Diagnostic Work through Evidence-Based Guidelines: Avoiding Gaps Between Development and Implementation of a Guideline for Problem Behaviour in Elderly Care

Diagnostic work is the reflexive work of figuring out what issues are at stake and determining the scope for action. This work is not generally accommodated by evidence-based guidelines, which generally promote a uniform, predefined approach to solving healthcare problems that risk narrowing the opportunities for diagnostic work in healthcare practice. Consequently, guidelines are often criticised as too general to solve situated, individual healthcare problems and gaps between guidelines and their implementation are often reported. The Netherlands has developed a guideline for problem behaviour in elderly care, explicitly designed for diagnostic work, thus stimulating a situated approach. Relational problem behaviour is highly embedded in its context. The guideline stimulates diagnostic work, which helps to unravel problem behaviour and is opening alternatives in elderly care. Diagnostic work does not transfer guideline development problems to healthcare practice, but simply structures the decision-making process without giving a predefined answer. Diagnostic work is thus important to consider in order to avoid a gap between guideline development and implementation.     

Where creativity resides: the generative power of unconscious thought

In three experiments, the relation between different modes of thought and the generation of "creative" and original ideas was investigated. Participants were asked to generate items according to a specific instruction (e.g., generate place names starting with an "A"). They either did so immediately after receiving the instruction, or after a few minutes of conscious thought, or after a few minutes of distraction during which "unconscious thought" was hypothesized to take place. Throughout the experiments, the items participants listed under "unconscious thought" conditions were more original. It was concluded that whereas conscious thought may be focused and convergent, unconscious thought may be more associative and divergent.     

A note on epistemics and discourse analysis

Discursive Psychology has the great merit of having introduced discourse analysis (DA) to social psychology and to have contributed to DA itself by its study of the expression of 'psychological' notions in text and talk. Within this perspective, this paper presents some elements of a proposal to study the expression of knowledge in discourse. Beginning with a brief summary of our multidisciplinary approach to knowledge, followed by a summary of discourse structures that express knowledge, the main argument of the paper is that we not only need to take discourse seriously in the study of knowledge, but cannot ignore their cognitive underlying structures if we want to describe and explain many properties of discourse, such as all implicit or presupposed knowledge, as well as the interactional and contextual management of old and new knowledge in text and talk.     

The Early Stoics and Aristotelian Ethics

Aristotle's philosophical legacy should be accepted as one of the historical influences that shaped Stoic moral and psychological thought,even if this influence needs to be demonstrated in each individual case rather than be taken for granted in general.Having discussed the methodological issues raised by the state of our documented evidence,I focus upon the particular philosophical agenda bequeathed by Aristotle,the issue of the structure of the human soul,and the theory of character and emotion.I argue that Aristotle's influence upon the Stoics is not only a matter of their adoption of Aristotelian themes or concepts but that,given the aporetic quality of much of Aristotle's writing,they accepted options as discussed,and actually rejected,by Aristotle.In particular,the Stoics have been influenced by deliberations in which Aristotle discusses,adapts or rejects positions associated with the philosophical hero of the Stoics,Socrates (in particular in De an.II,9-10 and EN Ⅶ,1-11).Seen in this light,the Aristotelian legacy appears to be even more relevant to explaining distinctive and in particular Socratic features of Stoic moral psychology than has been previously assumed.     

Choices,Consequences and Desert

It is a commonly held position in the literature on distributive justice that choices individuals make from an equalized background may lead to inequalities of outcome. This raises the question of how to assign consequences to particular types of behaviour. Theories of justice based on the concept of moral responsibility offer considerable guidance as to how society should be structured, but they rarely address the question of what the consequences of making a particular choice should be. To fill this lacuna, these theories must rely on a theory of consequences. I argue that the most plausible theories of consequences are substantive rather than procedural in nature. Such theories of consequences are inherently based on the concept of desert. By evaluating individuals' choices society may determine the appropriate consequences of choices for which they are responsible.