BROOKS J and RAFFERTY AM. Nursing Inquiry 2010; 17: 142–150Education and role conflict in the health visitor profession, 1918–39Health visiting was the public health profession in the UK, which arose during the Victorian period to support and supervise the mothers of the nation. The health visitor was expected to teach the new mothers hygiene, infant feeding and diet, help them in the home when necessary and then report back to the Medical Officer for Health. Her role (...) therefore was multifaceted and required education and training from a number of differing bodies. She needed nursing skills to help with the practicalities of observation and home care, sanitary knowledge to ensure that the buildings were safe and training in law and epidemiology. In order to fulfil these professional requirements, by the middle of the twentieth century the health visitor was expected to be a nurse by background, be educated for health visiting in a university and understand community medicine. These differing and sometimes opposing requirements meant that the health visitor was often caught in-between conflicting ideologies. It is this idea of ‘in-betweenness’ from the work of the anthropologist Marilyn Strathern and its relation to the work and education of the health visitor that this article will focus. (shrink)

One of the most unpredictable things the pandemic brought to our societies was the closure of hospitals and other health services to visitors. Preventing the spread of infection was the main reason for these decisions in the early days of the pandemic when there was no clarity about the means of transmission and the origin of the virus. However, in view of the persistence of the restrictions to date and the numerous negative consequences they have had on the (...) professional and personal quality of life of doctors, nurses, patients and carers, the aim of this article is to analyse in depth the reasons why these decisions have been and, above all, are still being applied, also considering the hypothesis that the choices made so far in the training of health professionals should be questioned. The persistence of restrictions, the constant reduction of human and economic resources in the face of an increase in the demand for care have exacerbated the distance between health professionals and users, to the point of escalating into actual acts of violence and aggression. According to the Critical Pedagogy approach, educators can play a central role in activating formative and collaborative strategies, such as maieutic groups, to rebuild an alliance between those who today find themselves on opposite sides: health professionals on the one hand, and patients and families on the other. (shrink)

Health care professionals are one of a large group of individuals who are exposed to significant risks by virtue of their occupation, such as the police, mountain rescuers, fire-service. The types of risk to which health care professionals are exposed are numerous, many of which remain largely unrecognised by the public and may even be underestimated by the professionals themselves. Examples of these health risks include fatigue, emotional/psychological trauma, physical injury caused by the use of machinery, back (...) injuries, possible even violent physical assault from a patient or hospital visitor. There is also a very significant risk of acquiring an illness in the course of employment, for example, physical damage caused by the prolonged use of toxic substances, and also infectious diseases which are acquired by various routes, such as air-borne infections, needle-stick injuries. Subjective risk evaluation and the notion of risk in health care from the patients' perspective has been widely considered over many years, and in a number of different areas, including medical research, screening procedures, consent to surgery or other medical intervention. In this paper, however, the moral dilemmas which may arise for health care professionals in relation to health risks are highlighted and specific questions are raised. (shrink)

Nonpharmaceutical interventions to minimize the transmission of the severe acute respiratory syndrome coronavirus 2 are necessary because we currently lack a vaccine or specific treatments. Healthcare facilities have adopted visitor restrictions and masking requirements. These interventions should be evaluated as public health measures, focusing on their efficacy, the availability of less-restrictive alternatives, and the minimization of the burdens and their balance with the benefits. These interventions, as well as exceptions, can be justified by the same analysis. For example, visitor (...) restrictions are sound, as are exceptions for women in labor, adults with disabilities, minor children, and individuals who are dying. In implementing these policies, specific rules are preferable to general principles because they are more efficient and reduce possible bias. There should, however, be appeal mechanisms and retrospective review processes. Evaluating requests for medical exemptions to masking requirements is particularly difficult, given the prevalence of nonmedical objections, false claims of medical exemptions, and a lack of objective medical criteria. Requiring written statements by licensed healthcare providers that undergo subsequent substantive review may therefore be justified. (shrink)

In 1878, amid a rapidly proliferating social interest in public health and cleanliness, a group of sanitary scientists and reformers founded the Parkes Museum of Hygiene in central London. Dirt and contagion knew no social boundaries, and the Parkes's founders conceived of the museum as a dynamic space for all classes to better themselves and their environments. They promoted sanitary science through a variety of initiatives: exhibits of scientific, medical and architectural paraphernalia; product endorsements; and lectures and certificated courses (...) in practical sanitation, food inspection and tropical hygiene. While the Parkes's programmes reified the era's hierarchies of class and gender, it also pursued a public-health mission that cut across these divisions. Set apart from the great cultural and scientific popular museums that dominated Victorian London, it exhibited a collection with little intrinsic value, and offered an education in hygiene designed to be imported into visitors’ homes and into urban spaces in the metropole and beyond. This essay explores the unique contributions of the Parkes Museum to late nineteenth-century sanitary science and to museum development, even as the growth of public-health policy rendered the museum obsolete. (shrink)

Identities ascribed to research staff in face-to-face encounters with participants have been raised as key ethical challenge in transnational health research. ‘Misattributed’ identities that do not just deviate from researchers' self-image, but obscure unequivocal aspects of researcher identity – e.g. that they are researchers – are a case of such ethical problem. Yet, the reasonable expectation of unconcealed identity can conflict with another ethical premise: confidentiality; this poses challenges to staff visiting participants at home. We explore these around a (...) case study of ‘follow-up’ staff, observed during an ethnographic study of a Kenyan HIV ‘trial community’, which included participant observation, conversations, and interviews with staff (n = 79) and participants (n = 89). We found that because of the need to maintain confidentiality and because of some suspicions towards researchers, research staff drew upon alternative identities – presenting themselves to non-participants as relatives or friends, rather than as researchers. Several staff experienced this as necessary but uncomfortable. Simultaneously, staff and participants forged close relations in line with their fictional identities, which however also posed challenges because they entailed personal responsibilities that were difficult to live up to, due to limited resources, and the trial's limited duration. Similar challenges may arise in transnational HIV treatment programmes and should be explored further in that context. (shrink)

This study is designed to test the hypothesis that events like the Holly Bough service held in Liverpool Cathedral on the fourth Sunday of Advent that attracts a wide range of participants, including regular churchgoers and occasional (sometimes annual) visitors, contribute significantly to the psychological health and well-being of these participants. At the Holly Bough service held in 2019, a total of 383 participants (139 men, 229 women and 15 individuals who preferred anonymity) completed a recognised measure of (...) psychological health and well-being (the Oxford Happiness Questionnaire) whilst they were waiting for the service to begin and again during a 5-min organ improvisation just before the close of the service. The data demonstrated a significantly higher score on the Oxford Happiness Questionnaire at time 2 than at time 1, suggesting that the experience of the service functioned as an agent of psychological health and well-being. Contribution: Situated within the science of cathedral studies, this paper confirms by means of a repeated-measure study that cathedrals promote psychological health; 383 participants at a Christmas service completed the same well-being measure before and after the service, with a significant increase in scores at time two. (shrink)

Civility is an essential feature of health care, as it is in so many other areas of human interaction. The article examines the meaning of civility, reviews its origins, and provides reasons for its moral significance in health care. It describes common types of uncivil behavior by health care professionals, patients, and visitors in hospitals and other health care settings, and it suggests strategies to prevent and respond to uncivil behavior, including institutional codes of conduct (...) and disciplinary procedures. The article concludes that uncivil behavior toward health care professionals, patients, and others subverts the moral goals of health care and is therefore unacceptable. Civility is a basic professional duty that health care professionals should embrace, model, and teach. (shrink)

This study was designed to test the hypothesis that events such as the Christmas Eve Carol Services at Liverpool Cathedral that include some regular churchgoers (people who attend services most weeks) and much larger numbers of occasional visitors (who may attend church only once or twice a year) make a significant impact on the psychological health and well-being of the participants. Using a repeat-measure design, participants were invited to complete a copy of the Oxford Happiness Questionnaire while they (...) were waiting for the service to begin and then to complete a second copy during a five-minute organ improvisation just before the close of the service. Data provided by 802 participants who completed both copies of the instrument demonstrated a significantly higher score on the Oxford Happiness Questionnaire at time two than at time one, suggesting that attendance at the service had exerted a positive impact on psychological health and well-being. Contribution: Situated within the science of cathedral studies, this article demonstrates by means of a repeated-measure study that cathedrals can make a significant impact on the psychological health and well-being of the wider community served by them. The same well-being measure was completed by 802 participants at the Christmas Eve Carol Services before and after the event, with a significant increase in scores at time two. (shrink)

In recent years, the growth of interest in global health among medical students and residents has led to an abundance of short-term training opportunities in low-resource environments. Given the disparities in resources, needs and expectations between visitors and their hosts, these experiences can raise complex ethical concerns. Recent calls for best practices and ethical guidelines indicate a need for the development of ethical awareness among medical trainees, their sponsoring and host institutions, and supervising faculty. As a teaching tool (...) to promote this awareness, we developed a scenario that captures many common ethical issues from four different perspectives. Each perspective is presented in case format followed by questions. Taken together, the four cases may be used to identify many of the elements of a well-designed global health training experience. (shrink)

Although there is no federal legislation yet on e-cigarettes, the U.S. Food and Drug Administration proposed regulations in April 2014 that would prohibit sales of e-cigarettes to anyone under eighteen and require that they be approved by the FDA as a tobacco product and carry warning labels for consumers on their packaging. Only three U.S. states have extended the same restrictions placed on tobacco products to e-cigarettes; however, eighteen states have passed legislation enacting use restrictions on venues such as schools, (...) state property, or workplaces. Until there is applicable legislation at the federal, state, or municipal levels, health care organizations will have to develop institutional policies if they wish to consistently address the use of e-cigarettes by patients and visitors on their property. (shrink)

In recent years, the growth of interest in global health among medical students and residents has led to an abundance of short‐term training opportunities in low‐resource environments. Given the disparities in resources, needs and expectations between visitors and their hosts, these experiences can raise complex ethical concerns. Recent calls for best practices and ethical guidelines indicate a need for the development of ethical awareness among medical trainees, their sponsoring and host institutions, and supervising faculty. As a teaching tool (...) to promote this awareness, we developed a scenario that captures many common ethical issues from four different perspectives. Each perspective is presented in case format followed by questions. Taken together, the four cases may be used to identify many of the elements of a well‐designed global health training experience. (shrink)

BackgroundFindings suggest pandemic control measures have modified maternal health practices, compromising the quality of care provided to new and expectant mothers and interfering with their birthing experiences. For this reason, this study explored the lived experiences of post-partum Victorian mothers during the pandemic as well as the potential influence of control measures over their perceptions regarding the health system.MethodsThis study used a qualitative approach. Recruitment was conducted between May and June 2021, using both the Australian Breastfeeding Association’s social (...) media pages and snowball recruitment. Interviews were semi-structured using open-ended questions relating to key themes. Seven Victorian post-partum mothers were identified and their transcripts analysed using Interpretative Phenomenological Analysis.ResultsMothers described how unexpected changes to maternal care exacerbated feelings of uncertainty regarding pregnancy and birth. Mothers also differentiated between impacts by the health system and the role healthcare professionals played in moderating these effects. Whilst visitor restrictions provided some benefit, restrictions to familial and social support left many of the mothers feeling alone during their pregnancy and interfered with their immediate post-partum experience.ConclusionThis study illustrates the importance of evidence-based practice in maternal care and provides insights for both health professionals and policy analysts in developing new or modifying existing guidelines that better balance the needs of expectant and post-partum mothers with pandemic control measures. (shrink)

Next SectionDr Thomas Stockmann, the protagonist of Ibsen's play, An Enemy of the People, discovers a serious health threat in the Baths of his Norwegian town. The Baths have been marketed as a health resort to lure visitors. Dr Stockmann alerts officials about the problem and assumes that they will close the Baths until it is corrected. He is met with fierce resistance, however. His brother, the town's mayor, favors keeping the Baths open and correcting the problem (...) gradually. He advances multiple arguments that appeal to the economic interests of the town and Thomas's role-related obligation as a citizen. His wife, Katherine, wants him to cooperate with the mayor. She marshals several arguments that appeal to his obligations as a father. This paper reconstructs and examines the competing arguments, shows how Ibsen's play has both contemporary relevance and moral depth, and demonstrates how Dr Stockmann's responses can be interpreted as an argument that complying with his duties to protect the public health do not force him to renege on his core commitments as a parent and as a citizen. (shrink)

The United Kingdom Central Council for Nursing, Midwifery and Health Visitors (UKCC) document, Exercising Accountability, states that the role of patient's advocate is an essential aspect of good professional nursing practice (1). The author examines the case for and against the nurse being the best person to act as advocate, and critically evaluates the criteria of advocacy. The problematic moral issues arising are discussed, and a case made for negotiation between the members of the multidisciplinary team and the (...) patient/client (or a significant person to the patient) in order to promote the well-being of the patient and to minimise suffering. She concludes that the health care professional's (including the nurse's) role is to help people to assert control over the factors which affect their lives, that is empowerment, rather than advocacy. (shrink)

IntroductionThe National Institute for Health and Care Excellence guidelines acknowledge the importance of the parent–infant relationship for child development but highlight the need for further research to establish reliable tools for assessment, particularly for parents of children under 1 year. This study explores the acceptability and psychometric properties of a co-developed tool, ‘Me and My Baby’.Study designA cross-sectional design was applied. The MaMB was administered universally with mothers during routine 6–8-week Health Visitor contacts. The sample comprised 467 mothers. (...) Dimensionality of instrument responses were evaluated via exploratory and confirmatory ordinal factor analyses. Item response modeling was conducted via a Rasch calibration to evaluate how the tool conformed to principles of ‘fundamental measurement’. Tool acceptability was evaluated via completion rates and comparing ‘completers’ and ‘non-completers’ demographic differences on age, parity, ethnicity, and English as an additional language. Free-text comments were summarized. Data sharing agreements and data management were compliant with the General Data Protection Regulation, and University of York data management policies.ResultsHigh completion rates suggested the MaMB was acceptable. Psychometric analyses showed the response data to be an excellent fit to a unidimensional confirmatory factor analytic model. All items loaded statistically significantly and substantially on a single underlying factor. The item response modeling showed that most MaMB items fitted the Rasch model. item reliability was high yet the test yielded little information on each respondent, as highlighted by the relatively low ‘person separation index’ of 0.1.Conclusion and next stepsMaMB reliably measures a single construct, likely to be infant bonding. However, further validation work is needed, preferably with ‘enriched population samples’ to include higher-need/risk families. The MaMB tool may benefit from reduced response categories and some modest item wording amendments. Following further validation and reliability appraisal the MaMB may ultimately be used with fathers/other primary caregivers and be potentially useful in research, universal health settings as part of a referral pathway, and clinical practice, to identify dyads in need of additional support/interventions. (shrink)

Based on a study undertaken by the Institute of Medical Ethics and the Royal College of Nursing, this book examines what nurses, midwives and health visitors are taught about ethics in the UK. It defines ethics and related terms and discusses their relevance to the practice of nursing.

The Diploma in Community Nursing at the University of Manchester began in 1959, after a long period of planning and negotiation. It was the earliest pre‐registration nursing education programme in a British university. The paper reports on a historical study which examined its foundation and development. The history of the ‘Manchester Scheme’, as it came to be known, is placed into the context of wider reforms and modifications in British nursing education. The methods used for the study were a broad‐based (...) literature review, examination of material from the 1950s to the present day, five oral history interviews with some of those who were influential in developing the diploma, and the interpretation of relevant documentary source materials. The Diploma in Community Nursing at the University of Manchester was important and innovative in its time, combining as it did nurse and health visitor training with a university‐based education. The paper traces the struggle to establish the course, which was largely due to the efforts of one charismatic individual, Fraser Brockington, Professor of Social and Preventive Medicine. It then goes on to examine the reforms and modifications the programme underwent from 1959 to 1969, as it was developed into the prototype for the ‘Bachelor of Nursing Degree’. (shrink)

During the coronavirus disease 2019 (COVID‐19) pandemic, bioethical analyses often emphasized population health and societal benefit. Hospital policies frequently focused on reducing risk of transmitting SARS‐CoV‐2 by restricting visitors; requiring protective equipment; and screening staff, patients and visitors. While restrictions can be burdensome, they are often justified as essential measures to protect the whole population against a virus with high rates of transmission, morbidity and mortality. Yet communities are not monolithic, and the impacts of these restrictions affect (...) different groups differently. An ophthalmological unit outreach program in Ethiopia serves to illustrate. Pre‐operative screening policies were designed to protect as many patients as possible but had adverse impacts on underserved communities. As this case study demonstrates, creating hospital policies that truly serve the good of the society may require a more holistic review of impacts on inequitably positioned communities. (shrink)

The peculiarities of the philosophy and practices of realization of the principles of a healthy way of life by the Seventh-day Adventist Church in Ukraine are considered. It has been established that the social and cultural changes caused by Ukraine’s independence have contributed to the opening of sanatoriums, boarding houses, and health centers by Adventist believers. It has been stated that since 1991, Adventists have generally conducted short-term health programs and exhibitions, but over time have shifted to the (...) Western system of providing services based on permanent health facilities. The philosophy and practices of the Church's implementation of a healthy lifestyle are outlined Seventh-day Adventists in Ukraine in the context of the work of medical, sanatorium and health facilities that belong directly to this religious organization. The practical novelty of the study is based on interviews with health care managers who were directly involved in the establishment of health facilities and the implementation of various Adventist health programs. It was found that representatives of other Protestant and Orthodox denominations who visited the recreation centers changed their minds about Adventism and Adventists, which, in turn, contributed to the creation of an atmosphere of religious tolerance and tolerance for each other. The activities of the inspected health centers, sanatoriums and boarding houses mainly carry out the mission of the Seventh-day Adventist Church, and the performers (staff) see their contribution to the service of God in the prevention of diseases and rehabilitation of patients. In addition, in the institutions we have studied, special attention is paid to teaching about the principles of a healthy lifestyle, proper nutrition, hydrotherapy and more. It is determined that the process of implementing health programs is based on the principles of Christian ethics, which managers and staff try to follow, seeing it as fulfilling Christ’s mission on earth, especially in the field of restoring and preventing the health of sanatorium visitors. (shrink)

People may be subjected to discrimination from a variety of sources in the workplace. In this study of mental health workers, we contrast four potential perpetrators of discrimination (managers, co-workers, patients, and visitors) to investigate whether the negative impact of discrimination on victims’ well-being will vary in strength depending on the relative power of the perpetrator. We further explore whether the negative impact of discrimination is at least partly explained by its effects on people’s sense of organizational justice, (...) and whether the strength of mediation varies according to the source of discrimination. Using survey data from 1,733 UK mental health workers, a structural equation model was designed to test these hypotheses following a bootstrap approach. Discrimination from all sources was related to well-being, with that from managers having the strongest effects. The results support an explanation of the effect of discrimination on well-being in terms of organizational justice perceptions for discrimination from managers and from visitors, but less so for discrimination from co-workers or from patients. The study highlights the importance of differentiating amongst sources of discrimination at work and the salience of organizational justice perceptions in explaining the effects of discrimination from some sources. (shrink)

Since the beginning of the pandemic spread of the Coronavirus, societies have been reminded that the impact of Covid-19 and public health measures of infection containment reflect known gradients of inequality. Measures focusing only the (acknowledged) frontstage of the pandemic and neglecting its (unacknowledged) backstage—understood as those framework conditions indispensable for societies to thrive—have worsened the impact of social determinants of health on the most vulnerable, as shown by the deleterious effects of prolonged social isolation of residents of (...) nursing homes. To reflect this phenomenon ethically, a framework is proposed which is inspired by the feminist philosopher Margret Little. At its core stands the assumption that caring for people and moral ends allows us to identify what is morally salient. This epistemological stance allows a critical look at the alleged dilemmas invoked to enforce brute, long-lasting policies of closing nursing homes in many places—especially in the light of their dubious effectiveness in preventing viral spread and the severe physical and psychological consequences for those affected. If moral salience is only fully perceived through the closeness of the caring relationship, the human suffering resulting from these policies reveals the utter inadequacy of the dilemma rhetoric used to justify them. This insight is illustrated by the personal experience of the author: He describes his role as an essential care partner of his mother living in a nursing home and forced into the role of a “visitor” who witnessed a constant deterioration of care. Based on an epistemological understanding of caring for making reliable moral judgments, potentially exclusionary effects of distinguishing essential from non-essential groups in care will be addressed together with the need to overcome strict boundaries between front- and backstage. Such efforts will strengthen the moral community of persons needing care, professional care givers and essential care partners. (shrink)

Social isolation and loneliness are ongoing threats to health made worse by the coronavirus disease 2019 pandemic. During the pandemic, half the globe's population have been placed under strict physical distancing orders and many long-term care facilities serving older adults went into lockdown mode, restricting access to all visitors, including family members. Before the pandemic emerged, a 2020 National Academy of Sciences, Engineering and Medicine report warned of the underappreciated adverse effects of social isolation and loneliness on (...) class='Hi'>health, especially among older populations. Social isolation and loneliness predict all-cause mortality at rates that rival clinical risk factors, such as obesity and smoking; they are associated with greater incidence of psychological, cognitive, and physical morbidities. This paper sets forth a proposal to design robots to function as companions and friends for socially isolated and lonely older people during pandemic emergencies and in aging societies more generally. “The proposal” section presents and defends the proposal. The “Replies to objections” section answers objections based on coercive design, replacement of humans with robots, privacy incursions, and counterfeit companionship. The “Conclusion” section submits that sociable robots offer a promising avenue for addressing social isolation and loneliness during pandemics and hold promise for aging societies more broadly. (shrink)

COVID-19 has truly affected most of the world over the past many months, perhaps more than any other event in recent history. In the wake of this pandemic are patients, family members, and various types of care providers, all of whom share different levels of moral distress. Moral conflict occurs in disputes when individuals or groups have differences over, or are unable to translate to each other, deeply held beliefs, knowledge, and values. Such conflicts can seriously affect healthcare providers and (...) cause distress during disastrous situations such as pandemics when medical and human resources are stretched to the point of exhaustion. In the current pandemic, most hospitals and healthcare institutions in the United States have not allowed visitors to come to the hospitals to see their family or loved ones, even when the patient is dying. The moral conflict and moral distress among care providers when they see their patients dying alone can be unbearable and lead to ongoing grief and sadness. This paper will explore the concepts of moral distress and conflict among hospital staff and how a system-wide provider wellness programme can make a difference in healing and health. (shrink)

During the “age of austerity” the UK government has progressively limited free health services for “overseas visitors” on the grounds of fairness and frugality. This is despite the fact that the cost of the additional bureaucracy required by the new system and the public health consequences are expected to exceed the sums saved. In this article I explore the interaction between the discourses of austerity and xenophobia as they relate to migrants’ access to healthcare. By examining the (...) available data and adjudicating various moral arguments, I cast doubt on the claim that the current charging regulations are cost-effective and fair. I instead contend that if the UK is concerned with running a health service that is economically-sustainable and morally-defensible, it is critical that migrants are welcomed, both as staff and as patients. I conclude by arguing that xenophobia has precipitated changes to the health service which do not qualify as “austerity” in the way that is claimed, but rather deliberately produce a “hostile environment” for migrants, despite this very likely generating economic losses. (shrink)

The UK’s 2014 Immigration Act aimed to create a ‘Hostile Environment’ for migrants to the UK. One aspect of this was the restriction of access to secondary care for overseas visitors to the UK, although it remains the case that everybody living in the UK has the legal right to access primary care. In this paper, we argue that the effects of this policy extend beyond secondary care, including preventing eligible people from registering with a General Practice, although as (...) an unintended consequence. This problem arises from misinterpretation of policy wording, misleading GP websites and gatekeeping behaviour from front-line staff, even though there are no grounds in the current guidelines or law to support this. Free access to primary healthcare among refugees and asylum seekers living in deprived populations is particularly important in protecting patient health, given the burden of ill-health in this population and the multiple barriers to accessing early intervention they face. The medical profession has a duty to communicate their rights to this patient group—their legal entitlement to access free healthcare, and the vital importance of doing so. (shrink)

Human connection is universally important, particularly in the context of serious illness and at the end of life. The presence of close family and friends has many benefits when death is close. Hospital visitation restrictions during the Coronavirus pandemic therefore warrant careful consideration to ensure equity, proportionality, and the minimization of harm. The Australian and New Zealand Society for Palliative Medicine COVID-19 Special Interest Group utilized the relevant ethical and public health principles, together with the existing disease outbreak literature (...) and evolving COVID-19 knowledge, to generate a practical framework of visiting restrictions for inpatients receiving palliative and end-of-life care. Expert advice from an Infectious Diseases physician ensured relevance to community transmission dynamics. Three graded levels of visitor restrictions for inpatient settings are proposed, defining an appropriate level of minimum access. These depend upon the level of community transmission of COVID-19, the demand on health services, the potential COVID-19 status of the patient and visitors, and the imminence of the patient’s death. This framework represents a cohesive, considered, proportionate, and ethically robust approach to improve equity and consistency for inpatients receiving palliative care during the COVID-19 pandemic and may serve as a template for future disease outbreaks. (shrink)

In mid-February 45b.c.e., in a tragedy that was to plunge the orator into seemingly irreparable despair, Cicero's beloved daughter Tullia died. She had given birth nearly a month before and at first seemed to be doing well. Soon, however, her health gave out and Cicero took her to his Tusculan villa to recover. In the end, there was little that could be done. After her funeral, Cicero stayed for about three weeks with Atticus in Rome, but the constant stream (...) of visitors offering condolences became too much to bear, and on the sixth of March the heartbroken father retired to a villa he owned on the coast at Astura, some 45 miles south of Rome. Three days later he dispatched the following anguished epistle (Att. 12.15):Apud Appuleium, quoniam in perpetuum non placet, in dies ut excuser videbis. in hac solitudine careo omnium colloquio, cumque mane me in silvam abstrusi densam et asperam, non exeo inde ante vesperum. secundum te nihil est mihi amicius solitudine. in ea mihi omnis sermo est cum litteris. eum tamen interpellat fletus; cui repugno quoad possum, sed adhuc pares non sumus. Bruto, ut suades, rescribam. eas litteras cras habebis. cum erit cui des, dabis. (shrink)

Responding to a major pandemic and planning for allocation of scarce resources under crisis standards of care requires coordination and cooperation across federal, state and local governments in tandem with the larger societal infrastructure. Maryland remains one of the few states with no state-endorsed ASR plan, despite having a plan published in 2017 that was informed by public forums across the state. In this article, we review strengths and weaknesses of Maryland’s response to COVID-19 and the role of the Maryland (...) Healthcare Ethics Committee Network in bridging gaps in the state’s response to prepare health care facilities for potential implementation of ASR plans. Identified “lessons learned” include: Deliberative Democracy Provided a Strong Foundation for Maryland’s ASR Framework; Community Consensus is Informative, Not Normative; Hearing Community Voices Has Inherent Value; Lack of Transparency & Political Leadership Gaps Generate a Fragmented Response; Pandemic Politics Requires Diplomacy & Persistence; Strong Leadership is Needed to Avoid Implementing ASR … And to Plan for ASR; An Effective Pandemic Response Requires Coordination and Information-Sharing Beyond the Acute Care Hospital; and The Ability to Correct Course is Crucial: Reconsidering No-visitor Policies. (shrink)

The article described at first conceptual of halal tourism which is based on Islamic Shariah. Second, analyses of halal tourism effectiveness practically. Third, research of Indonesia as biggest Muslim populations in the world provide and serve halal tourism. To research this thing authors used a descriptive analytical research method coupled with literacy techniques. As a summary that halal tourism is growing fast in Indonesia with some special advantages and efforts actually. Evidently, Indonesia has been selected as the best halal tourism (...) in the world by 2019 and the trend of increasing visitors especially from middle east whom mostly Muslim’s travelers to the country. The implications of the research are found relatively new development of halal tourism conceptually and the implications in promoting halal tourism, serving Muslims community to get satisfactions in tourism without deny their belief, halal tourism is a health tourism that provide only foods, beverages and healthy advertisement and also green tourism that secure environment practically. Practical implications there are first, promote halal tourism. Second, serve Muslims community to get satisfactions in tourism without deny their belief and Islamic tennets. Third, halal tourism is a health tourism that provide only foods, beverages and healthy advertisement and green tourism that secure environment. The article is original as a result of a research in international issue that concern of halal tourism which service tourists specially for Muslims, and also offers new platform in tourism business. (shrink)

Introduction: Interdisciplinary, transdisciplinary and action research of a city in lockdown. As we write this chapter, most cities across the world are subject to a similar set of measures due to the spread of COVID-19 coronavirus, which is now a global pandemic. Independent of city size, location, or history, an observer would note that almost all cities have now ground to a halt, with their citizens being confined to their private dwellings, social and public gatherings being almost entirely forbidden, and (...) commercial areas being nearly devoid of visitors. Striking as these apparent similarities are, closer scrutiny would reveal important differences between cities and within cities – differences that can be highly relevant to consider when scholars are assessing the responses of cities to this pandemic or trying to predict the consequences of those responses. For example, the public health systems in some cities are better prepared than in others for coping with the increasing number of patients in life threatening conditions. Multigenerational households, which are associated with a greater risk for elderly members, are not equally common in all cities. Tourist destinations have taken a more severe economic hit from the lockdown than those cities which are economically less dependent upon this particular source of income. Communal celebrations in one city will result in a higher number of contagions and perhaps even deaths in this situation, whereas that same social fabric generally does contribute to a population’s health. The pandemic has also had unprecedented effects on differences and inequalities within cities. In cities in the United States, neighborhoods primarily inhabited by African Americans have been disproportionately affected by COVID-19 due to living and health conditions, yet also due to the fact they disproportionately perform vital jobs. Parks and green spaces are crowded, while city centers like Amsterdam’s Red Light District have suddenly lost the bustle of tourism, providing opportunities for citizens to reoccupy scarce public spaces and reclaim ownership. Clearly, such differences between cities are in many cases only discernible to the eye of an expert, possessing the necessary background knowledge to interpret the perceptible local changes caused by the global pandemic. Typically, drawing upon his or her disciplinary training, the expert also knows how to further probe the impact of the pandemic in an appropriate way. However, compared to the usual application of expertise, this crisis situation might, in an unusual way, test even experts. For the pandemic has created a unique situation, imposing unfamiliar constraints on the health, economic, social, and other conditions of cities, constraints that interact in sometimes unexpected ways with each other. Such interactions in turn force experts to collaborate across the boundaries commonly associated with disciplines, their concepts, theories, methods, and assumptions (Klein, 1996). These brief observations of how a virus pandemic can have differential impacts upon various cities, and what this exceptional situation might mean for the application of city methods, allow us to draw a few consequences for the current context of this chapter on interdisciplinary and transdisciplinary research. First, whenever we are investigating a complex and dynamic phenomenon it is by no means easy to determine which disciplinary perspectives are required to do justice to it. Indeed, the choice of useful disciplines can only be made after an initial overview of the situation and a preliminary selection of what appear to be the most important features of the situation. Relevance is key in guiding this selection process and scholars must remain open to the possibility that they may need to revise their earlier assessments of what is relevant and what is not. Second, if scholars from different disciplines were to study different features of a city in isolation, their ‘multidisciplinary’ account would miss important dynamic and complex interactions, such as those between a city’s demographics and geographical situation, its governance and economy. In other words, it is the integration of the perspectives of different disciplines that is crucial, as only then are such interactions taken into account. Indeed, this integration between disciplinary perspectives is what distinguishes an interdisciplinary from a multidisciplinary account. Thirdly, in addition to checking the relevance of disciplines and aiming for their integration, the outcome of interdisciplinary and transdisciplinary research has typically limited generalizability. Since a city is sensitive to a multitude of internal and external dynamical factors, in ways that partly rest upon its socio-cultural history, its investigation will often have the nature of a case study rather than be capable of leading to law-like insights (Krohn, 2010; Menken & Keestra, 2016). As can be seen from these three characteristics of ascertaining the relevance of different disciplinary contributions, the challenge of their integration, and the limited generalizability of their results owing to the specificity of interdisciplinary (ID) and transdisciplinary (TD) research, such research into ‘real world problems’ is clearly distinct from most monodisciplinary research. A consequence of this distinction is the absence of a general ID/TD methodology that can guide specific case studies. By contrast, the collaboration implied in such research requires researchers – and stakeholders, if they are involved – to reflect upon their potential contribution and the implicit assumptions associated with that. We will elaborate on this in the next section. Next, we offer several typologies of integration that urban scholars could employ for their research projects, after which we will offer a few brief analyses of initial collaborations of urban research. Finally, we discuss in more detail the process of the interdisciplinary research project. This will include a brief reflection upon the decision-making process that is implied in such projects. In sum, we aim to provide some guidance in conducting an ID/TD project, albeit not in the form of a definite methodology. (shrink)

It is a rare patient who always does everything healthcare providers advise. Sometimes no harm comes from this; sometimes good does. But occasionally, great harm comes from not listening, as when it results in patients returning time and again for costly and invasive treatments of, say, infections, valve replacements, pressure ulcers, and so forth. No class of patients arouses more anger and resentment in healthcare providers, who often put out a call to invoke some version of the three strikes rule (...) and refuse care. And if the patients are also unemployed substance abusers who live in a local park, impolite or dangerous to staff, disruptive to other patients, and have intimidating visitors, the call to say “No” is louder. Can care ever be refused? If so, when? These are the questions we take up in this article. The answers we provide were developed as part of a Paraplegics and Quadriplegics with Pressure Ulcers Project carried out at Vancouver Hospital and Health Sciences Centre. Following an established usage, we refer to patients who exhibit a cluster of the above characteristics, the dominant one of which is a reluctance to heed medical advice, as “noncompliant patients.” This term is offensive to some, but the politically correct lexicon does not provide any alternative which is as short and clear or substantially different. We use the term as a convenient way of referring to a familiar class of patients and without any imputation of blame. (shrink)

Nell Toussaint is not well. In recent years, she has been diagnosed with uterine fibroids, uncontrolled hypertension, nephrotic syndrome, poorly controlled diabetes, hyperlipidemia, and a pulmonary embolism. She also suffers from decreased mobility, shortness of breath, and‐perhaps not surprisingly, given her other ailments‐anxiety. Toussaint is an indigent undocumented immigrant living in Canada who has been trying to secure medical coverage in the federal courts. In the process, she has sacrificed the medical confidentiality that most of us ordinarily enjoy. Toussaint first (...) came to Canada from Grenada as a visitor in 1999 and remained after the term of her visa expired. At first, she earned enough to sustain a living, but in 2006, her health began to deteriorate, and she was no longer able to work. Although she has received some medical care since then, it has been sporadic, on an emergency basis, and at great expense. When Toussaint applied for medical health coverage under Canada's Interim Medical Health Program, which covers the cost of emergency medical care for legally admitted indigents, her application was rejected. She challenged the decision in federal court on the grounds that her right to life and security of the person under the Canadian Charter had been violated and that the denial of coverage was discriminatory. (shrink)

Modern medical research shows that art aesthetic plays a positive role in healing and relieving people’s stress, improving mental health and improving social adaptability. Based on the aesthetic experience of visitors, this article conducts an empirical study on the aesthetic experience of the Long March Memorial Museum in Ninghua County, Fujian province, by means of survey data questionnaire (SD) and in-depth interview. Firstly, to conduct a questionnaire survey to understand the psychological characteristics of visitors’ aesthetic experience. Secondly, (...) the combination of in-depth interviews and the aesthetic differences of public art psychological analysis. Thirdly, to clarify the relationship between public art aesthetics and psychological healing. By constructing a model of the relationship between public art aesthetics and psychological healing, it puts forward five ways of psychological healing, such as enhancing aesthetic experience, arousing life interest, enriching cultural and artistic knowledge, shaping individual psychology and relieving emotional pressure. Contribution: Public art aesthetics is not only influenced by the politics, culture, customs and lifestyles of society but also has a close relationship with religious beliefs. This article attempts to explain the relationship between public art aesthetics and psychological healing from the dimension of cognitive psychology and proposes a path for public art aesthetics to promote psychological healing, so as to enrich and expand the connotation of traditional aesthetic thought and further deepen the study of religious art in psychological healing, aiming to provide useful ideas and references for promoting the all-round development of human beings. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How was Haiti?Sadath Sayeed"She smelled of milk and urine. Chacko marveled at how someone so small and undefined, so vague in her resemblances, could so completely command the attention, the love, the sanity of a grown man."—Arundhati Roy from The God of Small ThingsFather and SonTwenty minutes before I was to be taxied to the airport in Port-au-Prince, the baby boy handed to me did not breathe continuously. He (...) didn't breathe at all. Born a few hours earlier at home—probably in one of the hundreds of make-shift tent cities. I did ask if the baby cried after he came out of mom. Yes. He didn't suckle well and stopped crying. Dad decided to get help. Climbed onto a moped with his baby wrapped in a blanket. Must have tucked him under one arm and rode between piles of rubble to the closest health care facility.People at this other place tried to help his baby boy breathe. They pushed air into his mouth like you are doing. After a few minutes, they said that they couldn't help anymore."Go to the University hospital."From a shirt sleeve pocket, he pulled a crumpled white piece of paper with some writing scribbled on it. I gathered it documented this last visit. They took the time to hand him a note before they sent him on his way.What did Dad think? Thanks for the note. Okay, now what? Swaddle my baby. Tuck him under one arm. Hop on my moped.Strained ResourcesL'Université d'État d'Haïti has been the main teaching hospital for all of the country for decades. Many, if not most, formally trained Haitian health care providers have spent some time in Port-au-Prince at this institution. As important as it is, it has suffered from neglect over many, many years. The earthquake made matters exponentially worse. [End Page 98]Dad must have been directed to the pediatric service when he arrived. There, a few Haitian pediatric residents and nurses were doing what they did every morning. Tending to an overcrowded patient population of babies, children, and parents. The pediatrics building was left uninhabitable. All inpatient and outpatient care took place on a street where the tents had been erected.In the ICU, tent twenty beds filled a space probably meant for ten military style cots. Metal cribs and full adult hospital beds were jammed next to one another to fill every possible nook. Parents slept on the adult beds with their sick children or underneath the cribs. Siblings too. Outside, hundreds of parents would line up starting at six a.m. and stand in line for hours so that they could get their children seen in a couple of smaller tents that were used to run the outpatient clinics. Moms would fan their kids under the shade of trees on the side of the road. Feed them some milk or juice while they waited. Smile at us passers-by. They seemed to possess a bottomless well of patience.Power cords with extension wires littered the street-hospital floor under the canopy.When it rained, we were only modestly concerned about electrocution. A single 1950's style metal desk with two worn out chairs greeted visitors to the entry way and was usually occupied by some of the medical staff. A single, large metal fan that had collected enough dust and soot in its circular cage to look bearded hummed a breeze toward the desk.A bottomless well of patience and resiliency. In the popular media, this last word has been thrown around a lot to describe the character of the Haitian people. It is insufficient. Their adversity is truly absurd. Sense cannot be made of the scene in the pediatrics tents months after the earthquake struck, nor elsewhere on that campus, let alone outside its walls.The local medical staff hadn't been paid a dime in many months even prior to the earthquake. They suffered unimaginable losses during the earthquake. They still came to work."We love our children. They love us too."What so many of us think of as charity... (shrink)

This book reveals how, when, where and why vitalism and its relationship to new scientific theories, philosophies and concepts of energy became seminal from the fin de siècle until the Second World War for such Modernists as Sophie Tauber-Arp, Hugo Ball, Juliette Bisson, Eva Carrière, Salvador Dalì, Robert Delaunay, Marcel Duchamp, Edvard Munch, Picasso, Yves Tanguy, Gino Severini and John Cage. For them Vitalism entailed the conception of life as a constant process of metamorphosis impelled by the free flow of (...) energies, imaginings, intuition and memories, unconstrained by mechanistic materialism and chronometric imperatives, to generate what the philosopher Henri Bergson aptly called Creative Evolution. Following the three main dimensions of Vitalist Modernism, the first part of this book reveals how biovitalism at the fin de siècle entailed the pursuit of corporeal regeneration through absorption in raw nature, wholesome environments, aquatic therapies, electromagnetism, heliotherapy, modern sports, particularly rugby; water sports, the Olympic Games and physical culture to energize the human body and vitalize its life force. This is illuminated by artists as geoculturally diverse as Gustave Caillebotte, Thomas Eakins, Munch and Albert Gleizes. The second part illuminates how simultaneously vitalism became aligned with anthroposophy, esotericism, magnetism, occultism, parapsychology, spiritism, theosophy and what Bergson called "psychic states", alongside such new sciences as electromagnetism, radiology and the Fourth Dimension, as captured by such artists as Juliette Bisson, Giacomo Balla, Albert Besnard, Umberto Boccioni, Eva Carrière, John Gerrard Keulemans, László Mohology-Nagy, James Tissot, Albert von Schrenck Notzing and Picasso. During and after the devastation of the First World War, the third part explores how Vitalism, particularly Bergson's theory of becoming, became associated with Dadaist, Neo-Dadaist and Surrealist notions of amorality, atemporality, dysfunctionality, entropy, irrationality, inversion, negation and the nonsensical captured by Hans Arp, Charlie Chaplin, Theo Van Doesburg, Kazimir Malevich, Kurt Schwitters and Vladimir Tatlin alongside Cage's concept of Nothing. After investigating the widespread engagement with Bergson's philosophies, Vitalism and art by Anarchists, Marxists and Communists during and after the First World War, it concludes with the official rejection of Bergson and any form of Vitalism in the Soviet Union under Stalin. This book will be of vital interest to gallery, exhibition and museum curators and visitors plus readers and scholars working in art history, art theory, cultural studies, modernist studies, occult studies, European art and literature, health, histories of science, philosophy, psychology, sociology, sport studies, heritage studies, museum studies and curatorship. (shrink)

McNaught, Keith; Shaw, Geoffrey Organisations ubiquitously seek feedback from their customers, for a vast range of reasons. The data may assist in improving services, responding to concerns, celebrating excellent service, or determining that desired standards are being achieved. Australian hospitals utilise a range of techniques to collect patient feedback, and to use that patient feedback as part of continuous improvement. Whilst every hospital in Australia is expected to provide excellent medical care and treatment, private hospitals regularly purport to offer some (...) form of 'distinctive care', and options for patients that do not usually exist in public hospitals. Most often, private hospital patients are contributors to private health insurance, which is expensive, and additional 'out of pocket' expenses are the norm. Patients, therefore, often have particular expectations of a private hospital, which may include their choice of doctor, surgeon or anaesthetist; a private room and ensuite bathroom; a high standard of food choices; being kept well-informed with regard to their treatment; flexible hours and arrangements for visitors; a longer stay; and personalised care. (shrink)

In response to the Covid pandemic the Norwegian government put in place the strictest border closures in Norwegian modern history, restricting entry to most foreign nationals. The Prime Minister, Erna Solberg, justified these restrictions with reference to the rise of new Covid variants, and the need to limit visitors to Norway as much as possible. In this paper we critically examine both the justification given for the border closure, and explore the possible adverse effects this closure might bring about. (...) We argue that the recent closures are not morally justified, that they place an unjust burden on transnational citizens and Norwegians with close relations abroad, and that such border closures can have severe impacts for many individuals, on Norway’s international standing and on social cohesion. (shrink)

Guidelines provided by the Director of Public Prosecutions suggest that anyone assisting another to commit suicide in England and Wales, or elsewhere, will not be prosecuted provided there are no self-seeking motives and no active encouragement. This reflects the position in Switzerland. There, however, no difference is made between assistance and inducement. In addition, the Swiss approach makes it possible to establish organisations to assist the suicides of both their citizens and foreign visitors. It should not be assumed that (...) this approach is without controversy in Switzerland. Proposals for reform continue to be debated there, not least because of the concern about some of the actual practices of certain end-of-life organisations. It is likely that a few English citizens will continue to avail themselves of these services in Switzerland if they cannot find the help they require here. This paper explores the legitimacy of the current restrictive position adopted towards assisted suicide in England. It argues that the provisions within the guidelines prohibiting organisations that assist suicides, leaves some without the help they need. While legislative decriminalisation of assisted suicide and the establishment of state-sponsored suicide centres would represent the most permissive regime, this paper proposes that this would be a step too far. The preference here is for decriminalisation but adopting a ‘middle way’ between the two extremes: the more permissive approach provided by the ‘Swiss model’ is one that could be employed here, albeit within a more robust regulatory regime. (shrink)

Rambam Medical Center, the only tertiary care center and largest hospital in northern Israel, was subjected to continuous rocket attacks in 2006. This extreme situation posed serious and unprecedented ethical dilemmas to the hospital management. An ambiguous situation arose that required routine patient care in a tertiary modern hospital together with implementation of emergency measures while under direct fire. The physicians responsible for hospital management at that time share some of the moral dilemmas faced, the policy they chose to follow, (...) and offer a retrospective critical reflection in this paper. The hospital’s first priority was defined as delivery of emergency surgical and medical services to the wounded from the battlefields and home front, while concomitantly providing the civilian population with all elective medical and surgical services. The need for acute medical service was even more apparent as the situation of conflict led to closure of many ambulatory clinics, while urgent or planned medical care such as open heart surgery and chemotherapy continued. The hospital management took actions to minimize risks to patients, staff, and visitors during the ongoing attacks. Wards were relocated to unused underground spaces and corridors. However due to the shortage of shielded spaces, not all wards and patients could be relocated to safer areas. Modern warfare will most likely continue to involve civilian populations and institutes, blurring the division between peaceful high-tech medicine and the rough battlefront. Hospitals in high war-risk areas must be prepared to function and deliver treatment while under fire or facing similar threats. (shrink)

Critics of mass culture often identify 1950s-style status competition as one of the central forces driving consumerism. Thomas Frank has challenged this view, arguing that countercultural rebellion now provides the primary source of consumerism in our society, and that ‘cool’ has become its central ideological expression. This paper provides a rearticulation and defense of Frank's thesis, first identifying consumerism as a type of collective action problem, then showing how the ‘hip consumer’ is one who adopts a free-rider strategy in this (...) context. (shrink)

Proposed educational outcomes for the health humanities in medical education range from empathy to visual thinking skills to social accountability. This lack of widely agreed-upon high-level curricular goals limits humanities educators’ ability to design purposeful curricula toward clear, common ends and threatens justifications for scarce curricular time. We propose a novel approach to the hoped-for outcomes of health humanities training in medical schools, which has the potential to encompass traditional health humanities knowledge, skills, and behaviors while also (...) being concrete and measurable: humanistic practice. Humanistic practice, adapted from the concept of ethical sensitivity, is an intentional process of applying humanities knowledge and skills to a clinical scenario by 1) noticing that the scenario requires humanities knowledge or skills, 2) informing one’s clinical and interpersonal strategy and behavior with humanities knowledge or skills, 3) reflecting on the effectiveness of the strategy and behavior, and 4) reorienting to develop new approaches for future practice. The construct of humanistic practice may help address some of the foundational problems in health humanities outcomes research since it transcends the traditional diverse content domains in the health humanities, can link patient and provider experiences, and may bridge the divide among the additive, curative, and intrinsic epistemic positions of humanities to medical education. (shrink)