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PubMed2000

Hermeneutic-phenomenology: providing living knowledge for nursing practice.

The phenomenological approach has gained popularity among nurse researchers as an alternative investigative method to those used in the natural sciences. As more nurse scholars and nurse researchers utilize phenomenology as a research approach, it becomes critical to examine the implications this may have for nursing knowledge development and for the utilization of that knowledge in practice. In this paper, an examination of the results of phenomenological inquiry is presented and compared with the types of knowledge considered important for nursing by Carper and White. It is clear that phenomenology contributes to empirical, moral, aesthetic, personal, and socio-political knowledge development. Its contribution is not in developing predictive and prescriptive theory, but in revealing the nature of human experience. Although interpretive inquiry, such as hermeneutic phenomenology, does not prescribe action for use in clinical practice, it does influence a thoughtful reflective attentive practice by its revealing of the meanings of human experience.

Esthetics↗
PubMed2005

Religiosity and mental health.

Mental health is not considered only as absence of mental disorders, but rather as the achievement of higher standards of available psychical potentials. True devotion and obedience to The God give the one a huge and incredible strength, constant source of spiritual emotional and moral energy, which is of help in resisting destructive and slavery attacks of the environment and its materialistic-consuming tendencies, as well as social and mental disruption. According to the opinion of numerous worldwide recognized mental health experts, humankind of today is confronted with a number of problems, which are the consequence of spiritual and moral-ethical degradation of human being. Therefore, religiosity became the field of interest of mental health researchers. The results of new studies undoubtedly indicate beneficial effects of religion on life and mental health in humans. Religiosity reduces tendencies for risky behaviour, impulsive reactions and aggression; it corrects tendencies towards psychopathic and paranoid behaviour, reduces converse, depressive and schizoid tendency, and provides successful overcome of emotional conflicts. In comparison to low-religious adolescents, the factors such as inner conflicts, frustration, fear, anxiety, psychological trauma, low self-esteem, unbalance of psychical homeostasis, emotional instability, and negative psychical energy are less present in highly religious adolescents and neutralized in a healthier and more efficient way. Beneficial impact of religion on mental health derives from precise cognitive-behavioural patterns, which provide a clear life orientation, solid basis and safe frames for personality development, assuring human to be continually on the way to achieve its own generic essence and reach its own maturity and self-actualization.

Adolescent↗
PubMed1999

The moral metaphors of nursing.

The essence of metaphor is understanding and experiencing one thing in terms of another. Metaphorical concepts structure and reflect what we perceive, how we act, and how we relate to other people. In nursing ethics, several metaphors have emerged which have had a great impact on nursing practice. These metaphors include the military metaphor which exemplified nursing during the 1800s, the advocacy and academic metaphors which became a philosophical basis for nursing during the 1960s, and the individualist and community as caring metaphors which have emerged more recently. Although beneficial in some ways, these metaphors may be obscuring the complex moral reality of nursing practice. This article defines a moral metaphor, critiques nursing's moral metaphors, and provides an historical overview of their development with examples of how they have and do affect nursing practice.

Ethics, Nursing↗
PubMed2005

Is there any solution to the "brain drain" of health professionals and knowledge from Africa?

African public health care systems suffer from significant "brain drain" of its health care professionals and knowledge as health workers migrate to wealthier countries such as Australia, Canada, USA, and the United Kingdom. Knowledge generated on the continent is not readily accessible to potential users on the continent. In this paper, the brain drain is defined as both a loss of health workers (hard brain drain) and unavailability of research results to users in Africa (soft brain drain). The "pull" factors of "hard brain drain" include better remuneration and working conditions, possible job satisfaction, and prospects for further education, whereas the "push" factors include a lack of better working conditions including promotion opportunities and career advancement. There is also a lack of essential equipment and non-availability or limited availability of specialist training programs on the continent. The causes of "soft brain drain" include lack of visibility of research results in African journals, better prospects for promotion in academic medicine when a publication has occurred in a northern high impact journal, and probably a cultural limitation because many things of foreign origin are considered superior. Advocates are increasingly discussing not just the pull factors but also the "grab" factors emanating from the developed nations. In order to control or manage the outflow of vital human resources from the developing nations to the developed ones, various possible solutions have been discussed. The moral regard to this issue cannot be under-recognized. However, the dilemma is how to balance personal autonomy, right to economic prosperity, right to personal professional development, and the expectations of the public in relation to adequate public health care services in the developing nations.

Africa↗
PubMed1995

A cognitive developmental approach to mortality: investigating the psychopath.

Various social animal species have been noted to inhibit aggressive attacks when a conspecific displays submission cues. Blair (1993) has suggested that humans possess a functionally similar mechanism which mediates the suppression of aggression in the context of distress cues. He has suggested that this mechanism is a prerequisite for the development of the moral/conventional distinction; the consistently observed distinction in subject's judgments between moral and conventional transgressions. Psychopaths may lack this violence inhibitor. A causal model is developed showing how the lack of this mechanism would explain the core behavioural symptoms associated with the psychopathic disorder. A prediction of such a causal model would be that psychopaths should fail to make the moral/conventional distinction. This prediction was confirmed. The implication of this finding for other theories of morality is discussed.

Adult↗
PubMed2005

Patenting humans: clones, chimeras, and biological artifacts.

The momentum of advances in biology is evident in the history of patents on life forms. As we proceed forward with greater understanding and technological control of developmental biology there will be many new and challenging dilemmas related to patenting of human parts and partial trajectories of human development. These dilemmas are already evident in the current conflict over the moral status of the early human embryo. In this essay, recent evidence from embryological studies is considered and the unbroken continuity of organismal development initiated at fertilization is asserted as clear and reasonable grounds for moral standing. Within this frame of analysis, it is proposed that through a technique of Altered Nuclear Transfer, non-organismal entities might be created from which embryonic stem cells could be morally procured. Criteria for patenting of such non-organismal entities are considered.

Bioethics↗
PubMed1999

Enabling children: participation as a new perspective on child-health promotion.

As fellow citizens, all children need a stimulating social environment that helps them develop self-respect and social competence. Developmental research, however, shows, that many children do not or cannot fulfil the social, moral or cognitive developmental tasks which are necessary for healthy development. A lack of opportunities for gaining meaningful social experiences can be seen as a major source of psychosocial and behavioural problems in children. On the contrary, active commitment in educational environments such as the school and the neighbourhood, helps them to get an increasingly better grip on their own lives and health. Moreover, such 'children's participation' appears to have a protective and preventive effect for health-related problems. Therefore, it is argued, that 'enablement', a key-element of both the Ottawa Charter on Health Promotion and the International Convention on the Rights of the Child, should be at the core of every child-health promotion programme.

Adolescent↗
PubMed1999

Peer relationships and quality of life.

Measures of peer relationships during childhood have been shown to be reliable predictors of several indicators of functioning during adulthood. Within each of these areas of functioning, children who have troubled peer relationships are more likely to show signs of distress than are other children. In addition, experiences with peers appear to provide a context for the development of many fundamental human capacities (e.g., moral judgment, conflict resolution skills, emotional regulation, etc.). Three interrelated levels of analysis can be used to assess a child's experiences with peers: the level of the individual (i.e., what the child is like); the level of the dyad (e.g., experiences with friends); and the level of the group (e.g., experiences with the set of individuals with whom the child typically associates). By determining a child's functioning at these three levels of analysis (using assessments from teachers, parents, and peers), it is possible to obtain a good assessment of a central portion of the quality of a child's life. Such measures have been used to assess the quality of life of children across the height spectrum and preliminary findings show that the peer experiences of children who are substantially shorter than their peers are remarkably similar to those of other children.

Adolescent↗
PubMed2004

A case study: the clinical application of quadrangular dialogue--a caring in nursing teaching model.

Teaching caring in nursing is expected of nursing faculty, but the practical application is rarely explained. It has been regarded as the moral responsibility of faculty to teach in a caring way. This case study relates how one faculty applied the concepts to quadrangular dialogue a caring model of nursing education to the experience of baccalaureate student nurses in their first clinical rotation. The components of quadrangular dialogue will be described, and applied to a specific patient who was cared for by students in one semester. This model is developed from Habermas' (1995) Theory of Communicative Action and Moral Consciousness, Bishop and Scudder's (1990) Triadic Dialogue and a caring in nursing paradigm developed by this author. It explains how the patient, nursing student and nursing faculty are all first person in the interaction, while the illness is object. By acknowledging the humanness of participants, validation and fulfillment for each follow.

Clinical Competence↗
PubMed2001

Development of the ethical dimension in nursing theory.

Nurses encounter ethical dilemmas in their practice and need guidance in making relevant patient-care decisions. Nursing theory is believed to be the best source of such guidance. The aim of this paper is to describe the ethical dimension in nursing theory. A literature review shows the intricate relationship between ethics and nursing, yet there is lack of elaboration of ethical features in nursing theories. The identified elements of the ethical dimension include ethical theories and principles, values, ethical practice issues, moral reasoning and contextual factors. Criteria for the development and evaluation of the ethical dimension are presented, with an example using a middle range theory. The ethical components pertinent to a nursing theory need to be made explicit if theory is to guide practice. Nursing scholars are invited to elucidate the ethical dimension in their theories in order to enhance moral reasoning and provide a framework for ethical practice.

Empathy↗
PubMed1997

Trauma outcome analysis and the development of regional norms.

Early attempts to assess patient outcomes in trauma hospitals included morality reviews and expert panel chart audits. More recently, a statistical methodology combining the Revised Trauma Score and Injury Severity Score has been developed (TRISS). A modification of this methodology--TRISS-like analysis--allows the inclusion of patients who have required endotracheal intubation prior to the time of arrival at the trauma hospital. This study was undertaken to further improve this TRISS-like methodology by developing statistical coefficients based on regional data. It was hypothesized that his would allow the analysis to better identify those hospitals with significantly better worse outcomes than their peers. The Comprehensive Data Set of the Ontario Trauma Registry was accessed, which contains data on severely injured patients from all 11 lead trauma hospitals in the province. Three years' data were obtained, and checked for accuracy and completeness. Analysis was performed using the previously published coefficients. New coefficients were then derived, using regression analysis on the Ontario patient data. 5,258 of 6,389 files were complete and eligible for analysis. TRISS-like analysis resulted in an expected mortality of 21.2% (1115.6/5258) with a z score for the entire province of -14.102. Individual hospital scores were all negative (fewer deaths than expected), and 9/11 hospital scores were < -1.96 (statistically significant). The new coefficients were markedly different from those previously published, and their application resulted in an overall z score of 0.000. Institutional scores ranged from -3.309 to +4.686, with two hospitals < -1.96 and one > +1.96. The old coefficients predicted many more deaths than occurred in all of the hospitals. The new coefficients proved quite accurate overall in predicting outcomes, and identified one institution with significantly more deaths than would have been predicted for other hospitals in the province. Subsequently, a fourth year's data files were obtained, and used as a validation data set. The new coefficients again proved more useful than the original ones.

Humans↗
PubMedDate not supplied

Utilization management: a rehabilitation approach to cost control.

Santa Rosa Rehabilitation Hospital in San Antonio, TX, not unlike many healthcare facilities throughout the nation, was faced with several issues: (a) increased cost, (b) lower reimbursement, (c) high length of stay, and (d) low staff morale. The management team was responsible for developing a system to control these issues, the most noticeable and measureable of which was length of stay. In 1987, the facility reached a high length of stay of 43 days. In response, the managers of Santa Rosa Rehabilitation Hospital took the lead in instituting multidisciplinary utilization management, and the hospital saw the average length of stay decrease to 18 days in 1990. This article provides a detailed description of the development of multidisciplinary utilization management, as well as a brief history of the rationale behind the utilization management process. Limitations and advantages of the system also are described.

Cost Control↗
PubMed1994

Living a responsible life: the impact of AIDS on the social identity of intravenous drug users.

The dominant image of an intravenous (i.v.) drug user in U.S. society is that of the unbridled 'dope fiend'. It is common in treatment literature to refer to users as diseased and pathologically unable to control their lives. Female i.v. drug users, as the bearers of children, even more than males, are faced with the paradox posed by conflicting social messages labeling them as irresponsible, dirty 'dope fiends' while approaching them as responsible citizens who need to 'clean up their act' for their children. The paradox of these messages creates a profound moral dilemma involving agency--the ability to develop a flow of conduct by reflexively monitoring intention, purpose, and accountability of actions in the pursuit of a goal--and the social identity of 'junkie'. This article examines this social condition and how it affects the life and options of a woman diagnosed HIV positive. Using narrative discourse and analyzing it through the study of voice I show how an i.v. drug using woman uses her diagnosis to redefine her life and her social identity, as she changes a negative 'deviant' image into a positive one.

Acquired Immunodeficiency Syndrome↗