Movatterモバイル変換

Export citation   Bookmark  

Because of the gradual aging of the population, hospital facilities for socio-sanitarycare of the elderly are quite scarce relative to the very high number of elderly people present in the country. This has pushed a high number of families to privately hirehome-care workers. The scientific literature gives a picture of the psycho-physical risks that this type of profession is exposed to; however, there is still a need for a more systemic reflection with regard to representations (...) about their role and competences. The aim of the present study is to outline the representations of the role and the skills it requires fromhome-care workers’ point of view. We reconstructed howhome-care workers perceive and define the profession, and understand the necessary skills required from their point of view. Our results show that the professional profile ofhome-care workers still remains poorly defined and that professionals themselves struggle to find value and recognition, and to articulate what the skill set they develop is formed of. (shrink)

Direct download(2 more)   Export citation   Bookmark  

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients’ homes. This greatly impacts nurses’ work inhomecare, making their work increasingly diverse and demanding. In this study, we explorehome‐care nursing through a critical discourse analysis of focus group interviews withhome‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of (...) contextual changes. Nurses hold a crucial position inhome healthcare, particularly in ensuringcare for sicker patients with complex needs. Assessing health needs, performing advancedcare, and at the same time, providing customized solutions in various homes were identified as distinctive forhome‐care nurses’ work. Changes have made nurses’ work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgentcare seems to take precedence in nurses’ work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses’ work to help shape the further development ofhome‐care nursing. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark   3 citations  

Homecare is one of the fastest‐growing industries in the United States, providing valuable opportunities for millions of older adults and people with disabilities to live athome rather than in institutional settings.Homecare workers assist clients with essential activities of daily living, but their wages and working conditions generally fail to reflect the importance of their work. Drawing on the work of Eva Feder Kittay and othercare ethicists, we argue that good (...)care involves attending to the needs of another out of a concern for their well‐being. Suchcare should be standard in thehomecare system. Yet, because of the pervasive racial, gender, and economic inequalities that thehomecare industry perpetuates,homecare workers and their clients cannot reasonably be expected tocare about each other. We endorse reforms aimed at enablinghomecare workers and their clients to form and maintain professional relationships that cultivatecare.. (shrink)

Direct download(2 more)   Export citation   Bookmark   1 citation  

Unionization ofhomecare has depended on the state location of the occupation. Government social policies and funding createdhomecare, shaping the structure of the industry and the conditions of work. The welfare nexus, linking old age, disability, health, and welfare policies, however, also transformedcare hidden in thehome into a public service. Through case studies of California and Oregon, leaders in deinstitutionalizingcare of the elderly and disabled, we explore the (...) social struggles that forced the state to recognize its invisible workforce. Thehome location of personal attendants and other health aides has entailed not only organizing challenges but policy innovation as well. Using the welfare state location of the labor, workers allied with consumers to develop the public authority as a newstructure of representation. The history ofhomecare shows that social welfare and health policy have long been entangled with labor policy. (shrink)

No categories

Direct download   Export citation   Bookmark   1 citation  

Background: Over the last decade, new healthcare policies are transforming healthcare practices towards independent living and self-care of older people and people with a chronic disease or disability within the community. For professional caregivers inhomecare, such as nurses, this requires a shift from a caring attitude towards the promotion of patient autonomy. Aim: To explore how nurses inhomecare deal with the transformation towards fostering patient autonomy and self-care. Research design and (...) context: A case study was conducted in a professional development course (‘learning circle’) forhomecare nurses, including participant observations and focus groups. The theoretical notion of ‘relational agency’ and the moral concept of ‘practices of responsibility’ were used to conduct a narrative analysis on the nurses’ stories about autonomy. Participants: Eight nurses, two coaches and two university lecturers who participated in the learning circle. Ethical considerations: Informed consent was sought at the start of the course and again, at specific moments during the course of the learning circle. Findings: Three main themes were found that expressed the moral demands experienced and negotiated by the nurses: adapting to the person, activating patients’ strengths and collaboration with patients and informal caregivers. Discussion: On a policy and organisational level, the moral discourse on patient autonomy gets intertwined with the instrumental discourse on healthcare budget savings. This is manifested in the ambiguities the nurses face in fostering patient autonomy in their dailyhomecare practice. To support nurses, critical thinking, moral sensitivity and trans-professional working should be part of their professional development. Conclusion: The turn towards autonomy in healthcare raises moral questions about responsibilities forcare. Promoting patient autonomy should be a collaborative endeavour and deliberation of patients, professional and informal caregivers together. (shrink)

Direct download(2 more)   Export citation   Bookmark   5 citations  

This commentary responds to “HomeCare in America: The Urgent Challenge of Putting EthicalCare into Practice,” by Coleman Solis and colleagues, in the May‐June 2023 issue of the Hastings Center Report. More specifically, we respond to the authors’ call for “inquiry into the nature, value, and practice” ofhomecare. We argue that the most urgently needed normative reset for thinking aboutcare work is the replacement of dominant individualistic thinking with systemic thinking. (...) Deepening a focus on the social, economic, and historical forces that shape the state of contemporarycare work will help bioethicists to argue more effectively for improvements to working conditions. In turn, better working conditions will ease the oppositional stance between caregivers and receivers that has been set up by the current system, enabling all parties involved to better pursue the feminist ethical ideal ofcare. (shrink)

Direct download(2 more)   Export citation   Bookmark  

‘Client involvement’ has been a mantra within health policies, education curricula and healthcare institutions over many years, yet very little is known about how ‘client involvement’ is practised inhome‐care services. The aim of this article is to analyse ‘client involvement’ in practise seen from the positions of healthcare professionals, an elderly person and his relative in ahome‐care setting. A sociologically inspired single case study was conducted, consisting of three weeks of observations and interviews. The (...) study has a focus on the relational aspects ofhomecare and the structural, political and administrative frames that rulehome‐care practice. Client involvement is shown within four constructed analytical categories: ‘Structural conditions of providing and receivinghomecare’; ‘Client involvement inside thehome: performing a professional task and living an everyday life’; ‘Client involvement outside thehome: liberal business and mutual goal setting’; and ‘Converting ahome to a working place: refurnishing a life’. The meaning of involvement is depending on which position it is viewed from. On the basis of this analysis, we raise the question of the extent to which involvement of the client in publichome‐care practice remains limited. (shrink)

Direct download(2 more)   Export citation   Bookmark   7 citations  

In this paper, I argue that addressing the medical needs of older persons warrants expanding the array of insured services as described by the Canada Health Act to includehomecare. The growing importance of chroniccare supports my call for federally regulatedhomecare services as the nature of disease management has changed significantly in the last decades. In addition, if the values of equity, fairness and solidarity, which are the keystone values of the (...) CHA, are to be upheld within the current social and demographic context, then Canada’s healthcare system should adapt accordingly. I focus my argument on the services provided to older persons for two main reasons. First, the changing nature of disease management is best seen in this population. If it is to be successfully argued that the transformations in medicine warrant an expansion of insured services covered by the CHA, it will be best illustrated by looking at the needs of older persons. Second, with the demographic shift looming large in the policy agenda, an exploration of this issue is not only crucial but timely. (shrink)

Direct download(2 more)   Export citation   Bookmark   2 citations  

Nel Noddings, one of the central figures in the contemporary discussion of ethics and moral education, argues that caring--a way of life learned athome--can be extended into a theory that guides social policy. Tackling issues such as capital punishment, drug treatment, homelessness, mental illness, and abortion, Noddings inverts traditional philosophical priorities to show how an ethic ofcare can have profound and compelling implications for social and political thought. Instead of beginning with an ideal state and then (...) describing a role forhome and family, this book starts with an idealhome and asks how what is learned there may be extended to the larger social domain. Noddings examines the tension between freedom and equality that characterized liberal thought in the twentieth century and finds that--for all its strengths--liberalism is still inadequate as social policy. She suggests instead that an attitude of attentive love in thehome induces a corresponding responsiveness that can serve as a foundation for social policy. With her characteristic sensitivity to the individual and to the vulnerable in society, the author concludes that any corrective practice that does more harm than the behavior it is aimed at correcting should be abandoned. This suggests an end to the disastrous war on drugs. In addition, Noddings states that the caring professions that deal with the homeless should be guided by flexible policies that allow practitioners to respond adequately to the needs of very different clients. She recommends that the school curriculum should include serious preparation forhome life as well as for professional and civic life. Emphasizing the importance of improving life in everyday homes and the possible role social policy might play in this improvement, _Starting at Home_ highlights the inextricable link between the development ofcare in individual lives and any discussion of moral life and social policy. (shrink)

Export citation   Bookmark   122 citations  

Nel Noddings, one of the central figures in the contemporary discussion of ethics and moral education, argues that caring--a way of life learned athome--can be extended into a theory that guides social policy. Tackling issues such as capital punishment, drug treatment, homelessness, mental illness, and abortion, Noddings inverts traditional philosophical priorities to show how an ethic ofcare can have profound and compelling implications for social and political thought. Instead of beginning with an ideal state and then (...) describing a role forhome and family, this book starts with an idealhome and asks how what is learned there may be extended to the larger social domain. Noddings examines the tension between freedom and equality that characterized liberal thought in the twentieth century and finds that--for all its strengths--liberalism is still inadequate as social policy. She suggests instead that an attitude of attentive love in thehome induces a corresponding responsiveness that can serve as a foundation for social policy. With her characteristic sensitivity to the individual and to the vulnerable in society, the author concludes that any corrective practice that does more harm than the behavior it is aimed at correcting should be abandoned. This suggests an end to the disastrous war on drugs. In addition, Noddings states that the caring professions that deal with the homeless should be guided by flexible policies that allow practitioners to respond adequately to the needs of very different clients. She recommends that the school curriculum should include serious preparation forhome life as well as for professional and civic life. Emphasizing the importance of improving life in everyday homes and the possible role social policy might play in this improvement, _Starting at Home_ highlights the inextricable link between the development ofcare in individual lives and any discussion of moral life and social policy. (shrink)

Direct download(2 more)   Export citation   Bookmark   131 citations  

Background Moral distress is a far-reaching problem for nurses in different settings as it threatens their health. Aim This study examined which situations lead to moral distress inhome-care nursing, how and with which consequenceshome-care nurses experience moral distress, and how they cope with morally stressful situations and the resulting moral distress. Research design A qualitative interview study with reflexive thematic analysis was used. Participants and research context We conducted semi-structured interviews with 20home- (...) class='Hi'>care nurses in Germany. Ethical considerations The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. Findings Twenty (14 female and 6 male)home-care nurses were interviewed between April and August 2023 at their chosen location. The situations leading to moral distress were inadequatecare of the person in need ofcare, not being able to protect one’s health, extended responsibility for the entirecare arrangement, work–privacy conflicts, and conflicts between the understanding ofcare or professional ethics and the performance and billing system. The nurses experienced moral distress as they worked alone and providedcare in the patient’s territory. Short- and long-term strains with destructive cognitions, negative emotions, physical symptoms, and health consequences were reported. They faced challenges in coping with moral distress on institutional and individual levels. Conclusions In cases of tension between the service and billing system and the understanding of these nurses’care services, moral distress is unavoidable. Alternative forms of organization and billing modalities, such as payment by time and the expansion and refinancing of service, should be implemented. The latter relates to systematic case and ethics meetings. Further, a transfer of medical activities, such as the prescription of wound material to registered nurses, could prevent morally stressful situations and improve patients’ quality ofcare. (shrink)

Direct download(2 more)   Export citation   Bookmark  

The aim of this study was to identify and analyse ethical decision making in thehomecare of persons with long-term mental illness. A focus was placed on how healthcare workers interpret and deal with the principle of autonomy in actual situations. Three focus groups involving mental health nurses who were experienced in thehomecare of persons with chronic mental illness were conducted in order to stimulate an interactive dialogue on this topic. A (...) constant comparative analysis of the transcribed audiotaped sessions identified a central theme that concerned the moral symbolic meaning of ‘home’. This reflected the healthcare workers’ conflict between their professional role and their moral role, which they perceived as unclear. (shrink)

Direct download(2 more)   Export citation   Bookmark   7 citations  

Direct download(2 more)   Export citation   Bookmark  

Understanding how a nurse acts in a particular situation reveals how nurses enact their ethics in day-to-day nursing. Our ethical frameworks assist us when we experience serious ethical dilemmas. Yet how a nurse responds in situations of daily practice is contingent upon all the presenting cues that build the current moment. In this article, we look at how ahomecare nurse responds to the ethical opening that arises when the nurse enters a person’shome. We discuss (...) how thehome presents the nurse with knowledge that informs the provision of ethical nursingcare. The analysis is based on findings from an interpretive research study in palliativehomecare in Canada. Through interpretive analysis of a nursing situation we delineate how the nurse engages with the whole and acts inside the moment. The analysis shows howhomecare nurses are ethically determined to engage with whatever is going on in a patient’shome. (shrink)

Direct download(3 more)   Export citation   Bookmark   4 citations  

The aim of this study was to explore the meaning of experience forhome‐care nurses in a multicultural area of Sweden. Interviews and group discussions with a team of fivehome‐care nurses were interpreted in accordance with a hermeneutical perspective. The meaning was expressed in connection with the complexities of place, and space forcare. Contradictions developed from diversities of perspectives incorporated in this particular multicultural area. Nurses saw themselves as mediators and allowed complexity to (...) be considered in order to managecare. They took on responsibility of creating a ‘space ofcare’, while the organizational structures ofhomecare were perceived as something outside thecare praxis. Making contradictions evident renders an intermediary caring strategy feasible. (shrink)

Direct download(2 more)   Export citation   Bookmark   1 citation  

The glaring lack of formal and informal caregivers in Germany has not only become apparent in hospitals and nursing homes but also inhomecare arrangements. One tension is particularly pertinent in such arrangements: a ‘family-oriented’ logic of the long-termcare insurance and the individual wishes of those in need ofcare meet the actual possibilities of family carers. Thiscare gap has been compensated for by 24-hourcare workers, so-called ‘live-ins’, from Eastern Europe (...) for some years. This contribution maps the ‘live-ins’ situation comprehensively from an ethical perspective. Based on different constellations regarding the ‘live-ins’ status as a professional nurse or non-professional caregiver, which ethical principles and moral norms are affected by whom and potentially conflict with each other in suchhomecare arrangements at a micro and meso level ofcare are outlined. Special attention is paid to the tension between self-care andcare for others, and to questions of the shared responsibility in and social responsibility of those external services that are involved inhomecare in addition to the ‘live-in’. In order to uncover, understand and influence the current ethical problems, an ethical framework that considers both the divergent interests of all individuals involved in thehomecare arrangement and their mutual dependency and vulnerability is needed. (shrink)

Direct download(3 more)   Export citation   Bookmark   2 citations  

Nurses often play crucial roles on teams involved in providingcare to infants and families in the context of child protection services, making them well‐placed to research topics concerning these groups. Developed by North American legal scholar Martha Fineman in 2008, a contemporary macro‐legal‐political theory with potential to inform studies related to the nexus between healthcare and law is ‘vulnerability theory.’ Conceiving vulnerability as a universal, inevitable, and enduring aspect of the human condition, it contends that the onus is (...) on the State to respond to universal vulnerability by ensuring institutions and structures do not confer unfair advantage or disadvantage. When access to rights is particularly difficult, a ‘targeted group approach’ should be considered as well as consideration of the notion that responses to vulnerability have the potential to increase vulnerability. This paper outlines the background of vulnerability theory, explaining its key tenets and criticisms, before considering how it might be useful to inform studies focused on infants in out ofhomecare. (shrink)

Direct download(2 more)   Export citation   Bookmark  

Evidence of gender differences in the amount and type ofcare provided by family caregivers in hospice palliativehomecare suggests potential inequities in health and healthcare experiences. As part of a larger critical ethnographic study examining gender relations among clients with cancer, their family caregivers and primary nurses, this article describes gendered expectations and exemptions for family caregivers within the sociopolitical context of end‐of‐life athome. Data were collected from in‐depth interviews (n = (...) 25), observations of agencyhomecare visits (n = 9) and analyses of policy andhomecare agency documents (n = 12). Employing a critical feminist lens, a gender‐based analysis revealed that structural discourses emphasizing an artificial divide between public and private spheres constructed end‐of‐life athome as private and apolitical. Associated withcare ofhome and family, women were most impacted by these public/private discourses underpinning neoliberal values of cost‐efficiency. Findings suggest that a critical perspective is needed to assist policy makers and healthcare providers to view how caregiver experiences are shaped by structures that control the availability of resources. Thus, instead of focusing on caregivers' deficits, interventions should be directed at the social, political and economic conditions that shape gendered experiences. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark  

Internationally, primary healthcare has in recent years gained a more central position in political priorities to ensure sustainable healthcare for the population. Thus, more people receive healthcare locally and in their own homes, wherehome‐care nursing plays a large role. In this article, we investigate howhome‐care nursing is articulated and made visible in contemporary Norwegian policy documents. The study is a Fairclough‐inspired critical discourse analysis seeking to uncover the position (...) of nursing in the prevailing political ideologies on current primary healthcare. In the documents, we identified several complementary and conflicting understandings abouthome‐care nursing.Home‐care nursing is presented as a basic part of a municipality's health services, but at the same time, its content and contribution are unclear and almost invisible. We argue that the absence of nursing leads to significant perspectives being left out and tie this to the fact that some patient groups and tasks seem to be disadvantaged. The political placement ofhome‐care nursing in the health‐care landscape is thus not just about nursing as a professional practice but also concerns fundamentalcare values in our society in relation to disadvantaged groups and work tasks. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark  

The patient’shome is a common setting for palliativecare. This means that we need to understand current palliativecare philosophy and how its goals can be realized inhome‐care nursing encounters (HCNEs) between the nurse, patient and patient’s relatives. The existing research on this topic describes both a negative and a positive perspective. There has, however, been a reliance on interview and descriptive methods in this context. The aim of this study was to explore (...) planned HCNEs in palliativecare. The design was a multiple case study based on observations. The analysis includes a descriptive and an explanation building phase. The results show that planned palliative HCNEs can be described as a process of co‐creating possibilities for the patient to reach vital goals through shared knowledge in a warm and caring atmosphere, based on good caring relations. However, in some HCNEs, co‐creation did not occur: Wishes and needs were discouraged or made impossible and vital goals were not reached for the patients or their relatives. Further research is needed to understand why. The co‐creative process presented in this article can be seen as a concretization of the palliativecare ideal of working with a person‐centered approach. (shrink)

Direct download(2 more)   Export citation   Bookmark   4 citations  

Background Nurses frequently face situations in their daily practice that are ethically difficult to handle and can lead to moral distress. Objective This study aimed to explore the phenomenon of moral distress and describe its work-related predictors and individual consequences forhome-care nurses in Germany. Research design A cross-sectional design was employed. The moral distress scale and the COPSOQ III-questionnaire were used within the framework of an online survey conducted amonghome-care nurses in Germany. Frequency analyses, (...) multiple linear and logistic regressions, and Rasch analyses were performed. Participants and research context The invitation to participate was sent to every Germanhome-care service ( n = 16,608). Ethical considerations The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. Results A total of 976home-care nurses participated in this study. Job characteristics, such as high emotional demands, frequent work-life-conflicts, low influence at work, and low social support, were associated with higher disturbance caused by moral distress inhome-care nurses. Organizational characteristics ofhome-care services, such as time margin with patients, predicted moral distress. High disturbance levels due to moral distress predicted higher burnout, worse state of health, and the intention to leave the job and the profession, but did not predict sickness absence. Conclusions To preventhome-care nurses from experiencing severe consequences of moral distress, adequate interventions should be developed.Home-care services ought to consider family friendly shifts, provide social support, such as opportunities for exchange within the team, and facilitate coping with emotional demands. Sufficient time for patientcare must be scheduled and short-term takeover of unknown tours should be prevented. There is a need to develop and evaluate additional interventions aimed at reducing moral distress, specifically in thehome-care nursing sector. (shrink)

Direct download(3 more)   Export citation   Bookmark   3 citations  

Background: As part of an ongoing Scandinavian project on the dignity ofcare for older people, this study is based on ‘clinical caring science’ as a scientific discipline. Clinical caring science examines how ground concepts, axioms and theories are expressed in different clinical contexts. Central notions are caring culture, dignity, at-home-ness, the little extra, non-caring cultures versus caring cultures and ethical context – and climate. Aim and assumptions: This study investigates the individual variations of caring cultures in relation (...) to dignity and how it is expressed in caring acts and ethical contexts. Three assumptions are formulated: (1) the caring culture of nursing homes influences whether dignifiedcare is provided, (2) an ethos that is reflected on and appropriated by the caregiver mirrors itself in ethical caring acts and as artful caring in an ethical context and (3) caring culture is assumed to be a more ontological or universal concept than, for example, an ethical context or ethical person-to-person acts. Research design: The methodological approach is hermeneutic. The data consist of 28 interviews with relatives of older persons from Norway, Denmark and Sweden. Ethical considerations: The principles of voluntariness, confidentiality and anonymity were respected during the whole research process. Findings: Three patterns were revealed: dignity as at-home-ness, dignity as the little extra and non-dignifying ethical context. Discussion: Caring communion, invitation, at-home-ness and ‘the little extra’ are expressions of ethical contexts and caring acts in a caring culture. A non-caring culture may not consider the dignity of its residents and may be represented by routinizedcare that values organizational efficiency and instrumentalism rather than an individual’s dignity and self-worth. Conclusion: An ethos must be integrated in both the organization and in the individual caregiver in order to be expressed in caring acts and in an ethical context that supports these caring acts. (shrink)

Direct download(2 more)   Export citation   Bookmark   5 citations  

An aging population is often taken to require a profound reorganization of the prevailing healthcare system. In particular, a more cost-effectivecare system is warranted and ICT-basedhomecare is often considered a promising alternative. Modern healthcare devices admit a transfer of patients with rather complexcare needs from institutions to thehomecare setting. Withcare recipients set up with health monitoring technologies athome, spouses and children (...) are likely to become involved in the caring process and informal caregivers may have to assist kin-persons with advancedcare needs by means of sophisticated technology. This paper investigates some of the ethical implications of a near-future shift from institutionalcare to technology-assistedhomecare and the subsequent impact on thecare recipient and formal- and informalcare providers. (shrink)

Direct download(5 more)   Export citation   Bookmark   13 citations  

The cost-effectiveness of 24-hourcare makes it a major source of support for elderly people in need ofhome-basedcare in Austria. Language barriers, feelings of isolation when living with chronically ill people and a lack of adequate training and quality control create stressful working conditions for 24-hour caregivers in Austria, who mainly come from Slovakia, Hungary and Romania. The challenges not only affect the 24-hour caregivers themselves but also their clients, relatives and registeredcare agency (...) nurses incare settings. The aim of the qualitative study was to assess user needs in order to develop an app to improve working conditions and quality assurance in 24-hourhome-care. The study consisted of guided interviews, focus group and cultural probes and 45 interviewees. The collected data were analyzed using Kuckartz’s method of content structuring qualitative content analysis. The main results show that 24-hour caregivers predominantly require information about common geriatric diseases and the law on 24-hourcare. Additionally, medical emergencies can cause insecurities, which creates high interest in professional emergency management skills. Clients and relatives are especially interested in 24-hour caregivers having better German language skills.Care agencies and registered nurses would particularly welcome electroniccare documentation to ensure traceability of the activities and measures taken. The study points to the need for a digital tool that would meet demand for an appropriate assistance system for 24-hourhome-care that complies with the AAL requirements of the aligned project. Therefore, the intended software solution meets challenges in 24-hourhome-care for 24-hour caregivers, persons in need ofcare, their relatives and professionals involved in the 24-hourcare setting. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark  

p166 In February 1965, the United States escalated the war against South Vietnam radically, and also, on the side, began regular bombing of the North at a much lower level. That was a big public issue in the United States: Should we bomb North Vietnam? The bombing of the South was ignored. The same shows up in the internal planning, for which we now have an extremely rich record, not only from the Pentagon Papers, but from tons of declassified documents (...) that have been released in the last couple of years. It turns out again, one of the very few interesting revelations of the Pentagon Papers that there was no planning for the escalated bombing of the South. There was very meticulous planning about the bombing of the North carefully calibrated, when should we do it, and a lot of agonizing about it. The bombing of the South at triple the scale of the North is barely discussed. There are a few casual decisions here and there. The same shows up in McNamara's recent memoirs. He discusses at great length the bombing of the North. The bombing of the South he literally doesn't mention. He mentions what he did on January 21, 1965, a really important day: there was a big discussion about whether to bomb North Vietnam. He doesn't mention what we know from other documents, that on that same day, he authorized for the first time the use of jet planes to escalate the bombing of South Vietnam over and above the massive bombing that had been going on for years that's not even mentioned. (shrink)

Direct download   Export citation   Bookmark   1 citation  

Mysticism is condemned as often as it is praised. Much of the condemnation comes from mysticism’s apparent disregard of morality and ethics. For mystics, the experience of “union” transcends all moral concern. In this careful examination of the works of such practitioners or examiners of mysticism as Paul Tillich, Thomas Merton, Evelyn Underhill, and Martin Buber, the author posits a spectrum of uneasy relationships between mysticism and morality. Horne explores the polarities of apophatic (imageless) and imaginative mysticism, the contemplative and (...) the active life, and morality and amorality. He stresses the importance of the distinction between “proper-name” (entirely personal) morality and “social” morality, for the history of Christian mysticism is a mix of minimal moral concern, proper-name morality, and social morality. The volume will be of interest to students of religious experience, ethics, and the recent history of mysticism. Carefully reasoned and documented, the argument is couched in clear prose, easily accessible to lay readers as well as to scholars. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark  

The analysis undertaken in this paper explores the significance of a central finding from a recent field study ofhomecare case management practice: a notable feature of case management work is the preparation of an orderly, ordered space wherecare may be offered. However, out of their encounters with an almost endless variety of situations, out of people's diverse narratives of need, case managers seem able to pick out only limited range of recognized needs to which (...) to respond and demonstrate a series of responses themselves equally limited. Though this observation suggests a kind of efficiency that is currently highly valued within healthcare systems, it also underlines the system's inability to engage difference and variability in a meaningful way. This inability or limitation in effectively engaging difference is conceptualized here as, in some sense, a problem, and the nature of this problem is explored through the rhetorical process of problem setting. The central question becomes how might we develop and deploy an orderly and coherent system ofcare without essentializing people's experiences, without treating these experiences reductively, without, in a Foucaultian frame of reference, allowing what can be understood as similarity or resemblance among clients and situations to be folded back into sameness? As we encounter complexity, variability and difference in practice, how should we treat it? (shrink)

Direct download(3 more)   Export citation   Bookmark   6 citations  

Background: As part of an ongoing Scandinavian project on the dignity ofcare for older people, this study is based on ‘clinical caring science’ as a scientific discipline. Clinical caring science examines how ground concepts, axioms and theories are expressed in different clinical contexts. Central notions are caring culture, dignity, at-home-ness, the little extra, non-caring cultures versus caring cultures and ethical context – and climate. Aim and assumptions: This study investigates the individual variations of caring cultures in relation (...) to dignity and how it is expressed in caring acts and ethical contexts. Three assumptions are formulated: (1) the caring culture of nursing homes influences whether dignifiedcare is provided, (2) an ethos that is reflected on and appropriated by the caregiver mirrors itself in ethical caring acts and as artful caring in an ethical context and (3) caring culture is assumed to be a more ontological or universal concept than, for example, an ethical context or ethical person-to-person acts. Research design: The methodological approach is hermeneutic. The data consist of 28 interviews with relatives of older persons from Norway, Denmark and Sweden. Ethical considerations: The principles of voluntariness, confidentiality and anonymity were respected during the whole research process. Findings: Three patterns were revealed: dignity as at-home-ness, dignity as the little extra and non-dignifying ethical context. Discussion: Caring communion, invitation, at-home-ness and ‘the little extra’ are expressions of ethical contexts and caring acts in a caring culture. A non-caring culture may not consider the dignity of its residents and may be represented by routinizedcare that values organizational efficiency and instrumentalism rather than an individual’s dignity and self-worth. Conclusion: An ethos must be integrated in both the organization and in the individual caregiver in order to be expressed in caring acts and in an ethical context that supports these caring acts. (shrink)

Direct download(4 more)   Export citation   Bookmark   10 citations  

Background: In research on co-creation in nursing, a caring manner can be used to create opportunities whereby the patient’s quality of life can be increased in palliativehomecare. This can be described as an ethical cornerstone and the goal of palliativecare. To promote quality of life, nurses must be sensitive to patients’ and their relatives’ needs incare encounters. Co-creation can be defined as the joint creation of vital goals for patients through the process (...) of shared knowledge between nurses, patients and their relatives. Aim: The aim of this study was to explore nurses’ experiences of caring encounters and co-creation in palliativehomecare from an ethical perspective. Research design, participants, and research context: A hermeneutical approach was used. The material consisted of texts from interviews with 12 nurses in ahomecare context. The method was inspired by thematic analysis. Ethical considerations: Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Findings: An overall theme, a main theme and four sub-themes emerged. Through ethical sensitivity and perceptivity, nurses can balance their actions in the moment and change their nursingcare actions according to the patient’s wishes through co-creation in encounters. Here the time is crucial, as the time needed is unique to each patient. Discussion: The themes together can be considered prerequisites for good palliativehomecare. If nurses fail to be sensitive and perceptive in encounters with dying patients, good palliativehomecare cannot be achieved. Ethical sensitivity and perceptiveness can also be considered a part of nurses’ ethical competence. Conclusion: Patients’ dignity can be preserved through ethical sensitivity and perceptiveness, which is fundamental for good palliativecare. Co-creation from patients’ perspectives should be the focus of future research. (shrink)

Direct download(3 more)   Export citation   Bookmark   5 citations  

Technology and its interfaces with nursingcare, patients and carers, and thehome are many and varied. To date, healthcare services research has generally focussed on pragmatic issues such access to and the optimization of technology, while philosophical inquiry has tended to focus on the ethics of how technology makes thehome more hospital like. However, the ethical implications of the ways in which technology shapes the subjectivities of patients and carers have not been explored. In order (...) to explore this, poststructural theory, in particular the work of Butler, Foucault, and Deleuze, is used to theorize the relationship between subjectivity and materiality as ethically mandated on producing rather than precluding the development of subjectivities in novel ways. This theoretical understanding is then utilized through a process of ‘plugged in’ as described by Jackson and Massie that aims to link empirical data, research, and philosophical inquiry. Through this process, it is suggested that power, which the empirical data demonstrate, is frequently exercised through medical discourses and restricts patients' and carers' ability to shape the material environment of thehome as a place to live and be cared for in palliative stages of illness. Alternative discourses are suggested both from the empirical data as well as other research, which may offer patients and carers the possibility of reclaiming power over thehome and their subjectivities. Finally, the dichotomy between thehome and hospital, mediated via technology, is posited as being problematic. It is argued the dichotomy is false and should be moved away from in order to allow an ethical embrace of technology in palliativecare. (shrink)

Direct download(6 more)   Export citation   Bookmark   3 citations  

Direct download(2 more)   Export citation   Bookmark   1 citation  

Foucault's preoccupation with the visual, specifically his positing of a sort of ‘positive unconscious of vision’, offers an entry point for examining data generated through a field study ofhome‐care case management practice. In Foucault's work, our attention is directed not so much to what is seen but to what can be seen and to the effects of practices of knowledge and power in constituting these particular realities. Knowledge emerges as a matter of what it is possible for (...) knowers, for nurses, to see and to say, as well as the conditions that constitute these specific possibilities for seeing and saying in a given context. Given the significance of practices of seeing in case management – seeing clients, seeing situations – examining how possibilities for understanding are constituted through ways of seeing helps us to ‘see’ the limits of currently possible practice. In the case examined in this paper, these limits constitute a gap between what a client may actually need and what it is possible, in the context of current practice, to provide. To change practice it seems important, if only as a first step, to recognize the constraints of thought in what we see. (shrink)

Direct download(2 more)   Export citation   Bookmark   6 citations  

This study aimed to identify the ethical issues faced byhomecare physicians and nurses, and the support they require. It was conducted in collaboration with the Japanese Association forHomeCare Medicine from November to December 2020. An e-mail was sent to 2785 physicians and 582 nurses who are members of the society, requesting their participation in a web-based survey targeting physicians and nurses with practical experience inhomecare; 152 physicians and 53 (...) nurses responded.Homecare physicians and nurses face ethical issues, some of which are that “the patient’s wishes cannot be reliably understood owing to their impaired decision-making capacity” and “there is disagreement between the patient and their family members over the necessary healthcare.” The respondents sought “experience with, and insight into, healthcare ethics” and “homecare” from people with whom they would consult on ethical issues, but at the time of the actual consultation, those individuals were the main healthcare professionals involved with the patient. In addition, the respondents desired to have “multidisciplinary discussions in the community,” “participation of healthcare ethics experts at meetings,” and “meetings held by healthcare ethics experts” to discuss specific cases. Given these results and the history of healthcare ethics education in Japan—which has been implemented mostly for healthcare providers—we conclude that it is important for academic societies that offer healthcare ethics education to healthcare providers and regional core hospitals with ethics support resources to collaborate to provide ethics consultation services in the community. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark  

Aging populations have become a major concern in the developed world and are expected to require novelcare strategies. Public policies, health-care regimes and technology developers alike stress the need for a more individualizedcare to meet the increased demand forcare services in response to demographic change. Increasingly,care services are offered to individuals with diseases and or disabilities in their homes by means of Personalized Health-Monitoring (PHM) technologies. PHM-basedhomecare is (...) typically portrayed as the key to a cost-effective futurecare that better can accommodate the needs of an aging population and promotecare recipients’ independence. In light of the emerging technology-basedhomecare, this article sets forth to investigate the significance and implications of a strong emphasis on independence in relation to this novelcare form. Notions of independence as used bycare planners,care providers and technology developers are examined in relation to ICT-basedhomecare and the reasonableness of independence as an aim for future health-care is critically discussed. In conclusion, the need for a shift from a strong emphasis on independence to a right to healthy dependence is advocated. (shrink)

Direct download(3 more)   Export citation   Bookmark   4 citations  

Little is known about older persons’ expectancies (or anticipations) about the possible actions ofhome-care professionals, although such data have implications for the ethics ofhomecare andhome-care policies. From a longitudinal study of older women’s experience ofhomecare, findings are reported concerning their expectancies of professionalhome-care providers. A descriptive phenomenological method was used to detail the structure of the experience and its context. Data were analyzed from (...) a series of interviews with 13 women aged 82 to 96 years. Among the five key structures of experience were ‘finding that someone has the job of helping me here’ and ‘determining where the helper’s field lies’. Two subsets within a category of expectancies were differentiated: speculations about helpers’ possible actions and expectancies about outcomes of helpers’ actions. As parameters of relational ethics, clients’ speculations and expectancies are appropriate bases for dialogue about older widows’ relationships withhome-care professionals and the foci ofhome-care policies. (shrink)

Direct download(3 more)   Export citation   Bookmark  

Direct download(3 more)   Export citation   Bookmark   1 citation  

Interpretations of family carer empowerment in much nursing research, and inhome‐care practice and policy, rarely attend explicitly to families’ choice or control about the nature, extent or length of their involvement, or control over the impact on their own health. In this article, structural empowerment is used as an analytic lens to examinehome‐care nurses’ interactions with families in one Western Canadian region. Data were collected from 75 hrs of fieldwork in 59 interactions (18 nurses (...) visiting 16 families) and interviews with 12 nurses and 11 family carers. Generally, nurses prioritized client empowerment, and their practice with families appeared oriented to supporting their role and needs as carers (i.e. rather than as unique individuals beyond the caring role), and reinforcing the caring role through validation and recognition. Although families generally expressed appreciation for these interactions, a structural empowerment lens illustrates how the broad context ofhomecare shapes the interpretation and practice of empowerment in ways that can, paradoxically, be disempowering for families. Opportunities to effectively support family choice and control when a client is being cared for athome are discussed. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark  

Direct download(2 more)   Export citation   Bookmark   2 citations  

This article examines the involvement of residents and their relatives in end-of-life decisions andcare in Norwegian nursing homes. It also explores challenges in these staff—family relationships. The article is based on a nationwide survey examining Norwegian nursing homes’ end-of-lifecare at ward level. Only a minority of the participant Norwegian nursinghome wards ‘usually’ explore residents’ preferences forcare and treatment at the end of their life, and few have written procedures on the involvement of (...) family caregivers when their relative is in the terminal phase. According to the respondents, most staff seem to comfort relatives well. However, several challenges were described. The study revealed a need for better procedures in the involvement of residents and relatives in nursinghome end-of-lifecare. The findings emphasize a need to strengthen both the involvement of nursinghome physicians and staff communication skills. (shrink)

Direct download(2 more)   Export citation   Bookmark   8 citations  

The ethical dimension ofcare work is less explored in Chinese long-termcare (LTC) settings. This paper accentuatescare ethics embodied by directcare workers (DCWs) from an ethnographic study ofcare at Sunlight NursingHome in central China. I include the notion of xiao (filial piety) to construecare ethics by engaging both feminist and intersectional approaches. Empirical findings highlight the narrative of mei banfa (‘there is nothing you can do about it’) (...) in revealing the complexity of caregiving in a commercialised environment where both physical and emotionalcare intertwine. Mei banfa compels DCWs to invoke their agency incare practice despite inadequate support from the nursinghome and negative social portrayals ofcare work. It is a cognitive coping strategy of DCWs to harness their energy in upholdingcare ethics for both the elderly residents and their own family members. Such commitment is unlikely to be sustained if structural barriers continue to impede the recognition ofcare labour as part of social production. Arguably, an ethically informed approach to both policymaking andcare practice gives voice to human interdependency incare work and affords ways to reimagine a caring future. (shrink)

Direct download(2 more)   Export citation   Bookmark  

The performance ofhomecare globally is significantly impacted by the political reforms in the public and private sectors. This research investigated the Australian contexts ofhomecare quality and the use of “brokerage” during times of change. The research utilised a qualitative post‐structural approach to gather data abouthomecare service provision through conducting semi‐structured interviews of 10 Australianhomecare business leaders. What emerged in the discourse was how central to (...) everyday practices was the need for business leaders to network and ‘dance a political tango’ to ensure quality in service provision. Illuminated was how the leaders pushed back against governmental and economic structures by using models of brokerage to compensate for economic and staffing deficiencies. This is essential for the ongoing improvement and performance ofhomecare in the Australian social arena of caring for our most vulnerable consumers. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark  

Direct download   Export citation   Bookmark   2 citations  

Direct download   Export citation   Bookmark  

Choice overhomecare has become an important pillar in the provision of publicly financed long-termcare for people of all ages. In many European welfare states, cash-for-care schemes givecare recipients greater choice overhomecare arrangements by allowing them to pay forcare provided by acquaintances, friends and even family members. Paying for such informalcare, however, is increasingly contested due to growingcare needs, rising costs and the (...) perceived need to tighten access to publicly fundedcare. Citizens in paidcare-giving roles are thus pressured to continue theircare unpaid or re-divide theircare-giving responsibilities with lay ?citizen-carers?. On the basis of a Dutch case study, this article examines how paid familycare-givers experience this call for greater self-sufficiency in providingcare. An analysis of 25 interviews and 21 letters of complaint revealed thatcare-givers felt trapped between their desire to derive social status from paid work and their inability to reject or re-divide previously paidcare responsibilities. In a society where all citizens are expected to work,care-givers feel that their previously paidcare-giving is devalued from a public to a private matter, despite the government's attempts to reframecare as an act of good citizenship. (shrink)

Direct download(3 more)   Export citation   Bookmark   1 citation  

Background With an increasing older population, the pressure onhomecare resources is growing, which makes it important to ensure the maintenance of qualitycare. It is known that compassion and ethical sensitivity can improve the quality ofcare, but little is known aboutcare leaders’ perceptions on ethical sensitivity and compassion inhomecare and how it is associated with staff competence and thus quality ofcare. Aim The aim of the (...) study was to explorehomecare leaders’ perceptions of ethical sensitivity and compassion associated withcare quality inhomecare. Research design, participants, and research context A hermeneutical approach with a qualitative explorative design was used. The data consists of texts from 10 in-depth interviews withhomecare leaders. Content analysis was used as a method. Ethical considerations The study was conducted following the ethical guidelines of the Declaration of Helsinki and the Finnish Advisory Board of Research Ethics. Research ethics permission was applied for from a Research Ethics Board. Findings One overall theme and four subthemes were found. The overall theme was: “Compassion provides deeper meaning and ethical sensitivity provides means for knowing how to act”. Discussion If nurses fail to be sensitive and compassionate with patients, good and high qualitativehomecare cannot be achieved. Ethical sensitivity and compassion can be seen as resources inhomecare but the organization and thecare leaders need to provide the support for these to develop. Conclusion This study provides an understanding of the meaning of ethical sensitivity and compassion as sources of strength and their link to quality ofcare in ahomecare context. Further studies could focus on how to build compassion and ethical sensitivity intohome-basedcare and how to ensure adequate support for healthcare professionals’ compassion and ethical sensitivity. (shrink)

Direct download(3 more)   Export citation   Bookmark  

The aim of this study was to explore patients’ experiences of using the Integrated Palliativecare Outcome Scale (IPOS) during specialized palliativehomecare. The study adopted a qualitative approach with an interpretive descriptive design. Interviews were performed with 10 patients, of whom a majority were diagnosed with incurable cancer. Our findings suggest that the use of IPOS as a basis for conversation promotes safecare by making the patients feel confident that thecare provided (...) was adapted to them which gives them a sense of safety. IPOS facilitated discussions between patients and nurses aboutcare needs. The patients believed that using IPOS enabled reflection on their well‐being and life situation. In conclusion, the study finds that using IPOS is beneficial and provide ways to enable person‐centeredcare and with advantage could be used in specialized palliativehomecare. The results may help overcome barriers and facilitate the use of patient‐reported outcome measures (PROMs). To enable the use of PROMs such as IPOS in palliativehomecare, nurses need education and opportunities to develop routines that enable patients’ voice to be heard and thereby compose a basis forcare. (shrink)

No categories

Direct download(2 more)   Export citation   Bookmark  

Communitycare for frail elderly people rests heavily on the work of low-status, paraprofessionalhomecare workers.Homecare workers describe their work as highly personalized caring labor that often seeps out of its formal boundaries into informal, unpaid activities. Although these activities are valued by workers, their supervisors, elderly clients, and family members, they represent uncompensated and exploited labor. Cost-cutting trends inhomecare management that seek to depersonalizehomecare (...) labor are likely to increase its exploitative potential for paidcare workers and, simultaneously, to disadvantage and jeopardize elderlyhomecare clients and their unpaid family caregivers. (shrink)

No categories

Direct download   Export citation   Bookmark   3 citations  

Background Concepts of health have been widely discussed in the philosophy and ethics of medicine. Parallel to these theoretical debates, numerous empirical research projects have focused on subjective concepts of health and shown their significance for individuals and society at various levels. Only a few studies have so far investigated the concepts of health of non-professionals and professionals involved in long-termhomecare and discussed these empirical perspectives regarding moral responsibilities. Objectives To identify the subjective concepts of the (...) health of non-professionals (care recipients, informal caregivers) and professionals (registered nurses) involved in long-termhomecare and to discuss them against the background of existing normative guidelines addressing non-professionals and professionals’ responsibilities and rights concerning health. Research design A qualitative design was chosen to explore subjective concepts of health. Data were collected by semi-structured interviews; content analysis was applied according to Mayring. Participants and research context Twenty-eight interviews were conducted with non-professionals and professionals in long-termhomecare arrangements in Northern Germany. Ethical considerations Ethics approval was obtained from the Institutional Review Board at the University Medicine Greifswald (BB123/16). Findings Non-professionals and professionals consider health as a capability that enables them to participate in social activities and live their own lives according to their preferences. The former regard health particularly as a feeling and an attitude, the latter as the absence of disease with a focus on mental and emotional well-being. Both groups highlight the unsurpassable value of health and the personal responsibility for it. Discussion Normative guidelines applicable to practice in long-termhomecare discuss responsibilities and rights unevenly and raise several problems regarding non-professionals and professionals’ subjective concepts of health. Conclusion Individuals’ concepts of health are relevant for the subsequent interpretation of rights and responsibilities and should, thus, be reflected upon to address health-related needs effectively. (shrink)

Direct download(2 more)   Export citation   Bookmark   5 citations  

BackgroundIn PalliativeCare, family and close people are an essential part of provision ofcare. They assume highly complex tasks for which they are not prepared, with considerable physical, psychological, social and economic impact. Informal Caregivers often falter in the final stage of life and develop distress, enhancing emotional burden and complicated grief. The lack of available and accessible in-person counselling resources is often reported by ICs. Online resources can promote early access to help and support for patient-IC (...) dyads in palliativecare. The primary aim of this research is to co-design, develop and test the feasibility of the Help2Care-PAL mHealth app that addresses the needs of ICs of palliative patients cared for athome. This Digital Health Intervention in palliativecare will be used for education, symptom management, communication and decision-making, to enhance Quality of Life of patients and ICs, fostering anticipatory grief and the reach and efficiency of services.MethodsThis study will use an iterative co-design process and convergent mixed-methods design, following the MORECare consensus for developing a complex intervention. Construction of the DHI will follow four main phases: a needs assessment ; design and co-production of mHealth materials and interventions to support ICs; the development of a mHealth app; and usability and feasibility of the mHealth app. The Help2Care-PAL platform seeks to build resources from the perspectives and needs of both family dyads and nursing professionals working in the field of community palliativecare. User-centeredness will be ensured by the active participation of patient-IC dyads and professionals of the palliativecare community.DiscussionThis mixed-method study will offer new insights on needs and expectations of patient-IC dyads and nurses in community palliativecare regarding caregiving preparedness and online health resources. Through the implementation of an adaptive digital tool, we aim to improve access to palliativecare family support, which is highly linked with the wellbeing of patients and especially new ICs. (shrink)

Direct download(2 more)   Export citation   Bookmark