Nursing considered as moral practice: a philosophical-ethical interpretation of nursing

Discussions of ethical approaches in nursing have been much enlivened in recent years, for instance by new developments in the theory of care. Nevertheless, many ethical concepts in nursing still need to be clarified. The purpose of this contribution is to develop a fundamental ethical view on nursing care considered as moral practice. Three main components are analyzed more deeply -- i.e., the caring relationship, caring behavior as the integration of virtue and expert activity, and "good care" as the ultimate goal of nursing practice. For the development of this philosophical-ethical interpretation of nursing, we have mainly drawn on the pioneering work of Anne Bishop and John Scudder, Alasdair MacIntyre, Lawrence Blum, and Louis Janssens. We will also show that the European philosophical background offers some original ideas for this endeavor.     

Modernity and Identity: Themes and Perspectives in the Study of Older Adults

Developments in social gerontology have led to an increased awareness of the relationship between political economy, culture, and personal narrative as influences on social identity in later life. Central to this debate has been a growing interest in lifestyle choice as evidence of a change from modern to postmodern forms of aging. A key component of this process has been the erosion of a predictable framework for an aging identity, previously supplied by the welfare state. It is argued that, alongside the emergence of no-care zones in health and welfare, postmodern ideas on consumerism and the body have led to an assault on identity in old age. As a result, we may be seeing the emergence of no-identity zones which fail to sustain an authentic framework for supporting experiences in old age. A critical gerontology should include the study of identity as central to understanding the disjunction between aging from within and aging within society.     

Effects of Severity of Accident,Intent, and “Alcoholism is a Disease” Excuse on Judgments of a Drunk Driver1

One hundred fifty-five women and 122 men read scenarios of an accident caused by a male drunk driver. The severity of the accident was either high (death) or low (monetary damage). In addition, the driver either expressed or denied intent (he admitted or denied knowing he was drunk before deciding to drive) and the driver either accepted responsibility for the accident or used the excuse that alcoholism is a disease beyond his control. On trait ratings, the driver was evaluated as being more reckless and as feeling greater emotion when the accident was severe. The driver who used the “alcoholism is a disease” excuse was evaluated as being less sincere and more reckless than the driver who accepted responsibility for the accident. On attributional ratings, the driver was rated as deserving greater punishment when the accident was severe. On sanctions, only severity of the accident influenced recommended fines and prison sentences for the driver. This study was consistent with previous research showing that recommended punishment for a drunk driver who caused an accident is primarily a function of accident severity.     

Investigating Friendship Difficulties in the Pathway from ADHD to Depressive Symptoms. Can Parent–Child Relationships Compensate?

Attention deficit/hyperactivity disorder (ADHD) is associated with friendship difficulties. This may partly account for the increasingly recognised association between ADHD and subsequent depression. Little is known about the types of friendship difficulties that could contribute to the association between ADHD and depressive symptoms and whether other relationships, such as parent–child relationships, can mitigate against potential adverse effects of friendship difficulties. In a representative UK school sample (n?=?1712), three main features of friendship (presence of friends, friendship quality and characteristics of the individual’s classroom friendship group) were assessed in a longitudinal study with two assessment waves (W1, W2) during the first year of secondary school (children aged 11-12 years). These friendship features (W1) were investigated as potential mediators of the prospective association between teacher-rated ADHD symptoms (W1) and self-rated depressive symptoms (W2) seven months later. Parent–child relationship quality (W1) was tested as a moderator of any indirect effects of ADHD on depression via friendship. ADHD symptoms were inversely associated with friendship presence, friendship quality and positive characteristics of classroom friendship groups. Depressive symptoms were inversely associated with presence and quality of friendships. Friendship quality had indirect effects in the association between ADHD and subsequent depressive symptoms. There was some evidence of moderated mediation, whereby indirect effects via friendship quality attenuated slightly as children reported warmer parent–child relationships. This highlights the importance of considering the quality of friendships and parent–child relationships in children with ADHD symptoms. Fostering good quality relationships may help disrupt the link between ADHD symptomology and subsequent depression risk.

     

The heterogeneous processes of cheating: Attention evidence from two eye tracking experiments

Dishonesty erodes society. Although much is known about dishonesty, the process leading up to the decision of whether to be honest or dishonest is often assumed to be homogenous and is not well understood. In this paper, we take a more nuanced approach and explore more closely the process of deciding whether to cheat or be honest when an opportunity to cheat arises. We do this in two laboratory eye tracking experiments. In our first experiment (n = 193), we identify heterogeneity in the decision to cheat. Some decisions on whether to cheat or be honest exhibit relatively little variation and appear to be oriented towards cheating (or honesty) with apparently little consideration of the alternative, whereas other decisions seem to be characterized by a higher degree of consideration for both decision alternatives. Our second experiment (n = 299) demonstrates that a gaze dependent intervention in the choices process is able to affect the behavioral outcomes.     

Voices from the Front Lines: An Analysis of Physicians’ Reflective Narratives about Flaws with the ‘System’

Physicians often express frustration with the ‘system’ in which they work. Over time, this frustration may put them at risk of burnout and disengagement, which may impact patient care. In this study, we aimed to understand the nature of the system flaws that physicians identified in their published narratives and to explore their self-representation as agents of change. We reviewed all reflective narratives published in four medical journals (NEJM, JAMA, CMAJ, Annals IM) between January 2015 and December 2017 (n?=?282). By consensus, we identified those that addressed system flaws (n?=?87). Using content and narrative analysis, we analyzed the types of flaws and the physicians’ orientation to the flawed system. We identified seven recurring system flaws—five related to medical culture: failures of communication, erosive impact of the hidden curriculum, inadequate health advocacy, frenzied pace of work, and experience of stigma. Less frequently, physicians’ narratives also exposed limited and disparate healthcare resources and restrictive institutional practices as impeding patient-centered care. Physicians expressed agency to create change foremost when writing about flaws related to medical culture. While physicians are challenged by system flaws, they strive to practice in ways that do not succumb to them. We saw tension between the elements outside the physician’s control and those within it. This tension becomes a source of distress when the compromises that emerge from system flaws move physicians away from the values that define their professional identity.

     

Varsity medical ethics debate 2018: constant health monitoring - the advance of technology into healthcare

The 2018 Varsity Medical Ethics debate convened upon the motion: “This house believes that the constant monitoring of our health does more harm than good”. This annual debate between students from the Universities of Oxford and Cambridge is now in its tenth year. This year’s debate was hosted at the Oxford Union on 8th of February 2018, with Oxford winning for the Opposition, and was the catalyst for the collation and expansion of ideas in this paper.New technological devices have the potential to enhance patient autonomy, improve patient safety, simplify the management of chronic diseases, increase connectivity between patients and healthcare professionals and assist individuals to make lifestyle changes to improve their health. However, these are pitted against an encroachment of technology medicalising the individual and home, an exacerbation of health inequalities, a risk to the security of patient data, an alteration of the doctor-patient relationship dynamic and an infringement on individual self-identity. This paper will draw upon and develop these concepts, while contending arguments for and against constant health monitoring. This is not a review of medical devices and health monitoring, but a reflective development and more detailed elaboration of the main points highlighted in the 2018 Varsity Medical Ethics debate.