This well-known core text on nursing ethics provides an in-depth exploration of nursing ethics content from the western philosophical tradition along with some ...

Good nursing is more than exercising a specific set of skills. It involves the personal identity of the nurse. The aim of this article is to answer two questions: (1) what kind of person should the hospice nurse be? and (2) how should the hospice nurse engage in caring conversations? To answer these questions we analyse a nurse’s story that is intended to be a profile of an exemplary hospice nurse. This story was constructed from an analysis of five semistructured (...) interviews with hospice nurses, based on the ‘ethics of the caring conversation’, which is inspired by the ethical perspective of Paul Ricoeur. The research questions concentrate on the norms of respect, responsibility and reciprocity, which are integral parts of the ‘ethics of the caring conversation’. (shrink)

As a form of functional diversity, spinal cord injury expressed by tetraplegia is one of the most serious events that can impact people, affecting their family and socioeconomic life. The type of care relationship established in these cases will be essential for preserving autonomy. The objective of this study was to understand how care relationships influence the autonomy of people with tetraplegia and the dynamics that trigger practices of autonomy violation, maintenance and promotion. This research is inspired (...) by problematization as a methodology using the Arch of Maguerez as an analytical approach strategy that enables an engagement between empirical and theoretical data. Some models of care relationships identified in this study either promote or violate autonomy: the protectionist model, based on the biomedical interpretation model of disability and the bodily impediments caused by spinal cord injury; the participatory model, involving the patient's interest in adapting to their new condition of family and community life, seeking to understand the practical aspects of daily life; the sharing model, in which the complicity and understanding of new forms of bodily expression allow the caregiver to be almost an extension of the tetraplegic person's body; the delegate model, which occurs in relationships with professional caregivers; and the emancipatory model, which seeks to empower the patient, highlight potentialities, and encourage autonomy. The key components of these conceptual care models guided the elaboration of hypotheses for intervention with the objective of maintaining and promoting the autonomy of people with tetraplegia through supported care. (shrink)

Newborn screening involves the collection of blood from the heel of a newborn baby and testing it for a list of rare and inheritable disorders. New biochemical screening technologies led to expansions of NBS programs in the first decade of the 21st century. It is expected that they will in time be replaced by genetic sequencing technologies. These developments have raised a lot of ethical debate. We reviewed the ethical literature on NBS, analyzed the issues and values that emerged, and (...) paid particular interest to the type of impacts authors think NBS should have on the lives of children and their families. Our review shows that most authors keep their ethical reflection confined to policy decisions, about for instance the purpose of the program, and its voluntary or mandatory nature. While some authors show appreciation of how NBS information empowers parents to care for their children, most authors consider these aspects to be ‘private’ and leave their evaluation up to parents themselves. While this division of moral labor fits with the liberal conviction to leave individuals free to decide how they want to live their private lives, it also silences the ethical debate about these issues. Given the present and future capacity of NBS to offer an abundance of health-related information, we argue that there is good reason to develop a more substantive perspective to whether and how NBS can contribute to parents’ good care for children. (shrink)

A relational-self theory claims that one’s self is constituted by one’s relationships. The type of ethics that is said to arise from this concept of self is often called an ethics of care, whereby the focus of ethical deliberation is on preserving and nurturing those relationships. Some environmental philosophers advocating a relational-self theory tend to assume that the particular relationships that constitute the self will prioritize the natural world. I question this assumption by introducing the problem of artifact relationships. (...) It is unclear whether a relational-self theory recognizes relationships with the artificial world as beingmeaningful in any moral sense, and whether such relationships, if they can exist, should be accorded equal value to relationships with the natural world. The problem of artifact relationships becomes particularly apparent when the relational-self theory is linked to place-based ethics. If our ethics are to develop from our relations to place, and our place is largely an artificial world, is there not a danger that our ethical deliberations will tend to neglect the natural world? I adapt Holmes Rolston’s concept of “storied residence” to show how the inclusion of the artificial world will lead to different questions regarding one’s resident environment, and perhaps a different emphasis on what is valued. My aim in raising these questions is to challenge the optimism that writers such as Karen Warren and Jim Cheney have shown in supporting relational-self theories and place-based ethics. I conclude that the challenge to develop a relational-self/place-based ethic does not appear to have been met within Western environmental philosophy, which has perpetuated a silence on the matter of our embedment in the artificial world. (shrink)

A relational-self theory claims that one’s self is constituted by one’s relationships. The type of ethics that is said to arise from this concept of self is often called an ethics of care, whereby the focus of ethical deliberation is on preserving and nurturing those relationships. Some environmental philosophers advocating a relational-self theory tend to assume that the particular relationships that constitute the self will prioritize the natural world. I question this assumption by introducing the problem of artifact relationships. (...) It is unclear whether a relational-self theory recognizes relationships with the artificial world as beingmeaningful in any moral sense, and whether such relationships, if they can exist, should be accorded equal value to relationships with the natural world. The problem of artifact relationships becomes particularly apparent when the relational-self theory is linked to place-based ethics. If our ethics are to develop from our relations to place, and our place is largely an artificial world, is there not a danger that our ethical deliberations will tend to neglect the natural world? I adapt Holmes Rolston’s concept of “storied residence” to show how the inclusion of the artificial world will lead to different questions regarding one’s resident environment, and perhaps a different emphasis on what is valued. My aim in raising these questions is to challenge the optimism that writers such as Karen Warren and Jim Cheney have shown in supporting relational-self theories and place-based ethics. I conclude that the challenge to develop a relational-self/place-based ethic does not appear to have been met within Western environmental philosophy, which has perpetuated a silence on the matter of our embedment in the artificial world. (shrink)

A relational-self theory claims that one’s self is constituted by one’s relationships. The type of ethics that is said to arise from this concept of self is often called an ethics of care, whereby the focus of ethical deliberation is on preserving and nurturing those relationships. Some environmental philosophers advocating a relational-self theory tend to assume that the particular relationships that constitute the self will prioritize the natural world. I question this assumption by introducing the problem of artifact relationships. (...) It is unclear whether a relational-self theory recognizes relationships with the artificial world as beingmeaningful in any moral sense, and whether such relationships, if they can exist, should be accorded equal value to relationships with the natural world. The problem of artifact relationships becomes particularly apparent when the relational-self theory is linked to place-based ethics. If our ethics are to develop from our relations to place, and our place is largely an artificial world, is there not a danger that our ethical deliberations will tend to neglect the natural world? I adapt Holmes Rolston’s concept of “storied residence” to show how the inclusion of the artificial world will lead to different questions regarding one’s resident environment, and perhaps a different emphasis on what is valued. My aim in raising these questions is to challenge the optimism that writers such as Karen Warren and Jim Cheney have shown in supporting relational-self theories and place-based ethics. I conclude that the challenge to develop a relational-self/place-based ethic does not appear to have been met within Western environmental philosophy, which has perpetuated a silence on the matter of our embedment in the artificial world. (shrink)

Burnout is a multidimensional work-related syndrome that is characterized by emotional exhaustion, depersonalization – or cynicism – and diminution of personal accomplishment. Burnout particularly affects physicians. In medicine as well as other professions, burnout occurrence depends on personal, developmental-psychodynamic, professional and environmental factors. Recently, it has been proposed to specifically define burnout in physicians as “pathology of care relationship”. That is, burnout would arise, among the above-mentioned factors, from the specificity of the care relationship as it (...) develops between the physician and the patient. Accordingly, experimental studies and theoretical approaches have suggested that burnout and empathy, which is one of the most important skills in physicians, are closely linked. However, the nature of the relation between burnout and empathy remains not yet understood, as reflected in the variety of theoretical and contradictory hypotheses attempting to causally relate these two phenomena. Firstly, we here question the epistemological problem concerning the modality of the burnout-empathy link. Secondly, we hypothesize that considering the multidimensional features of both burnout and empathy, on one hand, and on the other hand, the distinction between empathy and sympathy enables to overcome these contradictions and, consequently, gives a better understanding of the relationship between burnout and empathy in physicians. Thirdly, we propose that clarifying the link between burnout, empathy and sympathy would enable developing specific training in medical students and continuous professional formation in senior physicians and would potentially contribute to the prevention of burnout in medical care. (shrink)

The origin of the concept of “emotional sharing” can be traced back to the first edition of Sympathiebuch [1913/23], in which Max Scheler paved the way to a phenomenology of emotions and to social ontology. The importance of his findings is evident: consider the central role of emotional sharing in Michael Tomasello’s analysis and the lively debate on social ontology and collective intentionality.

Social representations of addiction and the resulting stigmatization have been widely described and studied in the literature, but their effects are no less problematic. These representations, which also occur in care settings, generate a climate of distrust which damages the therapeutic relationship, and its ethical quality. This article, combining clinical experience and an ethical stance, offers an original, innovating approach to the existence of distrust in care relationships in the area of addiction. Pragmatic approaches deriving from the (...) human sciences and analytical philosophy provide an invitation to escape from the demanding climate of mistrust, and to take the gamble on trust so as to improve the quality of interactions between protagonists in care. In complementary fashion, a sociology of action can combat the disquiet generated by distrust through a new commitment to innovating forms of action. This “poetic” mode of action is legitimized by the reflection that backs it up, and by its presentation to peers qualified to approve it. Finally, continental moral philosophy underlines the importance of a carefully weighed commitment on the part of caregivers and addicted patients towards promises aiming to support a sincere care relationship, without damaging the therapeutic dynamic or the ethical quality by providing too many safety nets. This reflection is intended to achieve better identification of the clinical and ethical issues raised by mistrust, and inclusion of these aspects in the training of personnel and in care provision planning. (shrink)

Although we theorize that nurses ‘make a difference’ to patient outcomes and speculate that this happens because nurses ‘care’, there is so far little evidence to support this nebulous claim. Efforts to promote care as the defining characteristic of nursing, and an ‘ethic of care’ as the ethical basis of nursing, have sparked debate within the discipline. This debate has resulted in a polarization that has effectively stalled productive discourse on the issues. Moreover, the focus on (...) class='Hi'>care has been at the expense of understanding the true nature of the relationship between caring and the broader base of ethical knowledge that underpins nursing and that must underpin nursing if it is a viable practice profession. This paper used the framework of philosophical argument to explore the moral and ethical foundations of nursing from the perspective of personal and public morals, and responsive nurse–patient relationships as the reflection of ethical nursing knowledge. The foundation of ethical nursing knowledge is the personal moral sense that resides within the individual and that nurses hold in common with others. Personal moral knowledge is transformed into disciplinary ethical knowledge specific to nursing through disciplinary consensus. Responsive relationships are conceptualized in the nursing literature as founded on three essential elements: respect, trust, and mutuality. These three elements are grounded in ethical nursing knowledge; therefore responsive nurse–patient relationships reflect both personal moral knowledge and disciplinary ethical knowledge. By facilitating the articulation of ethical nursing knowledge in practice, responsive relationships connect theory, ethical knowledge, and clinical outcomes. (shrink)

Background:To provide care with high quality, nurses face a number of moral issues requiring them to have moral abilities in professional performance. Moral sensitivity is the first step in moral performance. However, its relation to the quality of care patients receive is controversial.Research objective:This study aims to determine the relationship between the moral sensitivity of nurses and the quality of care received by patients in the medical wards.Research design:A descriptive correlational study using validated tools, including Moral (...) Sensitivity Questionnaire and the Quality Patient Quality Scale.Participants and research context:In total, 198 nurses and 198 patients in 17 medical wards of hospitals affiliated with Tabriz University of Medical Sciences, Iran.Ethical considerations:The study was reviewed and approved by the Ethics Committee of Tabriz University of Medical Sciences.Findings:The mean values of nurses’ moral sensitivity and nurses’ quality care were 136.47 ± 13.30 and 196.36 ± 44.10, respectively. There was no significant relationship between the patient care quality and nurses’ moral sensitivity ( r = −.14, p =.5). However, there was a significant inverse relationship between the dimension of “Experiencing moral conflicts” and the overall score of quality care ( r = −.50, p =.04), the dimensions of “psychosocial ( r = −.50, p =.04)” and “physical ( r = −.50, p =.03).”Conclusion:Considering the significant inverse relationship between the score of patient quality care and the dimension of moral conflict experience, it seems when nurses make moral decisions, they experience a conflict between personal and professional values in their careers and thus experience moral tension. If this tension is not resolved properly, it can provide a way for them to distance themselves from patients, thereby making nurses indifferent to moral care. (shrink)

After Ontotheology: Reciprocal, Caring, Creative, and Right Relationships With the end of ontotheology we may realize, as Dewey did, that what sustains us is our caring relationships with physical nature, biological life, and other persons. My paper argues that relationships are ontologically basic and caring relations are morally basic. Right relationship binds us to the world and holds us together. We live by the grace of others. I conclude that after ontotheology, we must seek to form reciprocal, caring, and (...) creative relationships. (shrink)

Care ethicists have long insisted that Kantian moral theory fails to capture the partiality that ought to be present in our personal relationships. In her most recent book, Virginia Held claims that, unlike impartial moral theories, care ethics guides us in how we should act toward friends and family. Because these actions are performed out of care, they have moral value for a care ethicist. The same actions, Held claims, would not have moral worth for a (...) Kantian because of the requirement of impartiality. Although Kantian moral theory is an impartial theory, I argue that the categorical imperative in the Formulation of Humanity as an End and the duty of respect require that we give special treatment to friends and family because of their relationships with us. Therefore, this treatment does have moral value for a Kantian. (shrink)

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict (...) were higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

Whereas empathy is most often looked upon as a virtue and essential skill in contemporary health care, the relationship to sympathy is more complicated. Empathic approaches that lead to emotional arousal on the part of the health care professional and strong feelings for the individual patient run the risk of becoming unprofessional in nature and having the effect of so-called compassion fatigue or burnout. In this paper I want to show that approaches to empathy in health (...) class='Hi'>care that attempt to solve these problems by cutting empathy loose from sympathy—from empathic concern—are mistaken. Instead, I argue, a certain kind of sympathy, which I call professional concern, is a necessary ingredient in good health care. Feeling oneself into the experiences and situation of the patient cannot be pursued without caring for the patient in question if the empathy is going to be successful. Sympathy is not only a thing that empathy makes possible and more or less spontaneously provides a way for but is something that we find at work in connection to empathy itself. In the paper I try to show how empathy is a particular form of emotion in which I feel with, about, and for the other person in developing an interpretation of his predicament. The with and for aspects of the empathy process are typically infused by a sympathy for the person one is empathizing with. Sympathy can be modulated into other ways of feeling with and for the person in the empathy process, but these sympathy-replacement feelings nevertheless always display some form of motivating concern for the target. Such an understanding of empathy is of particular importance for health care and other professions dealing with suffering clients. (shrink)

The essence of caring for those in need of help consists in a certain relationality, in giving and receiving a certain relationship. The relationship as such is the protagonist of the care. Material help is always necessary, at least for the time it has to be dedicated. However, the material aspect takes on meaning from the relationship between the one who helps (caregiver) and the one who receives the help (care receiver). It is a lifeworld (...) relationship. What is lacking in today’s society is not so much material and technological resources, but rather the relational skills of welcoming, supporting and socially integrating people in difficulty. The care of the Other is increasingly entrusted to new technologies and impersonal welfare mechanisms, while interpersonal social relationships become increasingly weak, liquid and unavailable. The consequences are evident in the loss of social solidarity and in the degradation of the human condition. Situations of need due to fragility, hardship, marginalization are spreading. We need a social change, first of all cultural, which brings out, rather than concealing, the relational character of human needs and, correlatively, of the necessary response. (shrink)

This article addresses some ambiguities and normative problems with the concept of mature care in professional relationships and in health care priorities. Mature care has recently been introduced in the literature on care ethics as an alternative to prevailing altruistic conceptions of care. The essence of mature care is an emphasis on reciprocity, where the mature agent has the ability to balance the concerns of self with those of others and act from a principle (...) of not causing harm. Our basic claim is that the prevailing concept of mature care does not capture the real nature of professional relationships and role obligations in health care. As the focus of attention in professional care is and must be the patient’s particular medical and care needs, such care must principally be altruistic. Furthermore, we argue that mature care cannot adequately address moral conflict in health care without accepting some more principle-based approaches and a richer notion of partiality. (shrink)

The literature on migrant care workers has tended to place little emphasis on the multiple relationships that migrant carers form with care recipients, employers/managers and work colleagues. This article makes a contribution to this emerging field, drawing on data from qualitative interviews carried out with 40 migrant care workers employed in the institutional and domiciliary care sectors in Dublin, Ireland. While the analysis revealed generally positive carer—care recipient relationships, significant racial and cultural tensions were evident (...) within the vertical and especially the horizontal relationships in the care workplace. The article argues that these findings highlight the need for additional research on the relationships formed in the long-term care sector and further theorizing on the meaning and importance of the affective components of care work within increasingly commodified care markets. (shrink)

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

Relationships are central to enacting person‐centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person‐centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long‐term care. The (...) acute care setting is characterized by archetypal constraints which differentiate it from long‐term care, in terms of acuity and haste, task‐orientated work patterns and influence from “the rule of medicine,” all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re‐interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re‐presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person‐centred care versus relationship‐centred care by arguing that these are complementary rather than mutually exclusive and can be brought together in one theoretical framework acknowledging personhood as relational in essence. (shrink)

The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship. We now are in a “post-managed care era,” where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most (...) recent of numerous strains on the DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes. (shrink)

The conception of the doctor–patient relationship under Australian law has followed British common law tradition whereby the relationship is founded in a contractual exchange. By contrast, this article presents a rationale and framework for an alternative model—a “Trust Model”—for implementation into law to more accurately reflect the contemporary therapeutic dynamic. The framework has four elements: an assumption that professional conflicts with patient safety, motivated by financial or personal interests, should be avoided; an onus on doctors to disclose these (...) conflicts; a proposed mechanism to contend with instances where doctors choose not to disclose; and sanctions for non-compliance with the regime. (shrink)

This study aimed to determine the relationship between acute stress and quality of life and explore their influencing factors on health care workers. A descriptive cross-sectional study was conducted, and a sample of 525 health care workers was recruited from 15 hospitals through a convenient sampling method. Participants completed an online self-report questionnaire to assess their acute stress and quality of life. Descriptive and multiple linear regression statistics were used for this analysis. The results regarding acute stress (...) responses varied significantly among the differences in marital status, physical activity, work status, perceived risk of contracting COVID-19, and the expected duration of the pandemic. Moreover, a younger age, lack of physical activity, being a front-line medical staff, and higher acute stress scores indicated a worse quality of life. Healthcare workers’ acute stress was negatively correlated with their quality of life. Therefore, the authorities should pay special attention to health care workers’ mental health and provide them with timely protection during the pandemic. (shrink)

The relatively recent shift of family caregiving to the public market of service work raises questions about how to theorize paid caregiving. This article examines how to conceptualize child rearing when it is transferred to a paid worker. The gendered character of commodified caregiving is complicated by structural locations of race and class that define the employer-employee relationship. Previous discussions of paid child care work as emotionally meaningful work have been criticized as idealizations that mask the exploitative nature (...) of the work. Yet, emotional meaning is not simply a cover-up or an idealization of the labor; rather, it is an integral component of the work of caregiving, the practice of which is distorted by societal assumptions about gender and race. To better understand paid child care work, the significance of emotional meaning, as well as gender, race, and ethnic dimensions of paid child care work need to be explored. (shrink)

For over a decade, managed care has profoundly altered how healthcare is delivered in the United States. There have been concerns that the patient-physician relationship may be undermined by various aspects of managed care, such as restrictions on physician choice, productivity requirements that limit the time physicians may spend with patients, and the use of compensation formulas that reward physicians for healthcare dollars not spent. We have previously published data on the effects of managed care on (...) the physician-patient relationship from the physician's perspective. In 1999, we collected data on the impact of managed care arrangements on the physician-patient relationship from the patient's perspective. This article discusses our collective findings. (shrink)

Over the past several years, healthcare has been profoundly altered by the growth of managed care. Because managed care integrates the financing and delivery of healthcare services, it dramatically alters the roles and relationships among providers, payers, and patients. While analysis of this change has focused on whether and how managed care can control costs, an increasingly important concern among healthcare providers and recipients is the impact of managed care on the physicianpatient relationship, but little (...) data have been collected and analyzed. We designed a survey for distribution to Wisconsin physicians to analyze the prevalence and types of managed care arrangements in the state, and the impact of these arrangements on physicians and their relationships with patients. (shrink)

Background Nurses are the main protectors of goodness, honesty and morality in patient care. Conscience allows nurses to be understanding and careful while they provide patient care. In this research the researcher aimed to determine the relationship between conscientious intelligence levels and caring behaviours of nurses and to determine the factors affecting the conscientious intelligence levels and caring behaviours. Methods This research designed as a descriptive, cross-sectional and correlation study included 314 nurses working at three hospitals in (...) eastern Turkey. The data were collected by the researcher at a time when the nurses were available and not working. Written and oral informed consent was obtained from all the participants. Results A moderate significant positive correlation was observed between conscientious intelligence levels and caring behaviours of nurses. The length of service in nursing, sex and being pleased with the nursing profession were associated with conscientious intelligence levels and caring behaviours. Conclusion At the end of this research, it was determined that nurses with high conscientious intelligence had better caring behaviours. Although it is very important for nurses to be knowledgeable of and competent at providing care, taking their conscience into consideration in the care of his or her patients is more important. If a nurse is not pleased with the nursing profession, his or her behaviour should be monitored when he or she provides care for the patient. Persons without conscientious values should not be accepted into the nursing profession. (shrink)

This article will address the question: how can health care education best take seriously the task of educating for professional practice within a post-traditional, liberal democratic society? In the setting of modernity, the altered personal and professional self has to be explored and constructed as part of a reflective process of connecting personal and professional change: in essence, to develop self-knowledge. A moral life, or ‘working morality’, that evolves out of a process of ongoing dialogue and conversation is required. (...) What is advocated here is a more social model of health care education that acknowledges a social or communal dimension to knowledge and the centrality of relationships for the full development of the individual personally and professionally, fosters our capacity to identify who we are both personally and professionally, connects reason and dialogue, and educates for dialogue and dialogic relationships. (shrink)

OBJECTIVES: The subject of patient self-determination in health care has gained broad interest because of the increasing number of incompetent patients. In an attempt to solve the problems related to doctors' decision making in such circumstances, advance directives have been developed. The purpose of this study was to examine relationships between public attitudes towards patient autonomy and advance directives. SUBJECTS AND MAIN OUTCOME MEASURES: A stratified random sample of 600 adults in northern Sweden was surveyed by a questionnaire with (...) a response rate of 78.2%. The subjects were asked about their wish for control of their health care, their concerns about health care, their treatment preferences in a life-threatening situation (both reversible and irreversible), and their attitudes towards the application of advance directives. RESULTS: Numerous relationships between various aspects of self-determination in health care (desire for control, fears of over-treatment, and choice of treatment level) in general and advance directives, in particular, were found. Those who wanted to have a say in their health care (about 94%) also mainly supported the use of an advance directive. CONCLUSIONS: The fact that almost 30% of the respondents were undecided concerning their personal use of advance directives points to a lack of knowledge and to the necessity of education of the public on these issues. (shrink)

Intimacy contributes to our well-being and extends into older age, despite cognitive or physical impairment. However, the ability to enjoy intimacy and express sexuality is often compromised—or even controlled—when one moves into residential aged care. The aim of this study was to identify what factors influence senior residential aged care staff when they make decisions regarding resident intimate relationships and sexual expression. The study used vignette methodology and a postal survey to explore reactions to a fictionalised case study (...) of a couple—Norm and Carol—who develop a close, mutually satisfying relationship. Staff were first asked whether they would intervene in the relationship. Using an innovative approach, several variations to the case study were then presented to explore whether views about intervening changed according to varying contextual factors. Findings indicated that over 90% of respondents initially agreed that the relationship should continue, and only 10% indicated they would intervene. However, when the case study was varied, respondents indicated they were more likely to intervene, particularly if Norm was exhibiting distress in Carol’s presence (89%), but also if Norm was married and his wife was living in the community (40%). Other factors including level of cognitive impairment and family disapproval were also found to influence staff views. This study provides insight into how residential aged care staff make decisions regarding the intimacy and sexuality of older people living in residential aged care and how personal views and values likely guide practice in the absence of formal policies. (shrink)

A multifaceted, holistic approach to identifying potential predictors is needed to eradicate workplace bullying. The current study investigated the impact of an unfavourable organisational climate that plays a role in breeding workplace bullying. The present study also postulated that individual personality differences mediate between a caring climate and workplace bullying. Similarly, the interaction between workplace bullying and personality impacts PTSD. We also checked the role of workplace bullying as a mediator between a caring climate and PTSD. This research tested all (...) the proposed hypotheses, and the study was conducted in Pakistan. The data is analysed using the two-step partial least square structural equation modelling procedure. The first part assesses the measurement model, while in the second step, the structural model is evaluated. The results supported all the proposed hypotheses of this study. Type A behaviour moderated the caring climate—person-related bullying relationship, whereas it did not moderate the caring climate—work-related bullying in the suggested direction. Type A behaviour is moderated for both types of bullying and PTSD. Results also show significant indirect effects of a caring climate on PTSD through workplace bullying. This study will contribute theoretically to filling the literature gap on studies of climate-bullying and bullying-stress using contingency factors. (shrink)