Digital technologies induce organised immaturity by generating toxic sociotechnical conditions that lead us to delegate autonomous, individual, and responsible thoughts and actions to external technological systems. Aiming to move beyond a diagnostic critical reading of the toxicity of digitalisation, we bring Bernard Stiegler’s pharmacological analysis of technology into dialogue with the ethics of care to speculatively explore how the socially engaged arts—a type of artistic practice emphasising audience co-production and processual collective responses to social challenges—play a care-giving (...) role that helps counter technology-induced organised immaturity. We outline and illustrate two modes by which the socially engaged arts play this role: 1) disorganising immaturity through artivism, most notably anti-surveillance art, that imparts savoir vivre, that is, shared knowledge and meaning to counter the toxic side of technologies while enabling the imagination of alternative worlds in which humans coexist harmoniously with digital technologies, and 2) organising maturity through arts-based hacking that imparts savoir faire, that is, hands-on knowledge for experimental creation and practical enactment of better technological worlds. (shrink)

STAJDUHAR K, FUNK L, JAKOBSSON E and ÖHLÉN J. Nursing Inquiry 2010; 17: 221–230A critical analysis of health promotion and ‘empowerment’ in the context of palliative family care-givingTraditionally viewed as in opposition to palliative care, newer ideas about ‘health-promoting palliative care’ increasingly infuse the practices and philosophies of healthcare professionals, often invoking ideals of empowerment and participation in care and decision-making. The general tendency is to assume that empowerment, participation, and self-care are universally beneficial for (...) and welcomed by all individuals. But does this assumption hold for everyone, and do we fully understand the implications of health-promoting palliative care for family caregivers in particular? In this study, we draw on existing literature to highlight potential challenges arising from the application of ‘family empowerment’ strategies in palliative home-care nursing practice. In particular, there is a risk that empowerment may be operationalized as transferring technical and medical-care tasks to family caregivers at home. Yet, for some family caregivers, a sense of security and support, as well as trust in professionals, may be equally if not more important than empowerment. Relational and role concerns may also at times take precedence over a desire for empowerment. The potential implications of ‘family empowerment’ are explored in this regard. ‘Family empowerment’ approaches need to be accompanied by a strong understanding of how to best support individual palliative family caregivers. (shrink)

This study examines local communities’ lived experiences and organizations’ care-giving processes regarding four oil and gas projects deployed in three countries. Analyzing the empirical data through the lens of ethics of care reveals that, together with mature justice, the inclination to care conceived at the focal organization creates an ethical culture encouraging caring activities by individuals at the local level. Through close communications with communities, project decision makers at the local level recognize the demanded care (...) of local communities and develop organizations’ caring capacity. The empirical analysis revealed that the care-giving process can also be influenced by the power dynamics of the network of stakeholders. This research emphasizes on the success of a bottom-up approach in caring for local communities, and sheds light on the capability of large organizations in giving care to their distal stakeholders by adopting this approach. Furthermore, it indicates that justice and care both have some useful characteristics and are complementary but, most importantly, are socially constructed and not mutually exclusive. (shrink)

A retrospective ELSPAC study (N = 2756) compared three groups of mothers of three-year-old children: 1) employed, 2) voluntarily unemployed, and 3) involuntarily unemployed, about the quality of their partnership and family relationships. The results show that the involuntarily unemployed mothers have the lowest quality of family life. In these families there is more conflict, disagreement and hostile communication towards the woman and child. Employed mothers also experience some family problems. Overall, those most satisfied with their family lives are the (...) voluntarily unemployed mothers. There is more positive communication between partners, including sharing and intimacy in this group. The results were interpreted as stemming from the distress caused by involuntary unemployment, the double burden of the female role and gender role models in the family. (shrink)

According to the ethics of care, practices of care are sources of moral knowledge that take human relatedness into account. However, caregivers may also find themselves in situations that demand sacrifices, even to the point where their own self is at stake. This may not only be cause for concern about the risks of caregivers, the result of an unequal distribution of power, but it may as well be a chance for affirmation of one’s identity, of self-attestation. As (...) Ricoeur argues, giving of the self or even giving one’s life may be the ultimate expression of one’s belonging, in friendship, devotion or loyalty. Ricoeur also considers the meaning of giving a gift, which to him does not lie in any return gift, but rather in the gift as offering, as generosity. Giving is first of all a risk, a sacrifice, with only the hope that it will be received. In this article I aim to extend his argument to the realm of caregiving, thereby supporting my claim that some sort of self-sacrifice is implied in the very act of caring for others. (shrink)

This article is an ethnographic analysis of the mutuality that is possible in relationships between caregivers and women with intellectual disabilities who live together in L'Arche homes. Creating mutuality through which both parties grow and exercise agency requires that caregivers learn to negotiate delicate power relations connected to the physics of care and to reframe dominant stereotypes of disability. This helps them to support the women with intellectual disabilities to name and achieve their desires.

In lieu of an abstract, here is a brief excerpt of the content:Pride in Giving Care and Other Life Lessons from Certified Nursing AssistantsDelese WearMy father spent the last three weeks of his life in a hospice care facility. It's funny, now reading these narratives written by Certified Nursing Assistants (CNAs), that I can't picture him without Gloria, the CNA who worked the 7-3 shift, floating quietly in and out of his room, tending to him, tending to (...) us, speaking quietly to Dad even when he was no longer conscious, offering us conversation, often her affectionate observations of Dad and curiosity about his life, sometimes about life on the "outside," a kind of respite from total attention on Dad and our grieving. I remember the smell of the lotion she rubbed on his body. I remember no other caregivers in his room; there obviously were, but I can't picture them now, only Gloria. We never spoke directly to the medical director of the hospice. He was a phantom, rounding at 5 or 6 a.m.; we came to believe he did so to avoid speaking to families.Those three weeks led to my conceptions about CNAs—the nature of the work they do, the kinds of people who do such work, the awesome responsibilities involved in such work, and not least, the physical and emotional resiliency of those who undertake such work. My and my family's often recited, "How does she do this every day?" was answered time and again in the narratives written by CNAs in this issue of the journal.But before moving forward, I want to make note of how I will refer to the authors of these narratives. The name of one's occupation, the title one uses, and how others refer to your occupation, is obviously meaningful. If the snapshots of CNAs provided in these narratives are somewhat representative, we find those who refer to themselves and their occupation as nursing assistants, nurse assistants, Certified Nursing Assistants (CNAs), State Licensed Nursing Assistants (SLNA), or simply aides, to name a few. While it is beyond the space offered here, I want to make note of this, recognizing that titles/labels matter, and to acknowledge that status. As CNA Nanci Robinson notes, "most of us are certified... I wouldn't call an LPN a PN and leave out she's licensed." Passage of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), required each State to establish State-approved nurse aide training programs and establish requirements for nurse aide competency. Thus, I will refer to all the authors here as Certified Nursing Assistants (CNAs). I do wonder how significant of an issue these variations of titles are within the larger nursing assistant culture, and how it may contribute to disparities regarding pay schedules, duties, status, training and other relevant issues among all nursing assistants.In spite of problems, stressors, and other quality of life issues for CNAs, most of them spoke with pride and meaning regarding what was for many their "life's work," similar to what one might expect to find in other care giving occupations. Some spoke of a "love of the work," its "rewards" and "joys," [End Page 165] and the intense satisfaction of "making a difference" in patients' or residents' lives. These attitudes were not vague abstractions but were grounded throughout the narratives in rich examples of the affirming aspects of their work.It appears that much of the pleasure comes from what many refer to as the "hands on," "direct care," or "front line" nature of the work—often what other health professionals might view as things they would not want to do. And of course these other professionals—registered nurses, occupational therapists, and physicians—could make the same claim when describing the "hands-on" joys of their work. But the differences, it would seem, are profound between these other caregivers and CNAs. The CNA narratives report fundamentally intimate and often daily relationships with their clients/residents/patients. Danny Reed describes the "delight" he feels "in restoring dignity to every human in need of it regardless of cause," referring to himself as a "participant observer in a caring relationship," not as a "detached clinician." Many spoke directly... (shrink)

Background: Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit (ICU). There is a gap in our understanding of nurses’ perceptions of how organizational resources support them in addressing ethical conflict in the intensive care unit. Research question/objectives/methods: The aim of this qualitative, descriptive study was to explore how nurses experience ethical conflict and use organizational resources to support them as they address ethical conflict in their practice. Participants and research context: (...) Responses to two open-ended questions were collected from critical care nurses working in five intensive care units at a large, academic medical center in the Midwestern region of the United States. Ethical considerations: This study was approved by the Institutional Review Board at the organization where the study took place. Findings: Three main interwoven themes emerged: nurses perceive (1) intensive care unit culture, practices, and organizational priorities contribute to patient suffering; (2) nurses are marginalized during ethical conflict in the intensive care unit; and (3) organizational resources have the potential to reduce nurse moral distress. Nurses identified ethics education, interprofessional dialogue, and greater involvement of nurses as important strategies to improve the management of ethical conflict. Discussion: Ethical conflict related to healthcare system challenges is intrinsic in the daily practice of critical care nurses. Nurses want to be engaged in discussions about their perspectives on ethical conflict and play an active role in addressing ethical conflict in their practice. Organizational resources that support nurses are vital to the resolution of ethical conflict. Conclusion: These findings can inform the development of interventions that aim to proactively and comprehensively address ethical conflict in the intensive care unit to reduce nurse moral distress and improve the delivery of patient and family care. (shrink)

Growing data on the socioeconomic determinants of health pose a challenge to analysis and application of fairness in health. In Just health: meeting health needs fairly, Norman Daniels argues for a change in the population end of our thinking about just health. What about clinical care? Given our knowledge of the importance of wealth, education or social status to health, is fairness in medicine served better by continuing to avoid considering our patients’ social status in setting clinical priorities, or (...) by attempting to equalise existing health inequalities by giving priority to the socioeconomically disadvantaged at the point of care? In this article, I argue that doctors should not attempt the latter. Granted, giving priority to low status would go some way towards compensating unjust health inequalities and the impression of being left aside in other social spaces. It would represent reverse discrimination, but could still be justified inasmuch as disadvantaged groups could be identifiable, and as long as the intent was compensation rather than retribution. However, under current circumstances such priority would risk being attributed arbitrarily, would represent a form of medical proselytising, risk leaving the worst-off with less by alienating the powerful, and require teaching doctors to act in strongly counter-cultural ways—possibly at great cost. Crucially, however, we protect both equal health and equal regard by treating all alike: priority to low status would promote the first somewhat, but at the expense of sacrificing the second. (shrink)

Most of us have two strong intuitions (or sets of intuitions) in relation to fairness in health care systems that are funded by public money, whether through taxation or compulsory insurance. The first intuition is that such a system has to treat patients (and other users) fairly, equitably, impartially, justly and without discrimination. The second intuition is that doctors, nurses and other health care professionals are allowed to, and may even in some cases be obligated to give preference (...) to the interests of their particular patients or clients over the interests of other patients or clients of the system. These two intuitions are in potential conflict. One of the most obvious ways in which to ensure impartiality in a health care system is to require impartiality of all actors in the system, i.e. to give health care professionals a duty to treat everyone impartially and to deny them the ‘right’ to give their patients preferential treatment. And one of the possible side-effects of allowing individual health care professionals to give preference to ‘their clients’ is to create inequality in health care. This paper explores the conflict and proposes that it can be right to give preference to ‘your’ patients in certain circumstances. (shrink)

The conventional wisdom about advance care planning holds that the normative force of my prior wishes is simply that they are mine. It is their connection to me that matters. This paper challenges conventional thinking. I propose that the normative force of prior wishes does not depend exclusively on personal identity. Instead, it sometimes depends on a special relationship that exists between a prior, capacitated person and a now incapacitated person. I consider what normative guidance governs persons who stand (...) in a special relationship, and contrast these with the standard model of respect for autonomy. My conclusion is that advance care planning for individuals who have lost decision-making capacity should incorporate the virtues of prudence and integrity, even when one and the same person ceases to exist, and respect for personal autonomy is no longer relevant. (shrink)

Within contemporary health care, many of the decisions affecting the health and well-being of patients are not being made by the clinicians or health professionals, but by those involved in health care management. Existing literature on organizational ethics provides insight into the various structures, processes and strategies - such as mission statement, ethics committees, ethical rounds … - that exist to create an organizational climate, which fosters ethical practices and decision-making It does not, however, show how health (...) class='Hi'>care managers experience their job as being intrinsically ethical in itself. In the present article, we investigate the way in which ethical values are present in the lived experiences and daily practice of health care management. What does it imply to take up a managing position within a health care institution and to try to do this in an ethically inspired way? We carried out a qualitative study (Grounded Theory Approach) to explore the essence of values-based leadership in health care. We interviewed 15 people with extensive experience in health care management in the fields of elderly care, hospital care and mental health care in the various regions of Flanders, Belgium. Six predominant themes, presented as metaphors, illustrate the essence of values-based leadership in health care management. These are: (1) values-based health care management as managing a large garden, (2) as learning and using a foreign language, (3) going on a trekking with an ethical compass, (4) embodying integrity and authenticity in a credible encounter with everyone, (5) being a present and trustworthy leader during sun and storm, and (6) contributing to human flourishing by giving people wings to fly. Notwithstanding the importance of organizing a good ethics infrastructure, values-based leadership in health care entails much more than that. It is about the co-creation of an integrated and comprehensive ethical climate of which community-model thinking and authentic leadership are essential components. As a never-ending process, the six metaphors can help leaders to take substantive proactive steps to shape a fruitful ethical climate within their organization. (shrink)

Advances in life-sustaining medical technology as applied to neonatal cases frequently present ethical concerns with a strong emotional component. Neonates delivered in the gestation period of approximately 23held hostagemoral distress” regarding aggressive courses of treatment for some patients. Some of this distress results from a feeling of powerlessness regarding treatment decisions, coupled with a high intensity of hands-on contact with the patients and family. Lack of authority coupled with high responsibility may itself be a recipe for a different kind of (...) futility. (shrink)

The unexpected death of a child is one of the most challenging losses as it fractures survivors’ sense of parenthood and other layers of identity. Given that not all the bereaved parents who have need for support respond well to available treatments and that many have little access to further intervention or follow-up over time, online interventions featuring therapeutic writing and peer support have strong potential. In this article we explore how a group of bereaved mothers experienced the process of (...) participating in an online course in therapeutic writing for the integration of grief. Our research questions were: How do parents who have lost a child experience being part of an online course in therapeutic writing? What are the perceived benefits and challenges of writing in processing their grief? We followed an existential phenomenological approach and analyzed fieldwork notes (n= 13), qualitative data from the application and assessment surveys (n= 35;n= 21), excerpts from the journals of some participants (n= 3), and email correspondence with some participants (n= 5). We categorized the results in three meaning units: (1) where does my story begin? The “both and” of their silent chaos; (2) standing on the middle line: a pregnancy that does not end; (3) closures and openings: “careful optimism” and the need for community support. Participants experienced writing as an opportunity for self-exploration regarding their identities and their emotional world, as well as a means to develop and strengthen a bond with their children. They also experienced a sense of belonging, validation, and acceptance in the online group in a way that helped them make sense of their suffering. Online writing courses could be of benefit for bereaved parents who are grieving the unexpected death of a child, but do not replace other interventions such as psychotherapy. In addition to trauma and attachment informed models of grief, identity informed models with a developmental focus might enhance the impact of both low-threshold community interventions and more intensive clinical ones. Further studies and theoretical development in the area are needed, addressing dialogical notions such as the multivoicedness of the self. (shrink)

Expectations of receiving personal health information as a fringe benefit of biospecimen donation—termed diagnostic misconception—are increasingly documented. We developed an instrument measuring conflation of observational biospecimen-based research and clinical care for use with Latino communities, who may be particularly affected by diagnostic misconception due to limited health care access.

On political and social life issue in Malaysia.

This article provides a systematic analysis of the proposal to use Covid‐19 vaccination status as a criterion for admission of patients with Covid‐19 to intensive care units (ICUs) under conditions of resource scarcity. The general consensus is that it is inappropriate to use vaccination status as a criterion because doing so would be unjust; many health systems, including the UK National Health Service, are based on the principle of equality of access to care. However, the analysis reveals that (...) there are several unique features of Covid vaccination status in the context of a pandemic that make this issue disanalogous to cases (such as lung cancer caused by smoking) discussed previously. First, there is equality in access to care at the point of vaccination; the unvaccinated refuse the offer of preventive care when they decline vaccination, weakening their claim to ongoing care if they become ill (this is qualitatively different from ‘poor lifestyle choices’ such as smoking). Second, the decision of one person to refuse vaccination substantially increases the risk that they will become seriously ill and need ICU care; the person who chooses not to get vaccinated thus potentially increases the pressure on intensive care bed provision, as well as increasing the risk that he or she will infect others who in turn might end up needing ICU care. Third, justice cuts both ways, and giving unvaccinated patients equal priority may itself be unjust when other patients have reduced their risk of ending up on the ICU by getting vaccinated. (shrink)

We explore briefly Foucault's ideas about the care of the self, creating ourselves and what he meant by ethics. We then examine the work of five artists–Mark Rothko, Cindy Sherman, Helena Hietanen, Samuel Beckett, and Betty Goodwin–to help us begin to think very differently about illness and human suffering. Taking our lead from Beckett, we regard reason as being given too much responsibility for the work of a caring knowledge, and that it is through the arts that new ideas (...) about bioethics can emerge. (shrink)

The manuscript explores the plausibility of care-based epistemology in a comparative key. Investigating the epistemic virtue of care-giving, the work weaves together insights from care ethics, virtue epistemology and a particular reading of the Mah=abh=arata which, left to themselves, do not appear compatible with one another. Drawing on these traditions, the work goes on to provide a feminist vision of search for truth that is consistent with both ethical relations and interventions for justice.

This article casts its attention on acts of supplication in institutional settings. The article focuses upon institutions geared towards the provision of care, that is, sites that are designed to provide services to those in need. The article claims that every act of supplication is an act of violence deployed upon the supplicant by his/her interlocutor and the institution more broadly. This is not violence of an overt type; it is tacit and subtle and takes root at the very (...) essence of the supplicant, that is, his/her being. The article draws on Jacques Derrida’s provocative reading of the impossibility of the gift, an analysis that is indebted to Marcel Mauss’ exposition of the gift as obligatory and, thus, an existential nullity. Drawing upon both theorists, the article theorizes the violence of the gift and proceeds to read the violence in/of care/caring. The article explicates the grounding of this violence and how it is written into each request for care. (shrink)

The Spring 1999 issue of CambridgeQuarterly adds to the growing body of academic inquiry into the goals of neonatal intensive care practices. Muraskas and colleagues thoughtfully presented the possibility of nontreatment for neonates born at or under 24 weeks gestation. Jain, Thomasma, and Ragas explained that quality of future life must not be ignored in clinical deliberation. And Hefferman and Heilig described once again the dilemmas nurses face when caring for potentially devastated neonates kept alive by technology. These authors (...) take brave steps by publicly questioning the trend of intensive medical support for most every American-born product of conception. But many questions addressing the goals of neonatal intensive care remain, and few authors have actually tried to distill these goals. (shrink)

In this article we explore a notion of relationship which exists between humans. This notion of relationship takes as a point of departure that differences in human relations and interaction have to be safeguarded. Starting with the Irigarayan notion of ‘two’ as a gendered difference, opposed to an understanding of humans as one and same (gender), we elaborate an understanding of otherness which opens a space where both self and other are welcomed. This relational space cannot be appropriated by either (...) one for it to exist. We continue by drawing from Harry G. Frankfurt's discussion of care in order to understand human (inter)actions in this space. Through an elaboration of how love as a special form of care represents a motivational drive, a way in which a person's will is formed, we try to show how this attentiveness towards the other is possible. Our point of departure is two statements by female head teachers that prompted these theoretical inquiries into other possibilities for interpreting human (inter)action in leadership in education. (shrink)

This study explored the social determinants of chronic pain management among people who use drugs, focusing on the ethical notions shaping care‐giving and the social contexts in which they operate. It draws on qualitative data from interviews with people who were currently using drugs and had chronic pain, recruited in Uyo, Nigeria. Narratives show how pain‐related disability adversely impacted participants' livelihoods by hampering their ability to perform daily tasks. They also show how care‐giving, informed by the (...) ethical duty of care in nursing/healthcare professions and traditions of informal care, shaped the experience and meanings of chronic pain and helped participants overcome barriers to healthcare. Care‐giving was situationally undermined by the ethics of justice where chronic pain was seen as retribution for moral deviance and participants were deemed undeserving of care. The study contributes to the literature on chronic pain management among people who use drugs by showing how stigma undermines professional and informal care ethics through reframing chronic pain as retribution and care as something to be earned, rather than an ethical duty. It concludes by reflecting on the implications for nursing and healthcare practice and calling for interventions to tackle stigma and improve pain management for these persons. (shrink)

From the state to the family: reconfiguring the responsibility for long‐term nursing care at homeThis paper discusses the implications of the shift in the location of the provision of healthcare services from healthcare institutions to the home, which has occurred or is projected to occur in coming years. It is argued that the responsibility for the provision of care and assistance needed by the elderly living at home and people with long‐term conditions living at home has shifted from (...) public services to the family. Studies of care‐givers have shown that in many situations they experience tremendous burdens, financial difficulties and health problems. Their social lives have been confined to the home, and contacts with friends and neighbors have been significantly reduced. This situation needs to be addressed by nurses, who in many cases serve as the bridge between the home and the official healthcare system. Using Foucault’s exploration of power, particularly his idea of governmentality, a genealogy of care‐giving in the home in Iceland’s health‐care has been constructed. The main findings were that, although this is occurring somewhat later than in many other countries, the state is withdrawing from its previously defined responsibility for the health and well‐being of the nation. At the same time the citizen’s responsibility for maintaining health is emphasized. Based on these findings, the argument is made that nurses in Iceland can have a profound influence on policy‐making in relation to the organization of services provided in those homes. Suggestions are made as to how this can be done, which may be of interest to nurses in other countries. (shrink)

If Justice Louis Brandeis were alive to witness San Francisco’s recent experiment with universal health care legislation, he might amend his famous characterization of the states as “laboratories of democracy” to include municipalities as well. In San Francisco, where ten percent of residents have no health insurance and where fifteen percent of businesses provide no health coverage for their employees, the Board of Supervisors recently passed the San Francisco Health Care Security Ordinance, which funds a network of primary (...) care services for uninsured residents. While the Ordinance has, in the main, met with general approval, its provision mandating contributions from local businesses that do not meet minimum health spending requirements is the subject of ongoing litigation. The Ninth Circuit Court of Appeals recently ruled in the city’s favor, thereby allowing the spending provision to go forward pending a full appeal on the merits of the case. (shrink)

Because of the gradual aging of the population, hospital facilities for socio-sanitary care of the elderly are quite scarce relative to the very high number of elderly people present in the country. This has pushed a high number of families to privately hire home-care workers. The scientific literature gives a picture of the psycho-physical risks that this type of profession is exposed to; however, there is still a need for a more systemic reflection with regard to representations about (...) their role and competences. The aim of the present study is to outline the representations of the role and the skills it requires from home-care workers’ point of view. We reconstructed how home-care workers perceive and define the profession, and understand the necessary skills required from their point of view. Our results show that the professional profile of home-care workers still remains poorly defined and that professionals themselves struggle to find value and recognition, and to articulate what the skill set they develop is formed of. (shrink)

In this paper we argue that greater attention must be given to peoples’ expression of “care” in relation to consumption. We suggest that “caring about” does not necessarily lead to “care-giving,” as conceptualising an attitude–behaviour gap might imply, but that a closer examination of the intensity, morality, and articulation of care can lead to a greater understanding of consumer narratives and, thus, behaviour. To examine this proposition, a purposive sample of self-identified ethical consumers was interviewed. (...) class='Hi'>Care is expressed by the study’s participants in a variety of ways and linked to behaviour through diverse patterns that includes consumption and abstention. We find significant correspondence between the academic literature on the ‘ethics of care’ and our participants’ articulation of their ethical consumption behaviours. We suggest, therefore, that a close understanding of an ethics of care among consumers is important both in providing insight into the attitude–behaviour gap challenge evident in the literature and to the continued development of an ethical consumption discourse. (shrink)

This paper examines nurses’ international migration within the broader context of female migration, particularly against more studied groups of women who have migrated for employment in care‐giving roles. We analyze the similarities and differences between skilled professional female migrants (nurses) and domestic workers (nannies and in‐home caretakers) and how societal expectations, meanings, and values of care and ‘women's work’, together with myriad social, cultural, economic and political processes, construct the female migrant care‐giver experience. We argue that, (...) as the recruitment of foreign workers gains visibility, strategies are introduced to better prepare female migrant care‐givers for the marketplace. Language, specifically command of English and accent modification, is highlighted as one means to assimilate migrant care‐givers to host communities. (shrink)

Background: Compassion is seen as a core professional value in nursing and as essential in the effort of relieving suffering and promoting well-being in palliative care patients. Despite the advances in modern healthcare systems, there is a growing clinical and scientific concern that the value of compassion in palliative care is being less emphasised. Objective: This study aimed to explore nurses’ experiences of compassion when caring for palliative patients in home nursing care. Design and participants: A secondary (...) qualitative analysis inspired by hermeneutic circling was performed on narrative interviews with 10 registered nurses recruited from municipal home nursing care facilities in Mid-Norway. Ethical considerations: The Norwegian Social Science Data Services granted permission for the study (No. 34299) and the re-use of the data. Findings: The compassionate experience was illuminated by one overarching theme: valuing caring interactions as positive, negative or neutral, which entailed three themes: (1) perceiving the patient’s plea, (2) interpreting feelings and (3) reasoning about accountability and action, with subsequent subthemes. Discussion: In contrast to most studies on compassion, our results highlight that a lack of compassion entails experiences of both negative and neutral content. Conclusion: The phenomenon of neutral caring interactions and lack of compassion demands further explorations from both a patient – and a nurse perspective. (shrink)

Background: Providing information to patients is an essential aspect of care. The way in which such information is transmitted is also important and is affected by different variables. The perceptions of dishonest nursing staff have not been sufficiently discussed to date. Aim: The purpose is to explore the reasons for dishonesty in transmitting information to patients. Design and Method: In this qualitative content analysis study, data were collected using semi-structured interviews with Twelve Iranian Critical Care Nurses from January (...) 2020 till August 2020. Data were analyzed according to Graneheim and Lundman approach. Ethical consideration: The research protocol was authorized by the Ethics Committee of the Medical Sciences University of Tehran (Register number: 95-04-99-33485). Results: The findings indicated that dishonesty in giving information to the patients has many reasons. Although lying is not compatible with ethical care, working conditions sometimes forced nurses to hide the truth. Discussion and conclusion: Nurses believed honesty was an integral aspect of professional practice, but situational specifics have an effect on whether the truth is told or withheld. Finally, the nurses noticed a big gap between what they want to tell and what they were doing in practice. (shrink)

Caring is at the core of what nurses and other health professionals do. But caring encompasses more than simply looking after people's physical health needs. People requiring any health service will have psychological needs that affect their feelings, thoughts, and behaviour. Good psychological care can even help improve physical health outcomes. An Introduction to Psychological Care in Nursing and the Health Professions explains and promotes the importance of psychological care for people when they become physically ill, (...) class='Hi'>giving a sound theoretical basis to ensure care is evidence-based. It encourages the reader to think about the effects of illness and disability on patients, and to understand what can be done to identify and minimise any difficulties they might be experiencing in these areas. The chapters cover: the meaning and elements of care and holistic care; a model of psychological care in practice; the personal qualities and skills of carers that best underpin psychological care delivery, and how these might be enhanced; the knowledge needed for effective psychological caregiving; psychological care as it might be practised in a range of health care settings. This text contains key learning points, practical activities, reflective exercises and case illustrations. It is ideal for student and practising nurses, and health professionals who would like to improve their care for patients in this essential area. (shrink)

Patients with advanced cancer often experience a reduced ability to eat, which may result in tensions between patients and family members. Often with advanced cancer diagnoses, patients’ appetites decline markedly, while family members focus on nutritional intake with the hope that this will postpone death. This hope might cause tensions between the patient and family; the family may expect healthcare professionals to encourage the patient to eat more, whereas the patient needs to be supported in their reduced ability to eat. (...) When these tensions arise, healthcare professionals can experience challenges in providing good palliative care. To address these challenges in the provision of palliative care, healthcare professionals may adopt a care ethics approach. Similar to palliative care’s focus on patient and family members’ relationships, a care ethics approach emphasizes interdependency and social relationships. Using Joan Tronto’s care ethics approach, we conducted a normative analysis of what caring for patients with reduced ability to eat and their family members should look like. Tronto’s approach includes five phases of care: caring about, taking care of, care giving, care-receiving, and caring with. Based on our analysis and empirical studies on patients with advanced cancer and family members, concerns with their lack of appetite, we assert that healthcare professionals must be mindful of the potential of tensions related to appetite and be adept in dealing with these tensions. We urge that education is needed for healthcare professionals regarding the psychosocial impact of reduced ability to eat on both patients and family members and interprofessional collaboration is of the essence. (shrink)

According to Asha Bhandary, there is a liberal (Rawlsian) justification for including “the receipt of dependency care among the benefits of social cooperation” (“Liberal Dependency Care,” 43). The novelty is to claim that such care is among the Rawlsian circumstances of justice. I argue that liberalism does not support this extremely strong claim. Dependency care is indeed among the goods generated by social cooperation, broadly speaking—but so are virtually all goods, such as pizza provision, scarcely any (...) of which are among the circumstances of justice. Most of us have ample inclination toward caring for dependents—but neither is this extended to everyone else’s dependents, nor is it mostly a legal duty, as indeed having children at all is not. Nor should it be on liberal principles. Neither of the two Rawlsian Principles support general dependency care. And, Bhandary’s “strong proceduralism,” calling for the training of all persons in care-giving skills, would edge up toward totalitarianism—hardly a welcome outcome of liberalism. (shrink)

Dependency care is an asymmetric good; everyone needs to receive it, but it is not the case that we all have to provide it. Despite ethicists’ of care’s theorizing about the importance of dependency care, it has yet to be theorized within a form of liberalism. This paper theorizes two components of a liberal theory of dependency care. First, it advances a liberal justification to include the receipt of dependency care among the benefits of social (...) cooperation. Then, it advances an autonomy-based principle to guide how care should be provided (“strong proceduralism”). Strong proceduralism is based on an account of autonomy that incorporates the significance of a person’s skills when he parses options. Strong proceduralism consequently requires educational efforts to teach care-giving skills to groups who have not previously possessed them. I hypothesize that strong proceduralism will secure adequate care provision as the outcome of autonomous choice, but if an inadequate number of people choose to provide care, then a secondary stage of deliberations will be necessary. If the outcome of those secondary deliberations is that people want to have their care needs met, then a fair process for distributing infringements on autonomy must be devised. (shrink)

The aim of this study was to identify key aspects in the exchange of information and to determine how nurses communicate news to hospitalised children. For this study, we applied the critical incident technique with 30 children aged between 8 and 14 years. Data were collected in paediatric units in a hospital in Alicante (Spain) using participant observation and semi-structured interviews. The analysis yielded three main categories: the children’s reaction to the information, nursing staff behaviour as a key aspect in (...) the exchange of information and communication of news as well as children’s experience. This article emphasises the need to promote children’s consent and participation in nursing interventions. An analysis of these aspects will verify whether children’s rights are being respected and taken into account in order to promote children’s well-being and adaptation to hospitalisation. (shrink)

In recent years philosophers and bioethicists have given considerable attention to the concept of care. Thus we have seen important work on questions such as: whether there is a uniquely female approach to ethics, whether ethics should be partial or impartial, and whether care must be supplemented by justice. Despite this valuable and extensive work, however, some important distinctions have gone largely undiscussed. This paper tries to fill a gap left in our understanding of the concept of (...) class='Hi'>care itself by distinguishing between compassion and two kinds of pity. While all three are kinds of caring, we should not give them similar moral evaluations. Consequently, the distinction between compassion and different kinds of pity gives us an important insight into the question of whether we can consider care a virtue for health care professionals. (shrink)

Phenomenology, Uncertainty and Care in the Therapeutic Encounter is the latest in a series of books where Mark Leffert explores the therapeutic encounter as both process and situation; looking for evidence of therapeutic effectiveness rather than accepting existing psychoanalytic concepts of theory or cure without question. Phenomenology, Uncertainty and Care in the Therapeutic Encounter contributes a new understanding of familiar material and brings a new focus to the care-giving and healing aspects of psychoanalysis and psychotherapy leading (...) to a shift in the analyst's identity from that of one who analyses to one who cares for and heals. This book will be of interest to Psychoanalysts and psychotherapists, neuroscientists and academics in the fields of psychiatry, comparative literature and literature and the mind. (shrink)

This paper advances a Millian concept of care by re-evaluating his defense of the “common arrangement,” or a gendered division of labor in marriage, in connection with his views about traditionally feminine capacities, time use, and societal expectations. Informed by contemporary care ethics and liberal feminism, I explicate the best argument Mill could have provided in defense of the common arrangement, and I show that it is grounded in a valuable concept of care for care-givers. This (...) dual-sided concept of care theorizes care-giving both as a domain of human excellence and as labor with accompanying burdens. Liberal feminists should adopt this Millian concept of care, which can then inform principled thinking about distributive arrangements. (shrink)

Journal of Applied Philosophy, EarlyView.

The role of li, or ritual, in Confucianism is a perceived impediment to interpreting Confucianism to share a similar ethical framework with care ethics because care ethics is a form of moral particularism. I argue that this perception is false. The form of moral particularism promoted by care ethicists does not entail the abandonment of social conventions such as li. On the contrary, providing good care often requires employing systems of readily recognizable norms in order to (...) ensure that care is successfully communicated and completed through one's care-giving practices. I argue that li performs this communicative function well and that the early Confucians recommend breaching li precisely when its efficacy in performing this function is compromised. (shrink)

Since some care providers give colleagues’ interests priority over patients’ and families’, they are at risk of imposing their bias on patients without knowing this. In this piece I discuss how the risk increases when care providers have greater discretion and how they can best avoid this risk. I discuss identifying these situations, assessing them, and then, based on what they have concluded, intervening and use their having inadequate resources, their seeing what patients want as futile, and their (...) making decisions regarding surrogate decision makers as paradigmatic examples. As “remedies,” I suggest that care providers share with patients their rationales, validate adaptive aspects of difficult behaviors, self-disclose, and sometimes even go beyond their usual clinical practices. (shrink)

Distribution of sufficient health care resources to the maximum number of people in LIC is the central theme of the book. Bangladesh is taken as a representative of low income countries (LIe. In LIC, there is scarcity of health care resources like other resources but the deserving persons are numerous. Therefore, it requires an efficient distribution of resources. Considering 'Inequality to get access to health care' as the basic problem in LIC, John Rawls' principle of fair equality (...) of opportunity is proposed to apply to give people access to health care resources. In this book it is critically analyzed how the principle fails to return a good result in LIC. Instead the principle of maximizing utility is proposed for the purpose. It is argued that maximum number of people can be provided sufficient health care by applying the principle. The principle has also been justified theoretically in concerned low income country and a fruitful result has been achieved from the test. It is claimed that applying principle of utility to provide sufficient health care to the maximum number of people is the most efficient way of health care resources distribution in LIC. (shrink)

A critique and provincialization of Western social science and Global Northern academia by the author of The Digital Coloniality of Power, exposing shared colonial and extractive rationalities and histories of research, higher education, digitalization and bioeconomy while proposing in the idea of BluesCollarship a sketch for an alternative culture of worlding and commoning knowledge work and for making care matter in research and higher education. In a discourse analysis and provincialization of research and higher education, a tradition of elitarian (...) White Collaredness in academia and in the social sciences in general is criticized and an alternative attitude towards the production, transfer and use of knowledge - BluesCollarship - is proposed. The latter is rooted in a different idea of what 'infrastructure' is and in practices of decoloniality. Noting the current political climate of propaganda and populism, the persistence of social inequalities as well as of racism and misogynism, it is proposed that how people give warrant for knowledge claims should be reviewed under different terms. A coherent theme is that there is a genealogical root for current neo-extractive and neo-colonial rationalities in the Athenian idea of oikos conflating family, household, and property. In taking a distinctly writerly approach - rather than giving ready-made answers - the book aims at permanently provoking readers at every turn to think further, as well as before-and-beyond what is written, but to do so in thinking together with Others. Thereby the book addresses scholars and students from across the social sciences who seek challenges to established ways of thinking in academia without simply replacing one canon for merely another. This book is for those who think of themselves as knowledge and cultural laborers in this age of precarization who seek to replace the university and cognitive capitalism with a pluriversity and an infrastructure build on knowledge and culture as fundamental value. (shrink)

This article adds to critiques of discourses and practices of care that are enmeshed with coloniality. It does so via examining the prominent model of helping marginalized people through giving them the opportunity to care for themselves and their own by being recruited into paid (care) work, thus, becoming “useful” participants in society. This usefulness is read as a colonial project of subordinate inclusion into neoliberal racial capitalism. A perverse ideology of care is mobilized to (...) extract surplus value from marginalized workers “integrated” into the lower echelons of social reproduction. Using historic and contemporary examples, the argument is developed in three steps: First, I discuss how care workers are included via subordination. Second, I analyze how an inversion of care receiver and caregiver transforms marginalized care workers into recipients of integration measures, rendering their care work invisible. Third, I show how racial usefulness, the interpellation that racialized workers be/come “useful,” is undergirded by productivism within neoliberal racial capitalism. (shrink)

Joan Tronto defines care by three activities: maintaining, continuing, and repairing. These activities give care a maintenance quality, which is problematic given that caring often takes place within contexts of inequality and domination. Empirical research with paid support staff and people with intellectual and developmental disabilities (IDD) illustrate these problems: care practices tend to reinforce the social exclusion of people with IDD, particularly for people with challenging behavior. Yet, support workers’ care practices can facilitate a better (...) quality of life for people with IDD. This improved style of support maps onto Tronto’s fifth phase of care, caring with, which hinges practices of care on democratic principles of justice, equality, and freedom. As such, democratic care requires activities that Tronto excludes from care, including creativity, disruption, and pleasure. I use empirical research from the field of IDD to show how support workers and people with IDD practice creative, disruptive, and playful care to challenge persistent forms of exclusion, inequality, and stigma. (shrink)

The implementation of skills labs in Danish nursing education can, in itself, be viewed as a complexity. The students are expected to eventually carry out their work in a situated hospital practice, but they learn their professional skills in a different space altogether, detached and removed from the hospitals and practising on plastic dummies. Despite the apparent artificiality of the skills lab, this article will show that it is possible to analyse some of the fundamental aspects of care in (...) nursing by ethnographically following this phenomenon of simulation‐based training. These particular aspects of care are not explicated in the curriculum or textbooks; however, they surfaced once this crooked approach to studying care in a simulated practice was applied. The article start from the assertion that detached engagements are not recognized within the field of nursing education as an equal component to attachments. Yet empirical cases from the skills lab and hospitals illustrate how students sometimes felt emotionally attached to plastic dummies and how experienced nurses sometimes practised a degree of detachment in relation to human patients. Detached engagements will therefore be presented as part of care practices of nurses – rendering the ability to detach in engagement with patients a professional skill that students also need to learn. In the analysis to follow, attached and detached engagements are located on an equal plane by integrating both into the same conceptual framework, rather than imposing a priori notions about their dialectic relation. The analysis shows that it is the particular intertwinement of attachment and detachment that gives care its fundamental meaning. In conclusion, the need for a conceptual shift from a strong emphasis on attached engagement to a more balanced analytical approach to care work, as involving both attached and detached engagement within Danish nursing education, is advocated. (shrink)