situations, and what emotional feedback patients are given. This focus may involve less of a concentration on autonomous and rational clinical decision making otherwise stressed in standard PCC/SDM advocacy. (shrink)

In an increasingly globalized world, the accessibility of healthcare and medication has expanded beyond local healthcare systems and national borders. This study aims to investigate the transnational health and self-care experiences of 11 Japanese women who have resided in South Korea for a minimum of six months and have utilized oral contraceptives, including those that were acquired over-the-counter (OTC). Data were gathered through semi-structured interviews and analyzed by utilizing the NVivo software. The analysis yielded three significant thematic categories, (...) namely (1) experiences and perceptions of obtaining and utilizing contraceptive pills, including OTC access; (2) individual and social perceptions of pills and their accessibility in Japan, insights from actual users; and (3) enhancing pill accessibility, transnational health and self-care experiences and perspectives. Participants acknowledged that oral contraceptives are a global product and experienced communication challenges with healthcare providers as a result of differing understandings of these medications. Additionally, this study identified transnational strategies, such as purchasing an adequate supply of pills just before departure and seeking pills from local families or acquaintances. This study not only highlights the implications of clinical care for transnational patients but also underscores their critical global perspectives on access to oral contraceptives. Furthermore, it proposes two models for improving accessibility within the Japanese healthcare system, even in prescription-only contexts, by introducing OTC options. (shrink)

At the heart of soul care is self-care. Being able to love God and love others is rooted in how we love ourselves. Each person’s understanding of self-care is informed by their personal belief system and their implementation practices. This article will provide a multi-phasic model that describes the self-care journey and focuses on how to implement self-care practices. A key distinction of this model is that it is used (...) in an ongoing fashion. To avoid confusion between beliefs and practice, attention will be given to the decision-making process for self-care implementation. Specific activities that address the physical, mental, emotional, spiritual, and relational parts of people will be discussed. The article will also consider the nuances of assessing self-care and why it is important to value self-care, which is in keeping with the greatest commandments provided by Jesus in Mark 12:28–30. (shrink)

This paper will explore both the ways in which the practices of self-care, specifically related to mental health, have emerged as responses to the increasingly precarious status of life after the economic shocks of the Global Financial Crisis, whilst also looking to the work of Silvia Federici and Kathi Weeks to propose models for immanent critique of these practices. Although it cannot be taken as a pure origin, post-GFC mental health discourse has increasingly seen mental health discussed as (...) a form of resilience to precarity. Furthermore, practices of self-care, and psychological forms of treatment such as cognitive behavioural therapy have become vehicles for the intensification of personal resilience in the face of systemic crisis. If self-care involves an inward looking and depoliticised subject, surely political emancipation lies elsewhere. The possibility of some alternative to our present state of affairs, where self-care increasingly appears as a form of ‘voluntary servitude,’ that is to say, a form of self-subjugation with serious political risks, must surely be taken as a continual project for those engaged in critical inquiry. Then again, to suggest that those engaging in self-care are simply reproducing neoliberal subjectivity would surely miss the ways in which such forms of self-preservation might appear as unavoidable for the individuals in question. Through an engagement with their work—and one that draws parallels between their strategic critiques of reproductive labour broadly speaking, and the more specific area of mental illness and neoliberal governmentality—the question of the “necessity” of self-care will be brought into alignment with the possibilities of its practicality. (shrink)

This paper provides a philosophical critique of professional stereotypes in medicine. In the course of this critique, we also offer a detailed analysis of the concept of care in health care. The paper first considers possible explanations for the traditional stereotype that caring is a province of nurses and women, while curing is an arena suited for physicians and men. It then dispels this stereotype and fine tunes the concept of care. A distinction between ‘caring for’ and (...) ‘caring about’ is made, and concomitant notions of parentalism are elaborated. Finally, the paper illustrates, through the use of cases, diverse models of caring. Our discussion reveals the complexity of care and the alternative modes of caring in health care. (shrink)

This study is considered as a proposal to identify some metaphysical support of the self-care for a patient suffering from a chronic disease, as an extension of the bio-psycho-social paradigm. The methodology is dominated by a phenomenological perspective, supported by a hermeneutic conceptual analysis of the care of the self in Michel Foucault, focused on the Socratico-Platonic period and pervaded by the intention of having a translation and application to self-care. Foucault pleads for an (...) aesthetics of the self, called subjectivity, in which the subject is self-constituted through the so-called technologies of the self. The care of the self comes from the resignification of the philosophy as a way of life in which the subject is objectified. The translation and the applicability of the care of the self at the idea level to self-care are identified precisely in the acquisition of some important principles of the philosophy of care of the self from the Greek Antiquity: the role of awakener of consciousness of the one who is concerned about oneself as the first moment of the metaphor of awakening from the sleep, the ēthos as a way of being, a way of behaving and a life model. The pair self-knowledge – care of oneself justifies informing the former by the latter, in which being concerned about oneself means knowing oneself. Nevertheless, knowledge means care of the self where the self is synonymous with the soul and moreover, with the divine element in man. (shrink)

Whether self-deceivers can be held morally responsible for their self-deception is largely a question of whether they have the requisite control over the acquisition and maintenance of their self-deceptive beliefs. In response to challenges to the notion that self-deception is intentional or requires contradictory beliefs, models treating self-deception as a species of motivated belief have gained ascendancy. On such so-called deflationary accounts, anxiety, fear, or desire triggers psychological processes that produce bias in favor of the (...) target belief with the result that self-deceivers acquire and retain false beliefs in the face of a preponderance of counter-evidence. On the face of it, such approaches seem to exculpate self-deceivers insofar as their self-deceptive belief is the result of such a process. In this essay, I examine the conditions under which self-deceivers might be culpable on deflationary models proposed by Neil Levy. In particular, I contend that contrary to Levy, a self-deceiver need not doubt the target belief nor recognize its moral importance to be held morally responsible. (shrink)

상황의 위기는 정보의 위기이다. 왜냐하면 위기는 사건에 대한 정보의 부족이나 공백을 발생시키기 때문이다. 따라서 그런 결함들을 처리하고 불확실성을 제거하기 위해서 위기 상황에서는 사회적 메시지가 발화된다. 그러므로 ‘어떤 메시지가 그리고 어떻게 소통되어야 하는지’는 위기를 극복하는데 있어서 매우 중요한 요소이다. 현재 인류는 코로나19 팬데믹으로 인해서 경제적이고, 사회적이고, 심리적인 심각한 위기에 봉착해 있다. 신종 전염병인 코로나 19에는 예방 백신이 없을 뿐더러 치료제를 개발하는 데도 상당한 기간이 소요될 것으로 예상된다. 그리고 단지 시점이 언제이냐의 문제일 뿐이지 인류는 새로운 감염병인 이른바 “질병 X”를 겪을 것으로 예상된다. (...) 따라서 본 논문은 이러한 장기적이고 반복될 수 있는 위기를 극복하기 위한 방안의 일환으로 ‘메시지의 소통’ 문제를 논의하고자 한다.BR코로나19 사태에서 대중이 매일 듣는 가장 중요한 메시지는 ‘사회적 거리두기’이다. 그리고 자가격리 대상자에게는 ‘자가격리’라는 메시지가 전달된다. 그런데 이 두 메시지는 과연 적합한 또는 최선의 메시지인가? 필자는 코로나19 팬데믹 상황에서 메시지가 갖추어야 할 요건들을 검토한다. 이 요건들에 의거해서 ‘자가격리’와 ‘사회적 거리두기’라는 메시지를 비판적으로 고찰했을 때에, ‘격리 중 자기돌봄’과 ‘감염확산방지를 위한 거리두기’라는 메시지가 더 바람직하다. 뿐만 아니라 효과적일 수도 있다고 필자는 주장한다. 코로나19처럼 신종감염병이 창궐하는 상황에서 사전예방과 사후치료를 위한 의료적 수단이 부재할 경우에, 사회적 메시지는 최대한 의료적인 성격의 메시지여야 한다. (shrink)

This book focuses on two important, interlinked themes in psychiatry, i.e., the relation between self (or: person), context and psychopathology; and the intrinsic value-ladenness of psychiatry as a practice. -/- Written against the background of scientistic tendencies in today’s psychiatry, it is argued in Part I that psychiatry needs a clinical conception of psychopathology alongside more traditional scientific conceptions; that this clinical conception of psychopathology must be based on a fundamental rethinking of the interaction between illness manifestations, contextual influences (...) and the patient as person, such that psychopathology is conceived as the product of this interaction rather than as the outward manifestation of a broken mechanism within the patient. -/- In Part II, it is shown that self- and context-related factors have a large impact on who one is as a professional. I argue that an analysis is needed of the normative aspects of the relations that sustain and frame professional role-fulfilment. This analysis culminates into a so-called normative practice model (NPM) which distinguishes between qualifying, conditioning and foundational principles (or: rules, norms). The normative practice model helps to locate and resist scientistic defenses of the legitimacy of psychiatry and to replace them by a positive account that provides clinicians (and scientists) the conceptual tools they need to justify what they do in broader contexts. The main thrust of the argument is to show that psychiatry needs a value-sensitive account of its legitimacy, in which other normative dimensions are recognized than those that sustain the expert role. Psychiatrists should in other words not defend the legitimacy of their profession by referring to the expert role solely but provide a broader account in which justice is done to the broader social, legal, and economic contexts of professional activity. The analysis of this inherent normativity begins within clinical practice, it extends to the concept of disease as well as to wider domains of psychiatric care and the sociology of professions, and, finally, amounts into an analysis of the value-ladenness of interactions between healthcare institutions, the government, professional organizations and patient groups. (shrink)

Background Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students’ caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy. Research objective This study aimed to examine the mediating effect of moral sensitivity and (...) the moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours. Research design A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro. Participants and research context This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China. Ethical considerations This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students. Results The clinical internship environment ( B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity ( B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students’ caring behaviours via moral sensitivity ( B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours ( B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity ( B = 0.006, 95% CI = [0.003, 0.010]). Conclusion Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students. (shrink)

The paper offers an analysis of Plato’s conception of the care of the self in his Gorgias. There are two components of the self-care: self-knowledge and self-control. The first part deals with self-knowledge. The second part asks the question, wether there can be a fixed model of the individual soul’s order. The third part of the paper deals with Plato’s conception of self-control. The last part is concerned with the problem of (...) a self-control training. (shrink)

After a brief review of the literature on Student Evaluation of Teaching (SET), I employ a Foucauldian analysis to argue that student evaluations are forms of power that involve aspects of both discipline and governmentality. After examining how SETs are used to improve teaching, I identify some techniques that instructors use to respond to SET that undermine the legitimate interests of students or the educational institution. I endorse a hybrid model where a single global teaching question is used for (...) summative purposes and fifteen or twenty additional questions are used for formative purposes. Finally, I argue that to resist the normalizing pressure of SET, instructors might, as Foucault suggested, return to the Hellenistic concept of the care of self. Through techniques of the care of self, it is my hope that instructors could cultivate a more robust subjectivity, a subjectivity less vulnerable to the normative power of student evaluations. (shrink)

Palliative care is provided at a certain timepoint, both in a person's life and in a societal context. What is considered to be a good death can therefore vary over time depending on prevailing social values and norms, and the person's own view and interpretation of life. This means that there are many interpretations of what a good death can actually mean for an individual. On a more general level, research in palliative care shows that individuals have basic (...) common needs, for example physical, mental, social and spiritual well‐being. Therefore, in today's pluralistic Western society, it becomes important that palliative care is person centred to enable individuals to receive, as far as can be achieved, care that promotes as good a life as possible based on the person's own needs and preferences, and in accordance with evidence and current laws. For many years a research group, consisting nurse researchers together with nurses working in palliative care, has developed a model for person‐centred palliative care, the 6S‐model. The model's central concept is Self‐image, where the starting point is the patient as a person and their own experience of the situation. The other concepts: Self‐determination, Symptom relief, Social relationships, Synthesis and Strategies are all related to the patient's self‐image, and often to each other. The model's development, value base and starting assumptions are reported here, as are examples of how the model is applied in palliative care in Sweden. The model has been, and still is, constantly evolving in a collaboration between researchers and clinically active nurses, and in recent years also with patients and close relatives. (shrink)

Despite receiving considerable philosophical attention, the concept of autonomy remains contested. In this paper, we diagnose one source of the continuing problem—an excessive emphasis on reflective self-appraisal in the dominant procedural models of autonomy—and suggest a solution. We argue that minimalist conceptions of rational self-appraisal are subject to fatal counterexamples. Yet, attempts to provide a more robust account of rational self-appraisal are too demanding to capture our intuitions about who counts as an autonomous agent. We argue that (...) no procedure of rational reflection will confer autonomy; rather autonomy is a matter of an agent’s actions flowing from her substantive commitments. Instead of rational self-reflection, autonomous actions are the product of the motive of care, which anchors an agent’s occurent desires to her system of value. (shrink)

How might philosophically based counseling avoid becoming just one more form of private therapy, to be set alongside all the others now sold to individual consumers? Although several practitioners of philosophical counseling have sought to distinguish their approach from psychotherapeutic models, Foucault’s critique of the dominant modern model of ethical reflection might be used to argue for their essential continuity with one another, based on their common acceptance of the primacy of the imperatives of knowledge. Foucault turned in his (...) late writings to ancient Greek models of ethics as ‘care of the self ’, delineating a self-relation prior to knowledge. This paper argues for the interest and importance for philosophical counseling of the idea of ethics as ‘care of the self ’ in articulating a model of ethical reflection distinct from both rationalist and irrationalist tendencies in modern thought and focussed on self-mastery conceived as addressing our relation to otherness rather than as authenticity or autonomy. Moreover, the ‘aesthetics of existence’ that Foucault prescribes to the present has a significant and affirmative relationship to po­litical life; this distinguishes it from the private and individualistic project, dismissed by Foucault as ‘the Californian cult of the self ’, for which philosophical counseling can all too readily be mistaken. (shrink)

The practical aspect of ancient philosophy has been recently made a focus of renewed metaphilosophical investigation. After a brief presentation of three accounts of this kind developed by Martha Nussbaum, Pierre Hadot, and Michel Foucault, the model of the therapeutic argument developed by Nussbaum is called into question from the perspectives offered by her French colleagues, who emphasize spiritual exercise (Hadot) or the care of the self (Foucault). The ways in which the account of Nussbaum can be (...) defended are then discussed, including both a ‘negative’ defense, i.e. the indication of the weaknesses of Hadot and Foucault’s proposals, and a ‘positive’ one focused on the points in which Nussbaum can convincingly address doubts about her metaphilosophical account. In response to these analyses, some further remarks made by Hadot and Foucault are discussed in order to demonstrate that their accounts are not as distant from Nussbaum after all. Finally, a recent metaphilosophical study by John Sellars together with a therapeutic (medical) model developed by the author of the present article are suggested as providing a framework for potential reconciliation between all three accounts discussed and a resource for further metaphilosophical studies. (shrink)

This book proposes an alternative to the consent model which is currently at the heart of patient self-determination and which is shown here to have fundamental flaws that constrain its effectiveness. The proposed model is a property model in which the patient’s bodily integrity is protected from unauthorised invasion, and their legitimate expectation to be provided with the relevant information to make an informed decision is taken to be a proprietary right. This model enables the (...) courts to overcome the requirement to prove causation in consent cases and offers a complementary approach to patient self-determination. (shrink)

The deontic model of justice and ethical behavior proposes that people care about justice simply for the sake of justice. This is an important consideration for business ethics because it implies that justice and ethical behavior are naturally occurring phenomena independent of system controls or individual self-interest. To date, research on the deontic model and third-party reactions to injustice has focused primarily on individuals’ tendency topunishtransgressors. This research has revealed that witnesses to injustice will consider sacrificing (...) their own resources if it is the only way to sanction an observed transgressor. In this paper we seek to extend this model by arguing that punishment may not be the only “deontic” reaction, and that in fact, third-party observers of injustice may engage in moral self-regulation that would lead them to conclude that the most ethical response is to do nothing. We provide preliminary evidence for our propositions using voiced cognitions data collected during a resource allocation task. Results indicate that deonance may be more complex than originally thought, and previous tests of the model conservative in nature. (shrink)

Since the passage of Medicare, the self-regulation characteristic of professionalism in health care has come under steady assault. While Canadian physicians chose to relinquish financial autonomy, they have enjoyed far greater professional autonomy over their medical judgments than their U.S. counterparts who increasingly have their practices micromanaged. The Affordable Care Act illustrates the ways that managerial strategies and a market model of health care have shaped the financing and delivery of health care in the (...) U.S., often with little or no evidence of their effectiveness. (shrink)

In 1991 the United Nations General Assembly adopted the Principles for Older Persons as a framework for international policy responses to population ageing. These principles promote independence, participation, care, self-fulfilment and dignity as legitimate entitlements of all older people. Although these principles, or variations of them, are embedded in standards of best-practice in residential aged care facilities, the literature shows that in reality institutional care can deny older people opportunities to exercise some of these entitlements. More (...) specifically, residential aged care facilities can deprive older people of access and support to pursue opportunities for the full development of their potential, i.e. their entitlement to self-fulfilment. This discussion article explores the influence of institutional care on older people’s ability to exercise their entitlement to self-fulfilment. We identify the characteristics of a ‘good life’ in institutional care, according to aged care residents themselves. The Eden Alternative™ is presented as a model of aged care that aims to create the conditions for a ‘good life’ and self-fulfilment for aged care residents. (shrink)

Chronic obstructive pulmonary disease (COPD) is one of the most deadly and costly chronic diseases in the world characterized by many breathing problems. The management of COPD and the prevention of exacerbations are a priority goals to improve the quality of life in patients affected by this illness. In addition, it is also crucial to improve the patients’ adherence to care which, in turn, depends on their knowledge and understanding of some factors such as the prescribed medical treatment, changes (...) in dailylife, and the process of breathing. In turn, the adherence to care leads to greater autonomy for the patient who is thus able to better manage his illness. Here we presented the application of the Model IARA in patients affected by COPD in order to achieve their autonomy in illness management which, in turn, leads to a better quality of life. IARA is an intervention program which improve the awareness and knowledge of patients with respect to both the disease and symptoms through health education. Moreover, through IARA the patients are encouraged to become more actively involved in COPD care process, also regarding drug therapy adherence. Using St. George's Respiratory Questionnaire combined with qualitative analysis, we demonstrated that IARA could be considered a useful approach in COPD management. (shrink)

The paper takes its cue from the emergence in our society of a new view of the adolescent, which a branch of the psychological literature has spelled out in terms of a passage from Oedipus to Narcissus. It is argued that pre-college ethics education should engage with this passage by deploying educational strategies modelled according to the Care of the Self paradigm but revisiting it through Kierkegaard’s idea of repetition. The latter prevents that paradigm from fostering a sort (...) of aestheticization of ethical life and allows us to mobilize it in ethics education. Against this backdrop two pedagogical methods—autobiographical writing and essay writing—are discussed as possible tools for a Care-of-the-Self-oriented education. (shrink)

This paper considers the structure of the ethical subject found in Foucault’s late works on ethics, and gives an account of his two major ethical concepts: “care of the self” and “aesthetics of existence.” The “care of the self,” it is argued, gives Foucault a way of conceptualising ethics which does not rely on juridical categories, and which does not conceive the ethical subject on the model of substance. The “care of the self” (...) entails an understanding of the ethical subject as a process which is always in a relation, specifically in a relation to itself. Using his essay “What is an Author,” it is argued that the subject of the “aesthetics of existence,” like the author of a text, is understood to be fully immanent to the “object” which it is usually considered to be opposed to and separated from. Rather than aiming at a true expression of an “authentic” inner substance, Foucault’s “aesthetics of existence” leads instead to practices of “creativity,” whose form cannot be given in advance. (shrink)

Advance care planning is a process that encourages people to identify their values, to reflect upon the meanings and consequences of serious illness, to define goals and preferences for future medical treatment and care, and to discuss these goals with family and health-care providers. Advance care planning is especially important for those who are chronically ill, as patients and their families face a variety of complex healthcare decisions. Participating in advance care planning has been associated (...) with improved outcomes; yet, despite over 25 years of public awareness campaigns, research, and interventions developed to increase participation, advance care planning completion rates for people with chronic illnesses are no different than those in the general public (approximately 25%).Advance care planning has traditionally used an individualistic approach to autonomy, which puts forward an understanding of agents as independent, rational and self-interested persons. Because this individualistic approach has been largely unsuccessful in improving advance care planning uptake, a re-examination of the philosophical underpinnings of this practice and an exploration of alternative frameworks is warranted. In offering this exploration, we briefly outline two current perspectives on autonomy: the individualistic view and the relational view as articulated by feminist philosophers. Using a critical examination of the theoretical and empirical work on this topic, we argue that the individualistic view of autonomy does not sufficiently capture the relational and social complexities of the decision-making process of advance care planning. To offer a counterpoint, we examine the relational view of autonomy and suggest that this perspective is better aligned with the process of advance care planning. Specifically, we demonstrate that a relational model of autonomy is well suited to exploring advance care planning for four main reasons: (1) it recognizes the importance of relationships, (2) it reflects the fluctuating nature of autonomy in chronic illness, (3) it recognizes vulnerability, and (4) it is consonant with empirical work examining the advance care planning process. (shrink)

The recovery model, as applied in mental health, is significant because it intends to foster a critical retrieval by the subject of herself as a self-determining agent of change. This paper will show that the recovery model represents an approach to caring for the self that is congruent with critical themes inherent in some forms of contemporary philosophy, particularly that of Michel Foucault and Jurgen Habermas. The paper will also consider the contribution that Habermas’ discourse ethics (...) could make towards the non-coercive, dialogical resolution of differences between clients and professionals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 373-378 [Access article in PDF] The Forgotten Self:Training Mental Health and Social Care Workers to Work With Service Users Kim Woodbridge Keywords self, workers perspective, them and us, win-win situation The three main papers and the case studies presented in this issue of Philosophy, Psychiatry, & Psychology all focus on the service user perspective in relation to the self (...) as illustrated by different aspects of philosophy. This is also in the context of the service user looking for help during a time when they are experiencing levels of distress and difficulty.Important as this is, evident by the substantial clinical and philosophical literature in this area, what has been overlooked is the perspective of the mental health and social care worker responsible for the care of individuals whose sense of self is disturbed. The significance of this omission has been brought home to me through my experiences in running training workshops for workers working with service users with a diagnosis of personality disorder. (From here on, in this paper, the terms worker and trainee are used interchangeably to refer to the mental health and social care worker).During these workshops challenges to the worker's sense of self have been revealed emotionally ("this doesn't feel like me"), ideologically ("I am not a bad person"), and/or practically ("I don't usually behave like this") when discussing their work with service users. This paper draws from the workshop experiences to explore and consider the workers perspective in relation to the self in more detail.There follows a descriptive account of three workshop sessions which include the trainees responses. With each activity the responses are considered within the context of the self, particularly from the worker's perspective. In the conclusion the argument is made, as evidenced by these illustrations, for the importance of including the workers' perspective when attempting to understand the self. The Trainees and Service Users Workers from various professional and nonprofessional backgrounds attend the workshops. They include psychiatrists, nurses, social workers, support workers, and occupational therapists who work in both in-patient and community settings. They usually have several years of clinical experience working with people with a [End Page 373] diagnosis of personality disorder, but rarely have they had any formal education or training in the area. Discussing their experiences of working with this service user group generates strong and highly emotionally charged personal responses during training.It is their experiences of the relationships with service users whose sense of self is absent, inconsistent, or unstable, that make a substantial contribution to the content of the workshops.Often service users are struggling with fragmented, distorted, or threatening perceptions of the world, themselves, and others. The worker, while embedded within their own sense of self, is engaged in a relationship with the service user. The issues that arise as a part of this relationship can be challenging and distressing for the workers. There are two main areas:The impact the service user's chaotic, fragmented, and unstable sense of self has on the worker's own sense of self.The response of the workers when their sense of self is challenged, and the impact that response has on the service user. These can be seen in more detail in the examples taken from the training sessions presented later in this paper. The Training Sessions The training sessions are either run alone or form part of a 1- or 2-day workshop. As mentioned, the groups are composed of a variety of professionally and nonprofessionally qualified staff. The experiences they share mainly relate to people with a diagnosis of Borderline Personality Disorder, although other subcategories are mentioned occasionally. Information regarding these and other related sessions can be found in two recent publications: Making positive connections (Duff, Meredith, & Woodbridge,2003) and "Whose good practice?" (Woodbridge & Fulford, 2003). The First Activity: Revealing Internal Models Given the lack of available evidence, even the best-informed trainees are likely to have to fill in the knowledge gaps with their own interpretations of... (shrink)

Some theorists approach the Gordian knot of consciousness by proclaiming its inherent tangle and mystery. Others draw out the sword of reduction and cut the knot to pieces. Philosopher Thomas Metzinger, in his important new book, Being No One: The Self-Model Theory of Subjectivity,1 instead attempts to disentangle the knot one careful strand at a time. The result is an extensive and complex work containing almost 700 pages of philosophical analysis, phenomenological reflection, and scientific data. The text offers (...) a sweeping and comprehensive tour through the entire landscape of consciousness studies, and it lays out Metzinger's rich and stimulating theory of the subjective mind. Metzinger's skilled integration of philosophy and neuroscience provides a valuable framework for interdisciplinary research on consciousness. Metzinger's overall goal in Being No One is to defend a representational theory of subjectivity, one that reduces subjective mental processes to representational mental processes. Subjective experiences take place whe n there is a conscious perspective, an active first-person point of view. It occurs in. (shrink)

Against the backdrop of an aging global population and the increasing pressure of medical care expenditures for seniors, this paper used a fuzzy regression discontinuity model to explore the effects of retirement on the self-assessed health and objective physical and mental health of older people. Using survey data from the China Health and Retirement Longitudinal Study, our model addresses some relevant academic controversies. Our sample was comprised of male respondents from government agencies, enterprises, and public institutions. (...) The research explored the impact of retirement on lifestyle habits and included an in-depth analysis of the mechanism through which retirement influences different aspects of health. The results show that: Retirement does not have any significant impact on objective health, including depression and self-care ability, but it does cause a notable decline in subjective health assessment. Retirement shortened the sleep time of respondents, which may account for lower scores on subjective health self-evaluations, but it did not lead to any noticeable improvement in habits which are harmful to health, such as smoking and drinking. Marriage can help alleviate the problems of depression and smoking among older people, and education has a somewhat broader positive effect on their health and lifestyles; however, neither factor helps to improve the sleep problems of older people. Therefore, this paper recommends that efforts should be made to both optimize retirement policies and seek further ways to improve the health of the retired population. (shrink)

Reasoning and judgement in health care entail complex responses to problems whose demands typically derive from several areas of specialism at once. We argue that current evidence- or value-based models of health care reasoning, despite their virtues, are insufficient to account for responses to such problems exhaustively. At the same time, we offer reasons for contending that health professionals in fact engage in forms of reasoning of a kind described for millennia under the concept of wisdom. Wisdom traditions (...) refer to forms of deliberation which combine knowledge, reflection and life experience with social, emotional and ethical capacities. Wisdom is key in dealing with problems which are vital to human affairs but lack prescribed solutions. Uncertainty and fluidity must be tolerated in seeking to resolve them. We illustrate the application of wisdom using cases in psychiatry, where non-technical aspects of problems are often prominent and require more systematic analysis than conventional approaches offer, but we argue that our thesis applies throughout the health care field. We argue for the relevance of a threefold model of reasoning to modern health care situations in which multifaceted teamwork and complex settings demand wise judgement. A model based on practical wisdom highlights a triadic process with features activating capacities of the self, other and aspects of the problem itself. Such a framework could be used to develop current approaches to health care based on case review and experiential learning. (shrink)

As a form of functional diversity, spinal cord injury expressed by tetraplegia is one of the most serious events that can impact people, affecting their family and socioeconomic life. The type of care relationship established in these cases will be essential for preserving autonomy. The objective of this study was to understand how care relationships influence the autonomy of people with tetraplegia and the dynamics that trigger practices of autonomy violation, maintenance and promotion. This research is inspired by (...) problematization as a methodology using the Arch of Maguerez as an analytical approach strategy that enables an engagement between empirical and theoretical data. Some models of care relationships identified in this study either promote or violate autonomy: the protectionist model, based on the biomedical interpretation model of disability and the bodily impediments caused by spinal cord injury; the participatory model, involving the patient's interest in adapting to their new condition of family and community life, seeking to understand the practical aspects of daily life; the sharing model, in which the complicity and understanding of new forms of bodily expression allow the caregiver to be almost an extension of the tetraplegic person's body; the delegate model, which occurs in relationships with professional caregivers; and the emancipatory model, which seeks to empower the patient, highlight potentialities, and encourage autonomy. The key components of these conceptual care models guided the elaboration of hypotheses for intervention with the objective of maintaining and promoting the autonomy of people with tetraplegia through supported care. (shrink)

An organisation which operates without a ‘self-concept’ of its goals, authorised roles, governance procedures regarding sharing information, decisional powers and procedures, and distribution of benefits, or without continuous audit of its impact on its end-users, other players in the practice, and the state, does so at some ethical risk. This paper argues that a quasi-personal model of the collective ethical agency of organisations and states is helpful in suggesting some of these key areas which are liable to need (...) careful organisational design and control by leadership groups if the organisation as a whole entity (directors, operators, enablers) steered by the board/CEO as ‘mind/will,’ is to identify its stakeholders - internal and external - and treat them well. Such a quasi-personal model is outlined (QPM) in which six suggested areas should be covered by the leadership group in ethical governance: goals, roles, decision procedures, execution/verification, relations with endusers and other players in the practice, and relations with the community and the state. The ethical conception presupposed is Neo-Aristotelian Virtue Ethics (NAVE). In subsequent papers the many advantages of QPM/NAVE which will be claimed are these: it comes with an analysis of justice which straddles individuals, families, communities, markets, and states; it offers a more coherent normative account of ‘stakeholder’ and the internal/external stakeholder distinction, by differentiating their descriptive, ethical, and causal relations to the firm as collective agent; and it suggests that business practice and business corporations are partly creatures of the state, and merely one kind of evolving and changeable institution, in a practice with a specific socio-political permit, (not the source of ethics, politics, and social policy). (shrink)

Both Martin Heidegger and Harry Frankfurt have argued that the fundamental feature of human identity is care. Both contend that caring is bound up with the fact that we are finite beings related to our own impending death, and both argue that caring has a distinctive, circular and non-instantaneous, temporal structure. In this paper, I explore the way Heidegger and Frankfurt each understand the relations among care, death, and time, and I argue for the superiority of Heideggerian version (...) of this nest of claims. Frankfurt claims that we should conceive of the most basic commitments which practically orient a person in the world and define his identity (“volitional necessities”) as naturalistic facts, foundational for and located completely without the normative space of reasons. In support of this he appeals to the supposedly foundational role played in human life by the instinct for self-preservation, what Frankfurt calls the “love of living.” The claim is that in questions of practical identity there is a definite priority of the factual over the normative. Frankfurt’s naturalistic model of volitional necessity is motivated by a misunderstanding of the temporal structure of care, a misunderstanding that helps lead him to an implausible conception of the basic structures of human identity. Heidegger advances an anti-naturalistic conception of caring, one bound up with his way of understanding how human beings relate to their own future. I argue that the existential, temporal, and normative significance that Frankfurt attributes to the naturalized “love of living” is better captured by the Heideggerian claim that human identity is defined by being “for-the-sake-of” certain projects and commitments, a way of being lived out in the way Heidegger calls “being-towards-death.”. (shrink)

Patient-centered care is now recognized as a clinical method and ideal model for patient – health professional relationships, and many definitions have influenced its evolution. Overall the patient-centered care literature has provided relatively little to define patient-centered care at the level of the patient-professional relationship. Additionally, patient-centered care lacks grounding in ethical theory. This thesis asserts that theoretical concepts from the ethics of care can provide a stronger conceptual basis for patient-centered care.This thesis (...) begins with a critical interpretive review of the patient-centered care literature, yielding 12 articles that previously introduced new theoretical and definitional work on patient-centered care and patient-centered communication. Six common themes and ideas were discovered, and include Engaging the Patient as a Whole Person, Recognizing and Responding to Emotions, Fostering a Therapeutic Alliance, Promoting an Exchange of Information, Sharing Decision Making, and Enabling Self-Management and Patient Navigation. These elements were then compared to key elements of the ethics of care. This thesis argues that feminists have good reason to consider care as a type of moral duty, and it describes how this duty functions. This thesis also argues that a duty to care is triggered when caregivers are presented with particular substantive forms of vulnerability. Specifically, this thesis argues that vulnerable subjects whose constitutive needs are at risk require particular moral obligations. The links between the ethics of care and patient-centered care are discussed, including how an ethics of care response ought to function in the health care context. Finally, the cases of J.J. and Makayla Sault, two aboriginal girls who refused chemotherapy in favour of traditional aboriginal healing practices, are analyzed. This thesis offers a short scoping review of the bioethics discourse surrounding these cases. A review of this discourse revealed several common themes, which included the peripheral importance of culture and history, the equating of best interests with survival, the supremacy of science-based medicine, and the impartial application of ethical principles. This thesis recommends that health care professionals apply an ethics of care approach to similar ethical dilemmas in the future, which involves shifting one's ethical focus to the central relationships of the case, understanding the unique perspective of the patient's narrative, and promoting a care-based rather than a justice-based approach to problem-solving. (shrink)

This essay proposes that Socrates practiced various spiritual exercises, including meditation, and that this Socratic practice of meditation was habitual, aimed at cultivating emotional self-control and existential preparedness. Contemporary research in neurobiology supports the view that intentional mental actions, including meditation, have a profound impact on brain activity, neuroplasticity, and help engender emotional self-control. This impact on brain activity is confirmed via technological developments, a prime example of how technology benefits humanity. Socrates attains the balanced emotional self-control (...) that Alcibiades describes in the Symposium because of the sustained mental effort he exerts that directly impacts his brain and his emotional and philosophical life. The essay concludes that Socratic meditative practices aimed at manifesting true dignity as human beings within the complexities of a technological world offer a promising model of self-care worthy of embracing today. (shrink)

Self‐admission to inpatient treatment is a novel approach that aims to increase agency and autonomy for patients with severe psychiatric illness and a history of high utilization of inpatient care. By focusing on brief, preventive hospital admissions in times of increased risk of relapse, self‐admission seeks to reduce the need for prolonged episodes of inpatient treatment. Participants are generally satisfied with the model, which is not surprising given that self‐admission programs allocate a scarce resource—hospital beds—to (...) a select group. However, the patients targeted by these programs are not necessarily those in most need of hospital admission, which may compromise the commonly accepted ‘principle of need’ in allocation of public healthcare resources. In light of the current lack of consistent evidence of the usefulness and cost‐effectiveness of the model, several aspects need to be further studied in order to guide any large‐scale implementation of self‐admission in psychiatry. (shrink)

While Specific Informed Consent has been the established standard for obtaining consent for medical research for many years, it does not appear suitable for large-scale biobank and health data research. Thus, alternative forms of consent have been suggested, based on a variety of ethical background assumptions. This article identifies five main ethical perspectives at stake. Even though Tiered Consent, Dynamic Consent and Meta Consent are designed to the demands of the self-determination perspective as well as the perspective of research (...) as a public good, they are still also criticized from both perspectives. In addition, criticisms based on concerns of justice, participation and democratic deliberation, and relational concerns have been levelled at each of the models. As all of these perspectives have valid points to make, the task at hand lies in balancing these ethical perspectives. What constitutes an adequate balancing depends on contextual factors. These factors include digital infrastructure and digital literacy, data safety regulation, good scientific and clinical practice, transparent debates on ethically relevant features of research, social inequalities, anti-discrimination laws and practices, trust in health care institutions and recognition of patient preferences, and consensus on unethical research. We argue that the role of context in determining acceptable models of consent puts the ethical importance of models of consent into perspective. Since altering contextual factors can help to live up to the ethical concerns at stake in debates about models of consent, opting for such a shift of focus comes without ethical loss. (shrink)

The Tidal Model represents a significant alternative to mainstream mental health theories, emphasizing how those suffering from mental health problems can benefit from taking a more active role in their own treatment. Based on extensive research, The Tidal Model charts the development of this approach, outlining the theoretical basis of the model to illustrate the benefits of a holistic model of care which promotes self-management and recovery. Clinical examples are also employed to show how, (...) by exploring rather than ignoring a client's narrative, practitioners can encourage the individual's greater involvement in the decisions affecting their assessment and treatment. The Tidal Model 's comprehensive coverage of the theory and practice of this model will be of great use to a range of mental health professionals and those in training in the fields of mental health nursing, social work, psychotherapy, clinical psychology and occupational therapy. (shrink)

“At-own-risk discharges” or “self-discharges” evidences an irretrievable breakdown in the patient–clinician relationship when patients leave care facilities before completion of medical treatment and against medical advice. Dissolution of the therapeutic relationship terminates the physician’s duty of care and professional liability with respect to care of the patient. Acquiescence of an at-own-risk discharge by the clinician is seen as respecting patient autonomy. The validity of such requests pivot on the assumptions that the patient is fully informed and (...) competent to invoke an at-own-risk discharge and that care up to the point of the at-own-risk discharge meets prevailing clinical standards. Palliative care’s use of a multidisciplinary team approach challenges both these assumptions. First by establishing multiple independent therapeutic relations between professionals in the multidisciplinary team and the patient who persists despite an at-own-risk discharge. These enduring therapeutic relationships negate the suggestion that no duty of care is owed the patient. Second, the continued employ of collusion, familial determinations, and the circumnavigation of direct patient involvement in family-centric societies compromises the patient’s decision-making capacity and raises questions as to the patient’s decision-making capacity and their ability to assume responsibility for the repercussions of invoking an at-own-risk discharge. With the validity of at-own-risk discharge request in question and the welfare and patient interest at stake, an alternative approach to assessing at-own-risk discharge requests are called for. The welfare model circumnavigates these concerns and preserves the patient’s welfare through the employ of a multidisciplinary team guided holistic appraisal of the patient’s specific situation that is informed by clinical and institutional standards and evidenced-based practice. The welfare model provides a robust decision-making framework for assessing the validity of at-own-risk discharge requests on a case-by-case basis. (shrink)

Despite the prominence of person‐centred care (PCC) in nursing, there is no general agreement on the assumptions and the meaning of PCC. We sympathize with the work of others who rethink PCC towards relational, embedded, and temporal selfhood rather than individual personhood. Our perspective addresses criticism of humanist assumptions in PCC using critical posthumanism as a diffraction from dominant values We highlight the problematic realities that might be produced in healthcare, leading to some people being more likely to be (...) disenfranchised from healthcare than others. We point to the colonial, homo‐ and transphobic, racist, ableist, and ageist consequences of humanist traditions that have influenced the development of PCC. We describe the deep rooted conditions that structurally uphold inequality and undermine nursing practice that PCC reproduces. We advocate for the self‐determination of patients and emphasize that we support the fundamental mechanisms of PCC enabling patients' choice; however, without critical introspection, these are limited to a portion of humans. Last, we present limitations of our perspective based on our white*‐cisheteropatriarchy** positionality. We point to the fact that any reimagining of models such as PCC should be carefully done by listening, following, and ceding power to people with diversity dimensions*** and the lived experience or expertise that exists from diverse perspectives. We point towards Black, queer feminism, and critical disabilities studies to contextualize our point of critique with humanism and PCC to amplify equity for all people and communities. Theory and philosophy are useful to understand restrictive factors in healthcare delivery and to inform systematic strategies to improve the quality of care so as not to perpetuate the oppression of groups of people with diversity dimensions. *We purposely capitalize Black and use lower case for white to decentre whiteness and as an intentional act of antiracism (see White Homework a podcast series by Tori W. Douglas). **Cisheteropatriarchy describes people with intersecting identities of dominant social groups; cisgender is the gender identity that aligns with the gender you were assigned at birth, hetero means heterosexual, and patriarchy refers to structural systems of power based on maleness where women are often excluded and hold less power. ***With diversity dimensions, we refer to subjective lived experience and material realities of people that exist outside the ‘dominant minorities' of white‐cisheteropatriarchy, meaning groups of people in society who historically and currently hold more power and through this, structurally dominate the norms and possibilities of living for other people. (shrink)

The deontic model of justice and ethical behavior proposes that people care about justice simply for the sake of justice. This is an important consideration for business ethics because it implies that justice and ethical behavior are naturally occurring phenomenaindependent of system controls or individual self-interest. To date, research on the deontic model and third-party reactions to injustice has focused primarily on individuals’ tendency to punish transgressors. This research has revealed that witnesses to injustice will consider (...) sacrificing their own resources if it is the only way to sanction an observed transgressor. In this paper we seek to extend this model by arguing that punishment may not be the only “deontic” reaction, and that in fact, third-party observers of injustice may engage in moral self-regulation that would lead them to conclude that the most ethical response is to do nothing. We provide preliminary evidence for our propositions using voiced cognitions data collected during a resource allocation task. Results indicate that deonance may be more complex than originally thought, and previous tests of the model conservative in nature. (shrink)

In post-Fordist economies, the nature of laboring activities can no longer be subsumed under a Taylorized model of labor, and the service sector now constitutes a larger share of the market. For Maurizio Lazzarato, Michael Hardt, Antonio Negri, and other theorists in the post-Marxist tradition, labor has changed from a commodity-producing activity to one that does not produce a material object. For these authors, this new type of labor is immaterial labor and entails communicative acts as well as added (...) worker agency. This paper reflects on this new paradigm of labor by examining the paid practices of care defined as the activities performed by individuals who have a mandate to help another adult accomplish the tasks of self-care. Because care workers take care of other bodies, care labor exemplifies an embodied practice. I make use of the corporeality of care to put forward the notion of thin and thick embodiment in order to examine critically the meaning of immaterial labor and to support my claim that immaterial labor, as conceptualized by Hardt and Negri, erases both the materiality and relationality of care labor. Furthermore, typifying care labor as immaterial only serves to maintain its marginalized status.Care Assistant. Required to work within a private residential center to assist nursing staff. Experience desirable, qualifications an advantage, but caring and understanding more important than either. Must have good English to understand instructions and be co-operative to work in a friendly team environment (Toynbee 2007, 220). (shrink)

“At-own-risk discharges” or “self-discharges” evidences an irretrievable breakdown in the patient–clinician relationship when patients leave care facilities before completion of medical treatment and against medical advice. Dissolution of the therapeutic relationship terminates the physician’s duty of care and professional liability with respect to care of the patient. Acquiescence of an at-own-risk discharge by the clinician is seen as respecting patient autonomy. The validity of such requests pivot on the assumptions that the patient is fully informed and (...) competent to invoke an at-own-risk discharge and that care up to the point of the at-own-risk discharge meets prevailing clinical standards. Palliative care’s use of a multidisciplinary team approach challenges both these assumptions. First by establishing multiple independent therapeutic relations between professionals in the multidisciplinary team and the patient who persists despite an at-own-risk discharge. These enduring therapeutic relationships negate the suggestion that no duty of care is owed the patient. Second, the continued employ of collusion, familial determinations, and the circumnavigation of direct patient involvement in family-centric societies compromises the patient’s decision-making capacity and raises questions as to the patient’s decision-making capacity and their ability to assume responsibility for the repercussions of invoking an at-own-risk discharge. With the validity of at-own-risk discharge request in question and the welfare and patient interest at stake, an alternative approach to assessing at-own-risk discharge requests are called for. The welfare model circumnavigates these concerns and preserves the patient’s welfare through the employ of a multidisciplinary team guided holistic appraisal of the patient’s specific situation that is informed by clinical and institutional standards and evidenced-based practice. The welfare model provides a robust decision-making framework for assessing the validity of at-own-risk discharge requests on a case-by-case basis. (shrink)

Self‐management is often presented as a panacea for chronic disease care. It plays an important role at the policy level and increasingly guides the delivery of health care services. Self‐management approaches to care are founded on traditional individualistic views of autonomy in which the patient is understood as being independent, rational, self‐interested, and self‐governing. This conceptualization of autonomy has been challenged, particularly by feminist scholars. In this paper I review predominant critiques of (...) class='Hi'>self‐management and the traditional individualistic view of autonomy. I propose that a relational approach to autonomy, which is premised on social embeddedness and attends to social, political, and material conditions, is a more sound conception of autonomy capable of taking into consideration the complexities of illness experiences. I suggest that integrating a relational perspective of autonomy into self‐management will be valuable in guiding its progression and elaborate ways in which self‐management research and practice could benefit from incorporating a relational approach to autonomy. (shrink)

Expert nurses, as described by the work of Patricia Benner, are at the peak of clinical nursing practice and vitally important in ensuring the best possible patient care and clinical outcomes. The development of Benner's theory and its relationship with the Dreyfus model of skill acquisition provides context for understanding the progression necessary for expert development. Contemporary healthcare challenges present implications to the development of advancing levels of nursing practice. Engagement has been identified as critical to achieving expert (...) practice. I propose the incorporation of the philosophical framework of self‐appropriation from Benard Lonergan as a strategy to develop internal engagement in nurses to facilitate expert practice. I outline the synergy between Benner's theory and the work of Lonergan, which provide overlap and opportunity to overcome barriers to developing expert nursing practice. In the challenging climate of healthcare, there is an obligation to promote engagement and facilitate expert nurse development, necessary for patient outcomes as well as clinical role models, preceptors, and leaders to guide future nurses. (shrink)

Early data from several countries regarding the gendered implications of COVID-19 suggest that men are more likely to die as an effect of infection. This has been explained by biological factors but also by behavioral and life-style issues characteristic mostly for men. What has not been widely discussed, however, is the analysis of the relationships between men’s responses to the crisis, their care activities, and certain models of masculinity that persist in many societies. In this paper, I use a (...) three dimensional model of care – a) self-care, b) care for others, and c) care for one’s society – in order to analyze how certain masculine behaviors, rooted in socially constructed gender performances, resonate with the COVID-19 pandemic. The data used in this paper are of secondary character and will serve to analyze the most common responses of men within the three dimensions of care mentioned above. The theoretical framework utilizes the notion of caring masculinity supported by an emerging theory of protective masculinity. (shrink)

Background Patient dignity is sometimes neglected in intensive care unit (ICU) settings, which may potentially cause psychological harm to critically ill patients. However, no instrument has been specifically developed to evaluate the behaviors of dignified care among critical care nurses. Aim This study aimed to develop and evaluate ICU Dignified Care Questionnaire (IDCQ) for measurement of self-assessed dignity-conserving behaviors of critical care nurses during care. Methods The instrument was developed in 3 phases. Phase (...) 1: item generation; phase 2: a two-round Delphi survey and a readability pilot study; phase 3: cross-sectional survey with model estimation. The questionnaire was evaluated by item analysis, exploratory and confirmatory factor analysis, assessment of internal consistency reliability, and test-retest reliability. The investigation was conducted using a convenience sample of 392 critical care nurses from 6 cities in Zhejiang Province, China, of which 30 participated in the test-retest reliability survey 2 weeks later. Ethical considerations The study was approved by ethics committee. All participants provided written informed consent before the survey. The questionnaire survey was anonymous. Results The results showed acceptable reliability and validity of the IDCQ. The 17-item final version questionnaire was divided into 2 dimensions: absolute dignity and relative dignity. These two factors accounted for 62.804% of the total variance, and model fitting results were acceptable. The Cronbach’s alpha coefficient of the questionnaire was 0.94, and the test-retest intraclass correlation coefficient (ICC) was 0.88 after 2 weeks. Conclusions This study developed a brief and reliable instrument (IDCQ) to assess dignified care in ICU nursing. It can help critical care nurses identify their behaviors in maintaining patient dignity and discover their deficiencies. It may also serve as a clinical nursing management tool to help reduce patient disrespect experience in ICU. (shrink)

The aim of this paper is to get from a phenomenology of birth towards an ethics of obstetric care: Human rights violations in obstetrics are currently a globally debated phenomenon. Research suggests that maltreatment is widespread and a global phenomenon. However, the prevalence cannot yet be clearly quantified. In view of this problem, it is necessary to take the subjective perspective of those affected seriously. Narrative and phenomenological accounts of birth experiences could help to foster the dialogue between persons (...) giving birth and health professionals. First, I will present narrative accounts of birth experiences recorded by feminist phenomenologists. Second, I will interpret these narrative accounts within a feminist phenomenological framework in order to contribute to a phenomenology of birth, which, in a third step, shall help to develop an ethics of obstetric care. In engaging with the phenomenology of care outlined by feminist care ethicists, I will analyze the elements and conditions of good care, and draw conclusions for an ethic of obstetric and midwifery care. Drawing additionally on the theory of relational autonomy, my paper argues for a relational implementation of self-determination in childbirth. Lastly, I will discuss to what extent the ethical ideal of care has an affinity to the midwifery model of childbirth, and how the current situation of obstetrics prevents a women-centered birth culture. (shrink)