BackgroundCountries are increasingly devoting significant resources to creating or strengthening research ethics committees, but there has been insufficient attention to assessing whether these committees are actually improving the protection of human research participants.DiscussionResearch ethics committees face numerous obstacles to achieving their goal of improving research participant protection. These include the inherently amorphous nature of ethics review, the tendency of regulatory systems to encourage a focus on form over substance, financial and resource constraints, and conflicts of interest. Auditing and accreditation programs (...) can improve the quality of ethics review by encouraging the development of standardized policies and procedures, promoting a common base of knowledge, and enhancing the status of research ethics committees within their own institutions. However, these mechanisms focus largely on questions of structure and process and are therefore incapable of answering many critical questions about ethics committees' actual impact on research practices.The first step in determining whether research ethics committees are achieving their intended function is to identify what prospective research participants and their communities hope to get out of the ethics review process. Answers to this question can help guide the development of effective outcomes assessment measures. It is also important to determine whether research ethics committees' guidance to investigators is actually being followed. Finally, the information developed through outcomes assessment must be disseminated to key decision-makers and incorporated into practice. This article offers concrete suggestions for achieving these goals.ConclusionOutcomes assessment of research ethics committees should address the following questions: First, does research ethics committee review improve participants' understanding of the risks and potential benefits of studies? Second, does the process affect prospective participants' decisions about whether to participate in research? Third, does it change participants' subjective experiences in studies or their attitudes about research? Fourth, does it reduce the riskiness of research? Fifth, does it result in more research responsive to the local community's self-identified needs? Sixth, is research ethics committees' guidance to researchers actually being followed? (shrink)

BackgroundSexual boundary violations in healthcare are harmful and exploitative sexual transgressions in the professional–client relationship. Persons with mental health issues or intellectual disabilities, especially those living in residential settings, are especially vulnerable to SBV because they often receive long-term intimate care. Promoting good sexual health and preventing SBV in these care contexts is a moral and practical challenge for healthcare organizations.MethodsWe carried out a qualitative interview study with 16 Dutch policy advisors, regulators, healthcare professionals and other relevant experts to explore (...) their perspectives on preventing SBV in mental health and disability care organizations. We used inductive thematic analysis to interpret our data.ResultsWe found three main themes on how healthcare organizations can prevent SBV in mental health and disability care: setting rules and regulations, engaging in dialogue about sexuality, and addressing systemic and organizational dimensions.ConclusionOur findings suggest that preventing SBV in mental health and disability care organizations necessitates setting suitable rules and regulations and facilitating dialogue about positive aspects of sexuality and intimacy, as well as about boundaries, and inappropriate behaviors or feelings. Combining both further requires organizational policies and practices that promote transparency and reflection, and focus on creating a safe environment. Our findings will help prevent SBV and promote sexual health in mental health and disability care organizations. (shrink)

Charlotte Wolff was born in Riesenburg, West Prussia into a middle-class Jewish family. She studied philosophy and then medicine at several German universities, completing her doctorate in Berlin in 1926. Working in various institutions over the next few years, she was also interested in psychotherapy and had a small private medical and psychotherapeutic practice. In 1933 she was forced to leave Germany because of the Nazi regime, and settled for a few years in Paris. As a German refugee she (...) was unable to practice medicine, so she began her research into the correlation between hand traits and personality. In 1936 she went to London to continue her research work and lived there until her death. An active lesbian from an early age, her later research turned to sexology and her writing on lesbianism and bisexuality were influential early works in the field. This is a great opportunity to rediscover her early work, including her first autobiography. (shrink)

A fact of life for farmers, hunter-gatherers, and fishermen in the rural parts of the world are that crops fail, wild resources become scarce, and winds discourage fishing. In this article we approach subsistence risk from the perspective of "coexistence thinking," the simultaneous application of natural and supernatural causal models to explain subsistence success and failure. In southwestern Madagascar, the ecological world is characterized by extreme variability and unpredictability, and the cosmological world is characterized by anxiety about supernatural dangers. Ecological (...) and cosmological causes seem to point to different risk minimizing strategies: to avoid losses from drought, flood, or heavy winds, one should diversify activities and be flexible; but to avoid losses caused by disrespected spirits one should narrow one's range of behaviors to follow the code of taboos and offerings. We address this paradox by investigating whether southwestern Malagasy understand natural and supernatural causes as occupying separate, contradictory explanatory systems (target dependence), whether they make no categorical distinction between natural and supernatural forces and combine them within a single explanatory system (synthetic thinking), or whether they have separate natural and supernatural categories of causes that are integrated into one explanatory system so that supernatural forces drive natural forces (integrative thinking). Results from three field studies suggest that (a) informants explain why crops, prey, and market activities succeed or fail with reference to natural causal forces like rainfall and pests, (b) they explain why individual persons experience success or failure primarily with supernatural factors like God and ancestors, and (c) they understand supernatural forces as driving natural forces, so that ecology and cosmology represent distinct sets of causes within a single explanatory framework. We expect that future cross-cultural analyses may find that this form of "integrative thinking" is common in unpredictable environments and is a cognitive strategy that accompanies economic diversification. (shrink)

What determines if the first interaction between strangers will be a pleasant experience? We conducted an experiment to investigate the extent to which the perceived quality of an interaction is influenced by conversation content and context, and we document the physiological changes that are likely to play a role in establishing rapport. Females who did not know each other met in pairs and conducted a gossip- or creativity task, either face-to-face or online. The conversation content had no effect on the (...) quality of online interactions. However in the face-to-face condition gossip was associated with better interaction quality. Tonic electrodermal activity steadily declined throughout the interaction, while phasic electrodermal activity first peaked and then returned to baseline. Neither were related to perceived interaction quality. Heart rate variability dropped at first but then remained stable. A smaller drop in HRV drop corresponded to higher ratings of rapport and liking. Together these results suggest that gossip can improve the quality of a face-to-face interaction between strangers, and support the conjecture that parasympathetic activity is a marker of human openness to social engagement. (shrink)

Randomised placebo-controlled trials (RPCTs) are the gold standard for evaluating novel treatments. However, this design is rarely used in the context of orthopaedic interventions where participants are assigned to a real or placebo surgery. The present study examines attitudes towards RPCTs for orthopaedic surgery among 687 orthopaedic surgeons across the USA. When presented with a vignette describing an RPCT for orthopaedic surgery, 52.3% of participants viewed it as ‘completely’ or ‘mostly’ unethical. Participants were also asked to rank-order the value of (...) five different types of evidence supporting the efficacy of a surgery, ranging from RPCT to an anecdotal report. Responses regarding RPCTs were polarised with 26.4% viewing it as theleastvaluable (even less valuable than an anecdote) and 35.7.% viewing it as themostvaluable. Where equipoise exists, if we want to subject orthopaedic surgeries to the highest standard of evidence (RPCTs) before they are implemented in clinical practice, it will be necessary to educate physicians on the value and ethics of placebo surgery control conditions. Otherwise, invasive procedures may be performed without any benefits beyond possible placebo effects. (shrink)

From a cultural-historical perspective, the impairments of a child with a condition like cerebral palsy have biological origins, but the disability evolves from the mismatch between the child and his/her social conditions for development. One example of this dialectical production of disability can be seen in the challenge of the 21st-century welfare state: How to provide economically feasible health and educational services anchored in evidence-based methods and practices. Standardized social service pathways for children with CP illustrates an attempt to address (...) this challenge and moderate the mismatch by acting in the intersection between impairment and society. The aim of the article is to analyze challenges in the practice of connecting research and practice-based knowledge with societal practices in order to diminish the disability of the child. A multidisciplinary group assembled by the Danish National Board of Social Services engaged in a practice of developing a guideline for a social service pathway. Agendas and minutes from their series of meetings provide insight in how the work evolved through conflictual discussions. Rather than a neutral transformation of knowledge into practice, the practice revealed itself as a value-laden process in which the needs of the child and family were at times decentred and the focus shifted to how social services could be realised in complex, structured social practices. While the group managed to overcome several conflicts and agree of a social service pathway, a socio-economic analysis was unable to argue for the comprehensive social service pathway as an economic sound choice for municipal decision-makers. The conflict between the welfare ideology and economic feasibility remains unresolved and can be expected to limit the extent that impairments can be remedied and the mismatch decreased. Overcoming or diminishing the mismatch might never become economic worthwhile. As the political pendulum oscillates between welfare and economic concerns, the experience of disability will likewise diminish or expand. (shrink)

Parents, after learning of a life-limiting fetal condition (LLFC), experience emotional distress and must consider options that impact the remainder of the pregnancy, their future lives, and family members. For those who continue, little is known about their longterm presence or absence of regret about their choice, the reasons for this feeling, or its impact on their life. The aim of this research was to examine the concept of decision regret in parents who opted to continue a pregnancy affected by (...) an LLFC. The contextual factors, conditions, and consequences surrounding the presence or absence of regret were analyzed.Data were retrieved from a cross-sectional study using the Quality of Perinatal Palliative Care and Parental Satisfaction Instrument. Participants were parents (N = 405) who experienced a life-limiting prenatal diagnosis and opted to continue their pregnancy. Secondary data analysis examined qualitative responses (121/402) to an item addressing regret. Dimensional analysis was “I Would Do It All Over Again”: Cherishing Time and the Absence of Regret in Continuing a Pregnancy after a Life-Limiting Diagnosis Charlotte Wool, Rana Limbo, and Erin M. Denney-Koelsch used to examine data, identifying context, conditions, and consequences associated with the presence or absence of regret.Absence of regret was articulated in 97.5 percent of participants. Parents valued the baby as a part of their family and had opportunities to love, hold, meet, and cherish their child. Participants treasured the time together before and after the birth. Although emotionally difficult, parents articulated an empowering, transformative experience that lingers over time. (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)

Retrofit is a rising area of concern for Science and Technology Studies scholars of infrastructure. This paper sits at the junction between applied and theoretical approaches by using STS to support interventions in urban infrastructure systems and expand STS critique of retrofit. It discusses findings from a multidisciplinary project piloting retrofit possibilities to positively impact the way water, energy, and food resources were consumed in a London housing estate. Through qualitative research, we found that residents were making social and material (...) interventions in infrastructure systems to manage the way resources were consumed at home, driven by a commonly held motivation to avoid wastefulness. We then mapped the social and material factors that helped or hindered these individual ambitions and used them to inform our codesign process. We found it helpful to think of the residents as an infrastructural community; a group of residents that share a material connection that can help mobilize collective action on shared consumption. We suggest this concept is useful for interventions and critiques of infrastructure retrofit, particularly in cities in the Global North where retrofit programs aim to rescale national systems to neighborhood levels. The concept highlights the possibilities for participation that emerge from bottom-up retrofit. (shrink)

BackgroundInstrumented gait analysis post-stroke is becoming increasingly more common in research and clinics. Although overall standardized procedures are proposed, an almost infinite number of potential variables for kinematic analysis is generated and there remains a lack of consensus regarding which are the most important for sufficient evaluation. The current aim was to identify a discriminative core set of kinematic variables for gait post-stroke.MethodsWe applied a three-step process of statistical analysis on commonly used kinematic gait variables comprising the whole body, derived (...) from 3D motion data on 31 persons post-stroke and 41 non-disabled controls. The process of identifying relevant core sets involved: exclusion of variables for which there were no significant group differences; systematic investigation of one, or combinations of either two, three, or four significant variables whereby each core set was evaluated using a leave-one-out cross-validation combined with logistic regression to estimate a misclassification rate.ResultsThe best MR for one single variable was shown for the Duration of single-support or Duration of 2nd double-support phase, corresponding to an 89–90% probability of correctly classifying a person as post-stroke/control. Adding Pelvis sagittal ROM to either of the variables Self-selected gait speed or Stride length, alternatively adding Ankle sagittal ROM to the Duration of single-stance phase, increased the probability of correctly classifying individuals to 93–94%. Combining three variables decreased the MR further to 0.04, suggesting a probability of 96% for correct classification. These core sets contained: a spatial or a temporal variable, Pelvis sagittal ROM or Ankle plantarflexion during push-off, and Arm Posture Score or Cadence or a knee/shoulder joint angle variable. Adding a fourth variable did not further improve the MR.ConclusionA core set combining a few crucial kinematic variables may sufficiently evaluate post-stroke gait and should receive more attention in rehabilitation. Our results may contribute toward a consensus on gait evaluation post-stroke, which could substantially facilitate future diagnosis and monitoring of rehabilitation progress. (shrink)

Who is a native signer? Since around 95% of deaf infants are born into a hearing family, deaf signers are exposed to a sign language at various moments of their life, and not only from birth. Moreover, the linguistic input they are exposed to is not always a fully fledged natural sign language. In this situation, is the notion of native signer as someone exposed to language from birth of any use? We review the results of the first large-scale cross-linguistic (...) investigation on the effects of age of exposure to sign language. This research involved about 45 Deaf adult signers in each of three sign languages (Catalan Sign Language, French Sign Language, and Italian Sign Language). Across the three languages, participants were divided into three groups – those exposed from birth, those between 1 and 5 years of age, and those exposed between 6 and 15 years of age – and received a battery of tests designed for each language targeting various aspects of morphosyntactic competence. In particular, the tests focused on both those morphosyntactic phenomena that are known from the spoken language literature to be good detectors of language impairment or delay (i.e.,wh-interrogatives and relative clauses) and on morphosyntactic phenomena that are sign language specific (i.e., role shift and directional verbs). The results showed a clear effect of being native, with significant differences across languages and tests between signers exposed to sign language from birth and those exposed in the 1st years of life. This confirms the life-long importance of language exposure from birth and the reliability of the notion of “nativeness”, at least for syntax. On the other hand, while in most domains the differences observed between populations might be differences in performance, for some specific constructions, signers belonging to the three groups may have different grammars. This latter finding challenges the generalized use of native signers’ grammar as the baseline for language description and language assessment. (shrink)

In “The Bioethics of Environmental Injustice,” Ray and Cooper (2024) lay out compelling arguments to increase attention to environmental health within bioethics. Advocacy is crucial, they argue, co...

On the observational equivalence of continuous-time deterministic and indeterministic descriptions Content Type Journal Article Pages 193-225 DOI 10.1007/s13194-010-0011-5 Authors Charlotte Werndl, Department of Philosophy, Logic and Scientific Method, London School of Economics, Houghton Street, London, WC2A 2AE UK Journal European Journal for Philosophy of Science Online ISSN 1879-4920 Print ISSN 1879-4912 Journal Volume Volume 1 Journal Issue Volume 1, Number 2.

Background Levels of care deemed as inappropriate generate moral distress among nurses and other intensive care professionals. Inappropriate levels of care and related moral distress are frequently broached as individual and psychological phenomena, reduced to how individuals feel and think about specific cases. However, this tends to obscure the complex context in which these situations occur, and on which healthcare professionals can act. There is thus a need for a more contextual and team-level lens on inappropriate levels of care. Research (...) objective This study aims to explore and understand the issue of inappropriate levels of care in an intensive care unit (ICU) through a contextual and team-level lens. Research design Semi-structured interviews were conducted with nurses, respiratory therapists, and intensivists. Thematic analysis focused on understanding the causes and consequences of inappropriate levels of care, as well as potential avenues for improvement. This study is part of a 5-phase participatory living lab project on inappropriate levels of care conducted in the ICU of a Montreal (Quebec, Canada) hospital. This paper relates the initial phases of the project, focusing on understanding the issue, with reported events spanning from June 2022 to May 2023. Ethical considerations Ethics approval was sought and granted by the Research Ethics Board of the CIUSSS de l’Est-de-l’Île-de-Montréal. Findings/Discussion Five broad themes intrinsically related to the phenomenon of inappropriate levels of care were explored with and by participants: (1) the process of determining levels of care, (2) the distinction between appropriate and inappropriate levels of care, (3) causes of inappropriate levels of care, (4) consequences of inappropriate levels of care and (5) potential avenues for improvement. Conclusion This research provides a comprehensive understanding of inappropriate levels of care in the ICU and emphasizes the relevance of team-level explorations of complex ethical issues. (shrink)

The progress of electronic health technologies and biobanks holds enormous promise for efficient research. Evidence shows that studies based on sharing and secondary use of data/samples have the potential to significantly advance medical knowledge. However, sharing of such resources for international collaboration is hampered by the lack of clarity about ethical and legal requirements for transfer of data and samples across international borders. Here, the International Clinical Trial Center Network reports the legal and ethical requirements governing data and sample exchange (...) across four continents. The most recurring requirement is ethical approval, whereas only in specific conditions approval of national health authorities is required. Informed consent is not required in all sharing situations. However, waiver of informed consent is only allowed in certain countries/regions and under certain circumstances. The current legal and ethical landscape appears to be very complex and under constant evolution. Regulations differ between countries/regions and are often incomplete, leading to uncertainty. With this work, ICN illuminates the unmet need for a single international collaborative framework to facilitate DSE. Harmonising requirements for global DSE will reduce inefficiency and waste in research. There are many challenges to realising this ambitious vision, including inconsistent terminology and definitions, and heterogeneous and dynamic legal constraints. Here, we identify areas of agreement and significant difference as a necessary first step towards facilitating international collaboration. We propose the establishment of a working group to continue the comparison across jurisdictions, create a standardised glossary and define a set of basic principles and fundamental requirements for DSE. (shrink)

This book presents a series of informal biographies about major figures in the history of psychology. A unique combination of expertise and human appeal, the volume places the contributions of each pioneer in a new and fascinating perspective. For instance, several of the authors use the novel approach of having the pioneers return to the present day to reflect back on their work as it relates to the here and now. Revisions of speeches given in a popular series of invited (...) addresses at psychological conventions, the chapters offer appealing glimpses into the lives of individuals who made a difference in the early years of psychology as a field of study. Each of the five volumes in this series contains different profiles thereby bringing more than 100 of the pioneers in psychology more vividly to life. (shrink)

We explore physiological linkage among 34 same-sex male couples. Interbeat interval, an indicator of cardiovascular arousal, was collected across four conversational contexts in the lab: a baseline period that did not involve conversation, a conversation about body image, a conversation about health goals, and a recovery period that allowed for unstructured conversation. We used a newly developed R statistical package that simplifies the use of dynamic models for investigating interpersonal emotional processes. We identified two different PL patterns: a simple one (...) that was characterized by stable synchronization and low frequency of oscillation; and a complex one that was characterized by drifting synchronization, high frequency of oscillation, and eventual damping. Guided by social baseline theory and the reactive flexibility perspective, we explored the interactions between couple relationship functioning and conversational context as predictors of the PL patterns. The results suggest that partners in well-functioning relationships and emotionally challenging situations may be especially likely to show complex PL patterns that may reflect coregulatory processes. (shrink)

Background The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary Ethics- Support Cell (EST) was created to help medical teams consider the decisions that could potentially be sources of ethical dilemmas. Objectives The primary objective was to prospectively collect information on requests for EST assistance from 23 March to 9 May 2020. The secondary aim was (...) to describe the Cell’s functions during that period. Research design This observational, real-time study of requests for Cell consultations concerned ethical dilemmas arising during a public health crisis. The EST created a grid to collect relevant information (clinical, patient’s/designated representative’s preferences and ethical principles strained by the situation), thereby assuring that each EST asked the same questions, in the same order. Participants and research context Only our university hospital’s clinicians could request EST intervention. Ethical considerations The hospital Research Ethics Committee approved this study (no. CER-2020-107). The patient, his/her family, or designated representative was informed of this ethics consultation and most met with EST members, which enabled them to express their preferences and/or opposition. Findings/results 33 requests (patients’ mean age: 80.8 years; 29 had COVID-19: 24 with dyspnea, 30 with comorbidities). 17 Emergency Department solicitations concerned ICU admission, without reference to resource constraints; others addressed therapeutic proportionality dilemmas. Discussion Intervention-request motives concerned limited resources and treatment intensity. Management revolved around three axes: the treatment option most appropriate for the patient, the feasibility of implementation, and dignified care for the patient. Conclusions COVID-19 crisis forced hospitals to envisage prioritization of ICU access. Established decision-making criteria and protocols do not enable healthcare professionals to escape ethical dilemmas. That acknowledgement highlights ethical risks, enhances the added-value of nursing and encourages all players to be vigilant to pursue collective deliberations to achieve clear and transparent decisions. (shrink)

This book undertakes a critical survey of art history across Europe, examining the recent conceptual and methodological concerns informing the discipline as well as the political, social and ideological factors that have shaped its development in specific national contexts.

Researchers from diverse disciplines, including organismal and cellular physiology, sports science, human nutrition, evolution and ecology, have sought to understand the causes and consequences of the surprising variation in metabolic rate found among and within individual animals of the same species. Research in this area has been hampered by differences in approach, terminology and methodology, and the context in which measurements are made. Recent advances provide important opportunities to identify and address the key questions in the field. By bringing together (...) researchers from different areas of biology and biomedicine, we describe and evaluate these developments and the insights they could yield, highlighting the need for more standardisation across disciplines. We conclude with a list of important questions that can now be addressed by developing a common conceptual and methodological toolkit for studies on metabolic variation in animals. (shrink)

This book studies the major characteristics of the social pedagogical approach to early childhood education and care. It does so by investigating the distinctive elements of the Nordic approach and tradition. The cultural, educational, and ideological structures and values within the Nordic tradition indicate a strong "social pedagogical" rather than "early education" emphasis. The Nordic tradition applies a social learning approach that emphasizes play, relationships and outdoor life, and presumes that learning takes place through children's participation in social interaction and (...) processes. Set against this background, the book examines the characteristics of the pedagogue and the important features that develop through the Nordic approach. It compares children educated in the Nordic tradition with those educated in the French-English and Anglo-American tradition. It explores quality in relation to how children can enjoy childhood, and at the same time become able to actively participate in society and develop the social and cognitive skills and competences that individuals require to do well in society. (shrink)

This collection of 16 essays brings 20th-century French philosopher Henri Bergson's work on immanence together with the latest ideas in art theory and the practice of immanent art as found in painting, photography and film. It places Bergson's work and influence in a wide historical context and applies a rigorous conceptual framework to contemporary art theory and practice.

In the development of governmental policy for artificial intelligence that is informed by ethics, one avenue currently pursued is that of drawing on “AI Ethics Principles”. However, these AI Ethics Principles often fail to be actioned in governmental policy. This paper proposes a novel framework for the development of ‘Actionable Principles for AI’. The approach acknowledges the relevance of AI Ethics Principles and homes in on methodological elements to increase their practical implementability in policy processes. As a case study, elements (...) are extracted from the development process of the Ethics Guidelines for Trustworthy AI of the European Commission’s “High Level Expert Group on AI”. Subsequently, these elements are expanded on and evaluated in light of their ability to contribute to a prototype framework for the development of 'Actionable Principles for AI'. The paper proposes the following three propositions for the formation of such a prototype framework: preliminary landscape assessments; multi-stakeholder participation and cross-sectoral feedback; and, mechanisms to support implementation and operationalizability. (shrink)

BackgroundIn childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for clinical ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe (...) the MCD-related outcomes that healthcare professionals in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden.MethodsThis study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content validated European MCD Outcomes Instrument, before participating in regular MCDs. Answers to the main open-ended question, included in the questionnaire, was analysed according to systematic text condensation.ResultsData was collected from 161 responses from the healthcare professionals. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows:Interprofessional well-being in team interactionson a team level;Professional comfort when dealing with moral challengeson a personal level; andImproved quality of care for the child and the familyon a care level.ConclusionsHealthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then create relevant working conditions for clinical ethics support. (shrink)

The aim of the article is to illustrate concrete problems in the asymmetrical nurse–patient power relationship. It is an ethical demand that the nurse is faced with the challenges that the power in the relation is administered so that the patient's room for action is expanded and trust maintained. It is an essential message in care philosophy, but in clinical practice, success is not always achievable. A hidden and more or less unconscious restriction of the patient's room for action may (...) result in the excesses of care. Three selected aspects: dependence, trust, and power described by the Danish philosopher K.E. Løgstrup and the Norwegian nursing philosopher Kari Martinsen's care philosophy has inspired this empirically based examination of some current barriers in the asymmetrical nurse–patient relationship. On the basis of qualitative interviews with six patients and six nurses, the research thus provides an identifying and problem‐exploratory examination of some current obstacles in which the handling of trust and power reflects the excesses of care. The findings develop three themes. ‘Being a burden’ acknowledges that the balance of power will always tip to the nurse's advantage. The second theme, ‘Doing only what's absolutely necessary’, shows how a fixation with ‘technicalism’ creates a distance between people that may constrain the patient's room for action. The last theme is concerning the nurse's ability to navigate between closeness and distance is essential in avoiding ‘the excesses of care’, paternalism, and overprotectiveness. A situation in which distance takes the upper hand and care turns into paternalism. A different situation would arise if the nurse's emotions became sentimental or intimate with the result that closeness gets the upper hand. To avoid a harmful exercise of power and the excesses of care, the findings have demonstrated that a relationship‐based caring is a demand for situation‐specific sensitive attention skills. (shrink)

An introduction to logic from the perspective of algebra.