1
|
Kivunja S, Pryor J, River J, Gullick J. Conceptualising personhood in nursing care for people with altered consciousness, cognition and behaviours: A discussion paper. Nurs Philos 2024; 25:e12490. [PMID: 38973126 DOI: 10.1111/nup.12490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/18/2024] [Indexed: 07/09/2024]
Abstract
The aim of this discussion paper is to explore factors and contexts that influence how nurses might conceptualise and assign personhood for people with altered consciousness, cognition and behaviours. While a biomedical framing is founded upon a dichotomy between the body and self, such that the body can be subjected to a medical and objectifying gaze, relational theories of self, multiculturalism and technological advances for life-sustaining interventions present new dilemmas which necessitate discussion about what constitutes personhood. The concept of personhood is dynamic and evolving: where historical constructs of rationality, agency, autonomy and a conscious mind once formed the basis for personhood, these ideas have been challenged to encompass embodied, relational, social and cultural paradigms of selfhood. Themes in this discussion include: the right to personhood, mind-body dualism versus the embodied self; personhood as consciousness, rationality and narratives of self; social relational contexts of personhood and cultural contexts of personhood. Patricia Benner's and Christine Tanner's clinical judgement model is then applied to consider the implications for nursing care that seeks to reflexively incorporate personhood. Nurse clinicians are able to move between conceptions of personhood and act to support the body, as well as presumed autonomy and relational, social and cultural personhood. In doing so, they use analytical, intuitive and narrative reasoning which prioritises autonomous constructions of self. They also incorporate relational and social contexts of the person receiving care within the possibilities of technological advances and constraints of contextual resources.
Collapse
Affiliation(s)
- Stephen Kivunja
- Susan Wakil School of Nursing and Midwifery (Sydney Nursing School), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Neurosurgery, Western Sydney Local Health District, Westmead Hospital, Westmead, New South Wales, Australia
| | - Julie Pryor
- Susan Wakil School of Nursing and Midwifery (Sydney Nursing School), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Research Office, Royal Rehab Group, Milsons Point, New South Wales, Australia
| | - Jo River
- Faculty of Health, University of Technology Sydney, Broadway, Ultimo, New South Wales, Australia
- Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, Ryde, New South Wales, Australia
| | - Janice Gullick
- Susan Wakil School of Nursing and Midwifery (Sydney Nursing School), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Høybye MT, Andersen LM, Boelsbjerg HB. Making It Count - Tracing Signs of Consciousness and Potentiality in Severe Brain Injury in Denmark. Med Anthropol 2024; 43:115-129. [PMID: 38206318 DOI: 10.1080/01459740.2023.2300080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Healthcare professionals use various technologies to evaluate and support patients who have suffered severe brain injuries. They integrate monitoring and sensory assessments into their clinical practice, and these assessments can have an impact on treatment decisions and prognostication. Responses from patients during different interactions are interpreted as "signs of consciousness" when considered contextually relevant. This study is based on anthropological fieldwork conducted in specialized Danish intensive care units, where we explore how signs of consciousness are made to count through practices of enactment. We ethnographically trace how the clinical concept of potential influences the interpretation of signs of consciousness as a complex biosocial practice based on the biomedical assumption that consciousness is a vital indicator of what makes a life. The article provides insights into the potential for recovery as an emergent biosocial practice and contributes to a broader discussion within medical anthropology of the moral landscapes of clinical and experimental borderlands.
Collapse
Affiliation(s)
- Mette Terp Høybye
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Lise Marie Andersen
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Hanne Bess Boelsbjerg
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
3
|
Staquet C, Vanhaudenhuyse A, Kandeepan S, Sanders RD, Ribeiro de Paula D, Brichant JF, Laureys S, Bonhomme V, Soddu A. Changes in Intrinsic Connectivity Networks Topology Across Levels of Dexmedetomidine-Induced Alteration of Consciousness. Anesth Analg 2024:00000539-990000000-00713. [PMID: 38289856 DOI: 10.1213/ane.0000000000006799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Human consciousness is generally thought to emerge from the activity of intrinsic connectivity networks (resting-state networks [RSNs]) of the brain, which have topological characteristics including, among others, graph strength and efficiency. So far, most functional brain imaging studies in anesthetized subjects have compared wakefulness and unresponsiveness, a state considered as corresponding to unconsciousness. Sedation and general anesthesia not only produce unconsciousness but also phenomenological states of preserved mental content and perception of the environment (connected consciousness), and preserved mental content but no perception of the environment (disconnected consciousness). Unresponsiveness may be seen during unconsciousness, but also during disconnectedness. Deep dexmedetomidine sedation is frequently a state of disconnected consciousness. In this study, we were interested in characterizing the RSN topology changes across 4 different and steady-state levels of dexmedetomidine-induced alteration of consciousness, namely baseline (Awake, drug-free state), Mild sedation (drowsy, still responding), Deep sedation (unresponsive), and Recovery, with a focus on changes occurring between a connected consciousness state and an unresponsiveness state. METHODS A functional magnetic resonance imaging database acquired in 14 healthy volunteers receiving dexmedetomidine sedation was analyzed using a method combining independent component analysis and graph theory, specifically looking at changes in connectivity strength and efficiency occurring during the 4 above-mentioned dexmedetomidine-induced altered consciousness states. RESULTS Dexmedetomidine sedation preserves RSN architecture. Unresponsiveness during dexmedetomidine sedation is mainly characterized by a between-networks graph strength alteration and within-network efficiency alteration of lower-order sensory RSNs, while graph strength and efficiency in higher-order RSNs are relatively preserved. CONCLUSIONS The differential dexmedetomidine-induced RSN topological changes evidenced in this study may be the signature of inadequate processing of sensory information by lower-order RSNs, and of altered communication between lower-order and higher-order networks, while the latter remain functional. If replicated in an experimental paradigm distinguishing, in unresponsive subjects, disconnected consciousness from unconsciousness, such changes would sustain the hypothesis that disconnected consciousness arises from altered information handling by lower-order sensory networks and altered communication between lower-order and higher-order networks, while the preservation of higher-order networks functioning allows for an internally generated mental content (or dream).
Collapse
Affiliation(s)
- Cecile Staquet
- From the Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, Liege University, Liege, Belgium
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
- GIGA-In Vivo Imaging (CRC) Platform, GIGA-Research, Liege University, Liege, Belgium
- Interdisciplinary Center of Algology, Liege University Hospital, Liege, Belgium
| | - Audrey Vanhaudenhuyse
- Interdisciplinary Center of Algology, Liege University Hospital, Liege, Belgium
- Sensation & Perception Research Group, GIGA-Consciousness, Liege University, Liege, Belgium
| | - Sivayini Kandeepan
- Department of Physics and Astronomy, Western Institute for Neuroscience, University of Western Ontario, London, Ontario, Canada
- Department of Physics, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Robert D Sanders
- University of Sydney, Sydney, New South Wales, Australia
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Institute of Academic Surgery, Sydney, New South Wales, Australia
| | - Demetrius Ribeiro de Paula
- Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jean François Brichant
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, Liege University, Liege, Belgium; and
- Centre du Cerveau, Liege University Hospital, Liege, Belgium
| | - Vincent Bonhomme
- From the Anesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, Liege University, Liege, Belgium
- Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium
- Institute of Academic Surgery, Sydney, New South Wales, Australia
- Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Andrea Soddu
- Department of Physics and Astronomy, Western Institute for Neuroscience, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
4
|
Choi WJ, Young MJ. Disambiguating Consciousness in Clinical Settings. Neurology 2023; 101:896-900. [PMID: 37748883 PMCID: PMC10662996 DOI: 10.1212/wnl.0000000000207765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/26/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- William J Choi
- From the Warren Alpert Medical School (W.J.C.), Brown University, Providence, RI; and Department of Neurology (M.J.Y.), Massachusetts General Hospital, Boston.
| | - Michael J Young
- From the Warren Alpert Medical School (W.J.C.), Brown University, Providence, RI; and Department of Neurology (M.J.Y.), Massachusetts General Hospital, Boston
| |
Collapse
|
5
|
Blond N, Andersen LM, Wæhrens EE, Høybye MT. Perspectives on consciousness in patients with disorders of consciousness from brain injury: group concept mapping study across clinic, research, and families. BMC Health Serv Res 2023; 23:471. [PMID: 37165429 PMCID: PMC10173477 DOI: 10.1186/s12913-023-09438-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND An effective healthcare system depends on clinic, research, and patient/relatives interactions. Such interactions may at their core be challenged by misalignments of concepts and the practices that constitute them. The concept of consciousness and what is experienced and understood as signs of consciousness in patients with severe acquired brain injury is one of these potential areas of misalignment. Different perspectives and experiences of consciousness are challenging the delivery of care and the high-stake decision-making process on the potential withdrawal of treatment. The enhanced uncertainties call for reflections on how key stakeholders perceive and identify consciousness in current clinical encounters and practice. METHODS The study empirically explores the actual experiences and conceptions of consciousness concerning patients with disorders of consciousness (DoC) from the perspectives of researchers, health professionals, and relatives of patients, to understand the challenges of the diversity of understandings of consciousness. Engaging the stakeholders by employing Group Concept Mapping methodology, the study developed a situated conceptual map, which reflects nuances and the importance of perspectives on and signs of consciousness. RESULTS Twenty-seven participants contributed to the generation of ideas, 14 took part in the structuring of statements and 10 took part in the validation meeting to interpret the cluster rating map. A total of 85 unique statements were identified and organized into six clusters: (1) Presence, (2) Intentional Activity, (3) Experience of self, (4) Participation in Social Interaction, (5) (Repeated) Response, and (6) Unspecific Reaction. The conceptual mapping demonstrates an extensive overlap in perspectives on consciousness among participants, prioritizing signs that are observable at the bedside. CONCLUSIONS The study provides a first step toward a future framework for the difficult process of decision-making concerning a segment of patients with DoC. The study highlights the importance of repeatable signs of consciousness observed at the bedside and the patient's ability to participate in social interactions, while also considering the importance of non-clinically observable signs of consciousness.
Collapse
Affiliation(s)
- Niklas Blond
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Jens Chr. Skous Vej 4, Aarhus C, DK- 8000, Denmark
| | - Lise Marie Andersen
- Center for Elective Surgery, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Eva Elisabeth Wæhrens
- The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Occupational Science, Department of Public Health, User Perspectives and Community-based Interventions, University of Southern Denmark, Odense, Denmark
| | - Mette Terp Høybye
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Jens Chr. Skous Vej 4, Aarhus C, DK- 8000, Denmark.
- Center for Elective Surgery, Silkeborg Regional Hospital, Silkeborg, Denmark.
| |
Collapse
|
6
|
Fardeau E, Senghor AS, Racine E. The Impact of Socially Assistive Robots on Human Flourishing in the Context of Dementia: A Scoping Review. Int J Soc Robot 2023; 15:1-51. [PMID: 37359430 PMCID: PMC10115607 DOI: 10.1007/s12369-023-00980-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 06/28/2023]
Abstract
Socially assistive robots are being developed and tested to support social interactions and assist with healthcare needs, including in the context of dementia. These technologies bring their share of situations where moral values and principles can be profoundly questioned. Several aspects of these robots affect human relationships and social behavior, i.e., fundamental aspects of human existence and human flourishing. However, the impact of socially assistive robots on human flourishing is not yet well understood in the current state of the literature. We undertook a scoping review to study the literature on human flourishing as it relates to health uses of socially assistive robots. Searches were conducted between March and July 2021 on the following databases: Ovid MEDLINE, PubMed and PsycINFO. Twenty-eight articles were found and analyzed. Results show that no formal evaluation of the impact of socially assistive robots on human flourishing in the context of dementia in any of the articles retained for the literature review although several articles touched on at least one dimension of human flourishing and other related concepts. We submit that participatory methods to evaluate the impact of socially assistive robots on human flourishing could open research to other values at stake, particularly those prioritized by people with dementia which we have less evidence about. Such participatory approaches to human flourishing are congruent with empowerment theory.
Collapse
Affiliation(s)
- Erika Fardeau
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue Des Pins Ouest, Montréal, QC H2W 1R7 Canada
| | - Abdou Simon Senghor
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue Des Pins Ouest, Montréal, QC H2W 1R7 Canada
- Division of Experimental Medicine, McGill University, Montréal, QC Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, 110 Avenue Des Pins Ouest, Montréal, QC H2W 1R7 Canada
- Division of Experimental Medicine, McGill University, Montréal, QC Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC Canada
- Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC Canada
| |
Collapse
|
7
|
Imafidon E. Beyond continental and African philosophies of personhood, healthcare and difference. Nurs Philos 2022; 23:e12393. [PMID: 35561023 PMCID: PMC9286638 DOI: 10.1111/nup.12393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022]
Abstract
In this study, I explore the challenges that ideological hegemonies of personhood imbibed by nurses and other healthcare workers could pose for the nursing profession, particularly in terms of inhibiting the acknowledgment of difference. Dominant or hegemonic conceptions of personhood in particular spaces often consist of self‐contained ideas and essentialist ontologies and normativity of what it means to be a person, lack of which results in the denial of personhood and the othering as non‐person or sub‐person. The other as the residue of such self‐contained notions of personhood is most often denied the quality of care that the one who fits within such conceptions enjoy. For nurses and other healthcare workers to overcome such exclusionary tendencies in healthcare, they must overcome hegemonies and ideological dominance and be more open to alternative viewpoints and theories of personhood. I develop these lines of thought by focusing on the rich ideological traditions of Continental and African philosophies showing how exclusion takes place within these traditions based on conceptions of personhood and how such exclusion on the basis of difference impacts negatively on healthcare. I conclude by highlighting the need to go beyond hegemonic philosophies of personhood by decolonizing and demasculinizing healthcare, thereby allowing difference to flourish in an ecology of medical knowledge.
Collapse
Affiliation(s)
- Elvis Imafidon
- Department of Religions and Philosophies, School of History, Religions and Philosophies, SOAS University of London, London, UK
| |
Collapse
|
8
|
Maguire A. Towards a holistic definition of death: the biological, philosophical and social deficiencies of brain stem death criteria. New Bioeth 2019; 25:172-184. [PMID: 31130114 DOI: 10.1080/20502877.2019.1606148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
With no statutory definition of death, the accepted medical definition relies on brain stem death criteria as a definitive measure of diagnosing death. However, the use of brain stem death criteria in this way is precarious and causes widespread confusion amongst both medical and lay communities. Through critical analysis, this paper considers the insufficiencies of brain stem death. It concludes that brain stem death cannot be successfully equated with either biological death or the loss of integrated bodily function. The overemphasis of the brain-stem and its consequences leaves the criteria open to significant philosophical critique. Further, in some circumstances, the use of brain stem death criteria causes substantial emotional conflict for families and relatives. Accordingly, a more holistic and comprehensive definition of death is required.
Collapse
Affiliation(s)
- Abigail Maguire
- a Institute of Theology , St Mary's University , Twickenham , UK
| |
Collapse
|
9
|
Personhood across disciplines: Applications to ethical theory and mental health ethics. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jemep.2019.100407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|