This article combines a philosophical critique of the idea that public health nurses are primary technicians who neutrally hand over scientifically established facts on risks to the public and an empirical analysis of the actual work of public health nurses. It is argued that the relationship between facts and values in public health is complex and that, despite the introduction of several scientifically-based standards and guidelines, public health nurses are not technicians. They do moral work and experience ethical dilemmas. To (...) get a grip on the specific character of this moral work, we distance ourselves from the idea that there are ethical dilemmas in public health nursing for which we can provide general ethical rules and principles. Instead we suggest a contextual ethical approach, in which several different kinds of consideration may be important. To illustrate this, we analysed 15 in-depth interviews with nurses involved in the prevention of cot deaths in the Netherlands. It is shown that these nurses do not neutrally pass on the epidemiological facts on the risks of prone sleeping, warm bedclothes and passive smoking, but they are the moral architects of this preventive practice. It is also shown that this moral work and the ethical dilemmas they experience cannot be characterized in terms of general ethical rules and principles. It becomes clear that the moral work of nurses differs according to the three main risks at stake: the balance between virtue, risk taking and responsibility depends on the specific context. (shrink)

People are generally more accurate at categorizing objects at the basic level (e.g., dog) than at more general, superordinate categories (e.g., animal). Recent research has suggested that this basic‐level advantage emerges from the linguistic‐distributional and sensorimotor relationship between a category concept and object concept, but the proposed mechanisms have not been subject to a formal computational test. In this paper, we present a computational model of category verification that allows linguistic distributional information and sensorimotor experience to interact in a grounded (...) implementation of a full‐size adult conceptual system. In simulations across multiple datasets, we demonstrate that the model performs the task of category verification at a level comparable to human participants, and—critically—that its operation naturally gives rise to the basic‐level‐advantage phenomenon. That is, concepts are easier to categorize when there is a high degree of overlap in sensorimotor experience and/or linguistic distributional knowledge between category and member concepts, and the basic‐level advantage emerges as an overall behavioral artifact of this linguistic and sensorimotor overlap. Findings support the linguistic–sensorimotor preparation account of the basic‐level advantage and, more broadly, linguistic–sensorimotor theories of the conceptual system. (shrink)

Lower levels of news use are generally understood to be associated with less political engagement among citizens. But while some people simply have a low preference for news, others avoid the news intentionally. So far little is known about the relationship between active news avoidance and civic engagement in society, a void this study has set out to fill. Based on a four-wave general population panel survey in the Netherlands, conducted between April and July 2020 (N = 1,084) during a (...) crisis situation, this research-in-brief investigates the development of news avoidance and pro-social civic engagement over time. Results suggest that higher news topic avoidance results in higher levels of civic engagement. The study discusses different explanations for why less news can mean more engagement. (shrink)

Increased productivity may have negative impacts on farm animal welfare in modern animal production systems. Efficiency gains in production are primarily thought to be due to the intensification of production, and this has been associated with an increased incidence of production diseases, which can negatively impact upon FAW. While there is a considerable body of research into consumer attitudes towards FAW, the extent to which this relates specifically to a reduction in production diseases in intensive systems, and whether the increased (...) incidence of diseases represents a barrier to consumer acceptance of their increased use, requires further investigation. Therefore a systematic review of public attitudes towards FAW was conducted, with a specific focus on production diseases in intensive systems. Four databases were searched to identify relevant studies. A screening process, using a set of pre-determined inclusion criteria, identified 80 studies, with the strength of evidence and uncertainty assessed for each. A thematic analysis led to the identification of 6 overarching themes constructed from 15 subthemes. The results demonstrate that the public are concerned about FAW in modern production systems. Concern varied in relation to age, gender, education and familiarity with farming. Naturalness and humane treatment were central to what was considered good welfare. An evidence gap was highlighted in relation to attitudes towards specific production diseases, with no studies specifically addressing this. However, the prophylactic use of antibiotics was identified as a concern. A number of dissonance strategies were adopted by consumers to enable guilt free meat consumption. (shrink)

The purpose of the current study was to apply and evaluate a procedure to elicit expert judgments about correlations, and to update this information with empirical data. The result is a face-to-face group elicitation procedure with as its central element a trial roulette question that elicits experts' judgments expressed as distributions. During the elicitation procedure, a concordance probability question was used to provide feedback to the experts on their judgments. We evaluated the elicitation procedure in terms of validity and reliability (...) by means of an application with a small sample of experts. Validity means that the elicited distributions accurately represent the experts' judgments. Reliability concerns the consistency of the elicited judgments over time. Four behavioral scientists provided their judgments with respect to the correlation between cognitive potential and academic performance for two separate populations enrolled at a specific school in the Netherlands that provides special education to youth with severe behavioral problems: youth with autism spectrum disorder (ASD), and youth with diagnoses other than ASD. Measures of face-validity, feasibility, convergent validity, coherence, and intra-rater reliability showed promising results. Furthermore, the current study illustrates the use of the elicitation procedure and elicited distributions in a social science application. The elicited distributions were used as a prior for the correlation, and updated with data for both populations collected at the school of interest. The current study shows that the newly developed elicitation procedure combining the trial roulette method with the elicitation of correlations is a promising tool, and that the results of the procedure are useful as prior information in a Bayesian analysis. (shrink)

This paper is devoted to the investigation of term-definable connexive implications in substructural logics with exchange and, on the semantical perspective, in sub-varieties of commutative residuated lattices (FL ${}_{\scriptsize\mbox{e}}$ -algebras). In particular, we inquire into sufficient and necessary conditions under which generalizations of the connexive implication-like operation defined in [6] for Heyting algebras still satisfy connexive theses. It will turn out that, in most cases, connexive principles are equivalent to the equational Glivenko property with respect to Boolean algebras. Furthermore, we (...) provide some philosophical upshots like, e.g., a discussion on the relevance of the above operation in relationship with G. Polya’s logic of plausible inference, and some characterization results on weak and strong connexivity. (shrink)

Philippa Foot is one of the most original and widely respected philosophers of our time; her work has exerted a lasting influence on the development of moral philosophy. In tribute to her, twelve leading philosophers from both sides of the Atlantic have contributed essays exploring the various topics in moral philosophy to which she has made a distinctive contribution--virtue ethics, naturalism, non-cognitivism, relativism, categorical requirements, and the role of rationality in morality.

This is the Editorial Introduction to “S.I.: Strong and Weak Kleene Logics”.

BackgroundConsent for data research in acute and critical care is complex as patients become at least temporarily incapacitated or die. Existing guidelines and regulations in the European Union are of limited help and there is a lack of literature about the use of data from this vulnerable group. To aid the creation of a patient-centred framework for responsible data research in the acute setting, we explored views of patients and next-of-kin about the collection, storage, sharing and use of genetic and (...) health-related data for observational research.MethodsWe conducted qualitative interviews (n = 19) with Dutch sudden cardiac arrest survivors who donated clinical and socio-economic data and genetic samples to research. We also interviewed their next-of-kin. Topics were informed by ethics literature and we used scenario-sketches to aid discussion of complex issues.ResultsSudden cardiac arrest survivors displayed limited awareness of their involvement in health data research and of the content of their given consent. We found that preferences regarding disclosure of clinically actionable genetic findings could change over time. When data collection and use were limited to the medical realm, patients trusted researchers to handle data responsibly without concern for privacy or other risks. There was no consensus as to whether deferred consent should be explicitly asked from survivors. If consent is asked, this would ideally be done a few months after the event when cognitive capacities have been regained. Views were divided about the need to obtain proxy consent for research with deceased patients’ data. However, there was general support for the disclosure of potentially relevant post-mortem genetic findings to relatives.ConclusionsSudden cardiac arrest patients’ donation of data for research was grounded in trust in medicine overall, blurring the boundary between research and care. Our findings also highlight questions about the acceptability of a one-time consent and about responsibilities of patients, researchers and ethics committees. Finally, further normative investigation is needed regarding the (continued) use of participants’ data after death, which is of particular importance in this setting. Our findings are thought to be of relevance for other acute and life-threatening illnesses as well. (shrink)

The Routledge Handbook of Political Ecology presents a comprehensive and authoritative examination of the rapidly growing field of political ecology. Located at the intersection of geography, anthropology, sociology, and environmental history, political ecology is one of the most vibrant and conceptually diverse fields of inquiry into nature-society relations within the social sciences. The Handbook serves as an essential guide to this rapidly evolving intellectual landscape. With contributions from over 50 leading authors, the Handbook presents a systematic overview of political ecology's (...) origins, practices and core concerns, and aims to advance both ongoing and emerging debates. While there are numerous edited volumes, textbooks, and monographs under the heading 'political ecology,' these have tended to be relatively narrow in scope, either as collections of empirically based (mostly case study) research on a given theme, or broad overviews of the field aimed at undergraduate audiences. The Routledge Handbook of Political Ecology is the first systematic, comprehensive overview of the field. With authors from North and South America, Europe, Australia and elsewhere, the Handbook of Political Ecology provides a state of the art examination of political ecology; addresses ongoing and emerging debates in this rapidly evolving field; and charts new agendas for research, policy, and activism. The Routledge Handbook of Political Ecology introduces political ecology as an interdisciplinary academic field. By presenting a 'state of the art' examination of the field, it will serve as an invaluable resource for students and scholars. It not only critically reviews the key debates in the field, but develops them. (shrink)

Background: The development of implicit tests for measuring biases and behavioral predispositions is a recent development within psychology. While such tests are usually researched within a social-cognitive paradigm, behavioral researchers have also begun to view these tests as potential tests of conditioning histories, including in the sexual domain. Objective: The objective of this paper is to illustrate the utility of a behavioral approach to implicit testing and means by which implicit tests can be built to the standards of behavioral psychologists. (...) Design: Research findings illustrating the short history of implicit testing within the experimental analysis of behavior are reviewed. Relevant parallel and overlapping research findings from the field of social cognition and on the Implicit Association Test are also outlined. Results: New preliminary data obtained with both normal and sex offender populations are described in order to illustrate how behavior-analytically conceived implicit tests may have potential as investigative tools for assessing histories of sexual arousal conditioning and derived stimulus associations. Conclusion: It is concluded that popular implicit tests are likely sensitive to conditioned and derived stimulus associations in the history of the test-taker rather than ‘unconscious cognitions’, per se. Keywords: implicit association test; function acquisition speed test; relational frame theory; stimulus equivalence; sex offenders; sexual interests (Published: 15 March 2012) Citation: Socioaffective Neuroscience & Psychology 2012, 2 : 17335 - DOI: 10.3402/snp.v2i0.17335. (shrink)

Conflict framing is key in political communication. Politicians use conflict framing in their online messages (e.g., criticizing other politicians) and journalists in their political coverage (e.g., reporting on political tensions). Conflicts can take a variety of forms and can provoke different reactions. However, the literature still lacks a systematic and theoretically-grounded conceptual framework that accounts for the multi-dimensionality of political conflict frames. Based on literature from political epistemology, political communication, and related fields such as psychology, we present four conceptual dimensions (...) of political conflicts: (1) the style (civil/uncivil); (2) the subject (personal/substantive); (3) whether it is about underlying moral/epistemic principles or not (deep/superficial conflict); and (4) whether it concerns a normative or factual issue. Results of a content analysis of newspaper articles and politicians’ tweets confirm the usage of these conflict dimensions in the Netherlands during a non-election period. Interestingly, most of the conflicts are civil, substantive, and do not highlight deep fundamental clashes. In light of the current societal concerns about the lack of respect in political debates and the deepening of our political divides, these findings can be considered encouraging. (shrink)

Conflict framing is key in political communication. Politicians use conflict framing in their online messages (e.g., criticizing other politicians) and journalists in their political coverage (e.g., reporting on political tensions). Conflicts can take a variety of forms and can provoke different reactions. However, the literature still lacks a systematic and theoretically-grounded conceptual framework that accounts for the multi-dimensionality of political conflict frames. Based on literature from political epistemology, political communication, and related fields such as psychology, we present four conceptual dimensions (...) of political conflicts: (1) the style (civil/uncivil); (2) the subject (personal/substantive); (3) whether it is about underlying moral/epistemic principles or not (deep/superficial conflict); and (4) whether it concerns a normative or factual issue. Results of a content analysis of newspaper articles and politicians’ tweets confirm the usage of these conflict dimensions in the Netherlands during a non-election period. Interestingly, most of the conflicts are civil, substantive, and do not highlight deep fundamental clashes. In light of the current societal concerns about the lack of respect in political debates and the deepening of our political divides, these findings can be considered encouraging. (shrink)

This book provides a range of interdisciplinary and international perspectives on difficulties in literacy development. The high-profile team of contributors provide ethical and policy discussions, as well as contextualizing individual and collective strategies to addressing difficulties in literacy development. The chapters break new ground by encompassing a wide range of perspectives related to critical literacy, socio-cultural, cognitive, and psychological viewpoints, to help inform practice, policy and research into literacy difficulties. This book will be of interest to postgraduate students, teachers, researchers, (...) education professionals and policy makers who are keen to address difficulties in literacy development. (shrink)

We develop an approach to automatically identify the most probable multiword constructions used in children’s utterances, given syntactically annotated utterances from the Brown corpus of CHILDES. The found constructions cover many interesting linguistic phenomena from the language acquisition literature and show a progression from very concrete toward abstract constructions. We show quantitatively that for all children of the Brown corpus grammatical abstraction, defined as the relative number of variable slots in the productive units of their grammar, increases globally with age.

Experts provide an alternative source of information to classical data collection methods such as surveys. They can provide additional insight into problems, supplement existing data, or provide insights when classical data collection is troublesome. In this paper, we explore the (dis)similarities between expert judgments and data collected by traditional data collection methods regarding the development of posttraumatic stress symptoms (PTSSs) in children with burn injuries. By means of an elicitation procedure, the experts’ domain expertise is formalized and represented in the (...) form of probability distributions. The method is used to obtain beliefs from 14 experts, including nurses and psychologists. Those beliefs are contrasted with questionnaire data collected on the same issue. The individual and aggregated expert judgments are contrasted with the questionnaire data by means of Kullback–Leibler divergences. The aggregated judgments of the group that mainly includes psychologists resemble the questionnaire data more than almost all of the individual expert judgments. (shrink)

A major new source for research of the 19th century and history of ideas, this dictionary covers all of the major, and a range of the less well-known, thinkers and writers of the time.

Many studies have argued for distinct but complementary contributions from each hemisphere in the control of movements to visual targets. Investigators have attempted to extend observations from patients with unilateral left- and right-hemisphere damage, to those using neurologically-intact participants, by assuming that each hand has privileged access to the contralateral hemisphere. Previous attempts to illustrate right hemispheric contributions to the control of aiming have focussed on increasing the spatial demands of an aiming task, to attenuate the typical right hand advantages, (...) to try to enhance a left hand reaction time advantage in right-handed participants. These early attempts have not been successful. The present study circumnavigates some of the theoretical and methodological difficulties of some of the earlier experiments, by using three different tasks linked directly to specialized functions of the right hemisphere: bisecting, the gap effect, and visuospatial localization. None of these tasks were effective in reducing the magnitude of left hand reaction time advantages in right handers. Results are discussed in terms of alternatives to right hemispheric functional explanations of the effect, the one-dimensional nature of our target arrays, power and precision given the size of the left hand RT effect, and the utility of examining the proportions of participants who show these effects, rather than exclusive reliance on measures of central tendency and their associated null hypothesis significance tests. (shrink)

Background Payment of research participants helps to increase recruitment for research studies, but can pose ethical dilemmas. Research ethics committees (RECs) have a centrally important role in guiding this practice, but standardisation of the ethical approval process in Ireland is lacking. Aim Our aim was to examine REC policies, experiences and concerns with respect to the payment of participants in research projects in Ireland. Method Postal survey of all RECs in Ireland. Results Response rate was 62.5% (n=50). 80% of RECs (...) reported not to have any established policy on the payment of research subjects while 20% had refused ethics approval to studies because the investigators proposed to pay research participants. The most commonly cited concerns were the potential for inducement and undermining of voluntary consent. Conclusions There is considerable variability among RECs on the payment of research participants and a lack of clear consensus guidelines on the subject. The development of standardised guidelines on the payment of research subjects may enhance recruitment of research participants. (shrink)

ObjectiveFatigue after burns is often attributed to the hyperinflammatory and hypermetabolic response, while it may be best understood from a bio-psychological perspective, also involving the neuro-endocrine system. This longitudinal multi-center study examined the course of fatigue up to 18 months postburn. The contribution of bio-psychological factors, including burn severity, pain, and acute PTSD symptoms, to the course and persistence of fatigue was studied in a multifactorial model.MethodsParticipants were 247 adult burn survivors. Fatigue symptoms were assessed with the Multidimensional Fatigue Inventory (...) during the acute phase and subsequently at 3, 6, 12, and 18 months postburn, and were compared to population norms. Age, gender, burn severity, acute PTSD symptoms and pain were assessed as potential predictors of fatigue over time in a latent growth model.ResultsAt 18 months postburn, 46% of the burn survivors reported fatigue, including 18% with severe fatigue. In the acute phase, higher levels of fatigue were related to multiple surgeries, presence of pain, and higher levels of acute PTSD symptoms. Fatigue gradually decreased over time with minor individual differences in rate of decrease. At 18 months, pain and acute PTSD symptoms remained significant predictors of fatigue levels.ConclusionsProtracted fatigue after burns was found in almost one out of five burn survivors and was associated with both pain and acute PTSD symptoms. Early detection of PTSD symptoms and early psychological interventions aimed at reducing PTSD symptoms and pain may be warranted to reduce later fatigue symptoms. (shrink)

ObjectivesMany older adults with visual impairment also have significant hearing loss. The aim was to investigate the effectiveness of a newly developed Dual Sensory Loss protocol on communication and wellbeing of older persons with DSL and their communication partners in the Netherlands and Belgium.MethodsParticipants and their communication partners were randomized in the “DSL-protocol” intervention group or a waiting-list control group. The intervention took 3 to 5 weeks. Occupational therapists focused on optimal use of hearing aids, home-environment modifications and effective communication (...) strategies. The primary outcome was the Communication Strategies domain of the Communication Profile for the Hearing Impaired. Secondary outcomes measured in participants were the Low Vision Quality Of Life Adjustment subscale, the Center for Epidemiological Studies - Depression Scale, De Jong Gierveld Loneliness Scale and the Fatigue Assessment Scale. The Hearing Handicap and Disability Inventory - Reaction of Others subscale and the Care-related Quality of Life - 7 Dimensions was measured in communication partners. Measurements were taken at baseline and 3-month follow-up. Linear mixed models were used to analyze effects between groups over time for every outcome measure.ResultsIntention-to-treat analyses showed a significant effect of the DSL-protocol on the use of verbal strategies in favor of the control group, however, this effect was non-significant after adjustment for confounding. Effect sizes of other outcomes varied between −0.23 [−0.57, 0.12] and 0.30 [−0.05, 0.64]. The LMM showed a significant effect on the HHDI-Reaction of others scale in favor of communication partners in the treatment group, however, the effect did not remain significant at a 0.01 significance level and the effect size was very small and non-significant 0.12, 95% CI [−0.27 to 0.51]. Adjusted analyses did not reveal treatment effects.ConclusionThe DSL-protocol did not clearly contribute to the enhancement of communication and wellbeing in DSL-patients. Possible reasons for the lack of effects are OTs not being comfortable giving advice on communication and psychosocial issues or the short-term treatment and follow-up period. Further study is warranted to find out how the protocol may be adapted or whether it is necessary to involve mental healthcare professionals.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NTR2843. (shrink)

Social media are increasingly important in the news menu of media users. Differences in news production processes between traditional and social media may lead to differences in how political and social issues are depicted, and this may, eventually, have consequences for the information that reaches citizens about an issue. Against this background, this study compares content across the two media types to examine whether and how the framing of a sociopolitical issue differs between newspaper articles and posts on social media. (...) The empirical analyses are based on a content analysis of newspaper articles (n = 414) and social media messages (n = 2,771) conducted in the context of the socially contested issue of raising the retirement age in the Netherlands. Findings suggest that different content production processes can still lead to similar outcomes as both media types emphasize problems with (instead of solutions to) the retirement age issue. Our findings also confirm differences across traditional and social media, although these differences are substantially relatively small. While traditional news media emphasize conflict-related frames more often than social media, social media present more frame diversity in solutions. (shrink)

Researchers in the social and behavioral sciences often have clear expectations about the order/direction of the parameters in their statistical model. For example, a researcher might expect that regression coefficient β 1 is larger than β 2 and β 3. The corresponding hypothesis is H : β 1 > {β 2, β 3 } and this is known as an (order) constrained hypothesis. A major advantage of testing such a hypothesis is that power can be gained and inherently a smaller (...) sample size is needed. This article discusses this gain in sample size reduction, when an increasing number of constraints is included into the hypothesis. The main goal is to present sample-size tables for constrained hypotheses. A sample-size table contains the necessary sample-size at a pre-specified power (say, 0.80) for an increasing number of constraints. To obtain sample-size tables, two Monte Carlo simulations were performed, one for ANOVA and one for multiple regression. Three results are salient. First, in an ANOVA the needed sample-size decreases with 30–50% when complete ordering of the parameters is taken into account. Second, small deviations from the imposed order have only a minor impact on the power. Third, at the maximum number of constraints, the linear regression results are comparable with the ANOVA results. However, in the case of fewer constraints, ordering the parameters (e.g., β 1 > β 2 ) results in a higher power than assigning a positive or a negative sign to the parameters (e.g., β 1 > 0). (shrink)

Mastery imagery (i.e., images of being in control and coping in difficult situations) is used to regulate anxiety. The ability to image this content is associated with trait confidence and anxiety, but research examining mastery imagery ability's association with confidence and anxiety in response to a stressful event is scant. The present study examined whether trait mastery imagery ability mediated the relationship between confidence and anxiety, and the subsequent associations on performance in response to an acute psychological stress. Participants (N= (...) 130; 55% male;Mage= 19.94 years;SD= 1.07 years) completed assessments of mastery imagery ability and engaged in a standardized acute psychological stress task. Immediately prior to the task, confidence, cognitive and somatic anxiety intensity, and interpretation of anxiety symptoms regarding the task were assessed. Path analyses supported a model whereby mastery imagery ability mediated the relationship between confidence and cognitive and somatic anxiety interpretation. Greater mastery imagery ability and confidence were both directly associated with better performance on the stress task. Mastery imagery ability may help individuals experience more facilitative anxiety and perform better during stressful tasks. Improving mastery imagery ability by enhancing self-confidence may help individuals successfully cope with anxiety elicited during stressful situations. (shrink)

Engaging communities in community-based health research is increasingly being adopted in low- and middle-income countries. The use of community advisory boards is one method of practicing community involvement in health research. To date, few studies provide in-depth accounts of the strategies that CAB members use to practice community engagement. We assessed the perspectives, experiences and practices of the first local CAB in Eswatini, which was implemented as part of the MaxART Early Access to ART for All study. Trained Swazi research (...) assistants conducted two focus group discussions and 13 semi-structured interviews with CAB members who had been part of the MaxART study for at least 2.5 years. Interviews explored CAB composition and recruitment, the activities of CAB members, the mechanisms used to engage with communities and the challenges they faced in their role. The MaxART CAB played an active role in the implementation of the Early Access to Art for All study, and activities mainly focused on: promoting ethical conduct, in particular privacy, consent and confidentiality; communication and education, communicating about the study and educating the community on the benefits of HIV testing and early access to HIV treatment; and liaising between the community and the research team. Strategies for interacting with communities were varied and included attending general community meetings, visiting health facilities and visiting public places such as cattle dipping tanks, buses, bars and churches. Differences in the approach to community engagement between CAB members living in the study areas and those residing outside were identified. The experiences of the first CAB in Eswatini demonstrate that community engagement using CABs is a valuable mechanism for engaging communities in implementation studies. Considerations that could impact CAB functioning include clearly defining the scope of the CAB, addressing issues of CAB independence, the CAB budget, providing emotional support for CAB members, and providing continuous training and capacity building. These issues should be addressed during the early stages of CAB formation in order to optimize functioning. (shrink)

We analyse the electronic portfolio in higher education policy and practice.While evangelical accounts of the ePortfolio celebrate its power as a new eLearning technology,we argue that it allows the mutually-reinforcing couple of neoliberalism and the enterprising self to function in ways in which individual difference can be presented, cultured and grown, all the time within a standardised framework which relentlessly polices the limits of the acceptable and unacceptable. We point to the ePortfolio as a practice of government, arguing that grander (...) policy coalesces out of a halting, experimental set of technological instruments for thinking about how life should be lived. (shrink)

Eric Crégheur, Jeffery Aubin, Alice Fanguet, Gavin McDowell, Louis Painchaud, Paul-Hubert Poirier, Simon St-Arnault-Chiasson, Philippe Therrien, Benoît Tissot et Yann Vadnais.

In the UK, the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a widely used process, designed to facilitate shared decision-making between a clinician and a patient or, if the patient lacks capacity to participate in the conversation, a person close to the patient. A key outcome of the ReSPECT process is a set of recommendations, recorded on the patient-held ReSPECT form, that reflect the conversation. In an emergency, these recommendations are intended to inform clinical decision-making, and thereby (...) enable the attending clinician—usually a general practitioner (GP) or paramedic—to act in the patient’s best interests. This study is the first to explore the extent to which ReSPECT recommendations realise their goal of informing best interests decision-making in community contexts. Using a modified framework analysis approach, we triangulate interviews with patients and their relatives, GPs and nurses and care home staff. Our findings show that inconsistent practices around recording patient wishes, diverging interpretations of the meaning and authority of recommendations and different situational contexts may affect the interpretation and enactment of ReSPECT recommendations. Enacting ReSPECT recommendations in an emergency can be fraught with complexity, particularly when attending clinicians need to interpret recommendations that did not anticipate the current emergency. This may lead to decision-making that compromises the patient’s best interests. We suggest that recording patients’ values and preferences in greater detail on ReSPECT forms may help overcome this challenge, in providing attending clinicians with richer contextual information through which to interpret treatment recommendations. (shrink)

Nicolas Asselin,Stéphanie Audet,Eric Crégheur,Julio Cesar Dias Chaves,Gavin McDowell,Charles-Frédéric Murray,Louis Painchaud,Paul-Hubert Poirier,Maryse Robert,Philippe Therrien.