Much has been published about the ethical issues encountered by clinicians in genetics/genomics, but those experienced by clinical laboratory scientists are less well described. Clinical laboratory scientists now frequently face navigating ethical problems in their work, but how they should be best supported to do this is underexplored. This lack of attention is also reflected in the ethics tools available to clinical laboratory scientists such as guidance and deliberative ethics forums, developed primarily to manage issues arising within the clinic.We explore (...) what ethical issues are being experienced by clinical scientists, how they think such issues could be best analysed and managed, and whether their practice might be enhanced by more situated approaches to ethics deliberation and practice such as ethical preparedness. From thematic analysis of cases presented by clinical scientists at a specially convened meeting of the UK Genethics Forum, we derived three main ethical themes: (1) the redistribution of labour and responsibilities resulting from the practice of genomic medicine; (2) the interpretation and certainty of results and (3) the proposal that better standardisation and consistency of ethical approaches (for example, more guidelines and policy) could resolve some of the challenges arising.We argue that although standardisation is important for promoting shared understandings of good (including ethical) practice, supplementary approaches to enhance and sustain ethical preparedness will be important to help clinical scientists and others in the recently expanded genetic/genomic medicine environment foster quality ethical thinking. (shrink)

Background Moral courage means courage to act according to individual’s own ethical values and principles despite the risk of negative consequences for them. Research about the moral courage of whistle-blowers in health care is scarce, although whistleblowing involves a significant risk for the whistle-blower. Objective To analyse the moral courage of potential whistle-blowers and its association with their background variables in health care. Research design Was a descriptive-correlational study using a questionnaire, containing Nurses Moral Courage Scale©, a video vignette of (...) the wrongdoing situation with an open question about the vignette, and several background variables. Data were analysed statistically and inductive content analysis was used for the narratives. Participants and research context Nurses as healthcare professionals (including registered nurses, public health nurses, midwives, and nurse paramedics) were recruited from the membership register of the Nurses’ Association via email in 2019. A total of 454 nurses responded. The research context was simulated using a vignette. Ethical considerations Good scientific inquiry guidelines were followed. Permission to use the Nurses’ Moral Courage Scale© was obtained from the copyright holder. The ethical approval and permission to conduct the study were obtained from the participating university and the Nurses’ Association. Findings The mean value of potential whistle-blowers’ moral courage on a Visual Analogue Scale (0–10) was 8.55 and the mean score was 4.34 on a 5-point Likert scale. Potential whistle-blowers’ moral courage was associated with their socio-demographics, education, work, personality and social responsibility related background variables. Discussion and conclusion In health care, potential whistle-blowers seem to be quite morally courageous actors. The results offer opportunities for developing interventions, practices and education to support and encourage healthcare professionals in their whistleblowing. Research is needed for developing a theoretical construction to eventually increase whistleblowing and decrease and prevent wrongdoing. (shrink)

Autonomy has been recognised as a key principle in healthcare, but we still need to develop a consistent understanding of older people’s perceived autonomy in residential care. This study aimed to identify, describe and synthesise previous studies on the perceived autonomy of older people in residential care. Ethical approval was not required, as this was a review of published literature. We carried out an integrative review to synthesise previous knowledge published in peer-review journals in English up to September 2019. Electronic (...) and manual searches were conducted using the CINAHL, Philosopher’s Index, PubMed, SocINDEX, Scopus and Web of Science databases. The data were analysed using the constant comparison method. The review identified 46 studies. Perceived autonomy referred to the opportunities that older people had to make their own choices about their daily life in residential care, and achieving autonomy promoted both health and quality of life. Autonomy was linked to older people’s individual capacities, including their level of independence, physical and mental competence, personal characteristics, and whether relatives shared and supported their perceived autonomy. Professionals could facilitate or hinder older peoples’ autonomy in a number of ways, including providing opportunities for autonomy, how daily care needs and activities were managed, and controlling older people’s choices. Professionals’ characteristics, such as education and attitudes, and the older people’s living environments were also associated with their perceived autonomy and included organisational characteristics and physical and social care facilitators. Older people’s perceived autonomy promoted health and quality of life in residential care. However, their autonomy was associated with a number of protective and restrictive individual and environmental factors, which influenced whether autonomy was achieved. (shrink)

When evidence-based policymaking is so often mired in disagreement and controversy, how can we know if the process is meeting its stated goals? We develop a novel mathematical model to study disagreements about adequate knowledge utilization, like those regarding wild horse culling, shark drumlines and facemask policies during pandemics. We find that, when stakeholders disagree, it is frequently impossible to tell whether any party is at fault. We demonstrate the need for a distinctive kind of transparency in evidence-based policymaking, which (...) we call transparency of reasoning. Such transparency is critical to the success of the evidence-based policy movement, as without it, we will be unable to tell whether in any instance a policy was in fact based on evidence. (shrink)

Wicked problems are tricky to solve because of their many interconnected components and a lack of any single optimal solution. At the science–policy interface, all problems can look wicked: research exposes the complexity that is relevant to designing, executing and implementing policy fit for ambitious human needs. Expertise in philosophical research can help to navigate that complexity.

Tradicionalmente, el patrimonio se ha relacionado con la educación histórica desde una perspectiva restrictiva que dejaba fuera a buena parte de las manifestaciones patrimoniales, entre ellas, las que se incluyen en el ámbito del patrimonio inmaterial. En este sentido, el presente trabajo se centra en la relación entre patrimonio inmaterial y pensamiento histórico dentro de la formación del profesorado de Educación Primaria. Desde el paradigma interpretativo se han analizado 27 propuestas didácticas de un total de 54 estudiantes del Grado de (...) Educación Primaria, con el propósito de conocer la percepción que poseen del uso del patrimonio inmaterial para trabajar los conceptos asociados al desarrollo del pensamiento histórico. Los datos obtenidos apuntan a la existencia de una alta consideración del patrimonio inmaterial para trabajar el pensamiento histórico en la Educación Primaria. (shrink)

This article examines how corporate social responsibility (CSR) can serve as an external source of rents for governments that depend on foreign financing for state-building and development. The strategic, instrumental use of CSR has been overlooked in previous research on governments and CSR, especially in the Global South. To understand how CSR can serve as a lever for rents, the concept of “extraversion” is introduced to describe the way in which rent-seeking African governments instrumentalize their asymmetric external relations for political (...) and private benefit. The connection between CSR and rent-seeking is analyzed through a case study of large gas investments in Tanzania. The article finds that the government has set up regulation that enables local and central government authorities to appropriate, mediate, reclaim, or possibly trick CSR practices to gain rents. Based on the study, two contributions are made to the literature on CSR and governments. First, the instrumental use of CSR in the Global South is added to the variety of perspectives that can be taken when studying government agency. Second, CSR is conceptualized as a potential stream of rents for governments to exploit. The article ends with discussing that the outcome of CSR in a rent-seeking environment depends on whether the leveraged resources are managed well to support peaceful and locally beneficial economic development or whether they serve private accumulation through corruption. (shrink)

En nuestros días con el aumento de la longevidad, es importante una discusión sobre la calidad de vida y la salud mental de las personas mayores. Más que eso, se abren nuevos caminos para comprender las soluciones que la sociedad presenta con el tema longevidad, como la creación de entidades de larga permanencia. Así ocurre el inicio de la categorización de las personas mayores institucionalizadas. Objetivo: este estudio tiene como objetivo comprender cómo la literatura científica presenta la salud mental de (...) personas mayores institucionalizadas. Metodología: La metodología elegida es la Revisión Integrativa de la Literatura por medio de los recursos de información Scielo, EBSCO y PubMed, de 2019 a 2023. Descriptores utilizados: “Ancianos”; "Salud mental"; "Bienestar psicológico"; "Satisfacción personal"; “Salud del Mayor Institucionalizado” con operador booleano “AND”. Con base en la carga contextual de 13 artículos para discusión. La Revisión Integrativa de la Literatura es el método de investigación que se basa en la Práctica Basada en la Evidencia (PBE). Resultados: los estudios presentan la relación directa entre la salud mental de los ancianos institucionalizados y su implicación social. También demuestran como es importante la evaluación y la intervención psicológica en las instituciones de apoyo a los mayores. Los signos de depresión actúan negativamente en la calidad de vida de las personas mayores y el equipo de atención es un importante recurso de apoyo social. Conclusión: Así, el indicador de implicación social se identifica como uno de los factores que mantienen la calidad de vida. Se entiende que la configuración de residencias larga permanencia para mayores debe ser una parte integrada de la sociedad y de las familias como recurso de salud mental. (shrink)

Adherence to professional ethics in nursing is fundamental for high-quality ethical care. However, analysis of the use and impact of nurses’ codes of ethics as a part of professional ethics is limited. To fill this gap in knowledge, the aim of our review was to describe the use and impact of the Code of Ethics for Nurses with Interpretive Statements published by the American Nurses Association as an example of one of the earliest and most extensive codes of ethics for (...) nurses with their interpretative statements and constituting a strong basis for the International Council of Nurses’ Code of Ethics for Nurses. We based our review on previous literature using a scoping review method. We included both non-scientific and scientific publications to provide an analysis of codes of ethics which can be utilized in development and revision of other nurses’ codes of ethics. In the searches, we used CINAHL and PubMed databases limiting publications to texts with a connection to the Code of Ethics for Nurses published from January 2001 to November 2022 and written in English. Searches yielded 1739 references, from which 785 non-scientific and 71 scientific publications were included for analysis of the data. Although non-scientific and scientific publications addressed different number of categories, the results indicated that in the both groups the use and impact focused on professional ethics, nursing practice, and work environment and less on education, research, or social health issues. Nurses’ ethical standards were not addressed in non-scientific publications, and clinical issues and leadership were not in focus in scientific publications. To increase evidence-based knowledge of the impact of codes of ethics additional research is needed. Good scientific conduct was followed. (shrink)

The formative experiences carried out throughout the Franciscan Itinerary reveal that reflection on Franciscan Pedagogy and the respective role of educators in Franciscan institutions must be constant and in dialogue with practice, aiming for actions that characterize education based on principles, values, and attitudes. Therefore, it is necessary to know and delve into the life of Saint Francis of Assisi beyond the knowledge of Franciscan humanism, so that its values are intertwined with personal values, becoming foundations for pedagogical practice.

Background Intensive care nurses frequently encounter ethical issues with potentially severe consequences for nurses, patients, and next of kin. Therefore, ethical issues in intensive care units (ICU) should be recognized and managed. Research objectives To analyze ethical issues reported by intensive care nurses and how reported issues were managed within the organization using register data from the HaiPro critical incident reporting system (CIRS), and to explore the suitability of this system for reporting and managing ethical issues. Research design This was (...) a retrospective descriptive register study. CIRS reports on ethical issues in adult ICUs ( n = 12) in one hospital district in Finland over 25 months (2019–2021) were analyzed through inductive content analysis and descriptive quantification. The CIRS’s suitability for reporting and managing ethical issues was evaluated through a strengths, weaknesses, opportunities, and threats (SWOT) analysis. Ethical considerations The study was approved by the University Ethics Committee, and permission to conduct the research was granted before data collection within the organization. Results CIRS reports on ethical issues ( n = 35) made by nurses were found in seven of the 12 ICUs. The CIRS managers of these units managed these reports. The ethical issues described by the nurses were divided into four main categories: nature, situational information, consequences, and contributing factors. Management of reported ethical issues was divided into three main categories: preventive actions proposed by nurses, proposals for actions by CIRS managers, and actions taken by CIRS managers. Conclusions Systematic register data broadly describe ethical issues and their management, indicating that the CIRS could be suitable for reporting and managing ethical issues, thereby enabling the monitoring and development of ethical quality at the unit and organizational levels. (shrink)

One of the effects of the current COVID-19 pandemic is that low-income countries were pushed further into extreme poverty, exacerbating social inequalities and increasing susceptibility to drug use/abuse in people of all ages. The risks of drug abuse may not be fully understood by all members of society, partly because of the taboo nature of the subject, and partly because of the considerable gap between scientific production/understanding and communication of such knowledge to the public at large. Drug use is a (...) major challenge to social development and a leading cause of school dropout rates worldwide. Some public policies adopted in several countries in recent decades failed to prevent drug use, especially because they focused on imposing combative or coercive measures, investing little or nothing in education and prevention. Here we highlight the role of neuroscience education as a valid approach in drug use education and prevention. We propose building a bridge between schools and scientists by promoting information, student engagement and honest dialogue, and show evidence that public policy regulators should be persuaded to support such science-based education programs in their efforts to effect important positive changes in society. (shrink)

Trypanosoma brucei is the causal agent of African Trypanosomiasis in humans and other animals. It maintains a long‐term infection through an antigenic variation based population survival strategy. To proliferate in a mammal, T. brucei acquires iron and haem through the receptor mediated uptake of host transferrin and haptoglobin‐hemoglobin respectively. The receptors are exposed to host antibodies but this does not lead to clearance of the infection. Here we discuss how the trypanosome avoids this fate in the context of recent findings (...) on the structure and cell biology of the receptors. (shrink)

This article reflects on the concepts of health, well‐being, gender, and dignity when providing nursing care to older adults, focusing on their wisdom and the phenomena that can affect their health or improve their quality of life. These concepts are analyzed based on the current health conditions of older adults and their needs, on the perspectives of authors in this field of research, and on Patricia Benner's philosophy: the integration of science, clinical wisdom, and ethics in nursing practice. Furthermore, this (...) article aims at contributing to the health, well‐being, gender, and dignity of older adults, despite the discrimination that they may face, as well as to the reality of nursing practice. As such, this study stems from the observed reality, experiences as caregivers and reflection of nurses committed to the values of the profession. Therefore, the article begins with the conceptualization of health, well‐being, gender, and dignity, subsequently analyzing the health–disease status of older adults from a gender perspective, addressing nursing care for older adults based on Patricia Benner's philosophy and concluding with reflections on nursing practice for a better future for older adults. (shrink)

This paper discusses psychological hedonism with a special reference to the writings of Bishop Butler, and Elliot Sober and David Sloan Wilson. Contrary to philosophical orthodoxy, Sober and Wilson have claimed that Butler failed to refute psychological hedonism. In this paper it is argued: (1) that there is a difference between reductive and ultimate psychological hedonism; (2) that Butler failed to refute ultimate psychological hedonism, but that he succeeded in refuting reductive psychological hedonism; and, finally and more importantly, (3) that (...) Butler’s criticism of reductive hedonism can be used as a stepping-stone in another argument showing the implausibility of ultimate psychological hedonism as well. (shrink)

Provability, Computability and Reflection.

This article addresses the growing industry of retail socially responsible investment (SRI) profiled mutual funds. Very few previous studies have examined the final consumer of SRI profiled mutual funds. Therefore, the purpose of this study was to, in an exploratory manner, examine the impact of a number of pro-social, financial performance, and socio-demographic variables on SRI behavior in order to explain why investors choose to invest different proportions of their investment portfolio in SRI profiled funds. An ordinal logistic regression analysis (...) on 528 private investors revealed that two of the three pro-social variables had a positive impact on how much the consumer invested in SRI profiled funds. Moreover, there was proof of a non-altruistic motive for investing in SRI as consumers who perceive that financial return of SRI is equal or better than "regular" mutual funds, invested a greater proportion of their portfolio in SRI profiled mutual funds. Furthermore, the results showed that women and better-educated investors were more likely to invest a greater proportion of their investment portfolio in SRI. Overall, the findings indicate that both financial perceptions and pro-social attitudes are connected to consumer investment in SRI. (shrink)

This study investigated ideological belief bias, and whether this effect is moderated by analytical thinking. A Swedish nationally representative sample (N = 1005) evaluated non-political and political syllogisms and were asked whether the conclusions followed logically from the premises. The correct response in the political syllogisms was aligned with either leftist or rightist political ideology. Political orientation predicted response accuracy for political but not non-political syllogisms. Overall, the participants correctly evaluated more syllogisms when the correct response was congruent with their (...) ideology, particularly on hot-button issues (asylum to refugees, climate change, gender-neutral education, and school marketization). Analytical thinking predicted higher accuracy for syllogisms of any kind among leftists, but it predicted accuracy only for leftist and non-political syllogisms among rightists. This research contributes by refining a promising paradigm for studying politically motivated reasoning, demonstrating ideological belief bias outside of the United States across diverse political issues, and providing the first evidence that analytical thinking may reduce such bias. (shrink)

Este trabajo analiza algunas de las consecuencias jurídicas internacionales de la implicación de Estados extranjeros en el proceso de secesión catalán, presentando los datos de los que se dispone hasta ahora. Se seleccionan los comportamientos de la Federación de Rusia y del Reino de Bélgica y se analiza la posible subsunción de estos hechos en la norma internacional relativa a la prohibición de intervención en los asuntos de otros Estados. Se demuestra la difícil sino imposible imputación de responsabilidad internacional en (...) ambos casos. Pero, a la vez, los hechos muestran el interés ruso por ejercer su influencia en la zona y la irresponsabilidad política de algunos líderes secesionistas que consideraron que la República catalana bien valía la sumisión a un Estado autoritario como Rusia. Por su parte, el silencio de los dos Gobiernos de España ante los hechos de Waterloo, muestran, hacia el exterior, un posicionamiento de Estado débil ante los socios europeos y euroatlánticos; hacia el interior muestran a unos gobernantes con poco aprecio por la defensa de la Democracia y el Estado de Derecho, así como con un total desprecio por el derecho a la libre determinación interna de toda la población estatal. (shrink)

Abstract:When major waterfalls in Norway became possible to develop around 1900, a major step was achieved. The step was a major international technological leap paralleled with changes of established attitudes towards grand, and until then, useless nature. Taking the until-then-useless waterfall Rjukanfossen in Telemark into use was a convergence of grand nature, large technological installations, big business and strong emotions. Transforming this waterfall was a large undertaking and was considered to deserve artistic treatment. In 1907–1908 the Norwegian illustrator and painter (...) Theodor Kittelsen produced a series of five watercolors of the waterfall's transformation. They were hung up at the industrial company's representational villa in Notodden. Within traditional landscape painting, water, and especially cascading water, was a standard element. However, Kittelsen's paintings introduced new versions of nature and nature use. This waterfall was totally transformed by being put into service as part of a Norwegian fairy tale. Dragons, elves, and old men in the mountain appear in the waterfall as part of the transformation. The story the paintings tell did not fit well into the context of Norwegian national romanticism, where the Telemark region throughout the 1800s had been associated with “the nation's inner spirit.” The article will trace the production of these paintings, and the subjects depicted in them. It will analyse the nature versions the meeting between the company manager and the artist entailed. How did these paintings use Norwegian fairy tale images to depict a new version of controlled nature? The paintings did not simply thematize mastery over nature or grief over the loss of a waterfall, but a whole range of emotions like ambivalence, insecurity, envy and pride. They both confirmed and challenged the iconic status of major waterfalls in Norway. (shrink)

In this paper a bootstrap theory of rationality is presented. Such a theory is an attempt to explain how standards of rational inquiry may be rationally revised — without assuming that there are any basic and fixed standards for evaluating such revisions. The general bootstrap idea is briefly presented in the first sections. The main part of the paper consists of a discussion of what normative requirements a bootstrap theory should contain, and a number of requirements on rational revisions are (...) proposed. The final section deals with the question of whether a bootstrap theory is self-referentially coherent. (shrink)

The topic of this study is to what extent standards of rational inquiry can be rationally criticized and revised. It is argued that it is rational to treat all such standards as open to criticism and revision. Arguments to the effect that we are fallible with regard to all standards of rational inquiry are presented. Standards cannot be ultimately justified and with certainty established either as adequate or as inescapable presuppositions. Apel's attempt to give ultimate justifications of certain moral and (...) logical rules is examined and criticized. Special attention is given to our fallibility with regard to logical inference rules. The idea that certain logical rules cannot be put into question because any critical argument presupposes them is criticized. It has been claimed that there must be some basic standards which are such that they cannot be rationally evaluated and hence are rationally unrevisable. This is called "the unrevisability thesis". Related to this thesis is the normative policy according to which rationality requires that some standards be treated as unrevisable, the unrevisability policy. Two arguments that have been used to defend the unrevisability thesis and policy are examined and criticized. The conclusion is that we are not forced to accept either the thesis or the policy. The negation of the unrevisability policy is the revisability policy, according to which it is rational to treat all standards as open to rational criticism and revision. Objections that have been directed against the revisability policy are discussed and criticized. According to the objections, the revisability policy leads to rationality relativism. These objections are refuted, and it is argued that it is, on the contrary, rational to adopt the revisability policy and treat all standards of rational inquiry as criticizable and revisable. It is proposed that the rational change of standards should be viewed as a bootstrap process. General features of a bootstrap view of rational change of standards are presented, and it is argued that it is impossible to formulate a real theory of bootstrapping. Two models of standard change are presented and discussed: Laudan's reticulated model of scientific rationality and Briskman's bootstrap theory. It is claimed that in spite of defects and limitations, these models contribute to a richer understanding of bootstrapping. The fallibility and revisability of standards of rational inquiry have consequences for how the normativity of rationality should be understood. The book ends with an account of how the rationality of cognitive actions is related to the idea of the adequacy of standards. A distinction between absolute and standard-relative rationality is made, and it is argued that what an inquiring agent rationally ought to do coincides with what it is standard-relatively rational for him to do. It is shown that this view of rationality of inquiry is nevertheless inconsistent with rationality relativism, and that it is compatible with an objectivistic view of rationality. (shrink)

A recent report by the Swedish National Council for Crime Prevention in cooperation with the Swedish Security Service shows that the Internet has been extensively used to spread propaganda by proponents of violent political extremism, characterized by a worldview painted in black and white, an anti-democratic viewpoint, and intolerance towards persons with opposing ideas. We provide five arguments suggesting that philosophical dialogue with young persons would be beneficial to their acquisition of insights, attitudes and thinking tools for encountering such propaganda. (...) The arguments are based on stated requirements for problem solutions given by experts in violent political extremism, recent research about the effects of philosophical dialogue in young persons’ thinking skills, and parts of the basic theoretical framework of Philosophy for Children. Philosophical dialogues seem a promising way for young people to achieve a stronger democratic awareness and a more tenacious resistance against extremist views online. (shrink)

The topic of this study is a notion of empathy that is common in philosophy and in the behavioral sciences. It is here referred to as ‘the notion of empathy as emotional sharing’, and it is characterized in terms of three ideas. If a person, S, has empathy with respect to an emotion of another person, O, then (i) S experiences an emotion that is similar to an emotion that O is currently having, (ii) S’s emotion is caused, in a (...) particular way, by the state of O or by S’s entertaining an idea of the state or situation of O, and (iii) S experiences this emotion in a way that does not entail that S is in the corresponding emotional state. The aim of the study is to clarify this notion of empathy by clarifying these three ideas and by tracing the history of their development in philosophy. -/- The study consists of two parts. Part one contains a short and selective account of the history in Western philosophy of the notion of empathy as emotional sharing. In chapter 2 Spinoza’s theory of imitation of affects and Hume’s theory of sympathy are presented. It is argued that these theories only exemplify the second idea characteristic of the notion of empathy as emotional sharing. Chapter 3 contains presentations of Adam Smith’s theory of sympathy, and Schopenhauer’s theory of compassion. These theories are shown to exemplify the second and the third idea. In chapter 4 there are presentations of Edith Stein’s description of Einfühlung, and Max Scheler’s account of empathy and fellow-feeling. It is shown that these accounts contain explicit specifications of the third idea, and it is argued that they also exemplify the second idea. -/- In part two, the three ideas are further clarified and the notion of empathy as emotional sharing is defined. Chapter 5 contains a discussion of the main contemporary philosophical analyses of empathy. Three different views are distinguished: one that construes empathetic emotions as emotional states, one that construes them as imagined emotions, and one that construes them as off-line emotions. The first two views are criticized and rejected. The third is accepted and further developed in chapter 6, which contains a general analysis of the emotions. A distinction is made between two ways of experiencing an emotion, and it is argued that it is possible to have the affective experience characteristic of a particular kind of emotional state without being in that kind of state. In chapter 7, a definition of ‘empathy’ is proposed. This definition contains specifications of the three ideas characteristic of the notion of empathy as emotional sharing, and it shows both how the empathizer’s emotion resembles the emotion of the empathee, and how this emotion is caused and experienced. (shrink)

Feeling old: being in a phase of transition in later life The aim of the study was to illuminate very old persons’ experiences of feeling old in order to get a nuanced understanding of the ageing process in later life. Fifteen persons 85–96 years of age, living in their own homes, were interviewed in‐depth. Data were analysed utilising a phenomenological‐hermeneutic approach. Eight persons reported that they felt old. The experience of feeling old entailed four characteristics: being able to date the (...) beginning of feeling old, fear of helplessness and of being unable to manage one’s life situation, not recognising one’s former self, and feeling different from others. These characteristics corresponded to the main properties of a transition process. The comprehensive understanding was that the very old persons who also felt old were in a phase of transition. The distinguishing qualities of those that felt old were also found to be in line with the dystonic dominance in the ninth stage designated by Joan Erikson of the previously described life cycle. Knowledge about transition processes and sensitivity to very old people’s experiences of feeling old are of great importance to nursing in order to provide adequate health care services and prevent unhealthy transitions. (shrink)