In this article, I discuss the implications of the neoliberal transformations on healthcare that are justified under the aegis of economic efficiency. Drawing on the work of German critical philosopher Axel Honneth, I present a critical‐social and philosophical perspective that reinterprets these transformations as pathological consequences with devastating impacts on how we understand what human beings and social relations are. I argue that in a neoliberal context, nursing care becomes a form of reification defined as ‘forgetfulness of recognition’ of the (...) human identity of the patient which contradicts the assumed ethical foundations of nursing. The article provides a detailed account on how neoliberal rationality that governs nursing performance promotes an objective and a ‘neutral stance’ of care that neglects emotional engagement and deals with the patient as an object or a thing which violates all dimensions of patient recognition. I also emphasize that neoliberalism must rather be understood as a specific form of governmentality that goes beyond mere economization and structures a specific way of understanding people in the healthcare context. Neoliberal rationality, as conceptualized in this article, not only considers human being as homo economicus, where decisions are based on economic ideals, but also neutralizes relationships and disseminates an ‘objective’ and purely scientific stance in caring interactions. This leads to the detachment of nurses and reification of patients. Thus, nursing care is reduced to an instrumental rationality that focuses on technical care, which diminishes any possibility for nurses to engage with patients and understand their unique phenomenological world necessary for coping and recognition. Finally, nurses are urged to raise their voices against neoliberal rationality that programs their ideas of what ‘good care’ is. A critical emancipatory mode of thinking provides an opportunity to challenge neoliberal rationality and revitalize nursing agency to resist the devastating transformations taking place in health care. (shrink)

The development of person‐centred practice is inextricably linked with the debate about being a person and personhood. This debate takes on a particular relevance when certain prerequisites, which are often used as defining characteristics of persons, can no longer be autonomously fulfilled. This is the case, for example, with intensive care patients who are often (temporarily) impaired in their responsiveness and consciousness due to their critical state of health. Due to sedation, severity of illness and loss of voice, delivery of (...) person‐centred care in the intensive care setting is described as challenging. Despite far reaching implications on the therapeutic, ethical, and legal handling of patients in the intensive care setting, a definition of personhood at the stage of briefly diminished (by anesthetic measures), limited, or absent consciousness and ability to communicate has so far been discussed only superficially. To meet this challenge and to develop an understanding of person‐centred practice suitable for the context of intensive care, Emmanuel Levinas’ relational ethics and his understanding of radical alterity is discussed. We uncover the implications of Levinas Ethics of Radical Alterity on the care of the unconscious and unresponsive patient in the intensive care unit and further on the person‐centred approach to practice. The perspectives proposed in this paper provide an opportunity for the ontological embedding of a person‐centred care approach, which makes it possible to meet and care for these patients in a person‐centred manner. (shrink)

The Art of Caring model is developed from a general structure of the flow in the encounter between the injured patients and the different professionals within emergency care, in turn founded on four phenomenological essences, which encompass the experiences of patients, next of kin, and various professionals during the encounter at the scene of an accident and at the emergency department. The Art of Caring model represents a philosophical and theoretical rethinking of an ethical approach. It draws upon the works (...) of the Danish philosopher Løgstrup, the French philosopher Levinas as well as selected aspects of Merleau Ponty. The Art of Caring model is illustrated by coppersmith and artist Michaela Ivarsdotter, further developed and reflected upon with Anna Bratt, a psychologist working according to the compassion‐focused tradition. The model is made to disclose and visualise the Art of Caring and facilitate reflections on achieving a win‐win situation for both patients and different professionals within emergency care. Healthcare involves a variety of professions, and for the benefit of the patient, we must recognise the significance of professionals taking on the advocacy role from a caring science perspective, which includes the unique and shared experiences of the lifeworld. This is a challenge within the context of demanding efficiency and time pressure in emergency care. To address this, a concrete action plan for ethical reflections is needed to find a balance between giving and receiving, essential for healthcare professionals to avoid compassion fatigue. In the context of ethical competence and the challenges faced by different healthcare professionals within emergency care, the Art of Caring model could be used for ethical reflections, as an approach to achieve a balance between patient advocacy, ethical considerations, and effective emergency care delivery. Achieving this goal will lead to better patient outcomes and a more supportive work environment for the entire emergency care team. (shrink)

Nurses often play crucial roles on teams involved in providing care to infants and families in the context of child protection services, making them well‐placed to research topics concerning these groups. Developed by North American legal scholar Martha Fineman in 2008, a contemporary macro‐legal‐political theory with potential to inform studies related to the nexus between healthcare and law is ‘vulnerability theory.’ Conceiving vulnerability as a universal, inevitable, and enduring aspect of the human condition, it contends that the onus is on (...) the State to respond to universal vulnerability by ensuring institutions and structures do not confer unfair advantage or disadvantage. When access to rights is particularly difficult, a ‘targeted group approach’ should be considered as well as consideration of the notion that responses to vulnerability have the potential to increase vulnerability. This paper outlines the background of vulnerability theory, explaining its key tenets and criticisms, before considering how it might be useful to inform studies focused on infants in out of home care. (shrink)

In the care sector, professionals face numerous challenges, such as a lack of resources, overloaded wards, physical and psychological strain, stressful constellations with patients and cooperation with medical professionals. Care robots are therefore increasingly being used to provide relief or to test new forms of interaction. However, this also raises the question of trust in these technical companions and the potential vulnerability to which these people then expose themselves. This article deals with an ethical analysis of the two concepts of (...) trust and vulnerability in the context of care robotics. The first step is to examine what can be understood by vulnerability, focusing specifically on Misztal's three proposed types (relationships, future anticipation, past experiences). This strategy is often used as a starting point by authors and also seems relevant for the connection to the concept of trust. In a second step, these three types of human vulnerability are examined on the basis of a technical concept of trust. It is shown that (1) relationships and thus also interdependence can create additional options, (2) the anticipation problem with regard to the actions of others also makes responsibility transferable and (3) an explication of freedom is also associated with potential traumatic experiences. The final step brings together the previous considerations and makes it clear once again that trust in a care robot need not only be associated with vulnerability, but that vulnerability can also potentially be reduced, transferred and overcome. (shrink)

Research into how existentially aware nurses and nursing interventions have highlighted the benefits to patients and patient outcomes. Less is known about how existentially based training affects nurses themselves. This project sought to understand if and how a training programme developed to improve nurses' knowledge of existential theory would affect their well‐being. Overall, despite challenges to recruitment, follow‐up and data collection, three key themes were developed from the data: (1) Things Are Difficult, (2) We Need More… and (3) Well‐Being Is (...) Personal. Existentialist philosophy can be an effective way of providing nurses with the tools to develop and express their own definition of well‐being. It can also be useful to healthcare systems and administrators seeking to find ways of reducing burnout and turnover among nursing staff. (shrink)

This is a response on the interesting read “What can anarchism do for nursing” by Martin and Laurin (2023), published in a previous issue of this journal. My foremost point is congratulating the authors on emphasizing the urgent need for a deviant voice or movement within nursing. It is a needed and necessary plea. Without such a voice or movement, which deviates from the current discourse(s) in healthcare, the future of our healthcare systems are looking grim and perhaps even more (...) authoritarian than their current state. Rather than providing a comment to their work, I deemed it useful to make two additions and one suggestion to their essay. I would like to elaborate on (1) why alternative education is crucial in installing this type of thinking and action in nursing and (2) why, next to the concept of mutual aid, the concept of individual deviant action by nurses can be crucial in installing a new paradigm in nursing. I argue that both alternative education and individual action cannot be fostered by the traditional nursing education and common career paths and propose the reinvention of the concept of free (nursing) schools. Such free school could empower nurses, throughout their career, to acquire a general culture in which critical reflection and political awareness are cornerstones to identify the balances of power which affects them. This could enhance the solidarity between nurses and unity in the nursing profession. At the end of this reflection, I outline the principles of these free nursing schools. (shrink)

Nursing theory should reflect the pluralism inherent in nursing practice. Nurses routinely enact different kinds of knowledge in combination to achieve good nursing care. Nursing theoretical and philosophical literature includes many attempts to engage with epistemological pluralism. In this paper, concepts from the work of Michel Serres are introduced as a contribution to the resources available to think pluralistically about nursing. Serres' work is valuable because he is a pluralist thinker, who uses different conceptual tools to explore the complexity of (...) human life, including topology, isomorphism, and the excluded third. Serres' terms are discussed with examples of application to nursing. An extendeddd example of addictions nursing is used to pull together different concepts applied to a complex and multilayered area of practice. (shrink)

Armstrong's (2006) ‘Towards a strong virtue ethics for nursing practice’ is focused on how the practice of nursing necessitates morally good character traits as virtues including the intellectual virtue phronesis. Because of this, he claims, nursing ethics should also be grounded in virtue ethics. Illness creates a unique phenomenon that involves a special therapeutic as helping relationship necessitating good interpersonal skills and patient‐centred care that, for the role of a nurse and nursing ethics, requires a focus on persons and relationships, (...) character and emotions. Obligation, act centred normative theories are, according to Armstrong, incomplete and inadequate for nursing practice. They are incomplete and inadequate as moral theories because they ignore, or at least do not give appropriate moral importance to, other factors of life such as character, moral education, emotions and relationships. Armstrong grounds his virtue ethics in a ‘moralised’ eudaimonia. This leads to problems of getting from good for to good. It is suggested a non eudaimonistic, virtue ethics by Swanton might be just what Armstrong is after but as an account of ethics not morality. (shrink)

High levels of violence and conflict occur in inpatient psychiatric settings, causing a range of psychological and physical harms to both patients and staff. Drawing on critiques of vulnerability from the philosophical literature, this paper contends that staff's understanding of their relationship with patients (including how they should respond to violence and conflict) rests on the dominant, reductive account of vulnerability. This account frames vulnerability as an increased susceptibility to harm and so regards ‘invulnerable’ staff's responsibility to be protecting and (...) managing vulnerable patients. We offer an alternative view of vulnerability as an openness and capability to be changed, which illuminates how the common account of vulnerability is used to justify staff's coercive power over patients and to control staff behaviour. Our main argument is that staff's adoption of this negative approach to vulnerability is associated with a range of factors that are connected to the violence and conflict endemic to these settings. Staff's need to situate themselves as invulnerable and therefore incapable of harm, we argue, leads to significant issues through: damaging staff ability to emotionally regulate; coercing patients into an asymmetrical openness leading to aggression to restore status; damaging therapeutic relationships by enforcing separation between staff and patients; increasing staff's reliance on unhelpful and rigid techniques (such as de‐escalation); repressing staffs’ ability to learn and grow through encounters with patients. Finally, we offer recommendations for how vulnerability and openness could be cultivated as a relational and radical practice in spaces that are traditionally closed and hostile to it. (shrink)

Through technical rationality, healthcare professionals address instrumental problems by applying the theory and technique arising from scientific knowledge. Nevertheless, the divergent situations of practice characterised by uncertainty, instability, and uniqueness place nurses in a positivist epistemological dilemma. Decision‐making under uncertainty is a challenge that nurses face in clinical practice daily. Nurses anticipate critical events based on the interaction between (un)known factors of clinical reasoning, putting uncertainty tolerance into perspective. With undeniable epistemological relevance, few nursing researchers have addressed this issue. Based (...) on the insights garnered from the panel held at the 26th International Nursing Philosophy Conference, this discussion paper examines the inception of uncertainty within nursing reasoning, intertwining introspection, abstraction, and the rich discussions from the conference. Accordingly, the philosophical underpinnings of the perceived experience of uncertainty will be briefly addressed, while framing the decision‐making challenges faced by nurses. A compelling dimension of nursing care emerges when we delve into the inception of uncertainty, prompting a deeper examination of the interplay between its perception and consciousness in clinical practice, and the gravitation of uncertainty in the process of empirical reasoning. Navigating uncertainty involves varying individual responses, influenced by tolerance levels. Moral appropriateness is determined by their adaptability rather than solely their positivity or logical consistency, highlighting constancy as a quality demanding alignment with an understanding of challenges. (shrink)

The transformation of societies' age structures has intensified the need for nursing care, especially in economically developed regions of the world. This will necessitate societal decisions that determine how care needs are met in the long term. This article offers a sociological perspective on nursing care using Luhmann's systems theory. To make the designation of a functional nursing system with independent observation plausible, social changes were traced based on historical events, semantics, and other social structures to develop the primary view (...) of the nursing system. On this basis, a functional definition of the nursing system and its relationship to problems and problem‐solving is possible. This proposal is intended to clarify the fundamental questions of nursing science: What is nursing and what is behind it? Through abstraction, this article develops a unified representation of nursing's distinct way of observation to support the determination of a unique research object for nursing science as an academic discipline. In line with Brandenburg's statement that nursing science must follow the interests of others as long as it is not possible to conquer a terrain occupied by the discipline independently, the need to develop a genuine discipline remains. Only then, it is assumed, can nursing science significantly contribute to other functional systems and to societal decisions that will determine how care needs are addressed in the future. (shrink)

This article reflects on the concepts of health, well‐being, gender, and dignity when providing nursing care to older adults, focusing on their wisdom and the phenomena that can affect their health or improve their quality of life. These concepts are analyzed based on the current health conditions of older adults and their needs, on the perspectives of authors in this field of research, and on Patricia Benner's philosophy: the integration of science, clinical wisdom, and ethics in nursing practice. Furthermore, this (...) article aims at contributing to the health, well‐being, gender, and dignity of older adults, despite the discrimination that they may face, as well as to the reality of nursing practice. As such, this study stems from the observed reality, experiences as caregivers and reflection of nurses committed to the values of the profession. Therefore, the article begins with the conceptualization of health, well‐being, gender, and dignity, subsequently analyzing the health–disease status of older adults from a gender perspective, addressing nursing care for older adults based on Patricia Benner's philosophy and concluding with reflections on nursing practice for a better future for older adults. (shrink)

Both stigma and discrimination, defined as a lack of knowledge of and a sense of discomfort in providing care to lesbian, gay, bisexual, transgender, queer, intersex, and + (LGBTQIA+) migrants, was found to manifest in a sample of LGBTQIA+ migrants who received nursing care in a recent study. The study concluded that nurses continue to have a limited understanding of the experiences of LGBTQIA+ migrants in the Canadian context, and that LGBTQIA+ migrants continue to have troubling 'care' experiences with nurses. (...) Miranda Fricker has developed the concept of epistemic injustice drawing on feminist philosophy and social epistemology. Epistemic injustice refers to unfair treatment of a person by judging them as 'not a knower' in a communicative situation. For example, in a few circumstances when LGBTQIA+ migrants were admitted to psychiatric units due to suicide ideations as a direct result of identifying as a LGBTQIA+ migrants, the medical and nursing team responded with 'They are in Canada now. It is safe here!' and 'So, you are [LGBTQIA + ]! What's the big deal?' These unjust statements reflect an epistemic situation in which the hearer is negating what was heard, that is, that the speaker's intersecting identities of LGBTQIA+ and new immigrant has directly led to suicide ideation. The concept of epistemic injustice helps to frame this situation as one where the care provider is not doing justice to the needs of LGBTQIA+ migrants. This article draws on the narrative of an LGBTQIA+ migrant who is not recognised as a credible source of knowledge about their own lives and needs in the context of Canadian nursing care. Epistemic injustice helps to understand how stigma and discrimination is produced in this community by the very nursing profession who ostensibly want to help them. (shrink)

This article presents a conceptual analysis of the contemporary understanding of NURSING in Australia and proposes strategies for decolonisation. Through historical reflection and the lens of cultural safety and critical race theory, it examines some conditions which make up this concept, including “Florence Nightingale‐influenced practices,” “intellectual practitioners,” and “whiteness in nursing.” This analysis aims to identify conditions which we take to be necessary for the folk concept of NURSING to be satisfied and which result in negative outcomes. The article explores (...) why these conditions are plausibly included in this concept and possible objections to their inclusion. These conditions, and subsequently the concept of NURSING, are then critiqued. In this conceptual analysis of NURSING in Australia, we explore three conditions. By critically examining these conditions through the lens of cultural safety and employing decolonising methodologies, the article sheds light on the complex interplay of historical legacies, contemporary practices and potential negative outcomes within the nursing profession. The conclusions drawn propose a shift toward decolonisation, advocating for a cultural safety framework to address historical injustices and highlights possible ways in which one might amend the concept of nursing to be more inclusive of Aboriginal and Torres Strait Islander people. The need for this change is emphasised by the acknowledgement of historical conditions that perpetuated racism and hindered equitable healthcare. Ultimately, the article advocates for a comprehensive decolonisation of the concept of NURSING in Australia, urging the nursing profession to implement cultural safety for the overall well‐being of Aboriginal and Torres Strait Islander people. The authors of this article would like to acknowledge the people of the Dharawal and Dharug language group, who are the custodians of the unceded land we have worked on throughout this project. We would also like to acknowledge Aboriginal and Torres Strait Island people nationwide and warn them that some traumatic aspects of Aboriginal and Torres Strait Islander history are mentioned throughout this article. Always was, always will be, Aboriginal land. Two authors on this article identify as Aboriginal, while three do not. Two authors are registered nurses, one is an anthropologist, one is a philosopher and one is a historian. (shrink)

The concept of resistance in nursing has been garnering more interest in the last few years, with emerging focus on working conditions, power differentials in clinical settings, health inequities, and planetary health concerns. As a result, it's important to identify what is being resisted, and what is the purpose of the resistance carried out. In whatever way resistance is referenced in nursing, outright or not, it is our contention that it's in response to the same underlying cause, barring some local (...) and contextual variations, which we refer to as ‘the Beast’, where the real catastrophe is societal, and is ‘existential, affective and metaphysical’. It therefore seems coherent to consider this macro catastrophe from an ontological point of view, that is, from the standpoints of ‘being’ in relation to the world, which necessarily refers to specific ways of apprehending reality. In this article, we therefore present two ontologies ‐ antagonistic in every respect, to better situate resistance in nursing in a larger ecosystem. Using the Invisible Committee's book and call to action To our friends, this is our modest contribution to celebrate resistance, to help equip fellow nurses to better organise and strategize in the face of incessant growth and too often undesirable change in healthcare. (shrink)

The concept of professionalism is embedded into all aspects of nursing education and practice yet is rarely critically interrogated in nursing scholarship. This paper describes how professionalism in nursing is based on whiteness. When actualized, this oppressive construct homogenizes individuals' identities to assist nurses in building and wielding power against each other and against patients, and results in dehumanization and disconnection. Foregrounding an ethic of authenticity as a practice of resistance against white professionalism offers an alternative possibility for how nursing (...) could be taught, practiced and theorized. As such a practice must begin with oneself, the authors outline a reflexive process from which to begin this work. (shrink)

In this paper, we engage in philosophical inquiry to consider the relevance of Indigenous Knowledges (IKs) for reimagining dementia care for individuals living with dementia. We outline the limitations of philosophical perspectives aligned with Eurocentric academic knowledge, arguing that such knowledge relies on an individualistic view of self and neglects the body and embodied experience in dementia care. We demonstrate how a personal diachronicity perspective diminishes the importance of valuing the fluid and dynamic self‐identities of persons living with dementia. We (...) then turn to the epistemological foundations of IKs through philosophical inquiry, focusing on relationality, connectiveness, and holism, and discuss the role of IKs in institutional knowledge systems. We then explore the potential relevance of IKs to widen the epistemological and ontological gaze centering on the relational concepts of personhood, holism, continuity, embodiment, and homogeneity of self that are foundational to reimaging dominant approaches to dementia care. (shrink)

In this paper, we bring together Foucault's biography and oeuvre to explore key concepts that support the analysis of nurses' acts of resistance. Foucault reflected on the power relations taking place in health services, making his contribution especially useful for the analysis of resistance in this context. Over three decades, he proposed a nonnormative philosophy while concomitantly engaging in transgressive practices guided by values such as human rights and social justice. Hence, Foucault's philosophy and public activism are an apparent contradiction, (...) but we argue that when analysed together they allow for a different understanding of his work. We describe the evolution of the concept of resistance in Foucault's work, supported by the approaches of Brent Picket (1996) and Miguel Morey (2013). Foucault started his work considering the idea of transgressiveness as it connects to being at the margins of society. He then spent considerable time elaborating the concept of power and identifying resistance strategies as forms of power exercise. In doing so, he considered that people engage with social change from multiple positions, including limited desire for change, fomenting reforms, or engaging in everyday revolutionary acts. As he further elaborated on power relations and defined resistance, Foucault asserted that resistance involves both repressive and productive dimensions of power, governance of biological life, state governance, and deliberate practices of illegalisms. Finally, Foucault shifted his attention to the freedom of ethical subjects, proposing the use of counter‐conduct and counter‐discourses to speak truth against oppression. Such framework offers a comprehensive lens for analysing nurses' acts of resistance within the complexities of the healthcare system and in society. In summary, Foucault's conceptual framework on resistance expands the role of nurses, to understand them not only as caregivers, but also as political agents capable of confronting and transforming oppressive institutional practices. (shrink)

Sedufidelity—the contraction of seduction and fidelity—offers an interesting perspective for reflecting on the role of relationships and the ethics of care in highly technical healthcare settings. Understanding sedufidelity could help mitigate the observed social ruptures and promote a more humane approach to healthcare. However, challenges remain regarding its implementation, particularly in terms of building trust and loyalty towards management and healthcare policymakers. Furthermore, initiatives such as the ‘haie de déshonneur’ (‘hedge of dishonour’) can highlight the need and form of recognition (...) sought by caregivers, given their strong symbolism. However, other actions can also be considered to strengthen relationships and attention paid to caregivers, such as a prior consultation. (shrink)

The moral authority of advance directives (ADs) in the context of persons living with dementia (PLWD) has sparked a multifaceted debate, encompassing concerns such as authenticity and the appropriate involvement of caregivers. Dresser critiques ADs based on Parfit's account of numeric personal identity, using the often‐discussed case of a PLWD called Margo. She claims that dementia leads to a new manifestation of Margo emerging, which then contracts pneumonia. Dworkin proposes that critical interests, concerning one's higher moral values, trump experiential interests (...) (things or activities one enjoys because they are pleasurable). Dresser argues that Margo's current experiential interests override her self's critical ones, as they contribute significantly to her quality of life (QoL). To render the argument more realistic, I introduce a variation in which Margo develops delirium, a common and severe comorbidity in PLWD. I argue that delirium could precipitate a sudden decline in experiential interests and, consequently, a deterioration in QoL. Given the uncertain trajectory of Margo's illness, I contend that her competent self's critical interests, as reflected in her AD, along with her right to self‐ownership, should take precedence over current experiential interests. Thus, the AD possesses moral authority. However, it is imperative for healthcare professionals to offer consultations for PLWD, facilitating an understanding of ADs and enabling a shared decision‐making process. Such consultations are essential for honouring the autonomy and dignity of PLWD, ensuring that their values and preferences guide ethical decision‐making amidst the complexities of dementia care. (shrink)

Social justice is consistently upheld as a central value within the nursing profession, yet there are persistent inconsistencies in how this construct is conceptualized, further compounded by a lack of empirical inquiry into how nurses enact social justice in everyday practice. In the current context in which structural inequities are perpetuated throughout the health care system, and the emergency department in particular, it is crucial to understand how nurses understand and enact social justice as a disciplinary commitment. This research examines (...) how nurses' talk and institutional texts discursively construct social justice within the institutional context of the emergency department, and how such discourses shape the enactment of social justice within nursing practice. Guided by Iris Marion Young's theorizing of distributive and systemic social justice paradigms, this Foucauldian discourse analysis draws on emergency department nurses' talk (N = 25 interviews) and institutional documents (N = 27) as key texts that visibilize dominant and excluded discourses of social justice within the institutional context of the emergency department, and implications for how social justice is enacted through nursing practices. This analysis identified one overarching discursive pattern, in which social justice was discursively constructed through a hegemonic distributive paradigm, yet also resisted through nurses' conceptualization and enactment of a systemic social justice paradigm that facilitated their recognition and remediation of inequities. This central discursive pattern is explored through three exemplars of nurses' enactment of social justice as resistance: triage, harm reduction, and care planning. Findings from this analysis demonstrate that while a hegemonic distributive paradigm has dominated conceptualizations of social justice within nursing, a re‐construction of social justice through a systemic paradigm may guide nurses in enacting practices that remediate inequities in health and health care. (shrink)