Background The COVID-19 pandemic has forced rapid and widespread change to standards of patient care and nursing practice, inevitably leading to unprecedented shifts in the moral conditions of nursing work. Less is known about how these challenges have affected nurses’ capacity to meet their ethical responsibilities and what has helped to sustain their efforts to continue to care. Research objectives 1) To explore nurses’ experiences of striving to fulfill their ethical responsibilities of care during the COVID-19 pandemic and 2) to (...) explore what has fostered nurses’ capacity to fulfill these responsibilities. Research Design A generic qualitative approach was used incorporating concepts coming from fundamental features of care. Participants Twenty-four Canadian Registered Nurses from a variety of practice settings were interviewed. Ethical Considerations After receiving ethics approval, signed informed consent was obtained before participants were interviewed. Findings Four themes were identified. 1) Challenges providing good care in response to sudden changes in practice. 2) Tensions in juggling the responsibility to prevent COVID-19 infections with other competing moral responsibilities. 3) Supports to foster nurses’ capacity to meet their caring responsibilities. 4) The preservation of nurses’ moral identity through expressions of gratitude and health improvement. Discussion Infection control measures and priorities set in response to the pandemic made at distant population and organizational levels impacted nurses who continued to try to meet the ideals of care in close proximity to patients and their families. Despite the challenges that nurses encountered, the care they received themselves enabled them to continue to care for others. Nurses benefited most from the moral communities they had with their colleagues and occasionally nurse leaders, especially when they were supported in a face-to-face manner. Conclusion: Moral community can only be sustained if nurses are afforded the working conditions that make it possible for them to support each other. (shrink)

Advance care planning is a process that encourages people to identify their values, to reflect upon the meanings and consequences of serious illness, to define goals and preferences for future medical treatment and care, and to discuss these goals with family and health-care providers. Advance care planning is especially important for those who are chronically ill, as patients and their families face a variety of complex healthcare decisions. Participating in advance care planning has been associated with improved outcomes; yet, despite (...) over 25 years of public awareness campaigns, research, and interventions developed to increase participation, advance care planning completion rates for people with chronic illnesses are no different than those in the general public (approximately 25%).Advance care planning has traditionally used an individualistic approach to autonomy, which puts forward an understanding of agents as independent, rational and self-interested persons. Because this individualistic approach has been largely unsuccessful in improving advance care planning uptake, a re-examination of the philosophical underpinnings of this practice and an exploration of alternative frameworks is warranted. In offering this exploration, we briefly outline two current perspectives on autonomy: the individualistic view and the relational view as articulated by feminist philosophers. Using a critical examination of the theoretical and empirical work on this topic, we argue that the individualistic view of autonomy does not sufficiently capture the relational and social complexities of the decision-making process of advance care planning. To offer a counterpoint, we examine the relational view of autonomy and suggest that this perspective is better aligned with the process of advance care planning. Specifically, we demonstrate that a relational model of autonomy is well suited to exploring advance care planning for four main reasons: (1) it recognizes the importance of relationships, (2) it reflects the fluctuating nature of autonomy in chronic illness, (3) it recognizes vulnerability, and (4) it is consonant with empirical work examining the advance care planning process. (shrink)

Parkinson's Disease (PD) is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms generally come on slowly over time. Early in the disease, the most obvious are shaking, rigidity, slowness of movement, and difficulty with walking. Doctors do not know what causes it and finds difficulty in early diagnosing the presence of Parkinson’s disease. An artificial neural network system with back propagation algorithm is presented in this paper for helping doctors in identifying (...) PD. Previous research with regards to predict the presence of the PD has shown accuracy rates up to 93% [1]; however, accuracy of prediction for small classes is reduced. The proposed design of the neural network system causes a significant increase of robustness. It is also has shown that networks recognition rates reached 100%. (shrink)

-/- Background: Nurses who provide aggressive care often experience the ethical challenge of needing to preserve the hope of seriously ill patients and their families without providing false hope. -/- Research objectives: The purpose of this inquiry was to explore nurses’ moral competence related to fostering hope in patients and their families within the context of aggressive technological care. A secondary purpose was to understand how this competence is shaped by the social–moral space of nurses’ work in order to capture (...) how competencies may reflect an adaptation to a less than ideal work environment. -/- Research design: A critical qualitative approach was used. -/- Participants: Fifteen graduate nursing students from various practice areas participated. -/- Ethical considerations: After receiving ethics approval from the university, signed informed consent was obtained from participants before they were interviewed. -/- Findings: One overarching theme ‘Mediating the tension between providing false hope and destroying hope within biomedicine’ along with three subthemes, including ‘Reimagining hopeful possibilities’, ‘Exercising caution within the social–moral space of nursing’ and ‘Maintaining nurses’ own hope’, was identified, which represents specific aspects of this moral competency. -/- Discussion: This competency represents a complex, nuanced and multi-layered set of skills in which nurses must be well attuned to the needs and emotions of their patients and families, have the foresight to imagine possible future hopes, be able to acknowledge death, have advanced interpersonal skills, maintain their own hope and ideally have the capacity to challenge those around them when the provision of aggressive care is a form of providing false hope. -/- Conclusion: The articulation of moral competencies may support the development of nursing ethics curricula to prepare future nurses in a way that is sensitive to the characteristics of actual practice settings. (shrink)

Medical futility is often defined as providing inappropriate treatments that will not improve disease prognosis, alleviate physiological symptoms, or prolong survival. This understanding of medical futility is problematic because it rests on the final outcomes of procedures that are narrow and medically defined. In this article, Walker's `expressivecollaborative' model of morality is used to examine how certain critical care interventions that are considered futile actually have broader social functions surrounding death and dying. By examining cardiopulmonary resuscitation and life-sustaining intensive care (...) measures as moral practices, we show how so-called futile interventions offer ritualistic benefit to patients, families, and health care providers, helping to facilitate the process of dying. This work offers a new perspective on the ethical debate concerning medical futility and provides a means to explore how the social value of treatments may be as important in determining futility as medical scientific criteria. (shrink)

Although many studies have previously examined medicalisation, we add a new dimension to the concept as we explore how contemporary oncological medicine shapes the dying self as predominantly medical. Through an analysis of multiple case studies collected within a comprehensive cancer centre in Ontario, Canada, we examine how people with late‐stage cancer and their healthcare providers enacted the process of medicalisation through engaging in the search for oncological treatments, such as experimental drug trials, despite the incurability of their disease. The (...) seven cases included 20 interviews with patients, family, physicians and nurses, the analysis of 30 documents and 5 hr of field observation. A poststructural perspective informed our study. We propose that searching for life extension enacts medicalisation by shaping the dying person afflicted with terminal cancer into new medical subjectivities that are knowledgeable, active, entrepreneurial and curative. Participants initially took up medical thinking from the formal oncology system, but then began to apply and internalise medical rationalities to alter their personhood, thereby generating new curative possibilities for themselves. For people seeking life extension, the embodied and day‐to‐day experiences of suffering and being close to death became expressed and moderated in fundamentally medicalised terms. (shrink)

The Qur’ānic rhythmicity, represented in the intonations of the music emitted in folds of the Great Qur'ān came as the basis for the passion for recitation and listening pleasure. Although there have been several studies on this subject, the focus of the research has been on rhythmic forms: What they are, their composition, and the effect of their representation in Qur’ānic styles as a kind of renewed vision, understanding, and perception of Qur’ānic discourse. The research, therefore, followed the approach of (...) characterizing these forms and analyzing them by devising the bonds that made the rhythm spread meaning differently. It began by referring to the role of music provided by the rhythms of the Qur’ānic verses in paying attention to the vocal miracle, next presents the basic types of this rhythm and shows the foundations of this study that support the idea of its presence in the verses, to highlight its role in clarifying the meaning. This study focused on illustrating the forms of rhythm, ranging from the splendid through the rhythm of the suggestive rhythm, and ending with the syllabic rhythm, by describing each form and searching for it between letters, words, structures, and methods. Besides, it pays attention to rhythm's effects and indicates its reflection on meaning. The research has shown that the rhythm makes emotion peak, showing meaning embodied in terms. This embodiment represents the power of performance in demonstrating the exact purpose of speech choices within specific contexts and through various exquisite styles colored in psychological meanings. The importance and objectives of the research Rhythm are directly related to the different connotations it generates. Phonetic formations are activities and interactions between meanings. The sound structure, an essential element in the Holy Qur’ān, is one of the elements that form the rhythm in the structure of the verses of the Qur’ān. Its interaction with other elements contributes to shaping the Qur’ānic discourse with its creative vision and artistic and aesthetic dimensions while showing verbal consistency, collecting homogeneous words, and linking words. Common and synonymous in one sentence is something that avoids the language, and we find it common in the language of the Qur’ān to the maximum extent, to give it a harmonious rhythm distinct from the rhythm of poetry among the Arabs, and this is what attracted them to it and prompted them to pay attention to what it conveyed to them. (shrink)

MOHAMMED SA, WALTERS KL, LAMARR J, EVANS‐CAMPBELL T and FRYBERG S. Nursing Inquiry 2012; 19: 116–127 [Epub ahead of print]Finding middle ground: negotiating university and tribal community interests in community‐based participatory researchCommunity‐based participatory research (CBPR) has been hailed as an alternative approach to one‐sided research endeavors that have traditionally been conducted on communities as opposed to with them. Although CBPR engenders numerous relationship strengths, through its emphasis on co‐sharing, mutual benefit, and community capacity building, it is often challenging as well. (...) In this article, we describe some of the challenges of implementing CBPR in a research project designed to prevent cardiovascular disease among an indigenous community in the Pacific Northwest of the United States and how we addressed them. Specifically, we highlight the process of collaboratively constructing a Research Protocol/Data Sharing Agreement and qualitative interview guide that addressed the concerns of both university and tribal community constituents. Establishing these two items was a process of negotiation that required: (i) balancing of individual, occupational, research, and community interests; (ii) definition of terminology (e.g., ownership of data); and (iii) extensive consideration of how to best protect research participants. Finding middle ground in CBPR requires research partners to examine and articulate their own assumptions and expectations, and nurture a relationship based on compromise to effectively meet the needs of each group. (shrink)

This book is about the stories being told in the Anthropocene. Stories of irreparable damage being done to the global ecosystem, of sustainable growth, of dystopian collapse, of continued interspecies flourishing, of Gaia, and of accelerating capitalism’s dynamics in order to discover its outside. Stories of change. Stories of hope. Against them all, this book seeks to braid together a particular thread of storying in order to speak to the emergence of the mall at the end of the world; a (...) space where a new politics of “spectral capitalism” is played out. In doing so, we reflect that there never was any outside to Capital, that it can live forever, its performances and spectacles being preserved despite global ecological collapse. This book seeks to understand the nascence of the mall at the end of the world and the new people, thoughts, and dreams that come with it. (shrink)

Some children may face some developmental problems in one ormore areas of their developmental milestones. One of them is speech delay. Todate, a screening tool for speech delay early detection among children is stilllacking, especially in Malaysia. Parents do not know where to refer and whichorganisation can help them especially for first-time parents. The objective ofthis paper is twofold. First, this paper analyses existing screening system orapplication for speech delay in children. Second, this paper proposes a mobileapplication designed for Malaysian (...) parents to help them detect speech delayin their children. A qualitative expert review was used to design and build theapplication. The screening application proposed is for early detection and tourge parents to seek for early intervention through appropriate assessments. Inconclusion, early detection in speech delay is critically important to increasethe chances for improving speech and communication skills. Thus, a speechdelay screening tool is needed for parents to seek proper treatment for theirchildren. (shrink)

Legends thrive, but there is little tangible evidence about dozens of Malay kingdoms, which are said to have flourished long before the emergence of Melaka in the late 14th century. The Bujang Valley in South Kedah, for one, is Malaysia’s richest archaeological site. The valley is the guardian of countless hidden tales which are waiting to be unveiled. Here, the beliefs of the Malay ancestors were centred upon nature and the spirits which permeate every aspect of their lives. These beliefs (...) have been passed down to the next generation by the elderly. They have valuable information to share about their families and ethnicity of which written evidence is often scarce. Such tales may perish if they are not well documented. Oral history, adopted as its testimony, permits us to gather data not available in written records. Oral history techniques are able to elicit facts, feelings, and descriptions, contributing to social history. Moreover, this technique is able to reveal how individual values and actions shaped the past, and how the past shapes present-day values and actions. Findings include offerings made to appease the spirits of the rivers and lands. Other findings include the revelation of the Bujang Valley as the centre of knowledge. The establishment of madrasah – “sekolah pondok” brought about a better understanding of Islam resulting in the inherent beliefs in the supernatural to slowly diminish. All these recollections form a body of knowledge that is priceless and worth recording. Knowledge published in tangible forms is a key factor to worldwide recognition. Therefore, these efforts to safeguard oral history and family stories should be a top priority for new knowledge development and commercial enhancement for generations to come. (shrink)