Whilst the nature of human illness is not determined by time of day or day of week, we currently structure health service delivery around a five-day delivery model. At least one country is endeavouring to develop a systems-based approach to planning a transition from five- to seven-day healthcare delivery models, and some services are independently instituting program reorganization to achieve these ends as research, amongst other things, highlights increased mortality and morbidity for weekend and after-hours admissions to hospitals. In (...) this article, we argue that this issue does not merely raise instrumental concerns but also opens up a normative ethical dimension, recognizing that clinical ethical dilemmas are impacted on and created by systems of care. Using health policy ethics, we critically examine whether our health services, as currently structured, are at odds with ethical obligations for patient care and broader collective goals associated with the provision of publicly funded health services. We conclude by arguing that a critical health policy ethics perspective applying relevant ethical values and principles needs to be included when considering whether and how to transition from five-day to seven-day models for health delivery. (shrink)

Collaborative cross-sector business models for sustainability innovation (CCSBMSI) in response to grand challenges are rich foci for tensions. This is the case of CCSBMSI targeting independent living through Information and Communication Technology–enabled care. This research aims at identifying the relevant tensions, understanding their interactions, and assessing how they can be effectively managed so that CCSBMSI become more valuable for partners and transformative for society. A conceptual framework that understands the management of interrelated institutional and interorganizational tensions as a dynamic (...) capability is substantiated through in-depth, qualitative analysis of the long-term dynamics of a four-sector CCSBMSI in telecare—including government, businesses, nonprofits, and informal actors. Its effects on the transition of business models in terms of value creation, delivery, and capture; on relevant stakeholders—particularly nonprofits and beneficiaries; and on the development of the sustainability innovation are discussed. The conceptualization, tension categories, and management capabilities of CCSBMSI are amplified. (shrink)

With the aggravation of population aging, home health care services are paid more and more attention by the elderly. Previous studies aim at improving service quality and reducing cost, ignoring the coordinated and sustainable development of the economy and environment. From the perspective of sustainable development, this paper first establishes a linear optimization model considering transportation, time, and carbon emission costs. However, the uncertainty of service demand is a very difficult problem for HHC research. Most of the previous (...) studies only consider the deterministic model, which has difficulty dealing with the uncertain situation. Therefore, a robust optimization model is proposed to resist uncertain disturbances by introducing a robust uncertain set response. The experimental results show that the increase of low-carbon transition cost only increases the total cost of the LO model but has a significant positive impact on the RO model. With the increase of uncertainty, the robust model will pay the cost of robustness, but it can obtain a higher service level. In addition, when the carbon tax increases, the total transportation cost does not increase but decreases, thus obtaining environmental benefits. When the carbon tax increases by 25%, the average total cost of using the RO model is reduced by 8.274%. The research results of this paper can provide enlightenment and reference for the low-carbon transformation of HHC enterprises. (shrink)

This article is about a new definition of health and how this relates to transition processes. It focuses on the practical translation of the new concepts into challenges for mental health nurses. To that aim the Engagement Model is examined and operationalized. We did so as nurse researcher and lecturer involved in training nurse practitioners.

Abstract.Since the gene splicing debates of the 1980s, the public has been exposed to an ongoing sequence of genetic and reproductive technologies. Many issue areas have outcomes that lose track of people's inner values or engender opposing religious viewpoints defying final resolution. This essay relocates the discussion of what is an acceptable application from the individual to the societal level, examining technologies that stand to address large numbers of people and thus call for policy resolution, rather than individual fiat, in (...) their application. A major source of guidance is the “Genetic Frontiers” series of professional dialogues and conferences held by the National Conference for Community and Justice from 2002 to 2004. Genetic testing, human gene therapy, genetic engineering of plants and animals, and stem cell technology are examined. While differences in perspective on the beginning of life persist, a stepwise approach to the examination of genetic testing reveals areas of general agreement. Stewardship of life, human co‐creativity with the divine, and social justice help define the bounds of application of genetic engineering and therapy; compassionate care plays a major role in establishing stem cell policy. Active, sustained dialogue is a useful resource for enabling sharing of religious values and crystallization of policies. (shrink)

Nearly a million Indian women lack access to safe and dignified abortion services from public healthcare facilities and instead opt to induce abortions by themselves or with the help from unskilled and unauthorized practitioners. Unsafe abortions account for an estimated 9% of all maternal deaths in India despite the legalization of abortion on all grounds since 1971 via the MTP Act. However, the Act technically does not make any provision for abortion based on a woman’s request alone, subjecting her decision (...) to the approval of her healthcare provider, limiting reproductive autonomy. Moreover, the problem of female feticide through sex‐selective abortions has also contributed to a conflicting public agenda that prioritizes preventing the former over allowing women access to abortion services for other reasons. Women who are socio‐economically, culturally, and educationally vulnerable and minors may experience further abortion related stigmatization. These ethico‐legal considerations highlight the need for transition from a provider‐centered to a woman‐centered abortion service model. (shrink)

The World Professional Association for Transgender Health’s Standards of Care, now in its seventh edition, is a frequently cited, internationally recognized, evidence-based document that details a comprehensive framework for gender-related care of trans people. However, the WPATH SOC still relies heavily in some cases on gatekeeping practices, dubbed “triadic therapy,” or a process where a trans patient is encouraged to seek out psychotherapy, and hormone therapy, and only then be able to engage in surgical options for transitioning. I (...) use G. Alan Marlatt’s harm reduction framework to argue that the triadic process creates its own set of harms that trans people have to contend with, especially insofar as it focuses on resolving gender dysphoria in a demanding, moralizing, and top-down way as opposed to enriching trans lives by reducing harms that prevent us from flourishing. Using Marlatt’s criterion that harm reduction ought to be bottom-up, low threshold, and not moralizing, I develop a list of suggestions for what ought to be centrally considered in treating trans patients. (shrink)

Background:In Ontario, Canada, patients who lack decision-making capacity and have no family or friends to act as substitute decision-makers currently rely on the Office of the Public Guardian and Trustee to consent to long-term care (nursing home) placement, but they have no legal representative for other placement decisions.Objectives:We highlight the current gap in legislation for difficult transition cases involving unrepresented patients and provide a novel framework for who ought to assist with making these decisions and how these decisions ought (...) to be made.Research design:This paper considers models advanced by Volpe and Steinman with regard to who ought to make placement decisions for unrepresented patients, as well as current ethical models for analyzing how these decisions should be made.Participants and research context:We describe an anonymized healthcare transition case to illustrate the fact that there is no legally recognized decision-maker for placement destinations other than long-term care facilities and to show how this impacts all stakeholders.Ethical considerations:The case provided is an anonymized vignette representing a typical transition case involving an unrepresented patient.Findings:As a result of a gap in provincial legislation, healthcare providers usually determine the appropriate placement destination without a clear framework to guide the process and this can cause significant moral distress.Discussion:We argue for a team decision-making approach in the short term, and a legislative change in the long-term, to respect the patient voice, evaluate benefit and risk, enhance collaboration between healthcare providers and patients, and promote social justice. We believe that our approach, which draws upon the strengths of interprofessional teams, will be of interest to all who are concerned with the welfare and ethical treatment of the patients for whom they care.Conclusions:One of the main strengths of our recommendation is that it provides all members of the healthcare team (including nurses, social workers, therapists, and others) an increased opportunity to advocate on behalf of unrepresented patients. (shrink)

In this paper, the nonsmooth compound transmission control protocol with the gentle random early detection system with the state-dependent round-trip delay is investigated in detail. Uniqueness of the positive equilibrium is proved firstly. Then, the closed approximate periodic solutions in this state-dependent delayed nonsmooth compound TCP with the GRED model are obtained by employing the harmonic balance and alternating frequency/time domain method. Then, we compare the results generated by numerical simulations with those of the closed approximate expressions obtained by (...) HB-AFT. It indicates that HB-AFT is simple, correct, and powerful for state-dependent delayed nonsmooth dynamical systems. Finally, we find the complicated dynamic: chaos. It is a grazing chaos with a hybrid property, i.e., where usually w oscillates at a very low frequency and q oscillates at a very high frequency. And, the route to chaos is a very rare route, i.e., the instantaneous and local transition of stable equilibrium to chaos. So, to the end of stability and good performance, we should adjust the parameters carefully to avoid the periodic and chaotic oscillations. (shrink)

The Danish health care sector currently undergoes changes that imply a gradual transition from an evidence‐based activity model to a value‐based quality model centered on patient involvement and value‐based governance. The patient naturally occupies a central position in health care, and the transition therefore raises important questions about health care quality and how successive national health quality strategies value quality and ascribe roles and agency to patients. To explore the complexity of these quality strategies, we (...) analyze and discuss how political discourse moments influence the contents of the national health quality strategies and how variation in the construal of patient roles and agency indicates discursive struggle in Danish national health care policy. Underlying theoretical concepts are informed by New Public Management, the welfare state, health communication, and discourse theory. Our analytical approach is inspired by Critical Discourse Analysis and combines content analysis with linguistic analysis. (shrink)

According to the naive theory of vagueness, the vagueness of an expression consists in the existence of both positive and negative cases of application of the expression and in the non- existence of a sharp cut-off point between them. The sorites paradox shows the naive theory to be inconsistent in most logics proposed for a vague language. The paper explores the prospects of saving the naive theory by revising the logic in a novel way, placing principled restrictions on the transitivity (...) of the consequence relation. A lattice-theoretical framework for a whole family of “tolerant logics” is proposed and developed. Particular care is devoted to the relation between the salient features of the formal apparatus and the informal logical and semantic notions they are supposed to model. A suitable non-transitive counterpart to classical logic is defined. Some of its properties are studied, and it is eventually shown how an appropriate regimentation of the naive theory of vagueness is consistent in such a logic. (shrink)

In the mid-nineteenth century, healthcare delivery began transitioning from an individual, private payment model to a third-party payment model, dominated by the insurance industry. During the same time, productivity shifted from a transformational model, centered on the provider-patient relationship, to a transactional model, based on the distribution of services. The emergence of medical insurance and other third-party payers removed providers and patients from discussions about treatment plans, payment, and risk. This resulted in a weakening, if not (...) fracturing, of the provider-patient relationship. All healthcare providers enter their profession to care for people, yet what has most frequently been lost in the transformed relationship over the past century is context, communication, and trust—all elements of a relational ethic, or what ethicist and psychologist Carol Gilligan first described as, “the ethics of care.” This loss of relationality has led to a model of healthcare delivery that is fractured, isolated, and uncoordinated, with an epidemic of medical errors that by some estimates results in the death of approximately 400,000 individuals per year. Thus far, isolated foci on patient quality, outcomes, and safety have been feckless and unimpressive. However, new advanced payment models, such as value-based purchasing and patient-centered medical homes, have the potential to reduce medical error by addressing its root cause. In linking payment to factors such as context, communication, and trust, they bring relationality back into the healthcare system. This essay traces the historic devolution of the provider-patient relationship and the promise of new payment models to restore it. (shrink)

The transition from the paternalistic paradigm of the Hippocratic tradition to the present model of shared decision making has altered the patient–doctor relationship. This change has engendered conflicts between patients and physicians, especially in pediatric medicine, where the patients are depen­dent on their parents because of their inability to consent to an intervention independently. Navigating this complex relationship can become particularly fraught when medical futility is invoked. This situation is complicated further by the divergent approaches to shared decision making (...) among physicians and the ethical perspectives these positions reflect. Catholic doctrine on the role of parents in medical-ethical decision making provides insight into navigat­ing these difficult clinical issues and ideologies. (shrink)

With this nuanced and interdisciplinary work, political theorist Mihaela Mihai tackles several interrelated questions: How do societies remember histories of systemic violence? Who is excluded from such histories' cast of characters? And what are the political costs of selective remembering in the present? Building on insights from political theory, social epistemology, and feminist and critical race theory, Mihai argues that a double erasure often structures hegemonic narratives of complex violence: of widespread, heterogeneous complicity and of "impure" resistances, not easily subsumed (...) to exceptionalist heroic models. In dialogue with care ethicists and philosophers of art, she then suggests that such narrative reductionism can be disrupted aesthetically through practices of "mnemonic care," that is, through the hermeneutical labor that critical artists deliver—thematically and formally—within communities' space of meaning. Empirically, the book examines both consecrated and marginalized artists who tackled the memory of Vichy France, communist Romania, and apartheid South Africa. Despite their specificities, these contexts present us with an opportunity to analyze similar mnemonic dynamics and to recognize the political impact of dissenting artistic production. Crossing disciplinary boundaries, the book intervenes in debates over collective responsibility, historical injustice, and the aesthetics of violence within political theory, memory studies, social epistemology, and transitional justice. (shrink)

Objective: Contemporary ethical accounts of the patient-provider relationship emphasise respect for patient autonomy and shared decision making. We sought to examine the relative influence of involvement in decisions, confidence and trust in providers, and treatment with respect and dignity on patients’ evaluations of their hospital care.Design: Cross-sectional survey.Setting: Fifty one hospitals in Massachusetts.Participants: Stratified random sample of adults discharged from a medical, surgical, or maternity hospitalisation between January and March, 1998. Twelve thousand six hundred and eighty survey recipients responded.Main (...) outcome measure: Respondent would definitely be willing to recommend the hospital to family and friends.Results: In a logistic regression analysis, treatment with respect and dignity 3.4, 99% confidence interval 2.8 to 4.2) and confidence and trust in providers were more strongly associated with willingness to recommend than having enough involvement in decisions . Courtesy and availability of staff , continuity and transition , attention to physical comfort , and coordination of care were also significantly associated with willingness to recommend.Conclusions: Confidence and trust in providers and treatment with respect and dignity are more closely associated with patients’ overall evaluations of their hospitals than adequate involvement in decisions. These findings challenge a narrow emphasis on patient autonomy and shared decision making, while arguing for increased attention to trust and respect in ethical models of health care. (shrink)

The program provides psycho-social support to foster adolescents during both their placement in foster families and in transitional period of leaving care, until they manage to cope with independent living. It is concieved as a direct answer to the needs of young people disturbed by the insecure patterns of attachment, who needed an opportunity to explore and modify negative experiences and acquire more successful models on how to build and maintain relationships, how to integrate the past, develop self-esteem (...) and successfully enter the world of adults. It is based on the principles of community psychology, the concept of the group as the transitional object and group dynamics. It was created through interaction with the beneficiaries, with emphasis on their participation and linking with all relevant players on the local level. Applied methods: self-support groups, psychological workshops, supportive activities in socialization and social integration, trainings, educational courses, counselling service, co-operation with foster parents, schools, local community and participation activities with focus on campaigning for development of aftercare services. The Manual, which resulted from the programme, is prompting professionals to develop new services entitled to children and youth and to involve users themselves in the reforms of the system. (shrink)

Every successful health care system should be based on some general humanistic ideals. However, the nationally organized health care systems of most European countries usually suffer from a deficiency in common ethical values based on universal human principles. When transitional societies, such as that of Bosnia-Herzegovina are concerned, health care organizational models are even more dysfunctional. The sources of a dysfunction in medical care system of Bosnia-Herzegovina are manifold and mutually controversial, including a lack of (...) shared principles, an inappropriate involvement of politicians in medical care and practice, administrative difficulties arising from superficial communication systems, as well as economic limits concerned with the financing of health care. The deficiency of a moral culture of medicine, which is correlated to a general collapse of morality is also responsible for many problems affecting various aspects of life including medical care. Hence, medical ethics from a virtue perspective is becoming an important ingredient of any improvement deigned to provide better-quality medical care.The aim of this paper is to underline the influence of humanism on the organization of health care systems and the ethics of medical interrelations in the society of Bosnia-Herzegovina. It is not intended to diagnose or resolve the problems, but to analyze them. It is also a critique of specific socio-political-economic influences on this health care system, inquiring if well-educated individuals in the virtues, which are involved in medical practice and education, would counteract them.In conclusion, humanism creates a universal ethical structure, which is based on human values such as fidelity, trust, benevolence, intellectual honesty, courage, compassion and truthfulness. These values should represent the standard around which medical care is organized. Since the health care system in Bosnia-Herzegovina is not entirely founded upon humanistic ideals, addressing the socio-political-economic conditions that constantly undermine those values is a prerequisite for any much-needed improvements of the medical care. (shrink)

Every successful health care system should be based on some general humanistic ideals. However, the nationally organized health care systems of most European countries usually suffer from a deficiency in common ethical values based on universal human principles. When transitional societies, such as that of Bosnia-Herzegovina are concerned, health care organizational models are even more dysfunctional. The sources of a dysfunction in medical care system of Bosnia-Herzegovina are manifold and mutually controversial, including a lack of (...) shared principles, an inappropriate involvement of politicians in medical care and practice, administrative difficulties arising from superficial communication systems, as well as economic limits concerned with the financing of health care. The deficiency of a moral culture of medicine, which is correlated to a general collapse of morality is also responsible for many problems affecting various aspects of life including medical care. Hence, medical ethics from a virtue perspective is becoming an important ingredient of any improvement deigned to provide better-quality medical care. The aim of this paper is to underline the influence of humanism on the organization of health care systems and the ethics of medical interrelations in the society of Bosnia-Herzegovina. It is not intended to diagnose or resolve the problems, but to analyze them. It is also a critique of specific socio-political-economic influences on this health care system, inquiring if well-educated individuals in the virtues, which are involved in medical practice and education, would counteract them. In conclusion, humanism creates a universal ethical structure, which is based on human values such as fidelity, trust, benevolence, intellectual honesty, courage, compassion and truthfulness. These values should represent the standard around which medical care is organized. Since the health care system in Bosnia-Herzegovina is not entirely founded upon humanistic ideals, addressing the socio-political-economic conditions that constantly undermine those values is a prerequisite for any much-needed improvements of the medical care. (shrink)

This historical study aims to explain how the transition from student nurse service to fully qualified “graduate nurse” service in the United States in the 20th century affected assumptions about fundamental patient care in hospital wards and provide historical context for current apprenticeship programs. Through analysis of documents from 1920 when student nurse service, a nurse apprentice model, was the norm to 1960 when the nurse apprentice model was waning in favor of registered nurse service, this study (...) found that the replacement of student nurses with registered nurses led to weakened standardization of fundamental bedside care and the introduction of large numbers of unlicensed nursing assistants. While student nurses could perform all the functions of fully qualified graduate nurses, nursing assistants could not, resulting in a separation of fundamental nursing care from the professional nurse role and changes in assumptions and attitudes toward fundamental care. These changes had a negative effect on fundamental nursing care. New apprenticeship programs provide opportunities for improvement. (shrink)

By comparing alternative evolutionary models, the International Sexuality Description Project marks the transition of evolutionary psychology to the next level of scientific maturation. The lack of final conclusions might partly be a result of the composition of the Sociosexual Orientation Inventory and the sampled populations. Our own data suggest that correcting for both gives further support to the strategic pluralism model.

Numerous studies have revealed that health care transitions for chronically ill older adults are frequently poorly managed, often with devastating human and economic consequences. And poorly managed transitions and their consequences also occur among younger, relatively healthy individuals who have adequate resources and are prepared to advocate on their own behalf. Despite the rich base of research confirming that evidence‐based transitional care enhances patients’ experiences, improves health and quality of life, and reduces costs, organizational, regulatory, financial, and (...) cultural barriers have, until recently, prevented widespread adoption of these proven approaches. Provisions of the Affordable Care Act, such as reductions in Medicare payments to hospitals with very high thirty‐day rehospitalization rates, have reduced barriers, but uptake of evidence‐based transitional care beyond demonstration projects continues to be sporadic and far too slow. With a rich understanding about how to better anticipate and respond to the compelling problems experienced by patients, family caregivers, and health care professionals throughout episodes of acute illness, the time has come to frame transitional care as a system's ethical responsibility in an aging society. Embedding transitional care within the ethical obligations of a health care system requires the perspectives and involvement of nurses and nursing because of this profession's integral role in every aspect of care transitions. (shrink)

This article gives a practice-based and theoretical overview of the transformation from a traditional hierarchical organization in the care and cure sector towards a so-called Community-driven organization providing human happiness to 6000 elderly people. The actual case study is intertwined with conceptual information for better understanding of the innovative transition which took place at Humanitas. The case description includes its initial situation, its new core values, mission and objectives and shows the sequence of emerging policies and interventions that resulted (...) in a stakeholder oriented business model for the care sector. The selected concepts are Graves' Emerging Cyclical Level of Existence Theory (or Spiral Dynamics), Ken Wilber's Four Quadrant Model, Roberts Simons' Four Levers of Control and various elements from the European Corporate Sustainability Framework sponsored by the European Commission. The conclusion marks the match between theory and practice in transforming Humanitas Rotterdam into providing cure, care, housing and well-being to elderly people. (shrink)

Abstract.As an undergraduate at Cambridge, Newton entered into his ‘Waste Book’ an assumption that we have named the Equivalence Assumption (The Younger): ‘‘ If a body move progressively in some crooked line [about a center of motion]..., [then this] crooked line may bee conceived to consist of an infinite number of streight lines. Or else in any point of the croked line the motion may bee conceived to be on in the tangent.’’ In this assumption, Newton somewhat imprecisely describes two (...) mathematical models, a ‘‘polygonal limit model’’ and a ‘‘tangent deflected model,’’ for ‘‘one-body motion,’’ that is, for the motion of a ‘‘body in orbit about a fixed center,’’ and then claims that these two models are equivalent. In the first part of this paper, we study the Principia to determine how the elder Newton would more carefully describe the polygonal limit and tangent deflected models. From these more careful descriptions, we then create Equivalence Assumption (The Elder), a precise interpretation of Equivalence Assumption (The Younger) as it might have been restated by Newton, after say 1687. We then review certain portions of the Waste Book and the Principia to make the case that, although Newton never restates nor even alludes to the Equivalence Assumption after his youthful Waste Book entry, still the polygonal limit and tangent deflected models, as well as an unspoken belief in their equivalence, infuse Newton’s work on orbital motion. In particular, we show that the persuasiveness of the argument for the Area Property in Proposition 1 of the Principia depends crucially on the validity of Equivalence Assumption (The Elder). After this case is made, we present the mathematical analysis required to establish the validity of the Equivalence Assumption (The Elder). Finally, to illustrate the fundamental nature of the resulting theorem, the Equivalence Theorem as we call it, we present three significant applications: we use the Equivalence Theorem first to clarify and resolve questions related to Leibniz’s ‘‘polygonal model’’ of one-body motion; then to repair Newton’s argument for the Area Property in Proposition 1; and finally to clarify and resolve questions related to the transition from impulsive to continuous forces in ‘‘De motu’’ and the Principia. (shrink)

The ability of predicting upcoming events or conditions in advance offers substantial selective advantage to living beings. The most successful systematic tool for fairly reliable prognoses is the use of dynamical causal models in combination with memorised experience. Surprisingly, causality is a fundamental but rather controversially disputed concept. For both models and memory, symbol processing is requisite. Symbols are a necessary and sufficient attribute of life from its very beginning; the process of their evolutionary emergence was discovered by Julian Huxley (...) a century ago. In behavioural biology, this universal symmetry-breaking kinetic phase transition became known as ritualisation. Symbol use for predicting future dynamical processes has culminated in the unprecedented complexity of mental models used in science and technology, coining the historical ascent of modern humans. Observation and measurement transform structural information of physical exchange processes into symbolic information from which state quantities are derived by means of mental models. However, phylogenetically inherited models such as naïve realism do not necessarily explain the sophisticated insights revealed by modern experiments with, say, entangled quantum states. It is suggested to carefully distinguish observed exchange quantities from predicted unobservable state quantities, and physical reality from mental models thereof. (shrink)

This article gives a practice-based and theoretical overview of the transformation from a traditional hierarchical organization in the care and cure sector towards a so-called Community-driven organization providing human happiness to 6000 elderly people. The actual case study is intertwined with conceptual information for better understanding of the innovative transition which took place at Humanitas. The case description includes its initial situation, its new core values, mission and objectives and shows the sequence of emerging policies and interventions that resulted (...) in a stakeholder oriented business model for the care sector. The selected concepts are Graves'' Emerging Cyclical Level of Existence Theory (or Spiral Dynamics), Ken Wilber''s Four Quadrant Model, Roberts Simons'' Four Levers of Control and various elements from the European Corporate Sustainability Framework sponsored by the European Commission. The conclusion marks the match between theory and practice in transforming Humanitas Rotterdam into providing cure, care, housing and well-being to elderly people. (shrink)

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? Which strategies do nurses use to provide compassionate care? What is the specific model of compassionate care for the (...) nursing context? A grounded theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: contextual factors affecting compassionate care, the compassionate care actions, and the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses’ ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses’ ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model provides a model to guide nursing care and research. (shrink)

Abstract The values of the healthcare sector are fairly ubiquitous across the globe, focusing on caring and respect, patient health, excellence in care delivery, and multi-stakeholder collaboration. Many individual pharmacists embrace these core values. But their ability to honor these values is significantly determined by the nature of the system they work in. -/- The paper starts with a model of the prevailing pharmacist workforce model in Scotland, in which core roles are predominantly separated into hierarchically disaggregated (...) jobs focused on one professional ‘pillar’: Clinician /Practice Provider; Educator; Leader/Manager; and Researcher. This is the ‘Atomistic’ Model. This skills-segregation yields a workforce of individuals working in isolation rather than collaborating together, and lacking a shared information flow, purpose and identity. Key strategic flaws include suboptimal responsiveness to population and subpopulation needs, inconsistency and inequity of care, an erosion of professional agency, and lower job satisfaction. It is conjectured that this results from a lack of congruence between values, professional ethos, and organizational structure. ‘Atomism’ culminates in a syndrome of widespread professional-level cognitive dissonance. -/- The paper contrasts this with a new emerging workforce vision, The Collaborative Care Model. This new model defines a systems-first-approach, built on the principle that all jobs must include all four professional ‘pillars’. Vertical skills integration, involving education and task sharing, will support sustainability and succession planning. Horizontal skills integration (across practice, leadership and research) is included to improve responsiveness to population need and individual professional agency. The working conditions, supportive ethos, and career structure needed to make the model work are described. Moral theory and workforce theory are used to justify why the model may be more effective for population health, delivering greater job satisfaction for individuals and ultimately helping systematically realize and honor healthcare values. Finally, the paper sketches the first steps needed to implement the model at the national level, starting with the operationalization of new multi-pillar professional curricula across the career spectrum. Potential pitfalls and challenges are also discussed. -/- Co-Authors: 1. Paul Forsyth (PF) Lead Pharmacist Clinical Cardiology, Pharmacy, NHS Greater Glasgow & Clyde. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Writing - original draft (lead author), Writing - review & editing (lead author) 2. Andrew Radley (AR), Consultant in Public Health Pharmacy, NHS Tayside. Contribution: Conceptualization; Model curation; Model Theory; Writing - review & editing 3. Gordon Rushworth (GR), MPharm MSc FFRPS FRPharmS (Consultant). Programme Director, Highland Pharmacy Education & Research Centre, NHS Highland, Inverness. Contribution: Model curation; Writing - review & editing 4. Fiona Marra (FM) National Lead Clinician Scottish Infection and Immunology Network (SPAIIN) / Advanced Pharmacist HCV / HIV, NHS Greater Glasgow & Clyde. Contribution: Model curation; Writing - review & editing 5. Susan Roberts (SR) Associate Postgraduate Pharmacy Dean, NHS Education for Scotland. Contribution: Model curation; Writing - review & editing 6. Roisin O’Hare (RO) Lead Teacher Practitioner Pharmacist, Northern Ireland University Network, Southern Health and Social Care Trust. Contribution: Model curation; Writing - review & editing 7. Catherine Duggan (CD) Chief Executive Officer, International Pharmaceutical Federation (FIP). Contribution: Model curation; Writing - review & editing 8. Barry Maguire (BM) Senior Lecturer, School of Philosophy, Psychology and Life Sciences, The University of Edinburgh. Contribution: Conceptualization; Model Curation; Model Theory; Model Visualization; Supervision; Writing - original draft (senior academic supervisor), Writing - review & editing (senior academic supervisor) -/- . (shrink)

The role of churches in primary health care delivery in Africa's poor contexts is widely acknowledged. Discussion of churches' work in health largely focuses on the spiritual side and tends to downplay the practical side. A clear challenge and gap in the role of churches in primary health delivery is the lack of clear models and approaches to determine the efficacy of the interventions. Hence, the role of churches as a player in the delivery of primary health care (...) needs examination. This paper examines the role of church-driven primary health care, using a practical case study of the health work of the Salvation Army in East Africa. It outlines the primary health services rendered by the Salvation Army and deduces five models that emerged from the work of the various implementing churches in delivering primary health care. The article proceeds from an analysis of the meaning of primary health care and how churches are historically and currently positioned to contribute to primary health care. The article demonstrates that, viewed from a primary health care delivery perspective, churches in Africa play a critical practical contribution further to a spiritual role. From a practical theology perspective, the paper provides insight into how churches could operate in communities within the interface of church and health spaces. However, the church's role and function is organic and differs in every community. (shrink)

In the last two decades, studies on the relationship between spirituality and health have grown significantly in the International literature. In Brazil, the debate on this subject has reached greater visibility since 2009, mainly in the health sciences, with the appearance of the term "spiritual care". In theology, studies on spiritual care in the health care context are still scarce. This paper aims to contribute to the broadening of this reflection. Firstly, spiritual care is approached from (...) scientific publications in Portuguese language. Second, the interdisciplinary spiritual care model is presented as a holistic approach to patient care and consequences of applying a spiritual care model are outlined. The newly defined role of the hospital chaplains, pastoral counselors and spiritual caregivers is also discussed. As a conclusion, the paper mentions the main challenges going along with interdisciplinary spiritual care, especially those concerning the training of health care professionals. (shrink)

As of the end of October 2020, the cumulative number of confirmed cases of COVID-19 has exceeded 45 million and the cumulative number of deaths has exceeded 1.1 million all over the world. Faced with the fatal pandemic, countries around the world have taken various prevention and control measures. One of the important issues in epidemic prevention and control is the assessment of the prevention and control effectiveness. Changes in the time series of daily new confirmed cases can reflect the (...) impact of policies in certain regions. In this paper, a smooth transition autoregressive model is applied to investigate the intrinsic changes during the epidemic in certain countries and regions. In order to quantitatively evaluate the influence of the epidemic control measures, the sequence is fitted to the STAR model; then, comparisons between the dates of transition points and those of releasing certain policies are applied. Our model well fits the data. Moreover, the nonlinear smooth function within the STAR model reveals that the implementation of prevention and control policies is effective in some regions with different speeds. However, the ineffectiveness is also revealed and the threat of a second wave had already emerged. (shrink)

Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services. Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective (...) of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area. (shrink)

The energy domain is still dominated by equilibrium models that underestimate both the dangers and opportunities related to climate change. In reality, climate and energy systems contain tipping points, feedback loops, and exponential developments. This paper describes how to create realistic energy transition management models: quantitative models that can discover profitable pathways from fossil fuels to renewable energy. We review the literature regarding agent-based economics, disruptive innovation, and transition management and determine the following requirements. Actors must be detailed, heterogeneous, interacting, (...) learning, and strategizing. Technology should be represented as a detailed and heterogeneous portfolio that can develop in a bottom-up manner, using endogenous feedback loops. Assumptions about discount rates and the social cost of carbon should be configurable. The model should contain interactions between the global, national, local, and individual level. A review of modelling techniques shows that equilibrium models are unsuitable and that system dynamics and discrete event simulation are too limited. The agent-based approach is found to be uniquely suited for the complex adaptive sociotechnical systems that must be modelled. But the choice for agent-based models does not mean a rejection of other approaches because they can be accommodated within the agent-based framework. We conclude with practical guidelines. (shrink)

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)

The paper tackles the problem of the relation between rights and obligations. Two examples of situations in which such a relation occurs are discussed. One concerns the abortion regulations in Polish law, the other one—a clash between freedom of expression and freedom of enterprise occurring in the context of discrimination. The examples are analysed and formalised using labelled transition systems in the \ framework. Rights are introduced to the system as procedures allowing for their fulfilment. Obligations are based on the (...) requirement of cooperation in the realisation of the goals of the agent that has a right. If the right of an agent cannot be fulfilled without an action of another agent, then that action is obligatory for that agent. If there are many potential contributors who are individually allowed to refuse, then the last of them is obliged to help when all the others have already refused. By means of formalisation this account of the relation under consideration is precisely expressed and shown consistent. (shrink)

One of the most basic understandings of nursing is that a nurse is a caregiver for a patient who helps to prevent illness, treat health conditions, and manage the physical needs of patients. Nursing is often presented as a caring profession, which provides patient care driven by ideals of empathy, compassion and kindness. These ideals of care have further been foregrounded through the development and implementation of stress on patient centred care (PCC) and/or person‐centred practice (PCP). Although (...) the idealisation of nursing as a caring profession is common, and one certainly seen as integral by nurses and written into the heart of regulatory documentation, we contend that the actual delivery of care is being undercut by the very regulatory climate that strives to professionalise care. As we outline, with specific reference to the context of Australian Nursing, this transformation delivers a commodified, even McDonaldized, model of patient management rather than care. It seems that even with its explicit stress on PCC and PCP, Australian Nursing cannot live up to its own care ideals. Having outlined this problem, the paper then demonstrates the ways in which PCC is thwarted at the coal face of nursing practice and that there must be an institutionalised change to be able to provide genuine patient‐centred care. (shrink)

Evolutionary transitions in individuality (ETIs) involve the formation of Darwinian collectives from Darwinian particles. The transition from cells to multicellular life is a prime example. During an ETI, collectives become units of selection in their own right. However, the underlying processes are poorly understood. One observation used to identify the completion of an ETI is an increase in collective-level performance accompanied by a decrease in particle-level performance, for example measured by growth rate. This seemingly counterintuitive dynamic has been referred to (...) as fitness decoupling and has been used to interpret both models and experimental data. Extending and unifying results from the literature, we show that fitness of particles and collectives can never decouple because calculations of fitness performed over appropriate and equivalent time intervals are necessarily the same provided the population reaches a stable collective size distribution. By way of solution, we draw attention to the value of mechanistic approaches that emphasise traits, and tradeoffs among traits, as opposed to fitness. This trait-based approach is sufficient to capture dynamics that underpin evolutionary transitions. In addition, drawing upon both experimental and theoretical studies, we show that while early stages of transitions might often involve tradeoffs among particle traits, later—and critical—stages are likely to involve the rupture of such tradeoffs. Thus, when observed in the context of ETIs, tradeoff-breaking events stand as a useful marker of these transitions. (shrink)

Background:In China, the conventional family-based ageing care model is under pressure from social transitions, raising the question of whether and to what extent families are still capable of dealing with the care of the aged.Objective:This article examines the vulnerability and inadequacy of families to bear responsibility for the care of the aged against a backdrop of socioeconomic transformation and diminishing institutional support in rural China.Research design:This article adopts an empirical ethical approach that integrates empirical investigation with (...) ethical inquiry.Participants and research context:The empirical component of this article focuses on the lived experiences of caring for a wife and mother with dementia in one rural Chinese family, collected from a 6-month fieldwork study conducted at one primary hospital.Ethical considerations:Approval was obtained from the university ethics committee.Findings:The empirical study highlights a conflicted family process of managing and negotiating care that indicates the inadequacies and limited ability of families to deal with aged care tasks. In addition, inadequate structures and institutional deficiencies exacerbate the vulnerability of rural families and their inability to offer adequate care.Conclusion:Acknowledging the vulnerability of families as ageing care providers, this article calls for a socially supported family care model for rural older people in China and also proposes policy recommendations. (shrink)

Background: Omalizumab, an anti-immunoglobulin E antibody, reduces exacerbations and symptoms in uncontrolled allergic asthma. The study objective was to estimate the costs and consequences of omalizumab compared to usual care from a US payer perspective. Methods: We estimated payer costs, quality-adjusted survival (QALYs), and the incremental cost-effectiveness ratio (ICER) of omalizumab compared to usual care using a state-transition simulation model that included sensitivity analyses. Every 2 weeks, patients could transition between chronic asthma and exacerbation health states. The (...) best available evidence informed the clinical and cost input estimates. Five years of omalizumab treatment followed by usual care was assumed to estimate a lifetime horizon. Omalizumab responders (60.5% of treated) were modeled as a separate scenario where nonresponders reverted back to usual care after 16 weeks of active treatment. Results: The mean lifetime discounted costs and QALYs were $83 400 and 13.87 for usual care and $174 500 and 14.19 for omalizumab plus usual care resulting in $287 200/QALY (95% interval: $219 300, $557 900). The ICER was $172 300/QALY when comparing omalizumab to usual care in the responder scenario. One-way sensitivity analyses indicated that the results were sensitive to the difference in treatment-specific utilities for the chronic state, exacerbation-associated mortality, omalizumab price, exacerbation rates, and response definition. Conclusions: The results suggest that adding omalizumab to usual care improves QALYs at an increase in direct medical costs. The cost-effectiveness of omalizumab is similar to other chronic disease biologics. The value increases when omalizumab response is used to guide long-term treatment. (shrink)