Hope is a central concept in nursing and other fields of health care. However, there is no consensus about the concept of hope. We argue that seeking consensus is futile given the multifaceted and multidimensional nature of the concept, but instead we encourage in‐depth studies of the assumptions behind talk about hope in specific contexts. Our approach to the ‘science of hope’ is inspired by philosophical pragmatism. We argue that hope is a concept that opens different rooms for action in (...) different contexts and that accordingly, all hope interventions are contextually sensitive. Careful attention to how the relative positions and power of nurses and patients influence what can be inferred from their different ways of talking about hope may make hopeful conversations more meaningful in health care relationships. (shrink)

From good intentions to real life: introducing crisis resolution teams in Norway In Norway, as in most western countries, the adult services for people experiencing mental health problems have gone through major changes over the last decades. A report submitted to the Norwegian Parliament in 1997 summarized several areas of improvement in the provision of mental health‐care to its population, and led to the introduction of a national mental health programme in 1998 for its implementation to be completed by 2008. (...) The most significant recent development in Norway is ‘Crisis Resolution/Home Treatment’ (CRHT) teams that provide an alternative to acute hospital care services. The major aim of this study is to explore an emerging form of community mental health‐care, and present a framework for establishment and examination of CRHT teams applying the user perspectives. An illustration of user experiences in an already established CRHT team provides a background for understanding implications of this form of service in relation to service users’ needs in acute crises. (shrink)

BackgroundVascular surgery offers a range of treatments to relieve pain and ulcerations, and to prevent sudden death by rupture of blood vessels. The surgical procedures involve risk of injury and harm, which increases with age and frailty leading to complex decision-making processes that raise ethical questions. However, how vascular surgeons negotiate these questions is scarcely studied. The aim was therefore to explore vascular surgeons’ moral reasoning of what ought to be done for the patient.MethodsQualitative, semi-structured interviews were conducted with 19 (...) vascular surgeons working at three Swedish university hospitals. Data were analysed according to systematic text condensation.ResultsThe surgeons’ moral reasoning about what ought to be done comprised a quest to relieve suffering and avoid harm by exploring what is reasonable to do for the patient. Exploring reasonableness included to shift one´s perspective from the vessels to the whole person, to balance patient’s conflicting needs and to place responsibility for right decision on one´s shoulders. The shift from blood vessels to the whole person implied gaining holistic knowledge in pondering of what is best, struggling with one´s authority for surgery through dialogue, and building relationship for mutual security. To balance patient’s conflicting needs implied weighing the patient’s independence and a sense of being whole against ease of suffering, respecting the patient’s will against protecting life and well-being, and weighing longer life against protecting the present well-being. Finally, to place responsibility on one´s shoulders was conveyed as an urge to remind oneself of the risk of complications, withholding one’s power of proficiency, and managing time during the illness course.ConclusionsThis study contributes to uncovering how moral reasoning is embodied in the vascular surgeons’ everyday clinical discourse as a tangible part of their patient care. The results underpin the significance of moral considerations in the assemblage of medical knowledge and technical skills to further understand vascular surgeons’ clinical practice. The clinical application of these results is the need of forums with sufficient possibilities for articulating these important moral considerations in everyday care. (shrink)

Background Thirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area. Aim The aim of this study was to explore palliative care physicians’ experiences of ethical challenges in relation to thirst in terminally ill patients. Methods A qualitative interview (...) study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. Results When presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient’s autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering. Conclusions All physicians in this study reported that “Starting, continuing or discontinuing drips” was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular. (shrink)

In nursing practice, awareness of ethical inner values and a common understanding of nursing and caring are needed. It is therefore important to highlight ideas of caring in nursing practice. The aim of this paper was to illuminate nursing, caring and ethical inner values in caring and caring in nursing practice. By being attentive, open, respectful and treating the patient as a person, nurses can enhance both their own and the patient's sense of personal meaning in the caring relationship. Nurses (...) can use self‐reflection to create an awareness of nursing, caring and ethical inner values in caring. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Epistemic Leaks and Epistemic Meltdowns: A Response to William Morris on Scepticism with Regard to Reason Mikael M. Karlsson I. In an excellent paper which appeared in the April, 1989 issue of this journal,2 William Morris attemptsto demonstrate thatthe arguments which make up Hume's notorious chapter, "Of scepticism with regard to reason, are, in the first place, coherent—both internally and with the overall strategy of the Treatise—and, in (...) the second place, successful. Morris' paper is an exercise in the noble art of what I style constructive exegesis, an enterprise to which many readers of Hume Studies, and myself as much as any, are committed. It is a guiding principle ofthis art that we donotunderstandaphilosophical textuntil we can interpret it in such a way as to render it both coherent and correct. From this point ofview, coherence and correctness are not as independent of one another as they may seem to be to others who are differently committed. Some texts, such as Hume's chapter, "Ofscepticism with regard to reason," are notoriously resistant to constructive exegesis, despite the formidable bag of tricks which scholars and interpreters have developed; so resistant, that in gloomier moments we may be brought to wonder about our interpretative enterprise itself. Constructive exegesis is indeed a strange, and peculiarly optimistic, enterprise. Someday, I imagine, in a leisurely moment, I will think more reflectively about the principles ofour art. But not now.6 As a fellow practitioner of constructive exegesis, I am in full sympathy with what Morris tries to do in his paper; and I think that he does contribute substantially to our understanding of what Hume is up to in the chapter, "Ofscepticism with regard to reason." The third section of Morris' paper is, in my judgement, particularly successful in showing how Hume's chapter fits into the larger framework of the Treatise: Hume is, we see, attacking both what Morris labels "intellectualist rationalism" and its counterpart, which we may call 'unmitigated scepticism', although the chapter's two main arguments go primarily to the former. I also think that Morris gives very helpful, Volume XVI Number 2 121 MIKAEL M. KARLSSON and to my mind accurate, accounts of these two arguments, which I dub, respectively, the epistemic leak argument, and the epistemic meltdown argument. However, I have personally never found either of these arguments remotely convincing; and I still do not, despite Morris' clarification and defense. In what follows, I shall indicate some ofthe reasons for my dissatisfaction.?. Theepistemicleakargumentpurportsto"prove"(in Hume's sense)that reason or demonstration cannot support knowledge. Morris rightlyreminds us that whatHume meansby knowledge is perfect assurance or conviction: Knowledge is, in short, subjective certainty. This has caused confusion, for this is not what we usually mean nowadays by knowledge; nor was it what people, philosophers included, generally meant prior to Descartes. In Hume itis the product ofthe attempttoresolve all epistemic statesintomental eventsorwhat he calls "perceptions." In any case, we must—as Morris rightly explains—be clear that the epistemic leak argument is aimed at showing that demonstration cannot supportperfect conviction. Inoutline, the argumentissimple: Itworks, asMorrismakes clear, by shifting attention away from the subject-matter or "objects" of demonstration, that is, relations of ideas, to the exercise of demonstrative reason by human agents. The necessity of relations of ideas may suggest to us that we can be certain about them. Against this, one may point out that people do err in the conclusions arrived at by demonstration; this presumably shows that our (rational) understandingis fallible. And once we recognize this, our confidence in any conclusion produced by exercising this facultyislessened—thus do we move from knowledge, or subjective certainty, toprobability: belief, or imperfect conviction. Arguments ofthis general type (we can call them, using Descartes' famous figure, Totten-apple arguments ) were around long before Hume, although they were more commonly directed against the senses than against reason. We find them in antiquity—in Plato and Sextus Empiricus, for instance —and in Descartes, in parallel passages in the Discourse on Method, the First Meditation and the Principles of Philosophy, wherein one can discern a version directed precisely against reason and demonstration.12 To find out what, if anything, Hume has... (shrink)

The main causes of suicide and how suicide could and should be prevented are ongoing controversies in the scientific literature as well as in public media. In the bill on public health from 2008, the Swedish Parliament adopted an overarching “Vision Zero for Suicide” and nine strategies for suicide prevention. However, how the VZ should be interpreted in healthcare is unclear. The VZ has been criticized both from a philosophical perspective and against the background of clinical experience and alleged empirical (...) claims regarding the consequences of regulating suicide prevention. This study is part of a larger research project in medical ethics with the overarching aim to explore whether the VZ is ethically justifiable. The aim is to enrich the normative discussion by investigating empirically how the VZ is perceived in healthcare. Interviews based on a semi-structured interview guide were performed with 12 Swedish psychiatrists. The interviews were analysed with descriptive qualitative content analysis aiming for identifying perceptions of the Vision Zero for Suicide as well as arguments for and against it. Though most of the participants mentioned at least some potential benefit of the Vision Zero for Suicide, the overall impression was a predominant skepticism. Some participants focused on why they consider the VZ to be unachievable, while others focused more on its potential consequences and normative implications. The VZ was perceived to be impossible to realize, nonconstructive or potentially counterproductive, and undesirable because of potential conflicts with other values and interests of patients as well as the general public. There were also important notions of the VZ having negative consequences for the working conditions of psychiatrists in Sweden, in increasing their work-related anxiety and thwarting the patient-physician relationship. (shrink)

In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work?

Aus dem Inhalt: Views from the North: Hans Petter Graver: Law, Justice and the State: Nordic Perspectives u Jacob Dahl Rendtorff: The Danish Welfare State: Philosophical Ideals and Systemic Reality u Sigri!Dur *orgeirsdottir: Feminist Ethics and Feminist Politics u Kuellike Lengi: The Situation of Human Rights in Estonia u Einar Palsson: Pythagoras and Early Icelandic Law u Law, Discourse and Rationality: Mats Flodin: Internal and External Rationality of Legal Systems u Logi Gunnarsson: A Discourse About Discourse u Hjordi!s Hakonardottir: Legal (...) Language: A Tool of Justice u Ghita Holmstrom-Hintikka: On the Use of Expert Witness in Legal Reasoning and Inquiry u Law, State and Nation: Agust H. Ing*orsson: Democracy, Bureaucracy and Marginalization of the State u Aleksander Peczenik: Law-State, Legal Certainty and Legitimacy of Law u Ove K. Pedersen/Sverre Raffnsoe: Reorganizing Society u Juha Raikka: Mill on National Sentiment u Pall Skulason: Concepts of the State and Classes of Value u Problems of Law and Rights: Britt-Mari Blegvad: How to Cope With Uncertainty: Trust and Law u Jon Wetlesen: Animal Rights or Human Duties?. (shrink)

This article examines how one of the most striking differences between the central doctrines of the Catholic Church and the secular context of Swedish society, attitudes to abortion, is managed by the Swedish church hierarchy and commentators in the official newsletter of the Catholic Church of Sweden. Using Foucauldian concepts of power, the article concludes that in its marginal position, the Catholic Church in Sweden mixes the traditional pastoral and sovereign power of the church with the way pastoral power is (...) exerted in modern society, in its efforts to continue asserting its influence over the possible courses of action for pregnant women. While traditionally abortion has been a woman’s crime, in the Swedish Catholic context it becomes rather the crime of the secular society. This means also that the image of woman as being responsible for her decisions and in need of forgiveness gives way to an image of woman as a victim in need of understanding. (shrink)

Background: Ethics rounds are one way to support healthcare personnel in handling ethically difficult situations. A previous study in the present project showed that ethics rounds did not result in significant changes in perceptions of how ethical issues were handled, that is, in the ethical climate. However, there was anecdotal evidence that the ethics rounds were viewed as a positive experience and that they stimulated ethical reflection. Aim: The aim of this study was to gain a deeper understanding of how (...) the ethics rounds were experienced and why the intervention in the form of ethics rounds did not succeed in improving the ethical climate for the staff. Research design: An exploratory and descriptive design with a qualitative approach was adopted, using individual interviews. Participants and research context: A total of 11 healthcare personnel, working in two different psychiatry outpatient clinics and with experience of participating in ethics rounds, were interviewed. Ethical considerations: The study was based on informed consent and was approved by one of the Swedish Regional Ethical Review Boards. Findings: The participants were generally positive about the ethics rounds. They had experienced changes by participating in the ethics rounds in the form of being able to see things from different perspectives as well as by gaining insight into ethical issues. However, these changes had not affected daily work. Discussion: A crucial question is whether or not increased reflection ability among the participants is a good enough outcome of ethics rounds and whether this result could have been measured in patient-related outcomes. Ethics rounds might foster cooperation among the staff and this, in turn, could influence patient care. Conclusion: By listening to others during ethics rounds, a person can learn to see things from a new angle. Participation in ethics rounds can also lead to better insight concerning ethical issues. (shrink)

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most participants report (...) positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)

Few qualitative studies explore the phenomenon of positive ethical climate and what actions are perceived as promoting it. Therefore, the aim of this study was to explore and describe actions that acute care ward nurses perceive as promoting a positive ethical climate. The critical incident technique was used. Interviews were conducted with 20 nurses at wards where the ethical climate was considered positive, according to a previous study. Meeting the needs of patients and next of kin in a considerate way, (...) as well as receiving and giving support and information within the work group, promoted a positive ethical climate. Likewise, working as a team with a standard for behaviour within the work group promoted a positive ethical climate. Future research should investigate other conditions that might also promote a positive ethical climate. (shrink)

KARLSSON V, LINDAHL B and BERGBOM I. Nursing Inquiry 2012; 19: 247–258 Patients’ statements and experiences concerning receiving mechanical ventilation: a prospective video‐recorded studyProspective studies using video‐recordings of patients during mechanical ventilator treatment (MVT) while conscious have not previously been published. The aim was to describe patients’ statements, communication and facial expressions during a video‐recorded interview while undergoing MVT. Content analysis and hermeneutics inspired by the philosophy of Gadamer were used. The patients experienced almost constant difficulties in breathing and (...) lost their voice. The most common types of communication techniques patients used were nodding or shaking the head. Their expressions were interpreted as stiffened facial expression, tense body position and feelings of sadness and sorrow. Nursing care for patients’ conscious during MVT is challenging as it creates new demands regarding the content of the care provided. In caring for patients undergoing MVT while conscious, establishing a caring relationship, making patients feel safe and helping them to communicate seem to be most important for alleviating discomfort and instilling hope. (shrink)

In spite of stricter provisions inthe new EU directive on deliberate release ofgenetically modified organisms (GMOs), criticsstill advocate a moratorium on permits forcultivation of GMOs. However, in an attempt tomeet concerns raised by the public, thedirective explicitly gives Member States thepossibility to take into consideration ethicalaspects of GMOs in the decision-making. Thisarticle investigates the potential effects ofsuch formulation by means of an empiricalanalysis of experiences gained the last yearsfrom similar Swedish regulations for GMOs,aiming at promoting sustainable development.The faulty implementation shown (...) in the Swedishcase indicates that legal stipulations forethics as such have limited importance. It issuggested that public participation is animportant factor for successful implementationof the ethics of sustainable development. (shrink)

The aim of this study was to describe nurses' conceptions of decision making with regard to life-sustaining treatment for dialysis patients. Semistructured interviews were conducted with 13 nurses caring for such patients at three hospitals. The interview material was subjected to qualitative content analysis. The nurses saw decision making as being characterized by uncertainty and by lack of communication and collaboration among all concerned. They described different ways of handling decision making, as well as insufficiency of physician—nurse collaboration, lack of (...) confidence in physicians, hindrances to patient participation, and ambivalence about the role of patients' next of kin. Future research should test models for facilitating communication and decision making so that decisions will emerge from collaboration of all concerned. Nurses' role in decision making also needs to be discussed. (shrink)

What kind of a science is psychoanalysis? What constitutes its domain? What truth claims does it maintain? In this unique and scholarly work concerning the nature of psychoanalysis, Gunnar Karlsson guides his arguments through phenomenological thinking which, he claims, can be seen as an alternative to the recent attempts to cite neuropsychoanalysis as the answer to the crisis of psychoanalysis. Karlsson criticizes this effort to ground psychoanalysis in biology and neurology and emphasizes instead the importance of defining the (...) psychoanalytic domain from the vantage point of the character of consciousness. His understanding of the unconscious, the libido and the death drive offer new insights into the nature of psychoanalysis, and he also illuminates and develops neglected dimensions such as consciousness and self-consciousness. Karlsson's approach to psychoanalysis is rigorous yet original, and this book fills an intellectual gap with implications for both the theoretical understanding and clinical issues of psychoanalysis. (shrink)

Im Gegensatz zum drei Jahre jüngeren Schelling, dem er sein Leben lang verbunden blieb, wird Steffens nach seinem Tod nahezu vergessen; in der landläufigen Überlieferung hat er als der Überbringer der Romantik nach Dänemark überlebt. Erst mit Beginn des 21. Jahrhunderts wird er als Naturforscher, als Philosoph und Universitätsreformer wiederentdeckt, nicht zuletzt auch im Diskurs-Zusammenhang um das Anthropozän. Steffens-Forscherinnen und Forscher aus Norwegen, Dänemark und Deutschland setzen sich mit dem romantischen Denken der Zeit, mit den Aspekten der nationalen Wiedergeburt in (...) Kultur, Politik und Wissenschaft auseinander, mit Naturgeschichte und Kunst: Marit Bergner, Marie-Theres Federhofer, Bernd Henningsen, Lore Hühn, Daniel Fulda, Norman Kasper, Jesper Lundsfryd Rasmussen, Jessika Piechocki, Anna Lena Sandberg und Elisabeth Décultot. (shrink)

In the debate around ecological democracy, a pivotal point of contention has long been the question why democracy should actually be expected, as some claim, to deliver (more) ecological outcomes. This point is empirical as well as conceptual: it is difficult to conceive why voters would support any policies that – as is often (perceived to be) the case with environmental legislation – would leave them worse off; whilst democracy conceptually must remain open to all outcomes rather than being tied (...) to any particular agenda ex ante. Yet both empirically and conceptually, the nature and extent of this key puzzle has always hinged on the particular definitions used. This paper reconsiders the link between democracy and ecological sustainability from a cultural angle: I argue that conceiving of both sustainability and democratisation as essentially cultural transformations resolves the puzzle and thus makes a renewed case for ecological democracy. Only as cultural processes – the creation of new meanings of sustainable prosperity in people's everyday lives, and a culturally rather than institutionally based form of democratisation – can these transformations be deep-seated rather than superficial, and thus self-perpetuating rather than merely enforced. (shrink)

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into (...) moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded ‘grey zone articles’, in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients’ and caregivers’ views on ethical challenges, is presented. (shrink)

This study aims at discovering the essential constituents involved in the experiences of guilt and shame. Guilt concerns a subject’s action or omission of action and has a clear temporal unfolding entailing a moment in which the subject lives in a care-free way. Afterwards, this moment undergoes a reconstruction, in the moment of guilt, which constitutes the moment of negligence. The reconstruction is a comprehensive transformation of one’s attitude with respect to one’s ego; one’s action; the object of guilt and (...) the temporal-existential experience. The main constituents concerning shame are its anchorage in the situation to which it refers; its public side involving the experience of being perceptually objectified; the exclusion of social community; the bodily experience; the revelation of an undesired self; and the genesis of shame in terms of a history of frozen now-ness. The article ends with a comparison between guilt and shame. (shrink)

Deliberative democracy’s roots in critical theory are often invoked in relation to deliberative norms; yet critical theory also stands for an ambition to provoke tangible change in the real world of political practice. From this perspective, this paper reconsiders what deliberative democracy ought to look like as a critical theory, which has not just theoretical and practical, but also methodological implications. Against conceptions of activism as pushing through one’s pregiven convictions, recent debates in critical theory highlight the necessity for critical (...) activism to be emancipatory in way that is enabling rather than imposing, and inclusive rather than ‘enlightened’. As such deliberative democracy must be at once a critical theory of democracy and a democratic critical theory: committing itself to being an innately inclusive, itself reflexive and self-reflexive project rather than a substantive theory to be implemented. (shrink)

For some time we have seen a shift away from direct marketing, a core feature and dominant exchange form in the alternative food world, towards a greater role for intermediation. Yet, we still need to better understand to what extent and in what ways new mediated Alternative Food Networks represent an evolution of or departure from core tenets of alternative food systems. This paper focuses on AFNs with new intermediaries that connect small-scale producers with urban end-consumers. Based on original research (...) in Frankfurt, Berlin, and Calgary, we analyze three different types of mediated AFNs: one driven by consumers, one by an external intermediary, and one by producers. Our cases include non-capitalist, capitalist, and alternative capitalist economic practices as identified by Gibson-Graham. Conceptually, we base our analysis on the three-pillar-model of alternative agri-food systems, which we further refine. Besides comparing our cases with each other, for heuristic purposes we also compare them with an ideal-type model that adheres to core tenets of alterity in all three pillars. Our empirical analysis shows that intermediary organizations can bring important benefits and that mediated AFNs are in principle able to hold true to the core tenets of alternative agri-food systems. However, it is very important to develop models of democratic control and ownership as well as economic arrangements in which created value is fairly shared. Only then can the potentials of new mediated models be realized while the pitfalls of the conventional systems they seek to replace be avoided. (shrink)

With the rising of the reported cases of COVID-19 and home quarantine being implemented, the Internet became a channel for effective human interaction. Doing most of the work online brought an increasing number of online fraudsters to exploit the public fear of the pandemic to attack people through cybercrime. This paper introduces what cybersecurity is all about. It also lists some of the cybersecurity issues that are being faced at this time. Further, it discusses forms of attacks being encountered and (...) lists recommendations on how to be safe online. (shrink)

Nowadays it is increasingly common that the patients in the end of life phase choose to be cared for in their own home. Therefore it is vital to identify significant factors in order to prevent unnecessary suffering for dying patients and their families in end-of-life homecare. This study aimed to describe 10 nurses’ perceptions of significant factors that contribute to good end-of-life care in the patients own home. The transcribed texts from the interviews’ were analyzed using phenomenological hermeneutical method, which (...) focuses on the life-world of human beings. The results demonstrate that good end-of-life care presupposes that the aim of the caring staff is to provide safety, autonomy and integrity for the patient and family in order to create the respect required for as good and dignified a death as possible. (shrink)

In this study the awake patient's intraoperative situation and experiences during regional anaesthetics and surgery are reflected upon by using the work of the French philosopher Maurice Merleau‐Ponty. Merleau‐Ponty's phenomenological idea of the body as being at the centre of the world highlights the patient's embodied position and bestows significance onto the body as a whole, as a lived body. A case, based on the findings from a previous interview study, is presented as a contextual starting point where a patient (...) goes from having a familiar body recognized as her own to having a partially anaesthetized body experienced as an unknown object. The intraoperative caring space is described in this context as the mutual ground where the awake patient and the nurse anaesthetist (NA) can interact to create meaning. The NA can act as the patient's bodily extension to bridge the gap between the patient's experiences and the situation. This calls for the NA's proximity and genuine presence in order to meet and understand the patient's awake experiences. Learning from the patient's situatedness gives information that is valuable for NAs to share with patients who are less experienced with this contextual situation. The challenge for the NA is not to perform routine‐based care, but to acknowledge every patient's lifeworld and uniqueness thus enabling the patient to move easily along the mind–body–world continuum. The core of intraoperative care is to provide support and promote well‐being of awake patients in the intraoperative environment. The use of a philosophical perspective is relevant for nurses who work in an intraoperative setting where patients undergo regional anaesthetics. This study shows how nursing research using phenomenological philosophy can help uncover new meanings known only to the patients living the experience. (shrink)

Background: To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature. Methods: A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included. Ethical considerations: The review is conducted according to the Vancouver Protocol. (...) Results: There are few studies that study ethical challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good (beneficence) and inflicting harm (maleficence). In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion. Conclusion: There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress. (shrink)

Clinical ethics support, in particular Moral Case Deliberation, aims to support health care providers to manage ethically difficult situations. However, there is a lack of evaluation instruments regarding outcomes of clinical ethics support in general and regarding Moral Case Deliberation (MCD) in particular. There also is a lack of clarity and consensuses regarding which MCD outcomes are beneficial. In addition, MCD outcomes might be context-sensitive. Against this background, there is a need for a standardised but flexible outcome evaluation instrument. The (...) aim of this study was to develop a multi-contextual evaluation instrument measuring health care providers’ experiences and perceived importance of outcomes of Moral Case Deliberation. (shrink)

Two experiments with undergraduates as subjects were carried out with the aim of replicating and extending previous results showing that the implication of the behavioral life-cycle hypothesis (H. M. Shefrin & R. H. Thaler, 1988) that people classify assets in different mental accounts (current income, current assets, and future income) may explain how consumption choices are influenced by temporary income changes. In both experiments subjects made fictitious choices between paying for a good in cash or according to a more expensive (...) installment plan after they had received an income which was either less, the same, or larger than usual. In Experiment 1 subjects were supposed to have savings so that the total assets were equal, whereas in Experiment 2 the total assets varied. The results of both experiments supported the role of mental accounts in demonstrating that subjects were unwilling to pay in cash after an income decrease even though they had access to saved money. Thus, in effect they chose to pay more for the good than they had to. Indicating a need for further refinement of the concept of mental account, choices to pay in cash after an income decrease tended to be more frequent when the consumption and savings motives were compatible than when they were incompatible. Furthermore, increasing the total assets made subjects more willing to pay in cash after an income decrease. (shrink)

The idea behind this article is to discuss the importance and to develop the concept of reciprocity in asymmetric professional relationships. As an empirical starting point for an examination of the possible forms of reciprocity between patients and nurses in psychiatry, we chose two qualitative in-depth interviews with two different patients. The manners in which these two patients relate to medical personnel—one is dependent, the other is independent—show that this presents challenges to nurses. The theoretical context is provided by the (...) notion of mature care as it has been developed by feminist-oriented ethics of care, in contrast to the notion of altruistic care. In relation to the concept of mature care, we discuss how nursing can be perceived in demanding relationships with patients in psychiatry. Reciprocity implies that, in principle, the interests of the nurses also matter in a nurse-patient relationship. We show that reciprocity—in practice—is complicated and challenging in a number of different ways. Mature care—with its systematic inclusion of relationships and reciprocity—provides an alternative understanding of what takes place between patients and nurses compared with an altruistic notion of care. As such, mature care can be regarded as an useful paradigm for nurse-patient relationships in psychiatry. (shrink)

It is a contradictory argument to say on the one hand that social systems are always open and that there is nothing between closed and open systems, and on the other that there are pseudo-closed systems. Further, Petter Næss has shown that multivariate regression analysis can be used to help uncover mechanisms, something that should be impossible if social systems were always open. He has in addition found that the meaningful activity of urban planning requires for its existence the possibility (...) to make crude, qualitative predictions, which should also be impossible for the same reason. Critical realists therefore need to rethink the whole question of closed and open social systems. (shrink)

Background: The majority (70%) of cardiac arrests in Sweden are experienced in the patient’s home. In these situations, the ambulance nurses may encounter several ethical dilemmas. Aim: The aim was to investigate Swedish specialist ambulance nurses’ experiences of ethical dilemmas associated with cardiac arrest situations in adult patients’ homes. Methods: Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis. Ethical considerations: Ethical principles mandated by (...) the Swedish Research Council were carefully followed during the whole process. Findings: Two main themes with six sub-themes were identified: The scene – creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients’ integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being’s dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human. Conclusion: The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient’s dignity and to serve life and health. (shrink)

Two experiments with undergraduates as subjects tested explanations of how a prior temporary income change influences choices between buying and deferred buying. In Experiment 1 predictions from the behavioral life-cycle theory (Shefrin & Thaler, 1988), the renewable resources model (Linville & Fischer, 1991) and the loss-sensitivity principle (Garling & Romanus, 1997) were contrasted. The results are inconsistent with the latter two explanations since the framing of buying as positive (buying a new model of a product) or negative (replacing a broken (...) product) did not interact with the income change. Congruent with the behavioral life-cycle theory, willingness to buy was greater when subjects received a temporary income increase than when they received a temporary income decrease although total assets were equal. Further support for the behavioral life-cycle theory is obtained in Experiment 2 where four income-change conditions and durable and nondurable goods are compared. (shrink)

The distinction between acting and suffering underlies any theory of agency. Among contemporary writers, Fred Dretske is one of the few who has attempted to explicate this distinction without restricting the notion of action to intentional action alone. Aristotle also developed a global account of agency, one which is deeper and more detailed than Dretske's, and it is to Aristotle's account (with some modifications) that the bulk of this paper is devoted. Dretske's sketchier theory faces at least two ground-level problems. (...) It is shown in the course of the paper how these can be handled by the Aristotelian account, in a way which is friendly to Dretske's approach. (shrink)

Anthropomorphism has long been considered a cardinal error when describing animals. Ethicists have feared the consequences of misrepresenting animals in their reasoning. Recent research within human- animal studies, however, has sophisticated the notion of anthropomorphism. It is suggested that avoiding anthropomorphism merely creates other morphisms, such as mechanomorphism. Instead of avoiding anthropomorphism, it is argued that it is a communicative strategy that should be used critically. Instances of anthropomorphism in animal ethics are analyzed in this paper. Some analogies made between (...) people and non-human animals in present theories of animal ethics are clear instances of psychological anthropomorphism. Other analogies are implicit cases of cultural anthropomorphism. It is argued that animal ethics needs to take the wider discourse of critical anthropomorphism into account in order to sophisticate the understanding and use of anthropomorphic projections. Anthropomorphism is an efficient tool of communication, and it may be made an adequate one as well. (shrink)

Introduction: We discuss Carol Gilligan's original concept of mature care in the light of the altruistic approach to caring and good clinical judgment. Discussion: In particular, we highlight how the concept of mature care can capture important challenges in today's nursing. Further, we illuminate how mature care might differ normatively from an altruistic approach to caring and the traditional prudential virtues in nursing. We also discuss similarities between mature care and virtue ethics. Conclusion: For nursing and nurses' identity, in today's (...) health care system that is increasingly pressured to ‘produce' health, we believe it is important to both developing further theories on mature care and having normative discussions about care. (shrink)

_In this lively and groundbreaking book, arts educator Marit Dewhurst examines why art is an effective way to engage students in thinking about the role they might play in addressing social injustice._ Based on interviews and observations of sixteen high schoolers participating in an activist arts class at a New York City museum, Dewhurst identifies three learning processes common to the act of creating art that have an impact on social justice: connecting, questioning, and translating. Noting that “one of (...) the challenges of social justice art education has been the difficulty of naming effective strategies that can be used across multiple contexts,” Dewhurst outlines core strategies for an “activist arts pedagogy” and offers concrete suggestions for educators seeking to incorporate activist art projects inside or outside formal school settings. _Social Justice Art _seeks to give common language to educators and others who are looking to expand and refine their practices in an emerging field, whether they work in art education, social justice programming, or youth development. (shrink)

The phenomenon of entrepreneurship has attracted researchers from a variety of disciplines and a diverse number of analytical approaches. Currently, there is a considerable amount of confusion and a variety of conflicting theories which are being used interchangeably and ambiguously. In this important new book, the authors argue that there are analytically distinct forms of entrepreneurship, each of them having an individual logic of their own. They highlight the role of individual economic agents with endowments of new knowledge or new (...) combinations of old knowledge as entrepreneurs, and thus identify them as dynamic factors in the knowledge economy. Overall, this book not only provides a contemporary overview of current research in the field, but also summarizes the policy conclusions that can be drawn from current research. (shrink)