Many of the activities of clinical practice happen to, with or upon vulnerable human beings. For this reason numerous nursing authors draw attention to or claim a significant moral domain in clinical practice. A number of nursing authors also discuss the emotional involvement and/or emotional labour which is often experienced in clinical practice. In this article I explore the importance of emotion for moral perception and moral agency. I suggest that an aspect of being a good nurse is having an (...) emotional sensitivity to other human beings (patients), because this emotional sensitivity allows the nurse to perceive more accurately the context and perspective of the patient. It is thus important to the moral agency of the nurse and to morally sensitive clinical practice. As such education of the emotions should be a feature of the moral education of the nurse. A useful conception of the role of educated emotion in the moral life can be discovered in Aristotelian ethics. (shrink)

The visual world of adults consists of objects at various distances, partly occluding one another, substantial and stable across space and time. The visual world of young infants, in contrast, is often fragmented and unstable, consisting not of coherent objects but rather surfaces that move in unpredictable ways. Evidence from computational modeling and from experiments with human infants highlights three kinds of learning that contribute to infants’ knowledge of the visual world: learning via association, learning via active assembly, and learning (...) via visual-manual exploration. Infants acquire knowledge by observing objects move in and out of sight, forming associations of these different views. In addition, the infant’s own self-produced behavior—oculomotor patterns and manual experience, in particular—is an important means by which infants discover and construct their visual world. (shrink)

This paper situates the moral domain of practice within the context of a particular description of nursing practice – one that sees human interaction at the heart of that practice. Such a description fits not only with professional rhetoric but also with literature from patients and recent empirical work exploring the nature of nursing practice.Martha Levine in her 1977 description of ethics, within the context of nursing practice, indicated that what was important from an ethical perspective was how we interact (...) with each other, with patients and colleagues, on a daily basis. What enables such interaction to display moral sensitivity, insight into patient need, and a focus on the good for the patient? Of relevance when answering this question is the empirical evidence indicating that professional socialization, as a nurse or a doctor, may dull the individual’s moral sense. If this is the case, cognizance needs to be taken of such evidence when identifying theoretical approaches from mainstream ethics that may provide insight and value for nurse education. It is suggested that such insight and value can be gained from a consideration of the work of Aristotle, Murdoch, and Vetlesen. (shrink)

The Heythrop Journal, Volume 63, Issue 4, Page 807-816, July 2022.

Question processing involves parsing, memory retrieval, question categorization, initiation of appropriate answer‐retrieval heuristics, answer formulation, and output. Computational and psychological models have traditionally treated these processes as separate, sequential, independent, and in pursuit of a single answer type at a time. Here this view is challenged and the implications of a theory in which question processes operate simultaneously on multiple question interpretations are explored. A highly interactive model is described in which an expectation‐driven parser generates multiple question candidates, including partially‐specified (...) candidates. Question candidates act as constraints for a matcher which activates memory items. An answer retrieval process examines question candidates and the active portions of memory in an attempt to generate answer candidates. Answer candidates are examined by an output process that derives the final answer. These processes run simultaneously and interact. Three experiments on human question answering are also described which provide evidence that working memory load during question reading is affected by processes related to answer retrieval. (shrink)

A review of the literature on palliative care in the United Kingdom over the last fifteen years suggests that elements such as the development of the modern hospice, on the model developed by Cicely Saunders, have led to major improvements in the lot of the terminally ill.

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its importance in the healthcare (...) context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration. (shrink)

Current focus in the health care ethics literature on the character of the practitioner has a reputable pedigree. Rather than offer a staple diet of Aristotelian ethics in the undergraduate curricula, perhaps instead one should follow Murdoch's suggestion and help the practitioner to develop vision and moral imagination, because this has a practical rather than a theoretical aim. The imaginative capacity of the practitioner plays an important part in both the quality of the nurse's role enactment and the moral strategies (...) which the nurse uses. It also plays a central part in the practitioner's ability to communicate with a patient and in the type of person which the practitioner becomes. Can the moral imagination be stimulated and nurtured? Some philosophers and literary critics argue that not only is this possible, but that literature is the means of doing so. If this is the case then a place should be made for literature in already crowded health care curricula. (shrink)

We present a full completeness theorem for the multiplicative fragment of a variant of noncommutative linear logic, Yetter's cyclic linear logic. The semantics is obtained by interpreting proofs as dinatural transformations on a category of topological vector spaces, these transformations being equivariant under certain actions of a noncocommutative Hopf algebra called the shuffie algebra. Multiplicative sequents are assigned a vector space of such dinaturals, and we show that this space has as a basis the denotations of cut-free proofs in CyLL (...) + MIX. This can be viewed as a fully faithful representation of a free *-autonomous category, canonically enriched over vector spaces. This paper is a natural extension of the authors' previous work, "Linear Lauchli Semantics", where a similar theorem is obtained for the commutative logic MLL + MIX. In that paper, we interpret proofs as dinaturals which are invariant under certain actions of the additive group of integers. Here we also present a simplification of that work by showing that the invariance criterion is actually a consequence of dinaturality. The passage from groups to Hopf algebras in this paper corresponds to the passage from commutative to noncommutative logic. However, in our noncommutative setting, one must still keep the invariance condition on dinaturals. (shrink)

The focus of this article is perceptions of elderly patients and nurses regarding patients’ autonomy in nursing practice. Autonomy is empirically defined as having two components: information received/given as a prerequisite and decision making as the action. The results indicated differences between staff and patient perceptions of patient autonomy for both components in all five countries in which this survey was conducted. There were also differences between countries in the perceptions of patients and nurses regarding the frequency with which patients (...) received information from nursing staff or were offered opportunities to make decisions.This is the second of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented. (shrink)

This paper suggests that a consideration of health care practice is a necessary step in gaining insight into the appropriate composition of an ethics course for students in the health care professional. Health care practice, if it responds to the needs of society, is dynamic in nature. In the current climate of change in the health service, the author sug gests that the nursing profession needs to become more proactive in analysing and attempting to determine the future shape of nursing. (...) To protect patient care the nursing profession needs to have its eyes open to the ethical dimensions of changes in role and practice. The author argues that, in attempting to ensure that the education to which nursing students are exposed is of relevance, it is necessary to introduce an element of the ideal into the ethics component of their professional education. From early on in their profes sional development students should be aware of the scope and standards of practice, and the type of role enactment to which the profession requires them to aspire. (shrink)

In recent years, a convergence has occurred between the disciples of Leo Strauss and those of Eric Voegelin. Spurred in part by the publication of the Strauss-Voegelin correspondence, and in part by a shared sense of persecution at the hands of the "politically correct," this convergence has taken place almost exclusively on Straussian terms. While few, if any, Straussians speak of "compactness," "differentiation," or "the ground of being," more and more Voegelinians are using Straussian catchwords and phrases like "the conflict (...) between Jerusalem and Athens," "historicism," and "natural right.". (shrink)

Even a brief consideration of the nature of nursing will indicate that an ethical dimension underlies much, if not all, of nursing practice. It is therefore important that students and practitioners are facilitated in developing an ethical awareness and sensitivity from early in their professional development. This paper argues that Aristotelian virtue theory provides a practice-based focus for health care ethics for a number of reasons. Also, because of his emphasis on the character of the moral agent, and on the (...) importance of perception and emotion in moral decision-making, Aristotelian virtue theory provides a useful supplement to the traditional duty-based approaches to health care ethics analysis, which are increasingly being identified in the literature as having limits to their application within the health care context. (shrink)

We introduce a linear analogue of Läuchli's semantics for intuitionistic logic. In fact, our result is a strengthening of Läuchli's work to the level of proofs, rather than provability. This is obtained by considering continuous actions of the additive group of integers on a category of topological vector spaces. The semantics, based on functorial polymorphism, consists of dinatural transformations which are equivariant with respect to all such actions. Such dinatural transformations are called uniform. To any sequent in Multiplicative Linear Logic (...) , we associate a vector space of“diadditive” uniform transformations. We then show that this space is generated by denotations of cut-free proofs of the sequent in the theory MLL + MIX. Thus we obtain a full completeness theorem in the sense of Abramsky and Jagadeesan, although our result differs from theirs in the use of dinatural transformations.As corollaries, we show that these dinatural transformations compose, and obtain a conservativity result: diadditive dinatural transformations which are uniform with respect to actions of the additive group of integers are also uniform with respect to the actions of arbitrary cocommutative Hopf algebras. Finally, we discuss several possible extensions of this work to noncommutative logic.It is well known that the intuitionistic version of Läuchli's semantics is a special case of the theory of logical relations, due to Plotkin and Statman. Thus, our work can also be viewed as a first step towards developing a theory of logical relations for linear logic and concurrency. (shrink)

Are we on the wrong track, in terms of our expectations of a code of practice, professional ethics teaching or the wider field of moral philosophy, in our search for clear answers to the ethical problems that arise in clinical practice; or are we simply wrong in believing that there are always clear answers?This article examines a particular case, an account of which appeared in Nursing Standard at the end of 1996. The conclusion reached is that we are likely to (...) be misguided in assuming that there are always clear, straightforward answers to the ethical problems of clinical practice. However, more than a fleeting acquaintance with the field of ethics may help us to begin to think with greater clarity about what we do and why we do it. The hope is that this might lead to considered, humane practice by design, with the critical understanding and support of our professional peers and employers. (shrink)

It is frequently claimed that nursing is vital to the safe, humane provision of health care and health service to our populations. It is also recognized however, that nursing is a costly health care resource that must be used effectively and efficiently. There is a growing recognition, from within the nursing profession, health care policy makers and society, of the need to analyse the contribution of nursing to health care and its costs. This becomes increasingly pertinent and urgent in a (...) situation, such as that existing in Ireland, where the current financial crisis has lead to public sector employment moratoria, staff cuts and staffing deficits, combined with increased patient expectation, escalating health care costs, and a health care system restructuring and reform agenda. Such factors, increasingly common internationally, make the identification and effective use of the nursing contribution to health care an issue of international importance. This paper seeks to explore the nature of nursing and the function of the nurse within a 21st century health care system, with a focus on the Irish context. However, this analysis fits into and is relevant to the international context and discussion regarding the nursing workforce. This paper uses recent empirical studies exploring the domains of activity and focus of nursing, together with nurses perceptions of their role and work environment, in order to connect those findings with core conceptual questions about the nature and function of nursing. (shrink)

Modes of rationality in nursing documentation: biology, biography, and the ‘voice of nursing’ This article is based on a discourse analysis of the complete nursing records of 45 patients, and concerns the modes of rationality that mediated text‐based accounts relating to patient care that nurses recorded. The analysis draws on the work of the critical theorist, Jürgen Habermas, who conceptualised rationality in the context of modernity according to two types: purposive rationality based on an instrumental logic, and value rationality based (...) on ethical considerations and moral reasoning. Our analysis revealed that purposive rationality dominated the content of nursing documentation, as evidenced by a particularly bio‐centric and modernist construction of the workings of the body within the texts. There was little reference in the documentation to central themes of contemporary nursing discourses, such as notions of partnership, autonomy, and self‐determination, which are associated with value rationality. Drawing on Habermas, we argue that this nursing documentation depicted the colonisation of the sociocultural lifeworld by the bio‐technocratic system. Where nurses recorded disagreements that patients had with medical regimes, the central struggle inherent in the project of modernity became transparent — the tension between the rational and instrumental control of people through scientific regulation and the autonomy of the subject. The article concludes by problematising communicative action within the context of nursing practice. (shrink)

This paper revisits a 2003 publication in Nursing Philosophy: The need for accurate perception and informed judgement in determining the appropriate use of the nursing resource: hearing the patient's voice. The author suggests that the basic ideas and focus of this 16‐year‐old paper are still topical and relevant in considerations of nursing care. However, it is also suggested that greater attention to the importance of the nurse–patient relationship in considerations of resource allocation, and potential rationing of nursing care, would have (...) strengthened the original paper. (shrink)

We present a full completeness theorem for the multiplicative fragment of a variant of noncommutative linear logic, Yetter's cyclic linear logic (CyLL). The semantics is obtained by interpreting proofs as dinatural transformations on a category of topological vector spaces, these transformations being equivariant under certain actions of a noncocommutative Hopf algebra called the shuffie algebra. Multiplicative sequents are assigned a vector space of such dinaturals, and we show that this space has as a basis the denotations of cut-free proofs in (...) CyLL + MIX. This can be viewed as a fully faithful representation of a free *-autonomous category, canonically enriched over vector spaces. This paper is a natural extension of the authors' previous work, "Linear Lauchli Semantics", where a similar theorem is obtained for the commutative logic MLL + MIX. In that paper, we interpret proofs as dinaturals which are invariant under certain actions of the additive group of integers. Here we also present a simplification of that work by showing that the invariance criterion is actually a consequence of dinaturality. The passage from groups to Hopf algebras in this paper corresponds to the passage from commutative to noncommutative logic. However, in our noncommutative setting, one must still keep the invariance condition on dinaturals. (shrink)

Compromise as a notion is frequently met in discussion and debate regarding many everyday decisions, including health care. It therefore seems that it may be of interest and value to try to give this some careful consideration. In the following pages, an attempt is made to discuss what one might mean when one uses this concept. Consideration is then given to some possible uses of compromise in health care. Having suggested that in certain situations compromise is a morally valuable process, (...) the author also considers some of the possible limits of compromise. (shrink)

Are we on the wrong track, in terms of our expectations of a code of practice, professional ethics teaching or the wider field of moral philosophy, in our search for clear answers to the ethical problems that arise in clinical practice; or are we simply wrong in believing that there are always clear answers? This article examines a particular case, an account of which appeared in Nursing Standard at the end of 1996. The conclusion reached is that we are likely (...) to be misguided in assuming that there are always clear, straightforward answers to the ethical problems of clinical practice. However, more than a fleeting acquaintance with the field of ethics may help us to begin to think with greater clarity about what we do and why we do it. The hope is that this might lead to considered, humane practice by design, with the critical understanding and support of our professional peers and employers. (shrink)

Adults and infants display a robust ability to perceive the unity of a center-occluded object when the visible ends of the object undergo common motion (e.g. Kellman, P.J., Spelke, E.S., 1983. Perception of partly occluded objects in infancy. Cognitive Psychology 15, 483±524). Ecologically oriented accounts of this ability focus on the primacy of motion in the perception of segregated objects, but Gestalt theory suggests a broader possibility: observers may perceive object unity by detecting patterns of synchronous change, of which common (...) motion is a special case. We investigated this possibility with observations of adults and 4-month-old infants. Participants viewed a center-occluded object whose visible surfaces were either misaligned or aligned, stationary or moving, and unchanging or synchronously changing in color or bright- ness in various temporal patterns (e.g. ¯ashing). Both alignment and common motion con- tributed to adults' perception of object unity, but synchronous color changes did not. For infants, motion was an important determinant of object unity, but other synchronous changes and edge alignment were not. When a stationary object with aligned edges underwent syn- chronous changes in color or brightness, infants showed high levels of attention to the object, but their perception of its unity appeared to be indeterminate. An inherent preference for fast over slow ¯ash rates, and a novelty preference elicited by a change in rate, both indicated that infants detected the synchronous changes, although they failed to use them as information for object unity. These ®ndings favor ecologically oriented accounts of object perception in which surface motion plays a privileged role. Ó 1999 Elsevier Science B.V. All rights reserved. (shrink)