Background: The concept of dignity can be divided into two main attributes: absolute dignity that calls for recognition of an inner worth of persons and social dignity that can be changeable and can be lost as a result of different social factors and moral behaviours. In this light, the nursing profession has a professional dignity that is to be continually constructed and re-constructed and involves both main attributes of dignity. Objectives: The purpose of this study was to determine how nurses (...) described nursing’s professional dignity in internal medicine and surgery departments in hospital settings. Research design: The research design was qualitative. Ethical considerations: This study was approved by the ethics committees of the healthcare organizations involved. All the participants were provided with information about the purpose and the nature of the study. Participants: A total of 124 nurses participated in this study. Method: The data were collected using 20 focus group sessions in different parts of Italy. The data were analysed by means of a conventional inductive content analysis starting from the information retrieved in order to extract meaning units and sorting the arising phenomena into conceptually meaningful categories and themes. Results: Nursing’s professional dignity was deeply embedded in the innermost part of individuals. Regarding the social part of dignity, a great importance was put on the values that compose nursing’s professional identity, the socio-historical background and the evolution of nursing in the area considered. The social part of dignity was also linked to collaboration with physicians and with healthcare assistants who were thought to have a central role in easing work strain. Equally important, though, was the relationship with peers and senior nurses. Conclusion: The organizational environments under scrutiny with their low staffing levels, overload of work and hierarchical interactions did not promote respect for the dignity of nurses. To understand these professional values, it is pivotal to comprehend the role of different health professions in their cultural milieu and the evolution of the nursing profession in diverse countries. (shrink)

State law requirements for health care advance directive documents were reviewed in every state and the District of Columbia to determine whether they are consistent and/or flexible enough to permit the utilization by the public of “universal” advance directive forms, specifically a health care power of attorney, that would be valid under every state's advance directive statutes. Such documents would have to overcome the wide variability of state legal formalities for validity. If this could be accomplished, the public would benefit (...) from having a variety of multi-state or truly universal forms available that could be used with confidence in their validity.The review found that a basic, multi-state health care power of attorney appears to be feasible in 41 States and the District of Columbia, compared to 36 states and the District in 2005. Only nine states prevent recognition of a truly universal form. Some barriers were surmountable, including differing agent and witness requirements, execution requirements, and effectiveness triggers. Other barriers were insurmountable, including mandatory forms, mandatory disclosures, and decision-specific language requirements. The strategies identified for overcoming some barriers can be used by lawyers in drafting true multi-state directives. More importantly, states should simplify state advance directive laws to facilitate a more meaningful communication model of advance care planning. (shrink)

Health care is increasingly delivered by using medical technologies and specialized procedures. However, the systems through which it is delivered are coming under attack as lacking in care. Medicine is very capable of treating the human body, but it may be losing its sensitivity towards persons, especially concerning the vulnerability they are experiencing. Nurses are finding that the demands for more efficiency and cost-effective measures do not allow them sufficient time to offer the personal care for which they have always (...) felt responsible. The question of the meaning of care surfaces especially in treating those who are approaching death. The need is to balance the various dimensions of care, keeping its focus on the well-being of persons. (shrink)

Background: Nursing continues to gain legitimation epistemologically and ontologically as a scientific discipline throughout the world. If a profession gains respect as a true autonomous scientific profession, then this recognition has to be put in practice in all environments and geographical areas. Nursing professional dignity, as a self-regarding concept, does not have a clear definition in the literature, and it has only begun to be analyzed in the last 10 years. Objectives: The purpose of this meta-synthesis was to determine the (...) various factors that constitute the notion of nursing professional dignity. The target was to create a tentative model of the concept. Research design: The research design was a meta-synthesis (N = 15 original articles) of nursing professional dignity described in the literature, based on the guidelines by Noblit and Hare. Method and findings: Original studies were sought out from electronic databases and manual searches. The selection of literature was conducted on stages based on titles (n = 2595), abstracts (n = 70), and full-texts (n = 15) according to the inclusion and exclusion criteria. From this analysis, a clear definition of nursing professional dignity emerged that underscored two main macro-dimensions constituting this intertwined, multidimensional, and complex notion: characteristics of the human beings and workplace elements. Conclusion: The recognition of nursing professional dignity could have a positive impact on patients because the results clearly showed that nurses are more prone to foster patients’ dignity, patients’ safety, and a better quality of care if their own dignity is respected. If nurses are uncomfortable, humiliated, or not seen in their professional role, it is difficult to give to others good care, good support, or good relationships. (shrink)

Avant de s’appliquer à un exemple, celui de la croyance, l’article expose ce qu’on peut entendre par « distinction conceptuelle » : un geste philosophique qui consiste à établir la distribution, à la fois exhaustive et génétique, de formes organiques, dotées d’attributs propres. Ces formes se rangent ainsi de façon réglée sous un genre, qui est doté d’une extension et d’un degré de généralité plus grands, puisqu’il les contient toutes. Par exemple, le concept de vérité ne se réduit pas à (...) la correspondance entre ce qui est dit et ce qui est (sous les formes organiques suivantes : objectivité et véracité – dont la sincérité, la franchise et l’authenticité), si ce qui est dit doit d’abord, et indépendamment de la correspondance, être doté de sens, lequel est une forme, particulière, de vérité. S’ouvre alors une autre branche qui porte le nom de cohérence, où se trouvent les formes organiques qui y ont leur place : évidence et vraisemblance, etc. (shrink)

Medical technology, specialization, and the corporatization of health delivery systems in the late twentieth century have all helped give birth to an unwelcome but unavoidable responsibility for individuals with family or friends—serving as a health care proxy. The responsibility comes without monetary compensation, is often involuntary, and lacks any real guidelines beyond the duty to make life-and-death decisions in circumstances over which the proxy has little control.The parameters of the proxy's job have evolved somewhat awkwardly in statutes and case law, (...) as lawmakers and judges have tried to apply conventional concepts to novel circumstances. This article examines the legal and functional status of the proxy, as well as the strengths and weaknesses of current public policy as reflected by state advance directive and surrogate decision-making laws. The first section of the article provides a historical perspective of our current notions of agency law as relevant to health care proxies. (shrink)

Science increases understanding, and offers more and more approximate natural explanations. The process of rationality uncovering patterns as well as causes constitutes scientific inquiry. This book is a multidisciplinary study of the mind body problem. Hypothesis of this book challenges reductionist-scientists identification of mind and body, and the so-called common-sense religious dualism of soul-in-the-machine of the body. Though human mind cannot be disserved from its neuronal correlates as a separate entity, it is irreducible to the brain. If mind and brain (...) are neither two dichotomised substance nor one and the same substance, then what is it? As the brain is made up of components, even the thoughts or the self, in some sense, are emergent properties of those components. But how? Answer to these questions consist in the ubiquitous phenomenon of emergence. The inquiry incorporates essential themes such as complexity, system dynamics, emergence, cosmological-biological evolution, thermodynamics and evolution. Human mind as the emergent functionality of the human brain is a biological system embedded in the universe that has thermodynamic-evolutionary history. The universe, which is a matter-energy-information system, actualised in time and space, becomes conscious of itself at least through one of its invention viz. human mind-brain. (shrink)

This article details the results of a national survey conducted in 1999 of statewide laws and protocols providing for the creation and recognition of donot- resuscitate orders effective in nonhospital settings. Applicable primarily to emergency medical services personnel, most of these laws and protocols have been in existence for less than ten years, and there is little current comparative information on them. Such policies are commonly called out-of-hospital or prehospital DNR orders, although one state-Virginia-recently amended its DNR law to establish (...) a durable DNR order applicable to all health care providers and all settings. I will refer to the laws and policies examined here interchangeably as out-of hospital DNR protocols or EMS-DNR protocols. The survey produced a descriptive snapshot of such laws and protocols in effect on a statewide basis as of March 1999. (shrink)

Heidegger understands technology as an act of revealing rather than merely a human achievement. Within the modern era, technology represents the manner in which humans stand within and make manifest the open interplay and inter-relatedness that is world. The danger of this era is the extent to which everything has become available, accessible, and disposable to human manipulation, practically without limit. However, the very totalizing extent to which this is happening, and the forgetfullness that takes it all for granted, can (...) also make us suddenly aware that everything, including world itself, is at risk; that we ourselves are at risk; that we are the danger. He calls for an attitude of releasement that handles world with a sense of receiving, and not just taking, a sense of thankfulness. Such a change could directly impact how we see ourselves and our responsibilities as we go about developing and using technologies. (shrink)

As of December 1991, the Patient Self-Determination Act mandated that health care institutions which receive funding from Medicare or Medicaid provide written information about persons rights to participate in medical decision-making and formulate advance directives. The PSDA required each state…acting through a State agency, association, or other private nonprofit entity develop a written description of the law of the State concerning advance directives that would be distributed by providers or organizations under the requirements of [the Act].

The Physician Orders for Life-Sustaining Treatment Paradigm is designed to improve end-of-life care by converting patients’ treatment preferences into medical orders that are transferable throughout the health care system. It was initially developed in Oregon, but is now implemented in multiple states with many others considering its use. Accordingly, an observational study was conducted in order to identify potential legal barriers to the implementation of a POLST Paradigm. Information was obtained from experts at state emergency medical services and long-term care (...) organizations/agencies in combination with a review of relevant state law. Legal analysis of survey responses and existing laws identified several potential state legal barriers to a POLST Paradigm implementation. The most potentially problematic barriers are detailed statutory specifications for out-of-hospital DNR protocols. Other potential barriers include limitations on the authority to consent to forgo life-sustaining treatments, medical preconditions, and witnessing requirements for out-of-hospital DNR protocols. (shrink)

Chairman Hua emphasized in his speech last year at the opening ceremony of the Central Party School that: "Chairman Mao instructed us over and over that ‘the integration of theory and practice is the most fundamental principle of Marxism.’ Chairman Mao fought all his life against the evil work style of boasting and of separating theory from practice. … Political swindlers such as Lin Biao, Chen Boda, and the "gang of four" have messed up many basic theoretical issues and damaged (...) our Party's good learning style. We must make a tremendous effort to correct that.". (shrink)

Nel corso degli ultimi 20 anni c’è stata una espansione globale in materia di istruzione dottorale e in particolare di ‘dottorati professionali’. Difficoltà nell’avanzamento e nel completamento diventano sempre più il centro dell’attenzione per tutti i tipi di dottorato. È stato riconosciuto che una serie di fattori al di là di quelli prettamente demografici potrebbe influire sulla possibilità di completare gli studi. C’è ancora molto da imparare sul motivo per cui l’avanzamento e il completamento del dottorato sono così impegnativi. In (...) questo articolo vorremmo mettere in evidenza un settore che sembra trascurato dalla ricerca: l’esperienza emotivamente complessa del percorso di dottorato.Offriamo un contributo al dibattito su ciò che è necessario per facilitare il successo e intrinsecamente un soddisfacente avanzamento all’interno di un programma di dottorato professionale. Noi sosteniamo che una maggiore attenzione debba essere prestata al cammino esperienziale di studenti di dottorato dal momento che essi hanno il difficile compito di integrare la loro vita personale, professionale e accademica. Il nostro interesse per le risorse emotive di cui gli studenti possono avvalersi durante il loro percorso di dottorato è iniziato con la progettazione e lo sviluppo del nostro primo dottorato professionale in materia di sanità e cura. Attraverso la nostra iniziale esperienza con due gruppi di studenti, abbiamo riflettuto sullo sviluppo del dottorato professionale, in generale, e trasversalmente a diverse altre discipline, per comprendere meglio come facilitare una buona esperienza di dottorato e una conclusione nei tempi.L’importanza di partecipare all’esperienza emotiva all’interno del complesso percorso di dottorato professionale ci ha portato al concetto di ‘nourished scholarship’ . Si definisce la nozione di ‘nourished scholarship’ come un percorso di apprendimento che lega i valori personali, significativi e attuali, allo sviluppo e al contributo professionale. Tale nutrimento emotivo è caratterizzato da una soddisfacente esperienza di scambio tra il sé, l’apprendimento e la comunità di pratica/studio. La nostra opinione è che tale nutrimento emotivo sia una risorsa fondamentale da cui gli studenti attingono al momento di negoziare le sfide complesse del percorso professionale di dottorato. Al fine di illustrare il significato di ‘nourished scholarship’ descriviamo alcune delle sue dimensioni emotive chiave. Queste dimensioni possono essere agevolate in vari modi, ma qui ne segnaliamo uno in particolare: il sostegno reciproco e la supervisione di gruppo facilitata. Al fine di illustrare le dimensioni della ‘nourished scholarship’ quindi noi riflettiamo su un caso specifico, quello di una coorte di studenti di dottorato professionale. Sono state estratte alcune loro esperienze per illustrare sette dimensioni che sono importanti per contribuire all’esperienza di ‘nourished scholarship’ come una risorsa di sostegno:- Sperimentare i benefici di appartenenza- Aiutarsi vicendevolmente a contenere l’ansia- Vivere la crescente fiducia- Accettare comunanza e unicità- Miglioramento personale, identità professionale e accademica attraverso la chiarificazione dei valori- Sperimentare i benefici di relazionarsi ad una più ampia comunità scientifica- Accettare i ritmi dei tempi in cui ricevere dei tempi attivi.Inoltre, in questo articolo si riflette su come la particolare struttura del programma di dottorato è stata in grado di sostenere lo sviluppo di queste risorse. Ci sono state tre caratteristiche chiave che crediamo siano state fondamentali nel modo in cui il programma è stato progettato e realizzato:a) ‘Cohortness’ in cui gli studenti si impegnano con il programma come un gruppo in viaggio.b) Supervisione di coorte: anche se tutti studiavano diversi argomenti, si è formato un gruppo insieme a due facilitatori accademici per discutere il processo, l’esperienza del percorso e il loro apprendimento.c) Una strategia di valutazione flessibile che permette agli studenti di progredire in modo personale e non lineare.Il valore potenziale di questo articolo per i programmi educativi è che fornisce un quadro per focalizzare l’attenzione sull’importanza del percorso emotivo e sui modi per sostenere la motivazione degli studenti e la resilienza. Noi crediamo che questo quadro abbia un potenziale trasferibile ad altre situazioni in cui tali risorse emotive possono essere importanti.During the past 20 years there has been a global expansion in doctoral education and in particular professional doctorates. Difficulties with progression and completion have increasingly become the focus of attention within both academic and professional contexts. It has been acknowledged that a range of factors, beyond demographics, could be influential in whether students are able to sustain their studies to completion. In this paper we stress the importance of conceptualising professional doctoral studies as a personal, professional and academic journey that is sustained by emotional factors that may need more explicit attention. As such, our contribution is the delineation of a phenomenon that we call ‘nourished scholarship’. We wish to illustrate how such ‘nourished scholarship’ functions as a resource for sustaining motivation and integration through the doctoral journey. We offer seven dimensions that a doctoral programme needs to embody in order to facilitate ‘nourished scholarship’: belonging, containing anxiety, growing confidence, commonality and uniqueness, values clarification, scholarly community, and negotiating the rhythms of receptive and active times. We illustrate these dimensions in the context of a professional doctorate programme that emphasises ‘cohort supervision’ as the primary resource for facilitating such nourished scholarship. We believe that this notion has transferable potential to other provisions where such emotional resources may be important. (shrink)