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Background: Based on existing confusion and a suggested contradiction regarding empathy and compassion in relation to caring science as well as in clinical health care. Aim: The aim of the study was to find a knowledge base for the development of clinical caring science for, empathy, sympathy altruism, and compassion and their mutual relationship. Design: A theoretical paper. Results: The text discusses the different concepts separately, considering their history, research, obstacles, and bias and then brings them together in a concept model. The conclusion shows that empathy, sympathy, and altruism have no contradictions. Instead, they together form an evident triad based on compassion. Compassion is a prerequisite and a basis for the others to work. In clinical application, empathy is metaphorically a quality coming from the head, sympathy from the heart and altruism from the hand, merged in an attitude of compassion as a motif to care. The paper also reflects on the possibilities to increase and develop a compassionate mood and capacity by education and training. [ABSTRACT FROM AUTHOR]

As a follow-up to a recent study which highlighted the existence of medical dominance in multi-disciplinary team (MDT) meetings, this paper presents research findings from an Australian study which shows that medico-centrism is a key cause of tension within MDTs. The findings are from a 1-year qualitative study in a regional hospital that explored the ethical decision-making of health professionals within an acute care medical unit. This exploration was conducted through an iterative, phenomenological, qualitative research methodology that consisted of open-ended interviews with a multi-disciplinary representation of health professionals and a sample of consumers for whom they care. The paper situates the notion of nursing advocacy within the context of medico-centrism and examines how the nursing profession interfaces with other disciplines. The findings indicate that the professional framework of nursing includes the language of advocacy, whilst the framework of doctors centres around the medical decision-making process. All professional groups made reference to the MDT as the modus operandi for patient-centred care. All participants noted that time and familiarity with patients and their families is essential for patient-centred care and this could be achieved through MDT collaboration. However, doctors who have scant time to spend with patients saw it as their responsibility to direct the decisions of the MDT and viewed the MDT as adding confusion to the decision-making process. Nurses reported that the limited amount of time spent by doctors in patient consultation translated into the need for advocacy. Professional and clinical confidence and experience are noted as necessary to successfully engage in the process of advocacy. The findings of this article indicate that the adoption of an advocacy role by nurses represents an important means through which MDT operation can be enhanced, medico-centrism limited and patient-centred care improved. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 203-211 Diabetes and end of life: ethical and methodological issues in gathering evidence to guide care Introduction: Providing palliative care for people with diabetes at the end of life is part of the chronic disease care trajectory, but end of life care is complex and the presence of diabetes further complicates management. Aim: The aim of the paper is to discuss the ethical and methodological issues encountered when undertaking research to develop guidelines for managing diabetes at the end of life and the strategies used to address the issues. Method: The issues emerged as we developed guidelines for managing diabetes at the end of life, which included conducting individual interviews with 14 people with diabetes requiring palliative care and 10 family members. A reflexive researcher journal was maintained throughout the guideline development process. The interview transcripts and researcher's journal were analysed to determine key methodological, ethical and researcher-related issues. Findings: Key themes were vulnerability of the sampling population, methodological issues included recruiting participants and ensuring rigor, ethical issues concerned benefit and risk, justice, autonomy, privacy, professional boundaries and informed consent. Researcher-related issues were identified such as managing participant distress and their own emotional distress. People were willing to discuss end of life diabetes management preferences. Conclusions: Undertaking research with people at the end of life is complex because of their vulnerability and the ethical issues involved. However, the ethical principles of autonomy and justice apply and people should be given the relevant information and opportunity to decide whether to participate or not. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2010; 24; 38-45 The objectives of this article are to present a measurement instrument for virtues, and to examine the link between virtues and health. The instrument was tested by the occupational health care at a large Finnish pulp and paper manufacturer and was shown to be consistent, valid and reliable. In developing the scale, we had two samples of employees and used factor analysis and partial least squares modelling (PLS) on both samples. Factor analysis showed that pride is the most important virtue, followed by love and generosity. In the PLS analysis, we found virtues to significantly reduce the number of sick days. In addition, we found significant relationships between virtues and fatigue, depression and happiness. Virtuous behaviour decreased sick leave and depression. The virtues had a positive influence on happiness and on improvement in one's health. The results show that by taking into account virtues in working life, companies can significantly improve their employees' well-being. The measurement instrument helps broaden the traditional view on health and is meant to be used by health care professionals in their daily practice. By addressing a person's physical, mental and virtual well-being, health care practitioners can take care of employees on a broader level than before. [ABSTRACT FROM AUTHOR]

Patients’ experience of going through the diagnostic phase in hospital is apt to be overlooked by nurses and physicians; most of their inner preparative work for receiving the diagnosis is hidden because of the vulnerability of the situation. This paper discusses findings from a grounded theory study, of 18 in-depth interviews of 15 patients going through medical investigation at a gastric ward in a Norwegian university hospital. The interviews were conducted in 2002–2003. The generated ‘Preparative Waiting Theory’, which accounts for how patients in the diagnostic phase work to prepare themselves for receiving a diagnosis, is discussed in relation to the Danish theologian and philosopher Løgstrup’s writings about the ethical demand and life utterances of trust, openness and the untouchable zone. The ethical demand from patients going through medical investigations is silent and radical, and thus challenging for nurses and physicians to judge how to best fulfil. Examples from the interviews are used to illustrate patients’ vulnerability as they prepare to face the conclusion about their case. To the extent trust develops between patients and nurses/physicians, patients can reveal what is at stake in their lives without feeling exposed or embarrassed. Because of the power nurses and physicians have in the healthcare system, and because of laws, morals and conventions guiding practice, we have a professional responsibility to develop a culture that fosters the ability and willingness to take care of our patients. [ABSTRACT FROM AUTHOR]

The intertwining ideas of self-determination and well-being have received tremendous support in western bioethics. They have been used to reject medical paternalism and to justify patients’ rights to give informed consent (or refusal) and execute advanced directives. It is frequently argued that everyone is thoroughly unique, and as patients are most knowledgeable of and invested in their own interests, they should be the ones to make voluntary decisions regarding their care. Two results of the strong focus on autonomy are the rejection of the image of patients as passive care recipients and the suspicion against paternalistic influence anyone may have on patients’ decision-making process. Although the initial focus in western bioethics was on minimizing professional coercion, there has been a steady concern of family’s involvement in adult patients’ medical decision-making. Many worry that family members may have divergent values and priorities from those of the patients, such that their involvement could counter patients’ autonomy. Those who are heavily involved in competent patients’ decision-making are often met with suspicion. Patients who defer to their families are sometimes presumed to be acting out of undue pressure. This essay argues for a re-examination of the notions of autonomy and undue pressure in the contexts of patienthood and relational identity. In particular, it examines the characteristics of families and their role in adult patients’ decision-making. Building on the feminist conception of the relational self and examining the context of contemporary institutional medicine, this paper argues that family involvement and consideration of family interests can be integral in promoting patients’ overall agency. It argues that, in the absence of abuse and neglect, respect for autonomy and agency requires clinicians to abide by patients’ expressed wishes. [ABSTRACT FROM AUTHOR]

Empirical realities and technological advances in the clinical practice context continuously call for ethical dialogue among healthcare providers. The nurse’s voice of advocacy for humane caring grounded in an existential understanding of the complexities of the health experience remains a salient responsibility of moral agency. If nurses are to care for families, as society requires, then nurse caring, a phenomenon currently defined and understood primarily at the individual patient–nurse level, must be diligently and broadly explored in terms of its worth to guide nursing service with families. The purpose of this theoretical paper is to explore a conceptualization of care with families in the health experience that emanates from the philosophical tenets of existentialism and underpinnings of symbolic interactionism and is interpreted into action by the ethics of care. Current and classic literature, inclusive of philosophical and empirical works, provide the background for analysis of the following elements: existential caring orientation, family perspective, family–nurse interaction, construction of meaning, family meaning construction, nurse meaning construction, family–nurse co-construction of meaning and existential advocacy. Existential philosophy is understood as the basic underlying lens guiding the nurse in taking an existential caring orientation as depicted in the resultant conceptualization. Caring in the family health experience is best facilitated by a relational stance where the nurse acknowledges the family’s unique perspective. Through the family–nurse interaction the nurse gains understanding of the family’s perspective being constructed. Nursing practice with families confronting the empirical realities and technological advances of the new millennium will be enriched when moral agency includes ethical dialogue among healthcare providers and families. Existential advocacy with and for families grounded in the nurse’s understanding of the family perspective enhances the context for moral agency. [ABSTRACT FROM AUTHOR]

The ethical approach of artificial administration of food and fluids has been much enlivened in recent years. Nevertheless, the ethical implications of the day-to-day event of serving meals in nursing homes remain to be clarified. This paper has a double aim. First, I present a philosophical-ethical clarification of mealtime care in nursing homes. Second, I suggest several ethical orientations related to the nutritional problem among nursing home residents. I argue that caregivers must not only have considerable knowledge and skill in nutritional matters; it is only by integrating as much as possible an attitude of caring with the competent performance of care activities that 'good mealtime care' can be achieved. [ABSTRACT FROM AUTHOR]