In markets where vegetables are commonly cultivated with heavy use of synthetic pesticides, it is particularly important for consumers to be able to identify genuine organic produce. Organic Participatory Guarantee Systems (PGS) certification offers smallholder farmers an affordable way to build trust among consumers and secure premium prices for their organic produce. In Vietnam, the demand for vegetables with no, or low, pesticide residues is growing. The attractiveness of PGS certification should increase accordingly, but the number of organic PGS certified (...) farmers in Vietnam are stagnating or even decreasing. The aim of this study is to explain this paradox by investigating the factors that influence the adoption of organic PGS certification among Vietnamese vegetable farmers. We follow a mixed methods approach, combining a qualitative analysis of farmer interviews (_n_ = 62) and a quantitative analysis of a farm survey data (_n_ = 434) using a sample selection model that estimates adoption contingent on farmers’ awareness of PGS certification. Drawing on the Unified Theory of Acceptance and Use of Technology, we found that social relationships and positive attitudes towards farming and the environment drive the adoption of organic PGS. Barriers include insufficient knowledge of organic farming techniques, labour shortages, and ageing farmers. At the systemic level, support by (non-)governmental institutions facilitates adoption, but challenges such as lower yields and limited access to premium markets remain. To promote organic PGS among Vietnamese vegetable farmers, efforts should focus on disseminating organic farming techniques that boost yields, alleviate labour demands, and ensure secure markets for premium-priced organic vegetables. (shrink)

Many of us have a prereflective sense--or at least, a hope--that there are reasons to be moral which apply to an agent regardless of what his or her existing motivations may be. The view that there are no such reasons may, then, be regarded as a form of moral scepticism. The philosophical position which seems most fit to refute this form of moral scepticism, and hence to support our prereflective sense, is a Kantian view of morality, according to which (...) we are required to be moral solely in virtue of being rational. I examine a number of recent arguments for this position; I conclude that all of them fail, and for similar reasons. Nor, I argue, is there any non-Kantian view which could succeed at the same task. It is thus very tempting to infer that this form of moral scepticism is immune to any simple refutation. However, perhaps the best way to combat scepticism is not to argue for its negation--as do the positions examined so far--but to show that there is something problematic in the sceptic's whole approach to the issue. At this point I turn for enlightenment to an analogy with epistemological scepticism. Here, too, if we try to argue for the negation of scepticism, we seem bound to fail; but here the more subtle strategy of attacking the sceptic's whole approach has actually been attempted. I sketch a number of versions of this more subtle strategy; I then sketch some analogous responses to moral scepticism, and consider whether any of them are successful. I argue that the attempt fails--that even if epistemological scepticism is indeed amenable to this kind of treatment , moral scepticism is not. This conclusion is only strengthened when I argue that another, related strategy, which employs an analogy between morality and mathematics, also falls short at the same point. Moral scepticism therefore survives intact. The appropriate reaction, I suggest, is neither complete despair nor complete equanimity. (shrink)

Background Over the last years, there has been a growth in care solutions aiming to support home-dwelling persons with dementia. Assistive technology and voluntarism have emerged as supplements to traditional homecare and daycare centers. However, patient participation is often lacking in decision-making processes, undermining ethical principles and basic human rights. Research objective This study explores the perceptions of persons with dementia toward assistive technology, volunteer support, homecare services, and daycare centers. Research design A hermeneutical approach was chosen for (...) this study, using a semi-structured interview guide to allow for interviews in the form of open conversations. Participants and research context Twelve home-dwelling persons with dementia participated in the study. The participants were recruited through municipal daycare centers. Ethical considerations Interviews were facilitated within a safe environment, carefully conducted to safeguard the participants’ integrity. The Regional Committee for Medical and Health Research Ethics, Western Norway (Project number 2016/1630) approved the study. Findings The participants shared a well of reflections on experience and attitudes toward the aspects explored. They described assistive technology as possibly beneficial, but pointed to several non-beneficial side effects. Likewise, they were hesitant toward volunteer support, depending on how this might fit their individual preferences. Homecare services were perceived as a necessary means of care, its benefits ascribed to a variety of aspects. Similarly, the participants’ assessments of daycare centers relied on specific aspects, with high individual variety. Discussion and conclusion The study indicates that the margins between whether these specific care interventions were perceived as supportive or infringing may be small and details may have great effect on the persons’ everyday life. This indicates that patient participation in decision-making processes for this group is—in addition to be a judicial and ethical requirement—crucial to ensure adequate care and support. (shrink)

This study aimed to identify the ethical issues faced by home care physicians and nurses, and the support they require. It was conducted in collaboration with the Japanese Association for Home Care Medicine from November to December 2020. An e-mail was sent to 2785 physicians and 582 nurses who are members of the society, requesting their participation in a web-based survey targeting physicians and nurses with practical experience in home care; 152 physicians and 53 nurses responded. Home care physicians (...) and nurses face ethical issues, some of which are that “the patient’s wishes cannot be reliably understood owing to their impaired decision-making capacity” and “there is disagreement between the patient and their family members over the necessary healthcare.” The respondents sought “experience with, and insight into, healthcare ethics” and “home care” from people with whom they would consult on ethical issues, but at the time of the actual consultation, those individuals were the main healthcare professionals involved with the patient. In addition, the respondents desired to have “multidisciplinary discussions in the community,” “participation of healthcare ethics experts at meetings,” and “meetings held by healthcare ethics experts” to discuss specific cases. Given these results and the history of healthcare ethics education in Japan—which has been implemented mostly for healthcare providers—we conclude that it is important for academic societies that offer healthcare ethics education to healthcare providers and regional core hospitals with ethics support resources to collaborate to provide ethics consultation services in the community. (shrink)

Our homes are where we live and play, and for those making positive vegan choices, it's important for our domestic spaces to be environmentally friendly and cruelty-free. This book provides practical advice and inspiration to everyone who is building or renovating and wants a home that both supports their lifestyle and benefits the planet. Topics include making intelligent choices on appliances and creating butterfly-friendly gardens. With ideas, tips, and guidelines for every aspect of home design, readers will see how (...) easy it is to make smart choices and create a beautiful, safe space for living. (shrink)

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients’ homes. This greatly impacts nurses’ work in home care, making their work increasingly diverse and demanding. In this study, we explore home‐care nursing through a critical discourse analysis of focus group interviews with home‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. Nurses hold a (...) crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home‐care nurses’ work. Changes have made nurses’ work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses’ work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses’ work to help shape the further development of home‐care nursing. (shrink)

Background: Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment. Objective: To identify and describe family caregivers’ experiences regarding care decisions for situations (...) that can lead to involuntary treatment use in persons living with dementia at home. Research design: A qualitative descriptive interview design. Data were analysed using the Qualitative Analysis Guide of Leuven. Participants and research context: A total of 10 family caregivers providing care for 13 persons living with dementia participated in in-depth semi-structured interviews. Participants were recruited by registered nurses via purposive sampling. Ethical consideration: The study protocol was approved by the Ethics Committee of the University Hospitals Leuven and the Medical Ethical Test Committee Zuyderland. Findings: Family caregivers experience the decision-making process concerning care dilemmas that can lead to involuntary treatment as complicated, stressful and exhausting. Although they consider safety and autonomy as important values, they struggle with finding the right balance between them. Due to the progressive and unpredictable nature of dementia, they are constantly seeking solutions while they adapt to new situations. Family caregivers feel responsible and experience social pressure for the safety of persons living with dementia. They may be blamed if something adverse happens to the persons living with dementia, which increases an already stressful situation. Their experience is influenced by characteristics of the care triad (persons living with dementia, professional and family caregivers) such as practical and emotional support, knowledge, and previous experiences. Discussion and conclusion: To prevent involuntary treatment, professionals need to proactively inform family caregivers, and they need to support each other in dealing with complex care situations. (shrink)

Six case studies on nursing home staff attitudes to patient autonomy have been analysed. The case studies are based on six polarities within autonomy, as developed by Collopy. In total, 189 professional caregivers, comprising the staff of 13 nursing homes in the county of Stockholm, Sweden, responded to questions based on the case studies. Results show that the attitudes within each professional category had a high level of internal correspondence. Nurses consistently supported patient preferences to the highest degree, followed (...) by assistant nurses and auxiliary staff. Nurses' aides ranked lowest in supporting patient preferences. In only one of the cases were background variables of significance. (shrink)

In the United States, interest in urban agriculture has grown dramatically. While community gardens have sprouted across the landscape, home food gardens—arguably an ever-present, more durable form of urban agriculture—have been overlooked, understudied, and unsupported by government agencies, non-governmental organizations, and academics. In part a response to the invisibility of home gardens, this paper is a manifesto for their study in the Global North. It seeks to develop a multi-scalar and multidisciplinary research framework that acknowledges the garden’s social and ecological (...) or material dimensions. Given the lack of existing research, we draw on the more extensive literature on home gardens in the South and community gardens in the North to develop a set of hypotheses about the social-ecological effects of urban home food gardens in the North. These gardens, we hypothesize, contribute to food security, community development, cultural reproduction, and resilience at multiple scales; conserve agrobiodiversity; and support urban biodiversity. They may also have negative ecological effects, such as stormwater nutrient loading. Because of the entanglement of the social and the ecological or material in the garden, we review three theoretical perspectives—social ecological systems theory, actor-network theory, and assemblage theory—that have been or could be applied to the multi-scalar and multidisciplinary study of the garden. We also review sampling and analytic methods for conducting home garden research. The paper concludes with a discussion of opportunities to extend the research agenda beyond descriptive analysis, the primary focus of garden research to date. (shrink)

The aim of this study was to explore metaphors for discovering values and norms held by nurses in home-based nursing care. Ten interviews were analysed and interpreted in accordance with a metaphor analytical method. In the analysis, metaphoric linguistic expressions and two entailments emerged, grounded in the conceptual metaphor ‘home-based nursing care is an endless journey’, which were created in a cross-domain mapping between the two conceptual domains of home-based nursing care and travel. The metaphor exposed home-based nursing care as (...) being in constant motion, thereby requiring nurses to adjust to circumstances that demand ethical maturity. The study focuses on the importance of developing further theories supporting nurses’ expressions of their experiences of everyday ethical issues. (shrink)

This book analyzes practices in the home health care industry and concludes that they are highly exploitative of both workers and patients. Under the existing system, underpaid workers are expected to perform tasks for which they are inadequately trained, in unreasonably short periods of time. This situation harms workers and puts home health care patients at risk. To the extent that the majority of patients and workers in home health care are women, I turn to feminist ethics for an alternative (...) approach. Through an understanding of individuals as social beings with obligations to others, and of home health care as a public good, I explain how to develop the social benefits of good home health care and increase the role of government in providing financial support and regulatory oversight. (shrink)

Background: Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers in home care, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. Aim: To explore how nurses in home care deal with the transformation towards fostering patient autonomy and self-care. Research design and context: A case study was conducted (...) in a professional development course (‘learning circle’) for home care nurses, including participant observations and focus groups. The theoretical notion of ‘relational agency’ and the moral concept of ‘practices of responsibility’ were used to conduct a narrative analysis on the nurses’ stories about autonomy. Participants: Eight nurses, two coaches and two university lecturers who participated in the learning circle. Ethical considerations: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. Findings: Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients’ strengths and collaboration with patients and informal caregivers. Discussion: On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their daily home care practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. Conclusion: The turn towards autonomy in healthcare raises moral questions about responsibilities for care. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together. (shrink)

Background: Ought nursing homes to establish clinical ethics committees (CECs)? An answer to this question must begin with an understanding of how a clinical ethics committee might be beneficial in a nursing home context – to patients, next of kin, professionals, managers, and the institution. With the present article, we aim to contribute to such an understanding. Aim: We ask, in which ways can clinical ethics committees be helpful to stakeholders in a nursing home context? We describe in depth (...) a clinical ethics committee case consultation deemed successful by stakeholders, then reflect on how it was helpful. Research design: Case study using the clinical ethics committee’s written case report and self-evaluation form, and two research interviews, as data. Participants and research context: The nursing home’s ward manager and the patient’s son participated in research interviews. Ethical considerations: Data were collected as part of an implementation study. Clinical ethics committee members and interviewed stakeholders consented to study participation, and also gave specific approval for the publication of the present article. Findings/results: Six different roles played by the clinical ethics committee in the case consultation are described: analyst, advisor, support, moderator, builder of consensus and trust, and disseminator. Discussion: The case study indicates that clinical ethics committees might sometimes be of help to stakeholders in moral challenges in nursing homes. Conclusions: Demanding moral challenges arise in the nursing home setting. More research is needed to examine whether clinical ethics committees might be suitable as ethics support structures in nursing homes and community care. (shrink)

In a qualitative study, 22 stroke patients undergoing rehabilitation in three nursing homes were interviewed about constraints on and improvements in their autonomy and about approaches of health professionals regarding autonomy. The data were analysed using grounded theory, with a particular focus on the process of regaining autonomy. An approach by the health professionals that was responsive to changes in the patients’ autonomy was found to be helpful for restoration of their autonomy. Two patterns in health professionals’ approach appeared (...) to be facilitatory: (1) from full support on admission through moderate support and supervision, to reduced supervision at discharge; and (2) from paternalism on admission through partial paternalism (regarding treatment) to shared decision making at discharge. The approach experienced by the patients did not always match their desires regarding their autonomy. Support and supervision were reduced over time, but paternalism was often continued too long. Additionally, the patients experienced a lack of information. Tailoring interventions to patients’ progress in autonomy would stimulate their active participation in rehabilitation and in decision making, and would improve patients’ preparation for autonomous living after discharge. (shrink)

The ability of patients with decision-making capacity to refuse medically beneficial and even life-saving medical interventions is considered fundamental to upholding the principle of respect for a...

The assumption in current U.S. mainstream medicine is that birthing requires hospitalization. In fact, while the American College of Obstetricians and Gynecologists supports the right of every birthing person to make a medically informed decision about their delivery, they do not recommend home birth owing to data indicating greater neonatal morbidity and mortality. In this article, we examine the evidence surrounding home birth in the United States and its current limitations, as well as the ethical considerations around birth setting.

We propose an empirical mode decomposition (EMD-) based method to extract features from the multichannel recordings of local field potential (LFP), collected from the middle temporal (MT) visual cortex in a macaque monkey, for decoding its bistable structure-from-motion (SFM) perception. The feature extraction approach consists of three stages. First, we employ EMD to decompose nonstationary single-trial time series into narrowband components called intrinsic mode functions (IMFs) with time scales dependent on the data. Second, we adopt unsupervised K-means clustering to group (...) the IMFs and residues into several clusters across all trials and channels. Third, we use the supervised common spatial patterns (CSP) approach to design spatial filters for the clustered spatiotemporal signals. We exploit the support vector machine (SVM) classifier on the extracted features to decode the reported perception on a single-trial basis. We demonstrate that the CSP feature of the cluster in the gamma frequency band outperforms the features in other frequency bands and leads to the best decoding performance. We also show that the EMD-based feature extraction can be useful for evoked potential estimation. Our proposed feature extraction approach may have potential for many applications involving nonstationary multivariable time series such as brain-computer interfaces (BCI). (shrink)

Planned home birth has been considered by some to be consistent with professional responsibility in patient care. This article critically assesses the ethical and scientific justification for this view and shows it to be unjustified. We critically assess recent statements by professional associations of obstetricians, one that sanctions and one that endorses planned home birth. We base our critical appraisal on the professional responsibility model of obstetric ethics, which is based on the ethical concept of medicine from the Scottish and (...) English Enlightenments of the 18th century. Our critical assessment supports the following conclusions. Because of its significantly increased, preventable perinatal risks, planned home birth in the United States is not clinically or ethically benign. Attending planned home birth, no matter one’s training or experience, is not acting in a professional capacity, because this role preventably results in clinically unnecessary and therefore clinically unacceptable perinatal risk. It is therefore not consistent with the ethical concept of medicine as a profession for any attendant to planned home birth to represent himself or herself as a “professional.” Obstetric healthcare associations should neither sanction nor endorse planned home birth. Instead, these associations should recommend against planned home birth. Obstetric healthcare professionals should respond to expressions of interest in planned home birth by pregnant women by informing them that it incurs significantly increased, preventable perinatal risks, by recommending strongly against planned home birth, and by recommending strongly for planned hospital birth. Obstetric healthcare professionals should routinely provide excellent obstetric care to all women transferred to the hospital from a planned home birth. The professional responsibility model of obstetric ethics requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and address patients’ concerns about excessive interventions. Creating a sustained culture of comprehensive safety, which cannot be achieved in planned home birth, informed by compassionate and respectful treatment of pregnant women, should be a primary focus of professional obstetric responsibility. (shrink)

People who have mental illness are in particular need of what a home can provide, but they are especially vulnerable to not being in a place with a home-like environment, whether due to homelessness, incarceration, or hospitalization. At any given time, approximately 170,000 people are inpatients in psychiatric units or hospitals (NASMHPD 2017). Psychiatric hospitals are not homes, and they are not designed for long-term stay. The main purpose of the modern psychiatric hospital is to stabilize people in mental (...) health crises, such as those who are psychotic or suicidal; hospitals are best thought of as temporary, transitional dwellings. Even though a person may only reside there for a week or a month, however, it is a crucial period of stabilization and healing. As this paper argues, practices of home-making increase epistemic and moral agency, which enables crisis stabilization, healing, and recovery. This paper examines several functions of home and shows some of the ways that patients in psychiatric hospitals try to replicate these functions in the physical space they have given their many constraints. Because practices of home-making support the goals of hospitalization, the hospital experience should be designed to encourage these practices as much as possible. (shrink)

Emerging evidence has shown a positive association between the home literacy environment and monolingual children’s language and literacy development. Yet, far fewer studies have examined the impact of the HLE on second language development. This study examined relations between the HLE and children’s development of English as a second language in Hong Kong. Participants were 149 ethnic Chinese children and one of their caregivers. Caregivers completed questionnaires about their family backgrounds and HLE and children were assessed on their English language (...) and literacy skills. Findings revealed considerable variability in the types of literacy activities that caregivers were engaged in at home with their children. A series of multilevel regressions demonstrated that the HLE was differentially associated with English vocabulary, letter knowledge, phonological awareness, and word reading skills after controlling for child and family characteristics. Results highlight the importance of a literacy-rich home environment for children’s development of English as a second language and the need to support caregivers in providing a range of home literacy activities to facilitate different language and literacy skills. (shrink)

This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we discuss how a (...) case was discussed with CURA at a psychogeriatric ward of an elderly care home. Furthermore, we go into some considerations regarding the use of the instrument in clinical practice. Finally, we focus on the need for further research on the effectiveness and implementation of CURA. (shrink)

Humans have been called “cooperative breeders” because mothers rely heavily on alloparental assistance, and the grandmother life stage has been interpreted as an adaptation for alloparenting. Many studies indicate that women invest preferentially in their daughters’ children, but little research has been conducted where patrilocal residence is normative. Bangladesh is such a place, but women nevertheless receive substantial alloparental investment from the matrilateral family, and child outcomes improve when maternal grandmothers are alloparents. To garner this support, women must maintain (...) contact with their natal families. Here, the visiting behavior of 151 interviewed mothers was analyzed. Despite the challenges of patrilocality and purdah, almost all respondents visited their own mothers, and mothers-in-law were visited far less. This contrast persists in analyses controlling for proximity, respondent age, postmarital residence, family income, and marital status. These results affirm the importance women place on matrilateral ties, even under a countervailing ideology. (shrink)

In our globalized and interconnected world, companies are increasingly donating substantial amounts to good causes around the globe. Many companies choose to donate “at home” while others give to causes in faraway places where recipients are in dire need of support. Interestingly, past research on corporate donations has neglected the question of whether consumers differentially reward companies for geographically varying allocations of donation budgets. Through a mixed methods approach, this paper remedies this gap by developing and empirically testing a (...) conceptual framework of consumers’ preferences for geographically varying allocations of corporate donation budgets. In a first step, two preliminary field studies involving real donations explored customers’ preferences for donation allocations varying in geographical focus. A qualitative focus group study then investigated underlying rationales to inform the research and led to the development of hypotheses. Subsequently a large-scale between-subjects scenario experiment tested the predictions. Overall, results indicate that, in contrast with current managerial practice, customers prefer companies that split donations equally between domestic and foreign recipients or even donate only abroad. (shrink)

The Coming Home Project of the Snowflower Sangha in Madison, Wisconsin is an active member of MOSES, a nonpartisan interfaith organization that works to promote systemic change for social justice issues with a focus on mass incarceration and ending the use of solitary confinement in the state's prisons and jails. To support these efforts, and to restore dignity and safety to the entire community, CHP members work to make Wisconsin's sentencing rules and laws more just and humane, increase treatment (...) alternatives to incarceration, stop crimeless revocations back to prison, and remove barriers to employment for previously incarcerated individuals returning to their communities. (shrink)

What is the primary function of consciousness in the nervous system? The answer to this question remains enigmatic, not so much because of a lack of relevant data, but because of the lack of a conceptual framework with which to interpret the data. To this end, we have developed Passive Frame Theory, an internally coherent framework that, from an action-based perspective, synthesizes empirically supported hypotheses from diverse fields of investigation. The theory proposes that the primary function of consciousness is well-circumscribed, (...) serving the 'somatic nervous system[. For this system, consciousness serves as a frame that constrains and directs skeletal muscle output, thereby yielding adaptive behavior. The mechanism by which consciousness achieves this is more counterintuitive, passive, and “low level” than the kinds of functions that theorists have previously attributed to consciousness. Passive frame theory begins to illuminate (a) what consciousness contributes to nervous function, (b) how consciousness achieves this function, and (c) the neuroanatomical substrates of conscious processes. Our untraditional, action-based perspective focuses on olfaction instead of on vision and is 'descriptive' (describing the products of nature as they evolved to be) rather than 'normative' (construing processes in terms of how they should function). Passive frame theory begins to isolate the neuroanatomical, cognitive-mechanistic, and representational (e.g., conscious contents) processes associated with consciousness. (shrink)

Background Nurse leaders increasingly need effective tools that facilitate the prioritisation of ethics and help staff navigate ethical challenges and prevent moral distress. This study examined experiences with a new digital tool for ethical reflection, tailored to improve the capabilities of both leaders and employees in the context of municipal long-term care. Aim The aim was to explore the experiences of nurse leaders and nurses in using Digital Ethical Reflection as a tool for ethics work in home nursing care. Research (...) design The study employed a qualitative design, incorporating individual and focus group interviews for data collection. Qualitative content analysis was used to analyse the data. Participants and research context The participants comprised six nurse leaders and 13 nurses, representing six home care zones across two Norwegian municipalities. Ethical considerations The study involved informed, voluntary participation and was approved by the Norwegian Agency for Shared Services in Education and Research. Findings Four themes were developed: a constant walk on the edge between engagement and discouragement and lost in translation describe the process, while tuning in to the ethical dimension and navigating ethical uncertainties illuminate the experienced significance of Digital Ethical Reflection. Conclusion Success with Digital Ethical Reflection in home nursing care depends on clear leadership planning, nurses’ understanding of the tool’s purpose, and active use of digital registrations. Support from ethically interested nurses enhances overall engagement. Further research is needed to explore the potential of Digital Ethical Reflection as an additional tool in long-term care ethics work. (shrink)

The history of nursing in the home: revealing the significance of place in the expression of moral agencyThe relationship between place and moral agency in home care nursing is explored in this paper. The notion of place is argued to have relevance to moral agency beyond moral context. This argument is theoretically located in feminist ethics and human geography and is supported through an examination of historical documents (1900–33) that describe the experiences and insights of American home care/private duty nurses (...) or that are related to nursing ethics. Specifically, the role of place in inhibiting and enhancing care, justice, good relationships, and power in the practice of private duty nurses is explored. Several implications for current nursing ethics come out of this analysis. (i) The moral agency of nurses is highly nuanced. It is not only structured by nurses’ relationships to patients and health professionals, i.e. moral context, it is also structured by the place of nursing care. (ii) Place has the potential to limit and enhance the power of nurses. (iii) Some aspects of nursing's conception of the good, such as what constitutes a good nurse–patient relationship, are historically and geographically relative. (shrink)

Though “dwelling” is more commonly associated with Heidegger’s philosophy than with that of Merleau-Ponty, “being-at-home” is in fact integral to Merleau-Ponty’s thinking. I consider the notion of home as it relates to Merleau-Ponty’s more familiar notions of the “lived body” and the “level,” and, in particular, I consider how the unique intertwining of activity and passivity that characterizes our being-at-home is essential to our nature as free beings. I argue that while being-at-home is essentially an experience of passivity—i.e., one that (...) rests in the background of our experience and provides a support and structure for our life that goes largely unnoticed and that is significantly beyond our “conscious” control—being-at-home is also a way of being to which we attain . This analysis of home reveals important psychological insights into the nature of our freedom as well as into the nature of the development of our adult ways of coping and behaving. (shrink)

Background: Autonomy and participation are threatened within the group of older people living in nursing homes. Evidence suggests that healthcare personnel act on behalf of older people but are still excluding them from decision-making in everyday care. Objective: The purpose was to describe registered nurses’ experience of caring for older people in nursing homes to promote autonomy and participation. Research design: A descriptive design with a phenomenological approach was used. Data were collected by semi-structured individual interviews. Analysis was (...) inspired by Giorgi’s method. Participants and research context: A total of 13 registered nurses from 10 nursing homes participated. Ethical considerations: Ethical approval was obtained from the Regional Research Ethics Committee. Informed consent was achieved and confidentiality guaranteed. Findings: The essence of caring for older people in nursing homes to promote autonomy and participation consisted of registered nurses’ awareness of older people’s frailty and the impact of illness to support health and well-being, and awareness of acknowledgement in everyday life and trusting relationships. Paying attention to older people by being open to the persons’ wishes were aspects that relied on registered nurses’ trusting relationships with older people, their relatives and surrounding healthcare personnel. The awareness reflected challenges in caring to promote older people’s right to autonomy and participation in nursing homes. Registered nurses’ strategies, hopes for and/or concerns about development of everyday life in nursing homes were revealed and mirrored their engagement in caring for older people. Discussion and conclusion: Awareness of older people’s frailty in nursing homes and the importance of maintained health and well-being were described as the main source for promoting autonomy and participation. Everyday life and care in nursing homes needs to be addressed from both older people’s and healthcare personnel’s perspectives, to promote autonomy and participation for residents in nursing homes. (shrink)

The purpose of this study was to explore and interpret the meaning of relatives’ experiences of encounters with nurses when visiting residents in nursing homes. Thirteen relatives of residents in three nursing homes in Sweden were interviewed. The interviews were tape‐recorded and transcribed verbatim. The method used was hermeneutical text analysis. Four themes emerged in the analysis and interpretation of the whole text: ‘being paid attention to’, ‘being ignored’, ‘being involved’ and ‘being safe and secure’. A further interpretation (...) of the findings shows a deeper understanding of the meaning of relatives. This meaning was revealed as being invited into an encounter with nurses and gave a sense of community but the opposite was being ignored and left outside. This study gives a deeper understanding of the meaning of encounters between relatives and nurses in nursing homes; it also illuminates how these encounters also can affect the care of the residents. This new understanding can hopefully offer support for nurses during their encounters with relatives and optimise the ability to provide a positive outcome for residents in nursing homes. (shrink)

I examine experiences of married couples to better understand whether economic shifts that push couples into gender-atypical work/family arrangements influence gender inequality. I draw on in-depth interviews conducted in 2008 with stay-at-home husbands and their wives in 21 married-couple families with children. I find that the decision to have a father stay home is heavily influenced by economic conditions, suggesting that men’s increased job instability and shifts in the relative employment conditions of husbands and wives push some men into at-home (...) fatherhood. However, this shift in family arrangements can promote change toward greater gender equality even in couples that initially hold entrenched, gendered beliefs. The data indicate that at-home fathers come to value their increased involvement in children’s care in ways that reduce gender differences in parenting and that have the potential to translate into institutional change, particularly when they reenter the labor force. Furthermore, at-home father arrangements generally appear to provide increased support for women’s employment and promote changes in women’s work behavior that may reduce inequities that stem from traditionally gendered divisions in work/family responsibilities. (shrink)

Home births continue to constitute only a small percentage of all deliveries in the United States, in part because of concerns about their safety. While the literature is decidedly mixed in regard to the degree of risk, there are several studies that report that home birth may at times entail a small absolute increase in perinatal risks in circumstances that cannot always be anticipated prior to the onset of labor. While the definition of “small” will vary between individuals, and publications (...) vary in the level of risk they ascribe to birth at home, studies with the least methodological flaws and with adequate power often cite an excess death rate in the range of one per thousand.Home birth is, in that regard, but one example of patients’ choices and plans that sometimes carry increased risk or include alternatives that individual physicians feel uncomfortable supporting or recommending. Our intention in this opinion piece is not to advocate for or against home birth. Rather, we recognize that home birth is but one example of a patient choice that might differ from what a provider feels is in a woman’s best interests.In this article we will discuss ethical considerations in such circumstances using home birth as an example. We consider in this article how the ethical principles of respect for autonomy and non-maleficence can be balanced using, among other examples, the choice by some for a home birth. We discuss how absolute rather than relative risk should guide individuals’ evaluation of patient choices. We also consider how in some circumstances, the value and safety added by a physician’s participation may outweigh a potentially small increment in absolute risk that might result from a patient’s decision to deliver at home because of a perceived physician endorsement.We recognize, however, that doctors and midwives participating in choices they have not recommended, or may even believe will lead to or increase risk for adverse outcomes, presents dilemmas and raises important questions. When does respect for patient choice and autonomy become support for poor decision making? When is participation not respectful but enabling? Finally we discuss the role and responsibility of organized medicine in making all births as safe as possible. (shrink)

Context: The emergency situation caused by coronavirus disease 2019 (COVID-19) has affected different facets of society. Although much of the attention is focused on the health sector, other sectors such as education have also experienced profound transformations and impacts. This sector is usually highly affected by psychosocial risks, and this could be aggravated during the current health emergency. Psychosocial risks may cause health problems, lack of motivation, and a decrease of effectiveness at work, which in turn affect the quality of (...) teaching. Despite their importance, there are hardly any studies that analyze psychosocial risks of non-university teachers during a health emergency such as that caused by COVID-19. Objectives The aim of this study was to analyze the perception of COVID-19 and the psychosocial risks of non-university teachers comparing Spain and Mexico during the state of alarm caused by COVID-19. Methods Data were collected from 421 non-university teachers (80.2% women; 56.3% from Mexico, 43.7% from Spain) aged 24–60 ( M = 39.32, SD = 10.21) via a self-completed questionnaire during the pandemic from March to April 2020. Results Data analysis suggests that inequity is the most important risk, followed by work overload. Teachers appear to be moderately satisfied with the information on COVID-19 and the measures taken, while their satisfaction with the available resources is lower. When comparing the two countries, significant differences can be observed in every risk considered except for social support, with lower levels in Mexican teachers compared to Spanish ones. In the case of the perception of COVID-19 and its impact, the perception in general of levels of information, measures, and resources is better among Mexican teachers than among Spanish ones, who present higher scores of the impact of the health emergency. Conclusion The results underline the importance of the professional’s perception of resources during a health emergency, which could prevent to some extent burnout and possible alterations associated with it. The measures taken by the responsible entities and the provision of information do affect teachers not only directly but also indirectly by making them more vulnerable to psychosocial risks that could affect their health and professional performance, thus affecting students as well. (shrink)

I argue that, although we are inherently intersubjective beings, we are not first or most originally “public” beings. Rather, to become a public being, that is, a citizen—in other words, to act as an independent and self-controlled agent in a community of similarly independent and self-controlled agents and, specifically, to do so in a shared space in the public arena—is something that we can successfully do only by emerging from our familiar, personal territories—our homes. Finding support in texts (...) from philosophy, psychology, and the social sciences, I construe the claim that citizenship is a developed stance as a spatial issue. I conclude that a state (or, for that matter, a philosophy) that takes the human being to begin as an isolated individual agent fails to recognize the essential spatial relationships on which we depend—namely, those arising through our way of being-at-home in the world; and, as a result, such a stance not only misconstrues the parameters on which citizenship is itself possible but also risks developing a social situation that encourages behaviors we see in the agoraphobic—namely, the behaviors of alienated and fundamentally homeless human beings. (shrink)

In this paper, I argue that addressing the medical needs of older persons warrants expanding the array of insured services as described by the Canada Health Act to include home care. The growing importance of chronic care supports my call for federally regulated home care services as the nature of disease management has changed significantly in the last decades. In addition, if the values of equity, fairness and solidarity, which are the keystone values of the CHA, are to be upheld (...) within the current social and demographic context, then Canada’s health care system should adapt accordingly. I focus my argument on the services provided to older persons for two main reasons. First, the changing nature of disease management is best seen in this population. If it is to be successfully argued that the transformations in medicine warrant an expansion of insured services covered by the CHA, it will be best illustrated by looking at the needs of older persons. Second, with the demographic shift looming large in the policy agenda, an exploration of this issue is not only crucial but timely. (shrink)

A large body of scholarship in political economy suggests economic growth, and foreign direct investment in regulated industries in particular, is more likely to occur when formal institutions allow states to provide credible commitments regarding the security of property rights. In contrast, this article argues that we must instead examine differences in firm organizational structure and embeddedness to explain variation in the resilience of privatization contracts in weak institutional environments. Domestic investors—or, if contracts are granted at the subnational level, domestic (...) investors with diverse local holdings—work most effectively in the developing world. Domestic investors are better able to negotiate mutually beneficial adaptations to their formal contracts with host governments because they can draw on informal contractual supports that derive from cross-sector diversification and embeddedness in the market. This article finds strong support for this argument through an analysis of fourteen water privatization contracts in Argentina. (shrink)

Should Medicaid pay for supportive housing for homeless persons? After describing current limits on how states can use Medicaid funds to support housing, this article considers whether justice requires treating Medicaid recipients residing in nursing homes and Medicaid recipients needing supportive housing similarly.

Background: As part of an ongoing Scandinavian project on the dignity of care for older people, this study is based on ‘clinical caring science’ as a scientific discipline. Clinical caring science examines how ground concepts, axioms and theories are expressed in different clinical contexts. Central notions are caring culture, dignity, at-home-ness, the little extra, non-caring cultures versus caring cultures and ethical context – and climate. Aim and assumptions: This study investigates the individual variations of caring cultures in relation to dignity (...) and how it is expressed in caring acts and ethical contexts. Three assumptions are formulated: (1) the caring culture of nursing homes influences whether dignified care is provided, (2) an ethos that is reflected on and appropriated by the caregiver mirrors itself in ethical caring acts and as artful caring in an ethical context and (3) caring culture is assumed to be a more ontological or universal concept than, for example, an ethical context or ethical person-to-person acts. Research design: The methodological approach is hermeneutic. The data consist of 28 interviews with relatives of older persons from Norway, Denmark and Sweden. Ethical considerations: The principles of voluntariness, confidentiality and anonymity were respected during the whole research process. Findings: Three patterns were revealed: dignity as at-home-ness, dignity as the little extra and non-dignifying ethical context. Discussion: Caring communion, invitation, at-home-ness and ‘the little extra’ are expressions of ethical contexts and caring acts in a caring culture. A non-caring culture may not consider the dignity of its residents and may be represented by routinized care that values organizational efficiency and instrumentalism rather than an individual’s dignity and self-worth. Conclusion: An ethos must be integrated in both the organization and in the individual caregiver in order to be expressed in caring acts and in an ethical context that supports these caring acts. (shrink)

Cancer care has transitioned from clinical-based to home-based care to support longterm care in a more familiar and comfortable environment. This care transition has put family caregivers (FCGs) in a strategic position as care providers. Cancer care at home involves psychological and emotional treatment at some point, making FCGs deal with the stress of cancer patients frequently. Due to their limited care competencies, they need supportive care from healthcare professionals in cancer stress management. This study aims to examine how (...) types of demanded healthcare information affect the FCG’s role in reducing the stress of female cancer patients. The mindsponge theory was used in conceptual development and interpretation. Bayesian Mindsponge Framework (BMF) analytics were used for statistical analysis on a dataset of 48 spouses (husbands) and 12 other family members in five congested communities of Surabaya, Indonesia. Results showed that among the six types of healthcare information, FCGs with higher demand for cancer-specific information were more likely to need support in reducing the stress of female cancer patients. Meanwhile, FCGs with a higher demand for information about support services were less likely to need support to reduce cancer patients’ stress. Other types of healthcare information have ambiguous effects on the need for support in reducing cancer-induced stress. This study reveals that the demanded cancer-specific information, e.g., cancer prognosis or likely outcome, must be prioritized to assist FCG’s role in managing cancer stress. (shrink)

The COVID-19 pandemic resulted in the abrupt closure of circus schools, venues, and companies, introducing a myriad of novel stressors. Performers and students must now attempt to maintain their technical, physical, artistic, creative, and cognitive abilities without in-person support from their coaches and must manage the isolation from their training and performing spaces. For circus artists, the transposition of the work space to a home environment is not possible, which creates novel stressors that could lead to the exacerbation and (...) escalation of mental health issues. The purpose of this study is to develop, implement and evaluate a holistic interventional program based on the socio-ecological model of resilience and operationalized through physical literacy. This will be a prospective longitudinal study with a retrospective comparison to data from a similar student cohort pre-pandemic. Interventions were designed using a population-specific, participant-based developmental model within a knowledge translation framework. The interventional program includes group webinars, small group information sessions, and one-on-one Zoom meetings, in addition to the distribution of electronic educational materials. The interventions will holistically provide psychological, physical, social, technical, artistic, and creative supports. Resources will be deployed throughout the closure period and through recovery, as transitions to return to training after prolonged hiatus will magnify known psychological and physical difficulties. Repeated, longitudinal assessment of students will be utilized to track changes over time at key transitions in the pandemic and school year and will be compared to a pre-pandemic school year. The framework for this program will be translatable to other performing arts and high-performance contexts. The program has implications for the mental health and overall wellbeing of artists and for cultural and economic recovery of the industry. (shrink)

Adaptation and stress are two main concepts useful for better understanding the phases of illness and health-related human behavior. The two faces of adaptation, adaptation as a process and adaptation as a product, have raised the question of how long the adaptation process will take in cancer trajectories. The care setting transition from clinical-based into home-based cancer care has stressed the role of family caregivers (FCG) in cancer management. This study examines how types of demanded healthcare information affect the FCG’s (...) role in catalyzing the adaptation of female cancer patients. The mindsponge theory was used in conceptual development and results interpretation. Bayesian Mindsponge Framework (BMF) analytics was used for statistical analysis on a dataset of 48 spouses (husbands) and 12 other family members in five congested communities of Surabaya, Indonesia. Results showed that among the six types of demanded healthcare information, FCGs with a higher tendency to demand cancer-specific information are more likely to need support in catalyzing the adaptation of female cancer patients. Meanwhile, FCGs with a higher demand for information on alternative therapies are less likely to need support in catalyzing cancer adaptation. Other types of healthcare information have ambiguous effects on the need for support in cancer adaptation assistance. This study reveals that the demanded cancer-specific information, e.g., cancer’s prognosis or likely outcome, must be prioritized to assist FCG’s role in catalyzing adaptation among female cancer patients. Cancer prognosis and outcomes reflect the future of cancer care results. (shrink)

Many nursing homes have an influenza vaccination policy in which it is assumed that express (proxy) consent is not necessary. Tacit consent procedures are more efficient if one aims at high vaccination rates. In this paper I focus on incompetent residents and proxy consent. Tacit proxy consent for vaccination implies a deviance of standard proxy consent requirements. I analyse several arguments that may possibly support such a deviance. The primary reason to offer influenza vaccination is that vaccinated persons (...) have a significantly reduced risk of getting the flu. This reason however cannot support the assumption that each nursing home resident is ‘better off ’ if she is vaccinated. Neither can it support tacit proxy consent policies. More promising are arguments that take the collective nature of infectious diseases into account. A potentially strong, but ultimately insufficient, argument for non‐express consent is that vaccination contributes to prevention of harm to others. Other arguments emphasise the importance of group protection: herd immunity. I discuss three collective reasons for aiming at herd immunity: solidarity, a common interest in reducing the risk of illness, and a common interest in the prevention of an influenza outbreak. The latter argument appears to be most important. An outbreak is not just detrimental to the health of residents; it is detrimental to their everyday social life as well. Outbreaks can be seen as a collective evil. My analysis shows that there are valid (though not necessarily sufficient) moral arguments for a tacit proxy consent policy. (shrink)

Background: In the Netherlands, people with severe cognitive deficits due to Korsakoff syndrome are generally admitted to a specialized nursing home. Professional caregivers experience that these residents are often not aware of their deficits, and consequently, their willingness to accept care is relatively low. However, these residents need permanent support when performing daily tasks due to severe cognitive deficits. The combination of objective care needs and low subjective responsiveness makes caring for people with Korsakoff syndrome a complex undertaking. It (...) is unknown how professional caregivers deal with this complex task and how they manage the associated ethical challenges. Objectives: The aim of this study was to explore the professional caregivers’ perspectives on good care for residents with Korsakoff syndrome. Methods: A qualitative study design was used. Data were collected via semi-structured interviews. The Framework Method was used for the thematic analyses of the interview data. Participants and research context: Five specialized nursing homes participated in this study. Twelve professional caregivers, including nurses, nursing assistants, and support workers, were selected based on the ability to provide rich information on the study topics and to capture a variety of demographic and professional characteristics. Ethical considerations: The institutional review board of the VU University Medical Center Amsterdam approved the research protocol. The study was conducted in accordance with the ethical principles for medical research involving human subjects. Findings: Three perspectives on good care emerged: (1) making daily life a joint effort, (2) being steadfast, and (3) treating with respect. Discussion and conclusion: Professional caregivers try to achieve responsiveness in people with Korsakoff syndrome in three different ways. These perspectives reflect fundamentally different views on the care relationship and the autonomy of the resident. By elucidating the three perspectives, we hope to promote the practitioners’ reflection on their own ideas about good care for people with Korsakoff syndrome. (shrink)

Parents, peers, and teachers provide a powerful context for school students’ well-being. However, a detailed and systematic analysis of how parental, peer, and teacher support relate to students’ well-being, measured by the dimensions self-worth, psychological and physical well-being, is still missing. To address this research gap, the following study investigates 733 adolescent German students from grades 7 and 8 with respect to their perceived supportive relationships at home and within the school context. The study considers gender, socioeconomic status, and (...) school form as potential confounders. The results of the structural equation model, analyzed with the statistical software R, indicate that perceived teacher support was positively related to students’ self-worth and physical well-being, while peer support was related to psychological well-being. Students who perceived their parents as supportive reported higher well-being with respect to all three dimensions investigated. (shrink)

Smart homes based on the Internet of Things have been rapidly developed. To improve the safety, comfort, and convenience of residents’ lives with minimal cost, daily activity recognition aims to know resident’s daily activity in non-invasive manner. The performance of daily activity recognition heavily depends on solving strategy of activity feature. However, the current common employed solving strategy based on statistical information of individual activity does not support well the activity recognition. To improve the common employed solving strategy, (...) an activity feature solving strategy based on TF-IDF is proposed in this paper. The proposed strategy exploits statistical information related to both individual activity and the whole of activities. Two distinct datasets have been commissioned, to mitigate against any possible effect of coupling between dataset and sensor configuration. Finally, a number of machine learning techniques and deep learning technique have been evaluated to assess their performance for residents activity recognition. (shrink)

Interpretations of family carer empowerment in much nursing research, and in home‐care practice and policy, rarely attend explicitly to families’ choice or control about the nature, extent or length of their involvement, or control over the impact on their own health. In this article, structural empowerment is used as an analytic lens to examine home‐care nurses’ interactions with families in one Western Canadian region. Data were collected from 75 hrs of fieldwork in 59 interactions (18 nurses visiting 16 families) and (...) interviews with 12 nurses and 11 family carers. Generally, nurses prioritized client empowerment, and their practice with families appeared oriented to supporting their role and needs as carers (i.e. rather than as unique individuals beyond the caring role), and reinforcing the caring role through validation and recognition. Although families generally expressed appreciation for these interactions, a structural empowerment lens illustrates how the broad context of home care shapes the interpretation and practice of empowerment in ways that can, paradoxically, be disempowering for families. Opportunities to effectively support family choice and control when a client is being cared for at home are discussed. (shrink)