Introduction: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design: Data were analysed, codified and (...) triangulated using qualitative ethnographic content analysis. Participants and research context: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. Ethical considerations: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen. (shrink)

Contemporary healthcare practice has been progressively more regulated to increase efficiency, service user safety and practice quality. However, ethical issues in clinical practice that have not been implemented into regulations are undervalued by policymakers and healthcare institutions Considering the issues found by other authors, the use of a simple tool for policymakers to consider recurrent ethical issues could reduce those issues in a policy-driven clinical practice. The lack of tools to support structured ethical assessment of clinical policies was the main (...) reason to create the Clinical Policy Ethics Assessment Tool, but we realised of its possible advantages: limiting ethical dilemmas posed by policies, ensuring ethical practice by the use of policies and developing a consistent process for policymakers, institutions and healthcare professionals. Nonetheless, even if a tool can be implemented and it supports the creation of policies that reduce ethical issues, if the healthcare professionals are not aware of them they will not be implemented and the issues will continue. (shrink)

Contemporary healthcare practice has been progressively more regulated to increase efficiency, service user safety and practice quality. However, ethical issues in clinical practice that have not been implemented into regulations are undervalued by policymakers and healthcare institutions Considering the issues found by other authors, the use of a simple tool for policymakers to consider recurrent ethical issues could reduce those issues in a policy-driven clinical practice. The lack of tools to support structured ethical assessment of clinical policies was the main (...) reason to create the Clinical Policy Ethics Assessment Tool, but we realised of its possible advantages: limiting ethical dilemmas posed by policies, ensuring ethical practice by the use of policies and developing a consistent process for policymakers, institutions and healthcare professionals. Nonetheless, even if a tool can be implemented and it supports the creation of policies that reduce ethical issues, if the healthcare professionals are not aware of them they will not be implemented and the issues will continue. (shrink)

Introduction: Clinical policies control several aspects of clinical practice, including individual treatment and care, resource management and healthcare professionals’ etiquette. This article presents Clinical Policy Ethics Assessment Tool, an ethical assessment tool for clinical policies that could be used not only by clinical ethics committees but also by policy committees or other relevant groups. Aim: The aim of this study was to find or create a tool to identify ethical issues and/or confirm ethical validity in nursing practice policies, protocols and (...) guidelines. Methodology: The development of Clinical Policy Ethics Assessment Tool involved first a literature review, followed by modification of the Research Protocol Ethics Assessment Tool, which was created to identify research protocols’ ethical issues, and finally, a trial of Clinical Policy Ethics Assessment Tool to ensure its reliability and validity. Ethical consideration: The policies analysed trialling Clinical Policy Ethics Assessment Tool were in the public domain and did not contain any confidential information. Despite that, Clinical Policy Ethics Assessment Tool also had the approval of a research ethics committee. Results: Research Protocol Ethics Assessment Tool was chosen as the template for a Clinical Policy Ethics Assessment Tool, to which several modifications were added to adapt it to work within a nursing practice context. Clinical Policy Ethics Assessment Tool was tested twice, which resulted in a general test–retest reliability coefficient = 0.86, r = 0.84, α1 = 0.817, α2 = 0.824 and interclass correlation coefficient = 0.874. Discussion: Contemporary nursing practice in a developed country is often ruled by clinical policies. The use of Clinical Policy Ethics Assessment Tool could confirm the ethical validity of those clinical practice policies, impacting on nurses’ education, values and quality of care. Conclusion: Clinical Policy Ethics Assessment Tool has the potential to detect ethical issues and facilitate the correction and improvement of clinical policies and guidelines in a structured way. This is especially so as it has shown reliability in detecting issues in clinical policies involving human participants and in encouraging policymakers to consider common ethical dilemmas in nursing practice. (shrink)

El propósito de este artículo es describir el proceso por el cuál un individuo o grupo de individuos aplica violencia -psíquica o física- en pequeñas dosis a otro individuo con la intención de desestabilizarlo y hacerlo dudar de sus propios pensamientos y afectos. De esta forma se arrebata al otro su identidad, se niega y elimina la diferencia con el otro. El objetivo de esta conducta es paralizar a la víctima para evitar que surja el conflicto, para que no pueda (...) pensar ni comprenden, mantenerla a disposición del agresor mientras sea útil y adoctrinarla. El proceso pretende pervertir moralmente a la víctima y destruirla lentamente para conseguir un crimen perfecto, se elimina a la víctima por inducción al suicidio o violencia fisica. Llamamos a esta conducta "acoso moral" y la definimos como toda conducta abusiva -verbal o no verbal- que atenta por su frecuencia y repetición contra la dignidad o integridad psíquica o física de una persona. (shrink)

The subversion of tradition of ethics carried out by Kant in his Critique of Practical Reason is, according to Lacan, the intelligibility background on which it is possible a science of the subject as developed by Freud. This would be shown up in a particularly effective way if comparing Kant’s moral theory with Sade’s antimoral one. It is not difficult to show the formal-structural identity of the state of affairs established by inconditionality of law in both theoretical systems, and thus (...) expose the possibility of that anti-moral as a kind of Kantian variation. Moreover, Lacan holds, it is necessary to recognize in Sade’s Philosophy in the Bedroom the truth of Critique of Practical Reason. Our study proposes an examination of this well-known Lacanian thesis. On the one hand, we seek to establish the exact content of this thesis and the diagnosis of the relationship that it involves between Kant and Freud (between Enlightenment and psychoanalysis). On the other hand, we seek to confront that diagnosis with the reconstruction of the specific terms of the practical subject question in Kant’s philosophy. The ultimate aim is at least to raise a question about the place of the concept of “Reason” in psychoanalysis, that is, about the margin that the truth of the subject discovered by this theory leaves for making the difference (at least de iure) between the weight of reason and the illusions of moral masochism, and about the very conditions of psychoanalysis as a theory. (shrink)

This article intends to think a feminist theory in the speculative context that starts with the Hegelian metaphysics and continues with the French post-Hegelianism of J. Derrida, G. Deleuze and M. Foucault among others. The great challenge of these authors –and with them the great challenge of our time– consists in deconstructing the binary logic which has dominated western thought and culture, in order to overcome the political and social exclusion promoted by it. In this context lies the femininity-masculinity dualism, (...) whose overcoming we prefer to think as the intrinsic implication of a new relational and dynamic, multiple and concrete identity. (shrink)

Este repertorio registra información de Husserl en la Internet, una breve historia sobre los Nachlaß, el índice de la Husserliana, un listado de las publicaciones de y sobre Husserl disponibles en la Biblioteca Central de la Pontificia Universidad Católica del Perú, y los artículos sobre Husserl que se encuentran en la Hemeroteca. El listado abarca las publicaciones existentes hasta el año 1997.

Eight focus groups were conducted in four public hospitals in Madrid to explore healthcare professionals’ perceptions of advance directives in order to improve the understanding of their lack of success among physicians and patients. A purposive sample of sixty healthcare professionals discussed ADs and reasons for their infrequent use. Three main themes were identified: perceptions about their meaning, appraisals of their use in clinical practice, and decision-making about them. Healthcare professionals perceived a lack of clarity about their definition and (...) implementation. There is insufficient awareness of their efficacy in improving the quality of clinical relationships and decision-making, and they are often perceived only as a bureaucratic procedure. Advance directives are not integrated in the clinical practice of Madrid’s healthcare specialist services because their application is exceedingly complex, because of insufficient education about them, and because of lack of procedural clarity. Consequently, healthcare professionals are not aware of how ADs could improve clinical decision-making, of when and for whom their use is appropriate, and of who has responsibility for providing ADs-related information to patients. These circumstances contribute to patients’ lack of interest in completing these documents and to physicians’ sceptical views about their usefulness. (shrink)

Leibniz, in order to avoid both determinism and indifferentism, says that knowledge inclines the agent towards the best action without necessitating it. According to his modal theory, an action is contingent if the opposite is (logically) possible. The article examines the coherence of Leibniz’s notion of «inclining but not necessitating» in the context of contemporary philosophy of action, profiting from the distinction between reasons and causes. The kind of freedom which is possible according to Leibniz philosophy depends on this question.

An analysis of the particular kind of determinism that is to be found in the moral election according to Leibniz shows the model of practical reason held in his philosophy. The hermeneutical clue used in the article is to make a parallelism between the model of rationality of God’s election to create the best possible world and that of human moral election.

Reseña crítica del libro de Alicia H. Puleo titulado Ecofeminismo para otro mundo posible . Madrid, Cátedra, 2011.

Background: Serious games have shown positive results in increasing motivation, adherence to treatment and strengthening the therapeutic alliance in multiple psychiatric disorders. In particular, patients with impulse control disorders and other disorders in which the patient suffers from inhibitory control deficits have been shown to benefit from serious games.Aim: The aim of this study was to describe the characteristics and to evaluate the usability of a new serious videogame, e-Estesia. This serious videogame was designed to improve emotion regulation in patients (...) with gambling disorder. Preliminary results from a pilot sample are also reported.Method: A pilot sample of 26 patients undergoing treatment for GD was recruited. Participants used e-Estesia on a tablet, which was connected to a thoracic band that sent heart rate and heart rate variability data to the videogame platform in order to provide biofeedback. The System Usability Scale was completed by patients to determine the usability of e-Estesia.Results and Discussion: e-Estesia performed comparatively well for all the explored groups. Around 84.6% of the patients endorsed that it was easy to use. Female patients with GD presented higher HRV during the use of the serious videogame compared to men. (shrink)

Algunos autores han intentado considerar los delirios como certezas –entendidas en el sentido de Wittgenstein– debido a las similitudes que parecen existir entre sus respectivos estatus epistemológicos. Sin embargo, dicho intento ha sido criticado con agudeza, entre otras razones, porque el contenido de los delirios choca frontalmente con el contenido de las certezas, por lo que los delirios no pueden ser comprendidos debido a los cambios en las relaciones de significado. Pero es evidente que, aunque los delirios no se puedan (...) contemplar como certezas, muchos delirios afectan de un modo u otro al sistema de certezas del paciente. Partiendo de esta base, no es descabellado pensar que dicha influencia pudiera ser también recíproca: en otras palabras, parece sumamente recomendable analizar si algunos delirios se podrían contemplar como el resultado de variaciones en certezas. En este artículo llevo a cabo dicho análisis al intentar mostrar que el origen de algunos delirios pedestres y severos puede ser hallado en lo que llamaré “ceguera a posibilidades” e “incertidumbre”, términos que he desarrollado teniendo en cuenta la obra del filósofo Ludwig Wittgenstein. (shrink)

Wide analysis of "María Teresa López de la Vieja, La pendiente resbaladiza. La práctica de la argumentación moral . Madrid y México, D.F.: Plaza y Valdés, 2010, 288 páginas.".

Este artículo reseña: Oscar Celador Angón, Entidades locales y libertad religiosa, Ed. Dykinson, Madrid 2023, 214 pp.

Wittgenstein’s remarks in On Certainty about the acquisition of child language have gone nearly unnoticed for the commentators of his work. In this paper, I analyze some of those remarks to shed light on the main questions posed in On the categorical distinction between knowledge and certainty; the nature of language-games; the refutation of skepticism and, above all, the challenges involved by learning to believe.