Although there is a growing acknowledgement of the potential of a more nuanced healthcare paradigm and practice, the discourses of health promotion—and with that nursing and other healthcare professionals’ practice—still tend to focus on the medical diagnosis, disease and the rationale of biomedicine. There is a need for shifting to a human practice that draws on a broader perspective related to illness. This requires a transformation of practices which can be constructed within a narrative understanding. A narrative approach appreciates the (...) importance of emotion and intersubjective relation in the telling and listening that occur in the clinical encounter. The essence of nursing lies in the creative imagination, the sensitive spirit and the intelligent understanding of the individuals’ possibilities of becoming empowered in his or her own life. This entails that the focus of the use of patients’ narratives is, ultimately, not the story itself, but the nurses’ and other healthcare professionals’ ability to support the patients in finding useful meaning in their stories. Herein, it is of particular importance to let the patients narrate about what is sparkling moments or events in the lived life. Stories with such focus can open up for patients’ hopes and dreams, which gives inspiration for finding meaningful ways to cope in life empowering personal recovery. It is, therefore, crucial to transform clinical settings into places that acknowledge the need for imagination and creativity, aiming at creating the opportunity for sensibility and vision essential to encouraging a narrative approach and thereby the ability to reflect upon and promote a healing process. (shrink)

In the debate concerning the education of nurses that is currently taking place in Denmark, two widely differing views are apparent regarding the best way of training nurses such that the ethical aspect of their work is adequately considered. The first of these is based on the premise that practical care is fundamental to and justified by theories on nursing, care and ethics, which is why the theoretical part of nurse education deserves a higher priority. The second view is based (...) on the premise that social care cannot be taught by means of theories, but can be learnt only through practice. The master-apprentice principle of ancient Greece is stressed in connection with this as being a viable alternative to the theoretical model of education. These two very different views can be traced back to Plato’s and Aristotle’s ideas on ethics and teaching respectively; indeed, those engaged in the debate make specific reference to these philosophers. In Denmark, a third fundamental viewpoint exists, known as ‘ontological ethics’. Phenomenologist KE Løgstrup is one of the best-known representatives of this view. Basing the line of argument on Løgstrup’s ethics and the view of education associated with this, this article questions the relevance of ancient Greek thought to today’s world by illustrating a number of problems that are connected with the theoretical model of nurse education and with the master-apprentice principle. Løgstrup associates ethics with the aesthetic principle that ‘the useless is the most useful’ in human life and with the view we also see in Kierkegaard’s and NFS Grundtvig’s writings that ethics can be imparted only by indirect means. Løgstrup bases his understanding of ethics on the Judaeo-Christian concept of Genesis and the view that human beings were created with an ethical potential that is best nourished by aesthetic impressions. (shrink)

Patient‐centred care has gained ground in health service following a health policy initiative aimed at changing the paternalistic culture towards one with more patient involvement. Development of knowledge relating to people's lived experiences of illness is important in this context. Literature in the field of health science describes methods for exploring what is at stake for people affected by illness, and the French philosopher Paul Ricoeur has been a significant source of inspiration. Especially, Ricoeur's interpretation theory has been construed and (...) applied in different, often schematic, methodological variations, whereas his narrative philosophy is a little used source of inspiration. Health science has been characterized by a biomedical awareness of method and the idea that there is a direct and immediate path to patients' experiences, a viewpoint that can be traced back to Descartes and the philosophy of subjectivism. Opposed to Descartes, Ricoeur says that we are already embedded in a world of traditions and meanings over which we have no control. According to Ricoeur, we leave traces when we express ourselves, and traces are formed by the world of meanings and traditions to which we belong. Often, the sense in the traces is hidden, making it impossible to directly understand individual's experiences. Reflection on an individual's lived experiences must take place via the narratives in which the individual expresses themselves. The centrepiece of Ricoeur's narrative philosophy is the threefold mimesis, which is an approach to understanding the meaning of peoples' lived experiences. The philosophical hermeneutics of Gadamer plays an important role in Ricoeur's theory of interpretation, although he has criticized Gadamer for failing to include one dimension in his philosophy; he finds this dimension in Habermas' ideology critique. Ricoeur's ideology critique is absent in health science research, which is why it has been made a focal point in this article. (shrink)

In the debate concerning the education of nurses that is currently taking place in Denmark, two widely differing views are apparent regarding the best way of training nurses such that the ethical aspect of their work is adequately considered. The first of these is based on the premise that practical care is fundamental to and justified by theories on nursing, care and ethics, which is why the theoretical part of nurse education deserves a higher priority. The second view is based (...) on the premise that social care cannot be taught by means of theories, but can be learnt only through practice. The master-apprentice principle of ancient Greece is stressed in connection with this as being a viable alternative to the theoretical model of education. These two very different views can be traced back to Plato’s and Aristotle’s ideas on ethics and teaching respectively; indeed, those engaged in the debate make specific reference to these philosophers. In Denmark, a third fundamental viewpoint exists, known as ‘ontological ethics’. Phenomenologist KE Løgstrup is one of the best-known representatives of this view. Basing the line of argument on Løgstrup’s ethics and the view of education associated with this, this article questions the relevance of ancient Greek thought to today’s world by illustrating a number of problems that are connected with the theoretical model of nurse education and with the master-apprentice principle. Løgstrup associates ethics with the aesthetic principle that ‘the useless is the most useful’ in human life and with the view we also see in Kierkegaard’s and NFS Grundtvig’s writings that ethics can be imparted only by indirect means. Løgstrup bases his understanding of ethics on the Judaeo-Christian concept of Genesis and the view that human beings were created with an ethical potential that is best nourished by aesthetic impressions. (shrink)

In recent decades, the phenomenon of grief, when you lose a loved one, has been the subject of exploration and discussion among researchers. Because of this, prolonged grief is now recognized as a possible mental disorder as the latest version of the diagnosis manual; ‘International Classification of Diseases’ (ICD‐11) being published in 2018 is featuring a new diagnosis called ‘prolonged grief disorder’. The commencement of this new disorder indicates a shift in the way grief is being articulated why the notion (...) of rupture from the French philosopher Michel Foucault is applied as a philosophical approach in this paper. A Foucault‐inspired discourse analysis has been prepared and by considering the issue historically and tracing how the concept of grief has been articulated in different time periods throughout history, the aim is to map out the discursive transformation that has taken place and to gain insight into how the societal context has supported and enabled this transformation. This paper takes a historical look back from the 1800s to present and identifies when changes can be observed in the way grief is being articulated. These changes or ruptures are identified in the work of Søren Aabye Kierkegaard, Sigmund Freud and Margaret Stroebe & Henk Schut who all must be assumed to have contributed significantly to how grief is perceived in various historical time periods. The discourse analysis identifies how prominent thinkers have articulated grief in each period and how today's perception of grief, as a possible mental disorder, both relates to these prominent thinkers but also reflects dominant societal values and ideologies. (shrink)

Background: In modern society, death has become ‘forbidden’ fed by the medical technology to conquer death. The technological paradigm is challenged by a social-liberal political ideology in postmodern Western societies. The question raised in this study was as follows: Which arguments, attitudes, values and paradoxes between modern and postmodern tendencies concerning treatment and care of older persons with an implantable cardioverter defibrillator appear in the literature? Aims: The aim of this study was to describe and interpret how the field of (...) tension concerning older persons with an implantable cardioverter defibrillator – especially end-of-life issues – has been expressed in the literature throughout the last decade. Methods: Paul Ricoeur’s reflexive interpretive approach was used to extract the meaningful content of the literature involving qualitative, quantitative and normative literature. Analysis and interpretation involved naive reading, structural analysis and critical interpretation. Ethical considerations: The investigation complied with the principles outlined in the Declaration of Helsinki. Findings and discussions: The unifying theme was ‘Normativity under change’. The sub-themes were ‘Death has become legitimate’, ‘The technological imperative is challenged’ and ‘Patients and healthcare professionals need to talk about end-of-life issues’. There seems to be a considerable distance between the normative approach of how practice ought to be and findings in empirical studies. Conclusion: Modern as well as postmodern attitudes and perceptions illustrate contradictory tendencies regarding deactivation of the implantable cardioverter defibrillator and replacement of the implantable cardioverter defibrillator in older persons nearing the end of life. The tendencies challenge each other in a struggle to gain position. On the other hand, they can also complement each other because professionalism and health professional expertise cannot stand alone when the patient’s life is at stake but must be unfolded in an alliance with the patient who needs to be understood and accepted in his vulnerability. (shrink)