The voice of the profession: how the ethical demand is professionally refracted in the work of general practitioners

BACKGROUND

Among the myriad voices advocating diverging ideas of what general practice ought to be, none seem to adequately capture its ethical core. There is a paucity of attempts to integrate moral theory with empirical accounts of the embodied moral knowledge of GPs in order to inform a general normative theory of good general practice. In this article, we present an empirically grounded model of the professional morality of GPs, and discuss its implications in relation to ethical theories to see whether it might be sustainable as a general practice ethic.

METHODS

We observed and interviewed sixteen GPs and GP residents working in health care centres in four Swedish regions between 2015-2017. In keeping with Straussian Grounded Theory, sampling was initially purposeful and later theoretically guided, and data generation, analysis and theoretical integration proceeded in parallel. The focal concept of this article was refined through multidimensional property supplementation.

RESULTS

The voice of the profession is one of four concepts in our emerging theory that attempt to capture various motives that affect GPs' everyday moral decisionmaking. It reflects how GPs appreciate the situation by passing three professional-moral judgments: Shall I see what is before me, or take a bird's-eye view? Shall I intervene, or stay my hand? And do I need to speak up, or should I rather shut up? By thus framing the problem, the GP narrows down the range of considerations, allowing them to focus on its morally most pertinent aspects. This process is best understood as a way of heeding Løgstrup's ethical demand. Refracted through the lens of the GP's professional understanding of life, the ethical demand gives rise to specific moral imperatives that may stand in opposition to the express wishes of the other, social norms, or the GP's self-interest.

CONCLUSIONS

The voice of the profession makes sense of how GPs frame problematic situations in moral terms. It is coherent enough to be sustainable as a general practice ethic, and might be helpful in explaining why ethical decisions that GPs intuitively understand as justified, but for which social support is lacking, can nevertheless be legitimate.

Thoughts of creation and the discipline of nursing

AIM

The aim is to highlight thoughts of creation as a significant fundamental of the nursing discipline. This is achieved by exploring thoughts of creation in relation to everyday nursing care.

DESIGN

This study, based on a hermeneutical approach, provides reused data drawn from a larger Norwegian empirical study.

METHOD

A second thematic analysis was conducted. Data in the original study consisted of qualitative interviews and qualitative follow-up interviews with 13 nurses. The research context was the primary and secondary somatic and psychiatric health service, inside as well as outside institutions.

RESULTS

Three themes emerged: (a) Life as greater than a human being; (b) creational powers attributed to the human being; and (c) understanding life as basically good. Thus, thoughts of creation in terms of philosophical underpinnings seem to gain backing from nurses' experiences of everyday nursing care and it can be argued that it adds elements that enrich nursing care.

The `Little Extra' That Alleviates Suffering

Nursing, or caring science, is mainly concerned with developing knowledge of what constitutes ideal, good health care for patients as whole persons, and how to achieve this. The aim of this study was to find clinical empirical indications of good ethical care and to investigate the substance of ideal nursing care in praxis. A hermeneutic method was employed in this clinical study, assuming the theoretical perspective of caritative caring and ethics of the understanding of life. The data consisted of two Socratic dialogues: one with nurses and one with nursing students, and interviews with two former patients. The empirical data are first described from a phenomenological approach. Observations of caregivers offering `the little extra' were taken to confirm that patients were `being seen', not from the perspective of an ideal nursing model, but from that of interaction as a fellow human being. The study provides clinical evidence that, as an ontological response to suffering, 'symbolic acts' such as giving the `little extra' may work to bridge gaps in human interaction. The fact that `little things' have the power to preserve dignity and make patients feel they are valued offers hope. Witnessing benevolent acts also paves the way for both patients and caregivers to increase their understanding of life.

The movement of knowledge and benefit: the product of applied ethics and emotional intelligence to mental health research

This paper seeks to highlight that researchers can generate the potential for benefit to all stakeholders within the research process through maintaining a wide understanding of ethical and emotionally intelligent behaviours. A range of ethical perspectives is examined before introducing a model which highlights key challenges and benefits of undertaking research within mental health contexts. Excerpts from both current and recent projects are then applied to the model. Finally, it is argued that many of the most ethically challenging issues arise outside of the realms and remits of ethics committees, consequently requiring the mental health researcher to possess and develop his or her ethical and emotionally intelligent capabilities.

Navigating in the landscape of care: a critical reflection on theory and practise of care and ethics

The theory and practise of care is defined and enacted differently in different national as well as cultural contexts, illuminating how differently constructed the personal and societal structures in Europe are. A common trait is however that care work paid or non-paid, private or public is identified with women. To navigate in the landscape of care and ethics requires taking into account the constitutive relation between one’s identity, embodiment and position. The author suggests conceiving care as an existential condition of life demanded from all human beings. This will free care from the identification with women and pave a way towards a more gender equal and just society with less gender segregation in the labour market and at the arena of education.

Care for nurses only? Medicine and the perceiving eye

In this paper I introduce a theoretical framework on care developed by the Norwegian nurse and philosopher Kari Martinsen, and I argue that this approach has relevance not only within nursing, but also within clinical medicine. I try to substantiate this claim by analysing some of the key concepts in this approach, and I illustrate the potential clinical relevance of this approach by applying it in relation to two care scenarios. Finally, I discuss some of the concerns that have been raised in relation to the aim of highlighting care in medicine.

Understanding the creative processes of phenomenological research: The life philosophy of Løgstrup

The creative processes of understanding patients' experiences in phenomenological research are difficult to articulate. Drawing on life philosophy as represented by the Danish philosopher K.E. Løgstrup (1905-1981), this article aims to illustrate Løgstrup's thinking as a way to elaborate the creation of cognition and understanding of patients' experiences. We suggest that Løgstrup's thoughts on sensation can add new dimensions to an increased understanding of the creative process of phenomenological research, and that his thinking can be seen as an epistemological ground for these processes. We argue with Løgstrup that sense-based impressions can facilitate an flash of insight, i.e., the spontaneous, intuitive flash of an idea. Løgstrup stresses that an "flash of insight" is an important source in the creation of cognition and understanding. Relating to three empirical phenomenological studies of patients' experiences, we illustrate how the notions of impression and flash of insight can add new dimensions to increased understanding of the creative processes in phenomenological research that have previously not been discussed. We illustrate that sense-based impressions can facilitate creative flash of insights that open for understanding of patients' experiences in the research process as well as in the communication of the findings. The nature of impression and flash of insight and their relevance in the creation of cognition and understanding contributes to the sparse descriptions in the methodological phenomenological research literature of the creative processes of this research. An elaboration of the creative processes in phenomenological research can help researchers to articulate these processes. Thus, Løgstrup's life philosophy has proven to be valuable in adding new dimensions to phenomenological empirical research as well as embracing lived experience.

What matters to the parents? A qualitative study of parents' experiences with life-and-death decisions concerning their premature infants

The aim of this article is to generate knowledge about parents' participation in life-and-death decisions concerning their very premature and/or critically ill infants in hospital neonatal units. The question is: what are parents' attitudes towards their involvement in such decision making? A descriptive study design using in-depth interviews was chosen. During the period 1997-2000, 20 qualitative interviews with 35 parents of 26 children were carried out. Ten of the infants died; 16 were alive at the time of the interview. The comparative method (grounded theory) was used to analyse the data. The analysis was carried out continuously and in parallel with data collection. Six categories were revealed by the analysis: indecision and uncertainty (ambivalence); information and communication; participate, but do not decide; seeming to be included; the parents' child; and individual consideration. The findings appear to indicate that parents agree that they should not have the final word in decisions concerning their infants' future life or death. Such a responsibility would put too heavy a burden on parents who lack the medical knowledge and the professional experience needed to make such a decision, and would be likely to lead to them experiencing strong feelings of guilt. The findings show that parents should be well informed and listened to during the whole decision-making process. Their primary concern was how nurses and physicians communicate with parents who are experiencing a crisis, and how this serious information is presented.