Questions of social justice and health-care costs are some of the concerns of society. The cost caused by cardiovascular diseases can have an enormous impact, and it is important to know what patients think about illness costs when they are hospitalized. Two interviews were realized in a longitudinal study, in a sample of 106 patients submitted to expensive techniques in Cardiology (Portugal), to understand the patients’ perception about the health costs and behavior changes based on awareness. We can conclude that (...) cardiovascular diseases are a global phenomenon that generally affects all social groups. From those interviewed, 83% of the patients agree about getting information concerning the treatments and intervention costs during hospitalization because the information about costs can bring the necessary tools for improvement in patients and health resources; 70.8% of the patients say that this information could bring awareness to the patient’s life, enhancing responsibility and personal autonomy. (shrink)

De senere år har pleie- og omsorgstjenesten i mange norske kommuner startet med ulike former for etikkarbeid, oftest initiert av KS’ prosjekt “Samarbeid om etisk kompetanseheving”. Hensikten med vår studie var å evaluere innsatsen i de kommunene som deltok i prosjektet fra starten av, med vekt på hvilke tiltak som var iverksatt, hvilke virksomheter dette omfattet, og om tiltakene har fortsatt utover prosjektperioden. Studien har et kvalitativt design. Materialet er hovedsakelig basert på telefonintervjuer med kontaktpersoner for etikksatsingen i 34 kommuner. (...) Det transkriberte materialet er analysert ved kvalitativ innholdsanalyse. Med unntak av fem kommuner som aldri kom i gang med etikkarbeidet, hadde de fleste startet etikkrefleksjon innenfor flere tjenester, oftest i sykehjem og hjemmetjenester. Noen kommuner hadde imidlertid ikke klart å videreføre etikkarbeidet utover en prosjektperiode. Det var stor variasjon både i etikkarbeidets forankring i kommunen, omfang, hyppighet og metoder. Et gjennomgående funn er vektlegging av behovet for etikkkompetanse og oppfølging av dem som skal lede etikkarbeidet. Flertallet av kommunene som fortsatt gjennomfører etikkrefleksjon, tar utgangspunkt i egen praksis, men et mindretall anvender strukturerte metoder. Dersom etikkarbeidet i kommunen skal være levedyktig over tid, bør arbeidet forankres på flere nivåer i organisasjonen, og de som skal lede dette arbeidet, bør få styrket sin kompetanse i etikk og etikkrefleksjon.Nøkkelord: etikk, evaluering, kommunehelsetjenestenEnglish summary: Building ethical competence in Norwegian municipalities: What has been done and what has been sustainable?“Cooperation for building ethics competence” is a national project aimed to stimulate moral reflection and build competence in ethics in community health services in Norway. This article is based on an evaluation of the activities implemented by the first 34 participating municipalities, exploring which measures were implemented, which services and employees were involved, and if the measures are sustainable. The study has a qualitative design, and the data mainly consists of telephone interviews with “key” persons in 34 municipalities. With the exception of five municipalities that never really started ethics work, the majority had implemented ethical reflection in several areas, most often in nursing homes and home care services. There was great variation with regard to the implementation. Many had tried a variety of reflection models, and only a minority of the municipalities were using a structured method of ethical reflection. A consistent finding is the need for more competence; many of those who run ethical reflection are reported to need more competence both in ethics and methods for systematic reflection. There were also great variations in how well the ethics projects were anchored within the municipality. To make ethical interventions sustainable, this study indicates the importance of strong anchoring within the municipality, the need for ethical competence, as well as good methods for structuring ethical reflection. (shrink)

It has long been the habit of philosophers, and is still a common failing of ordinary playgoers, to see tragedy through the coloured spectacles of an acquired philosophical or religious outlook, and to commend or condemn rather from the standpoint of partiality for a certain view about life in general than from that of one assessing the intrinsic merits of a work of art. Because we all, whether laymen or specialists, theorize about the nature and destiny of that mysterious universe (...) which, for a brief span, our minds illumine, and because the working hypothesis so engendered is inevitably tinged by our personal idiosyncrasies of temperament and taste, there have been—and, building on such a foundation, there must be—almost as many different theoretical explanations of the tragic as theoreticians speculating on this high theme. Besides introducing that personal equation which has always been anathema to science, the distorted vision for which philosophical preconceptions are responsible brings with it minor illusions that are scarcely less injurious; the reading into a play or a novel of notions that had never entered the poet's brain, or the interpolation of history with incidents that never really occurred, the discarding of much that is genuinely tragic because it happens not to fit into the mould shaped by our own ideas, and the acceptance of much that is not merely untragic, but actually inartistic—pacifist, or communist, or feminist, or religious propaganda—because it happens to display the native hue of our own convictions. (shrink)

This article presents a novel perspective, arguing for a virtue-based weak version of political realism in Ottoman political thought (OPT). By recognizing realist elements in human nature and poli- tics in OPT tradition, we can gain a deeper understanding of the place of morality in politics. Challeng- ing the common sense understanding of morality that pervades all areas of politics, this paper provides compelling evidence to show how the understanding of the nature of politics in OPT was ever-chang- ing, singular, (...) and, to a certain extent, free of morality. This unique framing of politics and human na- ture in the OPT tradition makes it a realist one. Finally, I delve into the role of universals in explaining the intricate relationship between politics and morality through various analytical distinctions. (shrink)

Bu makale, Osmanlı siyaset düşünce geleneğinde fazilet temelli kendine has ılımlı bir siyasî realizmin var olduğunu savunmaktadır. Günümüz siyasî realizm literatürü ve Osmanlı fazilet ahlâkına dayalı karşılaş- tırmalı metotla, siyasetin mahiyeti ve insanın doğasına dair realist unsurları teşhis etmeden Osmanlı siyaset düşüncesinde ahlâkî argümanların siyaseti, devlet fikrini ve kurumları nasıl inşa ettiğini anlayamayacağı- mızı iddia ediyorum. Osmanlı fazilet ahlâkı geleneğinde ahlâkın her şeyi kapsadığına dair kanının aksine siyasetin mahiyeti itibariyle tekil, değişken, ahlâktan bir ölçüde bağımsız bir gerçeklik olarak anlaşıldığını gösteriyorum. (...) Bununla bağlantılı olarak Osmanlı siyaset düşünce geleneğinde fazilet ahlâkından gelen in- sanın acziyeti anlayışının, siyasî aktörleri ve eylemleri değerlendirmede onu realist yapan unsur olduğunu ifade ediyorum. Son olarak ahlâkın kapsamı ve siyasetin mahiyetini (gerek birbirleriyle olan ilişkileri açı- sından gerekse de birbirlerinden bağımsız olarak varlıklarını) açıklamada tümeller probleminin nasıl bir rol oynadığına işaret ediyorum. Tümeller probleminin siyaset ve ahlâk arasındaki karmaşık ilişkiye dair getirdiği analitik ayrımları ılımlı siyasî realizmin kaynağı olarak sunuyorum. (shrink)

Pour l'A., il n'existe aucune preuve tangible qui permette de relier la proskynèse et les segmenta. La description la plus complète de la proskynèse est disponible dans le traité de Constantin VII Porphyrogénète, le De cerimoniis, qui est un récit du cérémonial de la cour byzantine à son apogée. Andreas Alföldi a suggéré que l'introduction du rite du baiser du genou de l'empereur impliquait la présence de morceaux de tissus sur les vêtements de l'empereur au niveau du genou. Ces segmenta (...) n'apparaissent pas exclusivement sur les vêtements impériaux. (shrink)

Derek Nurse looks at variations in the form and function of tense and aspect in Bantu, a branch of Niger-Congo, the world's largest language phylum. Bantu languages are spoken in central, eastern, and southern sub-Saharan Africa south of a line between Nigeria and Somalia. By current estimates there are between 250 and 600 of them, as yet neither adequately classified nor fully described. Professor Nurse's account is based on data from more than 200 Bantu languages and varieties, a representative sample (...) of which is freely available on the publisher's website. He devotes substantial chapters to the analysis and comparison of the different tense and aspect systems found in Bantu. He also examines the verbal categories with which they interact, including negation and focus. Synchronic and diachronic perspectives are interwoven throughout the book. Following a brief history of Bantu over the last five thousand years, the final two chapters look systematically at the history of tense and aspect in Bantu. The first deals with the reconstruction of the earlier forms from which contemporary structures, morphemes, and categories are derived, and the second with the processes of change, including grammaticalization, by means of which older analytical structures and independent lexical items moved as they became incorporated as grammatical inflections and categories. (shrink)

The renowned Nobel Prize-winning scientist's elegant and concise explanation of the fundamental ideas in biology and their uses today. Hailed by Philip Pullman as "a great communicator" who is also "as distinguished a scientist as there could be," Paul Nurse writes with delight at life's richness and a sense of the urgent role of biology in our time. With What Is Life? he delivers a brief but powerful work of popular science in the vein of Carlo Rovelli's Seven Brief Lessons (...) in Physics. Nurse takes readers on a wondrous journey through five fundamental biological ideas-the Cell, the Gene, Evolution by Natural Selection, Life as Chemistry, and Life as Information-introducing the scientists who made the most important advances and taking us into his own lab to give us a sense of the thrill of scientific discovery. In a final chapter, Nurse addresses biology's most pressing ethical issues (including gene-editing, genetic testing, and genetically modified crops), and he concludes with a stirring encomium to biology's role in tackling infectious disease. (shrink)

Life is all around us, abundant and diverse, it is extraordinary. But what does it actually mean to be alive? Nobel prize-winner Paul Nurse has spent his career revealing how living cells work. In this book, he takes up the challenge of defining life in a way that every reader can understand. It is a shared journey of discovery; step by step he illuminates five great ideas that underpin biology. He traces the roots of his own curiosity and knowledge to (...) reveal how science works, both now and in the past. Using his personal experiences, in and out of the lab, he shares with us the challenges, the lucky breaks, and the thrilling eureka moments of discovery. To survive the challenges that face the human race today - from climate change, to pandemics, loss of biodiversity and food security - it is vital that we all understand what life is. (shrink)

Despite achieving broad acceptance of the moral case for treating animals fairly, the animal rights movement has reached an impasse concerning legal rights for animals. Zoopolis proposes a new approach to addressing this failure: integrating animal interests into human society via political institutions and practices. Zoopolis’s central theory that humans owe animals citizenship rights in a shared human-animal society, but that acceptance of responsibilities by animals also is required, has merit for the advancement of animal rights discourse. But its anthropocentric (...) approach, which itself exerts power over animals, necessitating suppression and policing of animals’ natural behavior, is problematic. (shrink)

In the yeasts Saccharomyces cerevisiae and Schizosaccharomyces pombe, the initiation of DNA replication is controlled at a point called START. At this point, the cellular environment is assessed; only if conditions are appropriate do cells traverse START, thus becoming committed to initiate DNA replication and complete the remainder of the cell cycle. The cdc2+ / CDC28+ gene, encoding the protein kinase p34, is a key element in this complex control. The identification of structural and functional homologues of p34 suggests that (...) it has a role in the control of DNA replication in all eukaryotes. The WHI1+, CLN1+ and CLN2+ gene products, identified in S. cerevisiae, are positive regulators that function at START and may interact with p34. Determining how passing the START control point leads to the initiation of DNA replication is a major outstanding challenge in cell cycle studies. (shrink)

Aim: To determine the current state of knowledge on nursing and ethics and to assess the knowledge and experience based on the evidence in this regard. Background: Although ethics is at the center of the nursing profession and the ethical issues affecting nurses are given much importance, few studies have focused on professional ethics in nursing. In this respect, ethics has become a concept that contains controversial and ambiguous situations. Design: The Preferred Reporting Items for Systematic Reviews (...) and Meta-analyses guide, a basic search algorithm, was taken. Data sources: Cochrane, PubMed, CINAHL Complete, PsycINFO, and ULAKBIM from 2012 to 2016. Review methods: Following a systematic search strategy, all papers were assessed in relation to inclusion criteria and type of study. When sufficient information was not available in the title and summary of the works, the necessary data were evaluated in full texts. Results: This review was completed with 27 articles meeting the research criteria. The evaluation identified six themes: (1) ethics and nursing, (2) ethical difficulties/ethical dilemmas and nursing, (3) ethical competence and nursing, (4) professional ethics and nursing, (5) ethics, education, and nursing, and (6) ethics in health research. Conclusion: As a result of the review, a synthesis of high evidence-level research relating to nursing ethics was obtained. The emphasis was on the importance of further research and education so that the ethical aspects of nursing can be better understood throughout the studies. Nursing researchers’ level of evidence on ethics and their orientation to high research design will shed light on uncertain and controversial aspects of the subject. Ethical consideration: Since this was a systematic review, no ethical approval was required. There is no conflict of interest in this literature review. (shrink)

Diagnostic frameworks are essential to many scientific and technological activities and clinical practice. This study examines the main fundamental aspects of such frameworks. The three components required for all diagnoses are identified and examined, i.e. their normative dimension, temporal nature and structure, and teleological perspective.The normative dimension of a diagnosis is based on (1) epistemic values when associated with Hempel's inductive risk concerning the balance between false‐positive and false‐negative outcomes, leading to probabilistic judgements; and (2) non‐epistemic values when related to (...) ideas such as well‐being, normality, illness, etc, as idealized norms or ideal points of reference.It should be noted that medical diagnoses match the three necessary components, while some essential diagnostic frameworks – the taxonomies ofGordon andNANDA– in nursing lack some components. The main lack is normative as the most popular frameworks in nursing diagnosis seem to be descriptions of observed reality rather than normative and value‐based judgements in which both epistemic and non‐epistemic values may coexist. (shrink)

Literature on racism, anti‐racism, whiteness, nursing education and nurse educators was reviewed and analysed for the development of race consciousness and application of anti‐racist pedagogy. The literature describes an oppressive educational climate for non‐white identifying people, a curriculum that does not attend to the social construction of difference, and a nursing culture that is not consciously situated in a broader sociopolitical context. A particular focus on studies of nurse educators demonstrates a stark need for personal and professional development (...) towards effectively delivering anti‐racist pedagogy and a deconstruction of white normativity and dominance amongst white faculty. The protection and reproduction of white privilege is identified through the scholarship itself through a lack of racial analysis, an externalization of the root of oppression and non‐specific study measures and outcomes. The persistence and pervasiveness of white dominance in nursing and the lack of anti‐racist competence in white educators, particularly, merits a shift in anti‐racist efforts away from short‐term skill acquisition initiatives towards the deconstruction of socialized white supremacy and enactments of white privilege in nurse educators themselves. (shrink)

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Although there are notable exceptions, examination of nursing's participation in colonizing processes and practices has not taken hold in nursing's consciousness or political agenda. Critical analyses, based on the examination of politics and power of the structural determinants of health, continue to be marginalized in the profession. The goals of this discussion article are to underscore the urgent need to further articulate postcolonial theory in nursing and to contribute to nursing knowledge about paths to work toward (...) decolonizing the profession. The authors begin with a description of unifying themes in postcolonial theory, with an emphasis on colonized subjectivities and imperialism; the application of a critical social science perspective, including postcolonial feminist theory; and the project of working toward decolonization. Processes involved in the colonization of nursing are described in detail, including colonization of nursing's intellectual development and the white privilege and racism that sustain colonizing thinking and action in nursing. The authors conclude with strategies to increase the counter‐narrative to continued colonization, with a focus on critical social justice, human rights and the structural determinants of health. (shrink)

Background: Ethics stimulation in nursing education focuses on human, non-technical factors in a clinical reality. Simulation as a teaching method began in the 1930s with flight simulators. In the beginning of the 1990s, simulations developed further in tandem with other technological and digital inventions, including touchscreen and three-dimensional anatomical models. Medical science first used simulation as a pedagogical teaching tool. In nursing education, simulation has been used for approximately a hundred years. Teaching has mainly focused on medical-technical, patient-specific (...) interventions and their management. Objective: The objective of this study was, from a caring science didactic perspective, to deepen the understanding of ethics simulation in nursing education. Design: Qualitative design and explorative, descriptive and hermeneutic approach of an inductive character. Methods: Semi-structured face-to-face interviews in 2016–2017 with six Norwegian nursing students who were encouraged to narrate about their experiences of ethics simulation in nursing education. Ethical considerations: Informed consent was obtained from the participants. Anonymity and confidentiality regarding data material were guaranteed. Results: Interpretation of the nursing students’ narratives resulted in the following meaning units: ethical being and ethos, nursing students’ formation process, bridge-building between theory and clinical practice, and teacher and ethics simulation. Conclusion: Through ethics simulation, nursing students can obtain an increased knowledge and a sense of being able to handle difficult ethical situations. Nursing students’ values, moral actions and ethical value base offer a positive point of departure, for both theoretical and practical ethics teaching, and an awareness of the unique human being, the patient, in clinical reality. The implementation of ethics simulation needs more attention in nursing education. (shrink)

The term ‘moral resilience’ has been gaining momentum in the nursing ethics literature. This may be due to it representing a potential response to moral problems such as moral distress. Moral resilience has been conceptualised as a factor that inhibits immoral actions, as a favourable outcome and as an ability to bounce back after a morally distressing situation. In this article, the philosophical analysis of moral resilience is developed by challenging these conceptualisations and highlighting the risks of such limiting (...) perspectives. It is argued that moral resilience is best understood as a virtue with two associated vices, faintheartedness and rigidity. The intellectual virtue of practical wisdom is required to express resilience as a virtue. This understanding leads to recommendations for professional education, for practice and for further research. (shrink)

Background: While nursing ethics education is commonly provided for undergraduate nursing students in most nursing colleges, consensus on the content and teaching modules for these ethics courses have still not been established. Objectives: This study aimed to examine the effects of nursing ethics education on the moral sensitivity and critical thinking disposition of nursing students in Korea. Research design: A one-group pre- and post-test design was used. Moral sensitivity was measured using the Korean version of (...) the Moral Sensitivity Questionnaire. Critical thinking disposition was measured using the Critical Thinking Disposition Questionnaire. Participants and research context: Participants were 70 undergraduate nursing students who were attending a university located in Seoul, Korea. The nursing ethics education was provided 7 times, from September to December 2010, and comprised 90-min sessions each week. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines. Findings: After the education, the levels for the patient-oriented care, a sub-domain of moral sensitivity, and inquisitiveness, a sub-domain of critical thinking disposition, significantly improved. There were no changes in overall scores for moral sensitivity and critical thinking disposition. There were significant positive correlations between moral sensitivity and critical thinking disposition both pre- and post-intervention. Conclusion: These results reflect the need for ongoing efforts to develop innovative content, structure, and instructional methods for undergraduate nursing ethics education programs. (shrink)

Background: The concept of conscientious objection is well described; however, because of its nature, little is known about real experiences of nursing professionals who apply objections in their practice. Extended roles in nursing indicate that clinical and value-based dilemmas are becoming increasingly common. In addition, the migration trends of the nursing workforce have increased the need for the mutual understanding of culturally based assumptions on aspects of health care delivery. Aim: To present (a) the arguments for and (...) against conscientious objection in nursing practice, (b) a description of current regulations and practice regarding conscientious objection in nursing in Poland and the United Kingdom, and (c) to offer a balanced view regarding the application of conscientious objection in clinical nursing practice. Design: Discussion paper. Ethical considerations: Ethical guidelines has been followed at each stage of this study. Findings: Strong arguments exist both for and against conscientious objection in nursing which are underpinned by empirical research from across Europe. Arguments against conscientious objection relate less to it as a concept, but rather in regard to organisational aspects of its application and different mechanisms which could be introduced in order to reach the balance between professional and patient’s rights. Discussion and conclusion: Debate regarding conscientious objection is vivid, and there is consensus that the right to objection among nurses is an important, acknowledged part of nursing practice. Regulation in the United Kingdom is limited to reproductive health, while in Poland, there are no specific procedures to which nurses can apply an objection. The same obligations of those who express conscientious objection apply in both countries, including the requirement to share information with a line manager, the patient, documentation of the objection and necessity to indicate the possibility of receiving care from other nurses. Using Poland and the United Kingdom as case study countries, this article offers a balanced view regarding the application of conscientious objection in clinical nursing practice. (shrink)

The aim of this review was to analyse the empirical studies that focus on ethics in nursing care for older people, scoping the need and areas for further study. A search of the MEDLINE and CINAHL databases (earliest to August 2009) was conducted using the the keywords: ethic* and nursing or care or caring and elderly or aged or older. After a four-stage process, 71 empirical articles were included in the review, with informants ranging from elderly people to (...) relatives, caregivers, managers and students in care settings. The review focusses on the concepts, contexts, methods and validity of these studies. Based on the analysis, the reviewed research seems to be fragmented and multifaceted, focussing on selected issues such as autonomy, self-determination and informed consent. No large research programs or research traditions were found so it was not possible to draw any conclusions about suitable methods, study designs or instruments of measurement for use in this research area. (shrink)

Background: The development of society and science, especially medical science, gives rise to new moral and ethical challenges in healthcare. Research question/objectives/hypothesis: In order to respond to the contemporary challenges that require autonomous decision-making in different work contexts, a pedagogical experiment was conducted to identify the readiness and responsiveness of current organisation of nursing higher education in Slovenia. It compared the successfulness of active learning methods online (experimental group) and in the traditional classroom (control group) and their impact on (...) the ethical competences of nursing students. The hypothesis set in the experiment, hypothesis 1 (the experimental group will be successful and will have good achievements in comprehension and application of ethical principles) was confirmed based on pre-tests and post-tests. The hypothesis tested by the questionnaire, hypothesis 2 (according to the students, the active learning methods online in the experimental group have a positive impact on the development of ethical competences) was confirmed. Research design: The pedagogical experiment was supported by a multiple-case study that enabled the in-depth analysis of the students’ attitudes towards the active learning methods in both settings. Participants and research context: The study included Slovenian first-year nursing students (N = 211) of all the enrolled students (N = 225) at the University of Ljubljana and University of Primorska in the academic year 2010/2011. Ethical considerations: Before the study ethical permission was obtained from the managements of both participating faculties. The students were given all the necessary information of the experiment before the tutorials. Findings: No significant difference was found between the two learning settings and both had a positive impact upon learning. The results of the content analysis show that the students’ active engagement with the active learning methods in the group enables the development of ethical competences and the related communicative competences, interpersonal skills, collaboration and critical thinking. Discussion: Active learning methods in the settings compared, online and the traditional classroom, enabled the development of a higher level of knowledge defined by the ability of critical thinking and reflective response, the core of ethical competences. Students develop ethical competence through active engagement in a group work, role play and discussion, and there is no difference between online or traditional learning settings. Conclusion: In the healthcare, it is crucial for providers to be capable of making autonomous decisions and managing various communication situations and contexts in which the moral attitudes and ethical sensibility are essential. (shrink)