Philosophy Of Care Research Articles

Parental viewpoints and experiences of therapeutic hypothermia in a neonatal intensive care unit implemented with Family‐Centred Care

To explore parental experiences of therapeutic hypothermia (TH) in their newborn infant suffering from hypoxic ischaemic encephalopathy following perinatal asphyxia. Since more than a decade, newborn infants are treated with TH following perinatal asphyxia to reduce mortality and disabilities and to improve neurological outcome. The infants' body temperature is lowered to 33.5°C for 72hr, and the infant is usually cared for in an open incubator. The parents are not able to hold their infant skin to skin, which risks causing emotional reactions in parents and a loss of normal parent-infant bonding. A qualitative descriptive design using semi-structured interviews. Up to 7months after the event, interviews were conducted with 14 parents of seven infants who had received TH in a neonatal intensive care unit (NICU) in Sweden. The interviews were transcribed and analysed using framework approach. Findings were reported following the Standard for Reporting Qualitative Research (SRQR) checklist. From the interviews, an overall theme was found: Transition through a life-altering time, and three categories: (a) trepidation about prognosis, (b) transitioning into parenthood supported by the caring philosophy of family-centred care (FCC) and (c) rewarming as a milestone. Parental experiences of TH are based on the immediate emotions and stress of uncertainty of the infant's prognosis. The values of FCC in the NICU append a natural transitioning into parenthood by parental involvement in nursing care and decisions. The rewarming of the infant is seen as a restart to more or less normal circumstances from the critical period of delivery and TH. The management of NICUs should update the awareness of and deepen knowledge about FCC. The emphasis ought to be on adequate information about TH and the values of FCC to parents in the NICU context.

One-week multidisciplinary post-graduate palliative care training: an outcome-based program evaluation

BackgroundA multi-professional, post-graduate, one-week palliative care training program was piloted in November 2019 at the University of Ivano-Frankivsk, Ukraine. A formal evaluation of this program was performed.MethodsThis is a comparative, retrospective outcome-based evaluation of an educational intervention. Participants completed evaluation forms at the end of the course (post-intervention = T1), covering demographics, comparative retrospective self-assessment (40 items, 6-point Likert scale), organizational aspects, and general feedback (free text). At T1, the responses represent actual self-assessment, pre-interventional (T0) scores were generated by retrospective self-assessment. The Retrospective Performance Gain (RPG) was calculated on group level for the comparative self-assessment, demographic and organizational variables were analyzed by descriptive statistics, and free text answers were processed by qualitative methodology (content analysis).ResultsFifty-three of 56 attendants from all professions relevant to palliative care completed the evaluation forms (response 94,6%), with mean age 39y (22–64) and mean working experience 13,6y (1–44). Overall ratings of the program were very positive. Comparative retrospective self-assessment demonstrated a marked RPG from T0 to T1 on all items. Free text comments emphasized the need for regular nation-wide educational programs and for further education in bereavement care; inter-professional practice; communication; palliative care philosophy; professional self-care; specific nursing skills; dementia care; and advocacy, while the general contribution of the program to palliative care development in Ukraine was acknowledged.ConclusionsSystematic evaluation of a post-graduate international training program in palliative care may provide a mutual learning experience and map country-specific barriers and facilitators that have to be addressed when setting up palliative care services.

Towards a Theory of Posthuman Care: Real Humans and Caring Robots

This essay interrogates the common assumption that good care is necessarily human care. It looks to disruptive fictional representations of robot care to assist its development of a theory of posthuman care that jettisons the implied anthropocentrism of ethics of care philosophy but retains care’s foregrounding of entanglement, embodiment and obligation. The essay reads speculative representations of robot care, particularly the Swedish television programme Äkta människor ( Real Humans), alongside ethics of care philosophy and critical posthumanism to highlight their synergetic critiques of neoliberal affective economies and humanist hierarchies that treat some bodies and affects as more real than others. These texts and discourses assist me in proposing a theory of care that regards vulnerability as the normative effect of posthuman vital embodiment, as opposed to an anomalous state that can be overcome or corrected via neoliberal practice.

Nurses' early and ongoing encounters with the dying and the dead: a scoping review of the international literature.

End-of-life care is high on policy and political agendas in the UK and internationally. Nurses are at the forefront of this, caring for dying patients, 'managing' the dead body, and dealing with the corporeal, emotional and relational dimensions of death. Little is known about nurses' prior or early professional experiences of and reactions to death, dying and the corpse and how these might influence practice. To appraise the international literature on nurses' early experiences of death, dying and the dead body, to better understand how these might influence subsequent practice, and how this might inform our teaching of death, dying and last offices. A scoping review was undertaken of peer-reviewed publications between, 2000 and 2019, which included nurses working in hospital, care homes and the community. Medline, PubMed, PsychINFO and CINAHL databases were searched and 23 papers meeting the inclusion criteria were read. Arksey and O'Malley's (2005) five-stage approach was adopted to scope the relevant international literature, using where relevant the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Selected papers were independently reviewed and subjected to thematic analysis, leading to the generation of five overarching themes. The five themes were: different philosophies of care; relationships; knowledge; impact of death; and giving care. The studies came from diverse geographical locations across different settings and were primarily qualitative in design. Students and registered nurses are impacted both positively and negatively by their early encounters with death and dying. Good communication with patients, families and between professionals, understanding of what constitutes a 'good' death, and high-quality mentorship and support were of particular importance.

Self-care as an ethical obligation for nurses.

As members of the largest and most trusted healthcare profession, nurses are role models and critical partners in the ongoing quest for the health of their patients. Findings from the American Nurses Association Health Risk Appraisal suggested that nurses give the best patient care when they are operating at the peak of their own wellness. They also revealed that 68% of the surveyed nurses place their patients' health, safety, and wellness before their own. Globally, several nursing codes of ethics include the requirement of self-care. Often, these codes embed the responsibility to protect and promote one's own health within the clearly described obligation to provide safe patient care. The American Nurses Association Code of Ethics for Nurses is unique in that it states explicitly that nurses must adopt self-care as a duty to self in addition to their duty to provide care to patients. One of the basic assumptions of Watson's Philosophy and Science of Caring is that caring science is the essence of nursing and the foundational disciplinary core of the profession. Watson's theory of human caring provides support for the engagement in self-care. Two important value assumptions of Watson's Caritas are that "we have to learn how to offer caring, love, forgiveness, compassion, and mercy to ourselves before we can offer authentic caring and love to others" and we also must "treat ourselves with loving-kindness and equanimity, gentleness, and dignity before we can accept, respect, and care for others within a professional caring-healing model." Embedded within several caritas processes is an outline for a holistic approach to caring for self and others that can guide nurses to improve their mental, physical, emotional, and spiritual health.

Development of palliative care services in Turkey.

Palliative care (PC) is a holistic philosophy of care that can only be obtained through the awareness of public and healthcare professionals, PC training and good integration into the health system. Depending on health system structures, there are differences in PC models and organisations in various countries. This study is designed to evaluate the current status of PC services in Turkey, which is strongly supported by national health policies. The data were collected through official correspondence with the Ministry of Health, Provincial Directorate of Health and hospital authorities. Numbers of patients who received inpatient PC, the number of hospital beds, diagnosis of disease, duration of hospitalisation, the first three symptoms as the cause of hospitalisation, opioid use, place of discharge and mortality rates were evaluated. A total of 48,953 patients received inpatient PC support in 199 PC centres with 2,429 beds over a 26-month period. The most frequent diagnosis for hospitalisation was cancer (35%), and the most common symptom was pain (25%). Opioids were used in 26.7% of patients. Steps should be taken for PC training and providing continuity through organisations outside the hospital and home care.

Morinian Complexity and the Nursing Curriculum.

This scientific essay argues about the relevance of including Edgar Morin's complex thinking in the Nursing curriculum development. The curriculum determines the professional profile of Nursing teachers and future nurses, comprising the cognitive, moral, clinical, affective, research and trade union competencies necessary for professional survival. Complexity allows us to build new creative and critical curricula, with multidisciplinary thinking, connecting fragmented knowledge, defending one's own cultural identity, based on the Philosophy of care, and responding, in parallel, to the challenges of a politically imposed globalization, which is elective. The design of curricula that respond to the demands of the 21st century requires competent curriculum engineering able to triangulate Nursing, Education and Philosophy, given that citizens are been trained and not only specialized workers. The sciences of complexity humanize and complement the Cartesian and positivist scientific approach, influenced by the patriarchal paradigm. The curriculum changes its structure by including complex thinking references.

Social media activity is associated with higher physician ratings by patients

Social media activity is associated with higher physician ratings by patients

Covid-19 Special Report: What About the Future? Holding on to Our Philosophy of Care

In this article, Bunty explores why it is important to continue to advocate for our midwifery philosophy of evidence-based care through and beyond the Covid-19 pandemic. Students can be advocates for change by remembering the importance of evidence-based practice, remaining true to their ethos and being the future of midwifery.

Components of a community model of dementia palliative care

PurposeThe Model for Dementia Palliative Care Project will develop a service-delivery model for community-based dementia palliative care. Many countries provide dementia palliative care services, albeit with considerable variability within these. However, little is known about what service providers consider to be the most important components of a dementia palliative care model. This study aimed to address this knowledge gap.Design/methodology/approachAn exploratory design using a survey method was used as an initial phase of the wider project. A web-based survey was developed, piloted (n = 5), revised, and distributed within five healthcare jurisdictions: the Republic of Ireland, Northern Ireland, England, Scotland, and Wales. The target population was health and social care professionals, policymakers, and academics interested in dementia and palliative care. Content analysis of open-ended questions identified common themes; descriptive statistics were applied to the closed-ended questions.FindingsOverall, N = 112 complete surveys were received. Key care principles incorporated the philosophies of palliative care and dementia care; many described “holistic” and “person-centred care” as the core. Important individual service components were the support for carers, advanced care planning, information, education and training, activities for “meaningful living”, comprehensive disease management, coordinated case management, and linking with community health services and social activities. Barriers included poor availability and organisation of healthcare services, stigma, misconceptions around dementia prognosis, insufficiently advanced care planning, and dementia-related challenges to care. Facilitators included education, carer support, and therapeutic relationships.Originality/valueThis study, as part of the larger project, will directly inform the development of a novel service delivery Model of Dementia Palliative Care for Ireland. The results can also inform service planning and design in other countries.

Knowledge and Myths about Palliative Care among the General Public and Health Care Professionals in Portugal.

Background: International research has shown that healthcare professionals (HCPs) and nonhealthcare professionals (NHCPs) are unaware of the goals and purposes of palliative care. This study evaluates the knowledge of palliative care among a sample of Portuguese adults and correlates their level of knowledge with age, gender, profession, and experience of family member’s palliative care. Method: A cross-sectional online survey was carried out on a sample of 152 HCPs and 440 NHCPs who completed an anonymous questionnaire of sociodemographic, family, and professional data, and an instrument of 26 dichotomous (true or false) questions focusing on palliative care goals and purposes. Results: The 592 participants had a mean age of 31.3 ± 11.1 years, and most were female. Statistically significant differences between statements considered as correct by HCPs and NHCPs were found in 24 statements; HCPs had the highest percentage of correct answers. The terms most frequently associated with palliative care mentioned by NHCPs were chronic and progressive disease (n = 76), while HCPs mostly mentioned quality-of-life promotion (n = 29). Women, the elderly, and HCPs had a higher level of knowledge regarding palliative care (p < 0.001). Conclusions: Results clearly show gaps in knowledge of palliative care, especially among NHCPs. An integrated approach is needed to inform and clarify the philosophy and goals of palliative care in different settings in order to improve knowledge.

Applying a ‘digital ethics of care’ philosophy to understand adolescents’ sense of responsibility on social media

ABSTRACT Through empirical work we conceptualise a framework of an ethics of care philosophy with digital media, coining the notion, a ‘digital ethics of care’. Increasing focus on the potential of social media to harm the mental wellbeing of adolescents has led to greater emphasis on their conduct online. Entrenched with adolescent conduct in digital spaces are moral theories of development as young people grapple with responsibility toward others from behind screens. Utilising thematic analysis on focus group data from 11–18-year-olds we applied a digital ethics of care understanding. We identified that adolescents found social media to play an important role in facilitating their caring relationships, they took responsibility for their own online behaviour and believed that when others failed in their moral reasoning online it led to negative consequences. Repositioning moral theory for congruence with a new digital society has valuable potential for the protection of adolescent mental health.

Post-incident reviews\u2014a gift to the Ward or just another procedure? Care providers\u2019 experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study

Public guidelines in many western countries recommend post-incident reviews (PIRs) with patients after restraint use in mental health care. PIRs are one of several elements of seclusion and restraint reduction in internationally used programmes. PIRs may improve restraint prevention, patients’ recovery processes and care providers’ ethical mindfulness. The knowledge base on PIRs is, however, vague. This qualitative study explores professional care providers’ experiences and considerations regarding PIRs that included patients after restraint use in a Norwegian context.MethodsWithin a phenomenological hermeneutical framework, 19 multidisciplinary care providers were interviewed about their experiences and views regarding PIRs that included patients after restraint events. The interviews were performed over the period 2015–2016. Data analysis followed a data-driven stepwise approach in line with thematic content analysis. A group of two patient consultants in mental health services, and one patient’s next of kin, contributed with input regarding the interview guide and analysis process.ResultsCare providers experienced PIRs as having the potential to improve the quality of care through a) knowledge of other perspectives and solutions; b) increased ethical and professional awareness; and c) emotional and relational processing. However, the care providers considered that PIRs’ potential could be further exploited as they struggled to get hold on the patients’ voices in the encounter. The care providers considered that issue to be attributable to the patients’ conditions, the care providers’ safety and skills and the characteristics of institutional and cultural conditions.ConclusionHuman care philosophies and a framework of care ethics seem to be preconditions for promoting patients’ active participation in PIRs after restraints. Patients’ voices strengthen PIRs’ potential to improve care and may also contribute to restraint prevention. To minimise the power imbalance in PIRs, patients’ vulnerability, dependency and perceived dignity must be recognised. Patients’ individual needs and preferences should be assessed and mapped when planning PIRs, particularly regarding location, time and preferred participants. Care providers must receive training to strengthen their confidence in conducting PIRs in the best possible way. Patients’ experiences with PIRs should be explored, especially if participation by trusted family members, peers or advocates may support the patients in PIRs.

Caring in community nursing practice: Inductive content analysis reveals an inter-dynamic system between patients and nurses.

To examine the understanding of caring in the practice of community nursing from the perspectives of patients and nurses. An increasing population of patients with chronic disease has produced a need for humanistic caring in communities. As a result, caring has become a core value of community nursing professionals. However, community nurses meet many difficulties in trying to practice person-centred care with their clients. Furthermore, most community nurses-especially in China-lack systematic education and training about caring because the practical meaning of caring in community practice is unknown. The qualitative study described herein employed inductive content analysis. Eleven community patients with chronic disease and fifteen community nurses who were nominated as a caring nurse from different community clinics in Beijing, China, participated in thirty-one interviews during January to August in 2018. Nine documents from the interviewed nurses were collected. Both interview data and documents were analysed using strategies of inductive content analysis. The COREQ checklist was used. Patients and their corresponding nurses described a wide range of caring experiences that were generalised into 28 concepts. Caring emerged as an inter-dynamic system that comprised the foundation and quality of a caring relationship, the caring philosophy and behaviours of interactions, and positive feedback from caring interactions. A relationship-based framework of caring in community nursing practice was constructed. Identifying this systematic concept of caring provides insights that are applicable to the creation of targeted management, education and practice interventions to ultimately enhance the quality of community health care-in China or elsewhere. The systematic understanding of caring in community nursing practice will inform nurses in community health clinics, their educators and their managers on how to provide care to community patients and how to develop caring competence for community nurses.

Time to change to improve health: clinical pharmacy and pharmaceutical care education in Turkey

The practice of clinical pharmacy had a positive impact on the profession by giving pharmacists more job opportunities. Moreover, the pharmacy began to gain the status it deserved, which was lost many years ago. In this paper, we aimed to give a brief explanation of the clinical pharmacy philosophy and definition of pharmaceutical care. What are the general and specific roles of clinical pharmacists in the modern world healthcare system? Also, how to implement clinical pharmacy in education to obtain competent pharmacists. We shared our observation and experience, specifically on the progress of implementation of clinical pharmacy education in Turkey. The stepwise method has been successfully followed in the implementation of clinical pharmacy education in Turkey. In the undergraduate program, the first step taken was the addition of clinical courses, such as the role of clinical pharmacy, patient education, etc. and practical hospital rounds (internal medicine, pediatrics, and surgery). The post-graduate program, such as master (MSc) and doctoral (Ph.D.) degrees, also offered to prepare clinically oriented pharmacy academicians. The continuous education programs were structured to implement clinical pharmacy idea for the pharmacists in practice. In conclusion, the stepwise approach significantly smoothed the transition from the product-oriented to the patient-oriented pharmacy education. Moreover, the adoption of the skills education system to educate pharmacists needs to review the policy regularly and gradually change it accordingly.

State-Community System of Care Development: an Exploratory Longitudinal Review.

The system of care (SOC) philosophy evolved into a framework to support access to effective behavioral health services for children. This study explored the use of the System of Care Implementation Survey (SOCIS) to monitor SOC development during one Midwestern state's federal planning and expansion grants. Utilizing a translational framework, results showed that despite fluctuations in SOC factor implementation over time, state and local SOCs had mid-level development. Further, inferential analysis of select factors indicated that outreach and access to services and the skilled provider network were significantly worse over time. Significant improvement in the treatment quality was documented but not sustained. Changes for Family Choice and Voice and Collaboration were not statistically significant. Variability in survey participation limited the evaluation. Refinement of evaluation methods is needed to monitor progress and to manage SOC development.

Conceptually Redefining Neonatal Palliative Care.

First defined in 2002 by Catlin and Carter, neonatal palliative care (NPC) is a relatively new model of care in neonatal pediatrics, first appearing in the medical literature in the early 1980s. The purpose of this article is to suggest a conceptual definition of NPC that encompasses all the essential concepts as a way of moving NPC forward by having a consistent approach. Following a review of the NPC literature, a thematic analysis as a method for identifying, analyzing, and interpreting patterns of meaning in the definitions ("themes") within the literature was undertaken. The major themes identified included philosophies of care, support, culture and spirituality, the team, and clinical management. At the heart of NPC is the primacy of maintaining quality of life, while providing ethical and humane care that supports a "good death." The extensive elements presented in this article are considered essential to a comprehensive and conceptual definition of NPC proposed here.

Inpatient Unit Leaders' Perspectives on Parent Engagement in Neonatal and Pediatric Intensive Care: A Secondary, Qualitative Analysis.

Hospital unit leaders help set the unit's priorities and are responsible for guiding the unit mission and philosophy of care; however, the perspective of leaders in facilitating parent engagement within intensive care units is limited. The purpose of this study was to explore how medical and nursing unit leaders facilitate parent engagement in intensive care settings. Qualitative secondary analysis of 16 semistructured interviews of unit leadership (medical directors and nurse managers). Directed content analysis explored themes within the interviews using systematic strategies to ensure rigor. Unit leadership described 3 main features of care delivery necessary for supporting parent engagement: (1) culture of care, (2) relationships in care, and (3) environment of care. Communication among providers and parents and timing of decision-making were key areas addressed, along with concerns about physical space limiting parent engagement. Unit leaders discussed how the 3 main features (unit culture, relationships, and physical space) of care delivery were interconnected to optimize parent engagement. Overall, unit leaders recognized the importance of each feature of care delivery in facilitating engagement. Parent engagement is ultimately influenced by the optimization of delivering inclusive care: the physical space, the policies surrounding medical and nursing care, and the overall culture of the unit. Future research needs to explore best practices around relationship building and managing space limitations. Further clarification of the needs and expectations of both parents and providers surrounding parent engagement in intensive care settings is needed.

Cancer Survivorship Care Roles for Primary Care Physicians.

Despite a burgeoning population of cancer survivors and pending shortages of oncology services, clear definitions and systematic approaches for engaging primary care in cancer survivorship are lacking. We sought to understand how primary care clinicians perceive their role in delivering care to cancer survivors. We conducted digitally recorded interviews with 38 clinicians in 14 primary care practices that had national reputations as workforce innovators. Interviews took place during intense case study data collection and explored clinicians' perspectives regarding their role in cancer survivorship care. We analyzed verbatim transcripts using an inductive and iterative immersion-crystallization process. Divergent views exist regarding primary care's role in cancer survivor care with a lack of coherence about the concept of survivorship. A few clinicians believed any follow-up care after acute cancer treatment was oncology's responsibility; however, most felt cancer survivor care was within their purview. Some primary care clinicians considered cancer survivors as a distinct population; others felt cancer survivors were like any other patient with a chronic disease. In further interpretative analysis, we discovered a deeply ingrained philosophy of whole-person care that creates a professional identity dilemma for primary care clinicians when faced with rapidly changing specialized knowledge. This study exposes an emerging identity crisis for primary care that goes beyond cancer survivorship care. Facilitated national conversations might help specialists and primary care develop knowledge translation platforms to support the prioritizing, integrating, and personalizing functions of primary care for patients with highly complicated issues requiring specialized knowledge.

Why re-invent the wheel if you've run out of road?

The COVID-19 disruption to 'business as usual' presents an opportunity for a profound change in oral healthcare experience for our patients and our profession. While the prospect of change has dominated professional dialogue for years, the post-COVID-19 era offers choices with respect to pace, proximity, preparedness, protection and equity. There is potential for a determined revision of the current activity-driven clinical approach, with the adoption of the minimally invasive oral care philosophy into routine practice and use of technology to remotely support our patients. Throughout COVID-19, the whole of the dental profession has demonstrated adaptability in redeployment and compassion in delivering care in a variety of settings. These vital traits and bold clinical leadership, prepared to make timely choices and act fast, will underpin our successful transition towards the safe resumption of routine dental services. In making the right choices, we have at hand a future integrated dental team care model with time to concentrate on personalised prevention advice, as well as the provision of effective, highly skilled treatment.