Background As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency (...) medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability. Methods A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis. Results Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting. Conclusions Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values. (shrink)

Drawing upon the literature on action research and case-study research, this paper discusses similarities and differences between these two forms of research practice. The paper also highlights some of the criticisms and challenges action researchers face. It suggests ways in which action researchers may enhance the discussability of action research by: (a) increasing the transparency of their research processes, (b) declaring the intellectual frameworks brought into action research projects, (c) discussing transferability of findings, and (d) defining accumulation of results. This (...) may require an extension to scientific discourse. In particular, the paper suggests that action researchers could change the ways in which action research results are reported to increase their reach among a wider audience. (shrink)

For us, narrative care is grounded in pragmatist philosophy and focused on experience. Narrative care is not merely about acknowledging or listening to people's experiences, but draws attention to practical consequences. We conceptualize care itself as an intrinsically narrative endeavour. In this article, we build on Lugones' understanding of playfulness, particularly to her call to remain attentive to a sense of uncertainty, and an openness to surprise. Playfulness cultivates a generative sense of curiosity that relies on a close attentiveness not (...) only to the other, but to who we each are within relational spaces. Generative curiosity is only possible if we remain playful as we engage and think with experiences and if we remain responsive to the other. Through playfulness, we resist dominant narratives and hold open relational spaces that create opportunities of retelling and reliving our experiences. Drawing on our work alongside older adults, as well as people who work in long‐term care, we show the possibilities of playfulness in the co‐composition of stories across time. By intentionally integrating playfulness, narrative care can be seen as an intervention, as well as a human activity, across diverse social contexts, places and times. (shrink)

This article takes its point of departure in a research project studying the psychosocial problems of living with HIV. The project was intended to participate in changing practices dealing with these problems. It became a project including many differently situated and intersecting personal and generalized perspectives. The article researches the development of the HIV project as a contribution to discussions related to Participatory Action Research and Practice Research. In mainstream approaches methodological indications are often presented as rules to follow in (...) order to ensure the quality of the obtained knowledge. But situated historical and societal processes are involved in the effectuation of the HIV project, like they are in any other project. Researching the project heightens the awareness of the necessity of reflecting on situated and historical issues of power and marginalization and on the positions of the researcher in a given field of research. Methodological flexibility may also be necessary in order to encompass different perspectives. Such reflections and strategies are necessary precisely to ensure the development of knowledge and practice alike. (shrink)

We describe our clinical experience in treating patients with Tourette syndrome and other tic disorders using infra-low frequency neurofeedback, often in conjunction with cognitive behavior therapy. Following a narrative description of our approach, we present outcome data for 100 successive cases. Many of the children and adolescents that we have treated since 2005 did not derive sufficient benefit from standard treatment for Tourette syndrome and other tic disorders. In our clinical experience, based on extensive before- and after- testing and symptom (...) tracking, this patient group derived significant additive benefit from complementary neurofeedback treatment. The majority of trainees attained a higher level of functioning and were able to live up to their potential in a way they were not able to prior to neurofeedback treatment. (shrink)

Dorian Gray pays a hefty price for years of sin and vice in this completely unabridged edition of The Picture of Dorian Gray.

Background:Many frail older persons who die in Swedish nursing homes need assisted bodily care. They must surrender their bodies to the authority of assistant nurses, which may affect their autonomy and dignity of identity. While assistant nurses claim to support older persons’ wishes, older persons claim they have to adapt to assistant nurses' routines. The provider–receiver incongruence revealed here warrants investigation.Aim:To describe the elements of assisted bodily care, as performed in a nursing home.Research design:Data were collected through thirty-nine observations of (...) assisted bodily care, analyzed with qualitative content analysis.Participants and research context:Seventeen older persons and twenty-two assistant nurses from a Swedish nursing home.Ethical considerations:The research was conducted in line with the Declaration of Helsinki, further approved by the regional ethics committee.Findings:Findings show that assisted bodily care consists of assistant nurses’ practical work, performed at a high tempo. Assistant nurses still attempt to adapt this work to the older persons’ wishes for self-determination, taking into account their day-to-day state of health. In spite of time pressure and occasional interruptions, there is room for consideration and affection in assisted bodily care.Discussion:Assistant nurses try to promote older persons’ dignity of identity, but sometimes fail, possibly due to lack of time. They nevertheless seem to know the older persons well enough to adapt the assisted bodily care according to their preferences and to support self-determination. This indicates that openness to older persons’ lifeworlds may be more important than the amount of time available.Conclusion:Nursing home contexts might benefit from adopting a person-centered palliative care perspective, highlighting the value of relationships and shared decision-making. If so, older persons and assisted nurses could agree on practices and goals in assisted bodily care beforehand. Such routines may be time-saving and beneficial to all. (shrink)

Background: Worldwide, older persons lack access to palliative care. In Sweden, many older persons die in nursing homes where care is provided foremost by assistant nurses. Due to a lack of beds, admission is seldom granted until the older persons have complex care needs and are already in a palliative phase when they move in. Objective: To describe assistant nurses’ perspectives of providing care to older persons at the end of life in a nursing home. Research design: Data were collected (...) in semi-structured individual interviews and analyzed with inductive qualitative content analysis. Participants and research context: Seven assistant nurses from a nursing home in Sweden were randomly selected. Ethical consideration: The research was approved by the local ethics committee. Results: Three main categories emerged; “Death a natural part of life”; “The older person’s well-being”; and “Care in the moment of death”; and seven sub-categories. The assistant nurses described themselves as knowing the older persons well enough to provide good end-of-life care. This was achieved by making small-talk while providing daily care. Relying on experience-based knowledge, they strove to provide end-of-life care built upon respect and engagement with the ambition to strengthen older persons’ dignity, for example, by lowering the tempo of care at the end of life, in spite of organizational restrictions. Discussion: The assistant nurses offered attentive end-of-life care, focusing upon bodily care. The existential needs of the older persons were not foregrounded. Conclusion: To develop their work, and to promote an ethical foundation for such care, assistant nurses might need support and education to be able to offer a care more in line with the aims of palliative care. Furthermore, the organization of care needs to promote, not impede, the realization of this development. (shrink)

When Gödel developed his functional interpretation, also known as the Dialectica interpretation, his aim was to prove consistency of first order arithmetic by reducing it to a quantifier-free theory with finite types. Like other functional interpretations Gödel’s Dialectica interpretation gives rise to category theoretic constructions that serve both as new models for logic and semantics and as tools for analysing and understanding various aspects of the Dialectica interpretation itself. Gödel’s Dialectica interpretation gives rise to the Dialectica categories , in: Contemp. (...) Math., vol. 92, Amer. Math. Soc., Providence, RI, 1989, pp. 47–62] and J.M.E. Hyland in [J.M.E. Hyland, Proof theory in the abstract, Ann. Pure Appl. Logic 114 43–78, Commemorative Symposium Dedicated to Anne S. Troelstra ]). These categories are symmetric monoidal closed and have finite products and weak coproducts, but they are not Cartesian closed in general. We give an analysis of how to obtain weakly Cartesian closed and Cartesian closed Dialectica categories, and we also reflect on what the analysis might tell us about the Dialectica interpretation. (shrink)

The paper describes a methodology to be used for analysis and design of human activity systems. The methodology is based on an analysis of the decision settings whereas most other decision analysis methodologies are analysing the process. The decision concept is analysed and discussed. A distinction between programmed and programmable as well as non-programmed and non-programmable decisions is proposed. A classification of different information types for decision making is presented. A methodology based on a systemic and systematic analysis of the (...) information requirements of an organization is proposed. This methodology also indicates organizational discrepancies and information imbalances. The methodology focuses the settings of the decisions on all levels of organizations. The methodology can be regarded as a dynamic, learning system. The author proposes further research on the individuals decision making abilities. (shrink)

Play and games are among the basic means of expression in intelligent communication, influenced by the relevant cultural environment. Games have found a natural expression in the contemporary computer era in which communications are increasingly mediated by computing technology. The widespread use of e-games results in conceptual and policy vacuums that must be examined and understood. Humans involved in design-ing, administering, selling, playing etc. computer games encounter new situations in which good and bad, right and wrong, are not defined by (...) the experience of previous generations. This article gives an account of the historical necessity of games, the development of e-games, their pros- and cons, threats and promises, focusing on the ethical awareness and attitudes of game developers. (shrink)

Dieser Beitrag diskutiert „kulturelle Fragen“ in klinischer Ethik am Beispiel der Hymenrekonstruktion. Zunächst werden drei grundsätzliche Argumente genannt: 1) Wenn „kultur-sensitive“ Themen in klinischer Ethik explizit als solche diskutiert werden, kann das zu einem essentialistischen Verständnis von Kultur beitragen. Stattdessen wird in diesem Beitrag für ein dynamisches Verständnis von Kultur argumentiert und für eine grundsätzlich kontextsensitive, pluralistische klinische Ethik. 2) Klinische Ethik fokussiert häufig auf die individuelle Arzt-Patienten-Beziehung. Public Health Ethik und Globale Bioethik sind dagegen eher mit den strukturellen Bedingungen (...) von Gesundheit und Gesundheitsversorgung befasst. Der Beitrag argumentiert für eine systematischere Verknüpfung dieser verschiedenen Ebenen. 3) „Migration“ als bioethisches Thema wird häufig unter „Kultur“ subsumiert. Doch diese beiden Themen sind nicht koextensiv, stattdessen umfassen beide Bereiche jeweils unterschiedliche Fragestellungen. Insbesondere im Bereich von „Migration“ bestehen in der Bioethik noch Forschungslücken. Auf diesen Ausgangsüberlegungen aufbauend wird die Hymenrekonstruktion aus ethischer Sicht diskutiert und dafür argumentiert, sie nur als ultima ratio durchzuführen. Zugleich sollte über die Unmöglichkeit eines Jungfräulichkeitsnachweises aufgeklärt werden. Es bleibt eine Herausforderung, „kultursensitive“ Gesundheitsversorgung zu leisten, dabei jedoch ein essentialistisches Kulturverständnis und Stereotypisierung zu vermeiden. Dieser Beitrag argumentiert für eine grundsätzliche Kontextsensitivität in einer globalisierten, heterogenen Welt, in der die Verbindung zwischen individuellem Handeln und strukturellen Gegebenheiten bewusst wird. (shrink)

Dieser Beitrag diskutiert „kulturelle Fragen“ in klinischer Ethik am Beispiel der Hymenrekonstruktion. Zunächst werden drei grundsätzliche Argumente genannt: 1) Wenn „kultur-sensitive“ Themen in klinischer Ethik explizit als solche diskutiert werden, kann das zu einem essentialistischen Verständnis von Kultur beitragen. Stattdessen wird in diesem Beitrag für ein dynamisches Verständnis von Kultur argumentiert und für eine grundsätzlich kontextsensitive, pluralistische klinische Ethik. 2) Klinische Ethik fokussiert häufig auf die individuelle Arzt-Patienten-Beziehung. Public Health Ethik und Globale Bioethik sind dagegen eher mit den strukturellen Bedingungen (...) von Gesundheit und Gesundheitsversorgung befasst. Der Beitrag argumentiert für eine systematischere Verknüpfung dieser verschiedenen Ebenen. 3) „Migration“ als bioethisches Thema wird häufig unter „Kultur“ subsumiert. Doch diese beiden Themen sind nicht koextensiv, stattdessen umfassen beide Bereiche jeweils unterschiedliche Fragestellungen. Insbesondere im Bereich von „Migration“ bestehen in der Bioethik noch Forschungslücken. Auf diesen Ausgangsüberlegungen aufbauend wird die Hymenrekonstruktion aus ethischer Sicht diskutiert und dafür argumentiert, sie nur als ultima ratio durchzuführen. Zugleich sollte über die Unmöglichkeit eines Jungfräulichkeitsnachweises aufgeklärt werden. Es bleibt eine Herausforderung, „kultursensitive“ Gesundheitsversorgung zu leisten, dabei jedoch ein essentialistisches Kulturverständnis und Stereotypisierung zu vermeiden. Dieser Beitrag argumentiert für eine grundsätzliche Kontextsensitivität in einer globalisierten, heterogenen Welt, in der die Verbindung zwischen individuellem Handeln und strukturellen Gegebenheiten bewusst wird. (shrink)

An electronic poster from "Polarity from Different Perspectives," New York University, 2005. The authors present an experiment that investigated to what extent six negative polarity items (slept a wink, in ages, ever, much, at all, and yet) are licensed by 9 potential licensers.

Compassion is often understood as central to nursing and as important to ensure quality nursing and healthcare. In recent years, there has been a focus on strategies in nursing education to ensure compassionate nurses. However, it is not always clear how the concept of compassion is understood. Theoretical conceptualisations that lie behind various understandings of compassion have consequences for how we approach compassion in nursing education. We present some ways in which compassion is often understood, their philosophical underpinnings and the (...) consequences these understandings can have for nursing education. We argue that it is useful for nursing education to understand compassion as a cognitive emotion and discuss how such an understanding can inform educational approaches to compassion. (shrink)

This article analyses problem situations in the context of anaesthesia care. It considers what it means for nurse anaesthetists to be in problematic situations in the anaesthesia care of older patients. Benner’s interpretive phenomenological approach proved useful for this purpose. Paradigm cases are used to aid the analysis of individual nurses’ experiences. Thirty narrated problematic anaesthesia care situations derived from seven interviews were studied. These show that experienced nurse anaesthetists perceive anaesthesia care as problematic and highly demanding when involving older (...) patients. To be in problematic anaesthesia care situations means becoming morally distressed, which arises from the experience or from being prevented from acting according to one’s legal and moral duty of care. An important issue that emerged from this study was the need for an ethical forum to discuss and articulate moral issues, so that moral stress of the kind experienced by these nurse anaesthetists can be dealt with and hopefully reduced. (shrink)

In der genannten Epoche werden Grundentscheidungen gefällt, welche die Fundamentalfrage der Philosophie, die Seinsfrage, in die Krisis führen, in den Nihilismus unter ontologischem, metaphysischem, epistemologischem, axiologischem Aspekt. Den Extrempositionen der Systemdenker Hegel, Schopenhauer und Schelling erwachsen in den Hegelkritikern Feuerbach, Br. Bauer, Marx und Stirner Kontrapositionen, die das Wahrheitsproblem der Beliebigkeit unterstellen. Kierkegaard klagt unter existentiellem Aspekt das Problem der Wahrheit ein. Nietzsche überholt durch Abschaffung der Wahrheit alle Positionen,was seinen Standort in der europäischen Denkgeschichte ausmacht und als Ergebnis der (...) problemgeschichtlichen Analysen zu charakterisieren ist. Die Rückgewinnung des Vernunfthorizontes setzen erst die Problemdenker N. Hartmann und M. Heidegger ins Werk durch kritische Erneuerung der Seinsfrage. (shrink)

To study how populist sentiments have increasingly influenced businesses in society, we examine how German and Swedish corporations addressed the refugee situation in their 2015 and 2016 annual reports. We find that corporations changed their communication once refugee migration became subjected to populist political sentiments, but that they did so without subscribing to those sentiments. Although populism is based on such sharp oppositions as welcoming refugees or closing borders, our analysis shows that corporations have found ways to communicate about the (...) refugee migration beyond these oppositions. Rather than taking a political stance, the corporations studied have primarily articulated the refugee situation as it pertains to their business operations. We identify four modes of articulation: the refugee as someone needing international aid, as a factor for economic analysis, as a benefit recipient, or as a potential stakeholder. These findings help nuance our understanding of how corporations navigate contested political issues. (shrink)

The vocabulary for describing odors in English natural language is not well understood, as prior studies of odor descriptions have often relied on preselected descriptors and odor ratings. Here, we present a data-driven approach that automatically identifies English odor descriptors based on their degree of olfactory association, and derive their semantic organization from their distributions in natural texts, using a distributional-semantic language model. We identify 243 descriptors that are much more strongly associated with olfaction than English words in general. We (...) then derive the semantic organization of these olfactory descriptors, and find that it is captured by four clusters that we name Offensive, Malodorous, Fragrant, and Edible. The semantic space derived from our model primarily differentiates descriptors in terms of pleasantness and edibility along which our four clusters are positioned, and is similar to a space derived from perceptual data. The semantic organization of odor vocabulary can thus be mapped using natural language data (e.g., online text), without the limitations of odor-perceptual data and preselected descriptors. Our method may thus facilitate research on olfaction, a sensory system known to often elude verbal description. (shrink)

Online news sites have become an internet ‘staple’, but we know little of the forces driving the popularity of such sites in relation to what could be understood as the latest iteration of the web – social media services. This research in brief article discusses empirical results regarding the uses of Twitter for news sharing. Specifically, we present a comparative analysis of links emanating from the service at hand to a series of media outlets over a six-month period in two (...) countries; Sweden and Norway. Focusing on linking practices among highly active Twitter accounts, we problematize the assumption that online communication involves two or more humans by directing attention to more or less automated ‘bot’ accounts. In sum, it is suggested that such automated accounts need to be dealt with more explicitly by researchers as well as practitioners interested in the popularity of online news as expressed through social media activity. (shrink)

The quest for causes behind health and sickness proposes deeper causes like per- sonality and general view of life. Two such concepts have been shown to associate with health indicators in a systematic way, sense of coherence and view of life. Sense of coherence is defined as the sum of three factors, comprehensibility, manage- ability, and meaningfulness. View of life consists of three components, general theories of man and the world, a central value system, and a basic attitude. Two em- (...) pirical studies are summarized where the concepts are related to bereavement and health, respectively. It is concluded that there are many similarities between the two concepts. They both emphasize integration and coherence and connote basic struc- tures in belief systems. They can be related to personality structure and the coping process. The concepts differ in scope and depth. SOC can be considered as part of the connotation of VOL. SOC is quantitatively measurable while VOL presumes qualitative methods of assessment. In studies of health, where factors pertaining to world view or sense of coherence are not in focus, but studied rather as possible confoun- ders, methodological simplicity points to use of the SOC concept. In studies of health where the deeper causal structures are in focus, VOL should also be used, since it per- mits greater depth of analysis. Ideally, both concepts should be applied for a full un- derstanding between man's inner processes and health. (shrink)

In relation to semantics, “grounding” has two relevant meanings. “Symbol grounding” is the process of connecting symbols to perception and the world. “Communicative grounding” is the process of interactively adding to common ground in dialog. Strategies for grounding in human communication include, crucially, strategies for resolving troubles caused by various kinds of miscommunication. As it happens, these two processes of grounding are closely related. As a side-effect of grounding an utterance, dialog participants may adjust the meanings they assign to linguistic (...) expressions, in a process of semantic coordination. Meanings of at least some expressions include perceptual aspects which enable DPs to classify entities as falling under the expression or not based on their perception of those entities. We show how perceptual grounding of symbols can be achieved in a process of interactively adding to common ground. This requires that perceptual aspects of meaning can be updated as a result of participating in linguistic interaction, thereby enabling fine-grained semantic coordination of perceptually grounded linguistic meanings. A formal semantics for low-level perceptual aspects of meaning is presented, tying these together with the logical-inferential aspects of meaning traditionally studied in formal semantics. The key idea is to model perceptual meanings as classifiers of perceptual input. This requires a framework where intensions are represented independently of extensions, and structured objects which can be modified as a result of learning. We use Type Theory with Records, a formal semantics framework which starts from the idea that information and meaning are founded on our ability to perceive and classify the world, that is, to perceive objects and situations as being of types. As an example of our approach, we show how a simple classifier of spatial information based on the Perceptron can be cast in TTR. (shrink)

ABSTRACTColin Hay's constructivist institutionalism and Vivien A. Schmidt's discursive institutionalism are two recent attempts to theorize ideas as potential explanations of institutional change. This new attention to the causal role of ideas is welcome, but Hay and Schmidt do not take into consideration the constitutive and structural aspects of ideas. Instead they reduce ideas to properties of individual conscious minds, scanting the respects in which ideas are intersubjectively baked into the practices shared by individuals. This aspect of ideas—arguably, the institutional (...) side of ideas—is developed in post-structuralist thought, which therefore demands a place in ideational research. (shrink)

Large, black, flightless birds with unpredictable tempers and colourful heads and necks, cassowaries have enthralled European audiences for centuries, but perhaps no one more so than private collector and zoologist Lionel Walter Rothschild (1868-1937). Throughout the late 19th and early 20th centuries, Rothschild acquired hundreds of living cassowaries which were kept in his private zoological collection. This paper explores the nature of Rothschild's private zoo and how the collection of living cassowaries was used to support his zoological activities. Spread across (...) three sites-the family estate at Tring Park, the zoological gardens in Regent's Park, and the business premises of Cambridge-based taxidermist Frederick Doggett-it will examine how Rothschild used the living birds kept in his private zoo to devise and inform a process for the preparation and display of cassowary specimens in museum galleries. It will show how he recruited specialist artists and taxidermists to perfect the art, and the significant financial investment this entailed. This is followed by exploration of how Rothschild's access to and observations of living birds informed his taxonomic work and, in particular, the identification of species and subspecies. The argument is made that Rothschild's private zoo and access to living cassowaries enabled his dedication to the study of the genus and ultimately underpinned his reputation as a world authority on cassowaries in the early 20th century. (shrink)

ABSTRACT The technocratic dimension of government—its reliance upon knowledge claims, usually in scientific guise—is of great importance if we wish to understand modern power and governance. In Power Without Knowledge: A Critique of Technocracy, Jeffrey Friedman investigates the often-overlooked question of the relationship between technocratic knowledge/power and ideas. Friedman’s contribution to our understanding of technocracy can therefore be read as a contribution to governmentality studies, one that introduces the possibility of adding normative solutions to this critical tradition.