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2017
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(2017): The Influence of Politeness Behavior on User Compliance with Social Robots in a Healthcare Service Setting. In: International Journal of Social Robotics 9 (5), S. 727-743. DOI: 10.1007/s12369-017-0420-0
Abstract: Particularly in the healthcare service domain, social robots are expected to be good assistants, advisers, or practitioners. To increase the effectiveness of healthcare services provided by social robots, patients must comply with their requests. Research is plentiful on what makes patients comply with healthcare advice. In this paper, which is based on Bulgurcu's study of rationality-based beliefs, command-compliance theory, and social exchange theory, we propose a research model of compliance during interaction with social robots, examining beliefs about and overall assessments of the consequences of complying with robot requests and extending the findings of previous studies to the setting of healthcare services. We specifically investigate the perceived level of politeness in robots' speech and gestures as a determinant of compliance intention. Using a social robot, NAO, as a provider of healthcare services, we conducted an experiment. The results suggest that the aforementioned theories are useful in understanding user behaviors toward social robots in a healthcare service setting. Interestingly, and unlike in other settings, the perceived level of politeness of a social robot in a healthcare service setting negatively affects the perceived benefit of compliance, and, hence, intention to comply. A lower politeness level is closer to a command or strong recommendation than a suggestion or causal recommendation, which is common in shopping, tourism, or convention settings. The findings of this study imply that polite behavior from a social robot is an important factor in the compliance of healthcare service users. Direct speech with polite gestures is the most effective way to increase patient compliance in with healthcare advice provided by social robots in healthcare settings. However, higher levels of politeness do not always increase patients' intention to comply.
Keywords: Assistenztechnik, Befehle/eindringliche Empfehlung als Marker für Unhöflichkeit, Compliance, Disziplin, doppelter Treffer, Höflichkeit, Höflichkeitsforschung, human-robot interaction, Ingenieurswissenschaft, Interaktionspartner, Medizin, Mensch oder Maschine, Mensch-Technik-Relationen (MTR), polite social interaction, Politeness, Politeness Theory, Realtechnik, Robotics, Serviceroboter, Social exchange theory, Social robot, Soziale Angemessenheit, Soziale Robotik, Technik, Technikbezug -
(2017): Pushing boundaries-culture-sensitive care in oncology and palliative care. A qualitative study. In: Psycho-oncology 26 (6), S. 763-769. DOI: 10.1002/pon.4217
DOI: http://www.ncbi.nlm.nih.gov/pubmed/27429221 Abstract: OBJECTIVE In increasingly globalized societies, patient-centered cancer care requires culture-sensitive approaches in order to ensure patients well-being. While migrant patients' needs are frequently reported in the literature, staff members' perception of work with migrant patients, associated challenges, or individual work approaches are largely unknown. This study addresses this research gap through qualitative exploration of experiences of multicultural health care professionals in supportive oncology and palliative care, working with patients from different cultural backgrounds. This study aims to understand staff experience of the impact of culture on cancer care. METHODS This study was conducted at the Medical University of Vienna, including staff from different settings of oncology and palliative care, in different professional positions, and with a range of individual migration backgrounds. Semistructured interviews were conducted with 21 staff members working with patients from different cultural backgrounds. Interviews explored views on the impact of culture on care were audio-taped, transcribed, and analyzed using a rigorous method of thematic analysis, enhanced with grounded theory techniques. RESULTS Interviews revealed 4 key topics: culture-specific differences, assumed reasons for differences, consequences of multicultural care, and tools for culture-sensitive care. Strategies to better deal with migrant patients and their families were suggested to improve work satisfaction amongst staff. CONCLUSIONS This study identifies relevant staff challenges in work with migrant patients. Concrete suggestions for improvement include measures on an organizational level, team level, and personal tools. The suggested measures are applicable to improve work satisfaction and culture-sensitive care not only in cancer care but also in other areas of medicine.
Keywords: Adult, Attitude of Health Personnel, Culturally Competent Care, Culture, culture specific, Female, Gesellschaftsprofit, Health Personnel/psychology/statistics & numerical data, Humans, Interaktion, Job Satisfaction, Kultur, kulturspezifisch, Male, Medical Oncology, Medizin, Middle Aged, Neoplasms/ethnology/therapy, Observablen/Kriterien für sozial angemessenes Verhalten und dessen Bewertung, Palliative Care, Pflege, Qualitative research, Umgangsformen, Young Adult 2016
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(2016): Improving Medical Decision Making and Health Promotion through Culture-Sensitive Health Communication. An Agenda for Science and Practice. In: Medical decision making : an international journal of the Society for Medical Decision Making 36 (7), S. 811-833. DOI: 10.1177/0272989X15600434
DOI: http://www.ncbi.nlm.nih.gov/pubmed/26296619 Abstract: This review introduces the concept of culture-sensitive health communication. The basic premise is that congruency between the recipient's cultural characteristics and the respective message will increase the communication's effectiveness. Culture-sensitive health communication is therefore defined as the deliberate and evidence-informed adaptation of health communication to the recipients' cultural background in order to increase knowledge and improve preparation for medical decision making and to enhance the persuasiveness of messages in health promotion. To achieve effective health communication in varying cultural contexts, an empirically and theoretically based understanding of culture will be indispensable. We therefore define culture, discuss which evolutionary and structural factors contribute to the development of cultural diversity, and examine how differences are conceptualized as scientific constructs in current models of cultural differences. In addition, we will explicate the implications of cultural differences for psychological theorizing, because common constructs of health behavior theories and decision making, such as attitudes or risk perception, are subject to cultural variation. In terms of communication, we will review both communication strategies and channels that are used to disseminate health messages, and we will discuss the implications of cultural differences for their effectiveness. Finally, we propose an agenda both for science and for practice to advance and apply the evidence base for culture-sensitive health communication. This calls for more interdisciplinary research between science and practice but also between scientific disciplines and between basic and applied research.
Keywords: Clinical Decision-Making, Communication, Cultural Competency, culture sensitive, Disziplin, Health Behavior, Health Promotion/standards, Humans, Kultur, Kulturtheorie, Medizin, Models, Psychological, Observablen/Kriterien für sozial angemessenes Verhalten und dessen Bewertung, Pathologie, Risk-Taking, Social Norms -
(2016): Effects of culture-sensitive adaptation of patient information material on usefulness in migrants. A multicentre, blinded randomised controlled trial. In: BMJ open 6 (11). DOI: 10.1136/bmjopen-2016-012008
DOI: http://www.ncbi.nlm.nih.gov/pubmed/27881523 Abstract: OBJECTIVES To evaluate the usefulness of culture-sensitive patient information material compared with standard translated material. DESIGN Multicentre, double-blind randomised controlled trial. SETTING 37 primary care practices. PARTICIPANTS 435 adult primary care patients with a migration background with unipolar depressive disorder or non-specific chronic low back pain were randomised. Patients who were unable to read in the language of their respective migration background were excluded. Sufficient data were obtained from 203 women and 106 men. The largest group was of Russian origin (202 patients), followed by those of Turkish (52), Polish (30) and Italian (25) origin. INTERVENTIONS Intervention group: provision of culture-sensitive adapted material. CONTROL GROUP provision of standard translated material. MAIN OUTCOME MEASURES Primary outcome: patient-rated usefulness (USE) assessed immediately after patients received the material. SECONDARY OUTCOMES patient-rated usefulness after 8 weeks and 6 months, symptoms of depression (PHQ-9), back pain (Back Pain Core Set) and quality of life (WHO-5) assessed at all time points. RESULTS Usefulness was found to be significantly higher (t=1.708, one-sided p=0.04) in the intervention group (USE-score=65.08, SE=1.43), compared with the control group (61.43, SE=1.63), immediately after patients received the material, in the intention-to-treat analysis, with a mean difference of 3.65 (one-sided 95% lower confidence limit=0.13). No significant differences were found for usefulness at follow-up (p=0.16, p=0.71). No significant effect was found for symptom severity in depression (p=0.95, p=0.66, p=0.58), back pain (p=0.40, p=0.45, p=0.32) or quality of life (p=0.76, p=0.86, p=0.21), either immediately after receiving the material, or at follow-up (8 weeks; 6 months). Patients with a lower level of dominant society immersion benefited substantially and significantly more from the intervention than patients with a high level of immersion (p=0.005). CONCLUSION Cultural adaptation of patient information material provides benefits over high quality translations. Clinicians are encouraged to use culture-sensitive material in their consultations, particularly with low-acculturated patients. TRIAL REGISTRATION NUMBER German Register for Clinical Trials: DRKS00004241, Universal Trial Number: U1111-1135-8043, Results.
Keywords: Adult, Aged, Cultural Competency, culture sensitive, Depressive Disorder, Major/therapy, Disziplin, Double-Blind Method, Female, Focus Groups, Health Literacy, Humans, Italy, Kultur, Kulturtheorie, Language, Low Back Pain/therapy, Male, Medizin, Middle Aged, Pamphlets, Patient Education as Topic/methods, Patient Participation, Poland, Psychologie, Quality of Life, Rolle (Beruf), Russia, Transients and Migrants, Translating, Turkey -
(2016): The Detour of an Obstetric Technology. Active Management of Labor Across Cultures. In: Medical anthropology 35 (1), S. 17-30. DOI: 10.1080/01459740.2015.1091817
DOI: http://www.ncbi.nlm.nih.gov/pubmed/26484745 Abstract: Active management of labor (AML) is an obstetric technology developed in Ireland in the 1970s to accelerate labor in nulliparous women. This technology achieved rapid success in Great Britain and in English-speaking countries outside America, which adopted it before many other states around the world. In this article, I explore AML's technical and social characteristics when it was first designed, and then examine its local inflections in a Jordanian and a Swiss maternity hospital to shed light on the ways its transnational circulation modifies its script. I argue that its application is shaped by local material constraints and specific sociocultural configurations, gender regimes, and hospital cultures. Finally, I make a comparative analysis of AML practices in these two settings and in the foundational textbook to disentangle the technical and sociocultural components modeling its local applications.
Keywords: Active management of labor (AML), ANTHROPOLOGY, Disziplin, Ethnology, Female, Geburt, Gender, Human Body, Humans, Jordan, Konventionen, Kriterien für sozial angemessenes Verhalten und dessen Bewertung, Kultur, Kulturdifferenz, Kulturspezifizität, Kulturtechnik, Kulturtheorie, Kulturvergleich, labor, Medical, Medizin, Normen, Observablen, Obstetrics, Pregnancy, script, Switzerland, Women 2015
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(2015): Reconsidering Respect for Persons in a Globalizing World. In: Developing world bioethics 15 (2), S. 98-106. DOI: 10.1111/dewb.12045
DOI: http://www.ncbi.nlm.nih.gov/pubmed/24720355 Abstract: Contemporary clinical ethics was founded on principlism, and the four principles: respect for autonomy, nonmaleficence, beneficence and justice, remain dominant in medical ethics discourse and practice. These principles are held to be expansive enough to provide the basis for the ethical practice of medicine across cultures. Although principlism remains subject to critique and revision, the four-principle model continues to be taught and applied across the world. As the practice of medicine globalizes, it remains critical to examine the extent to which both the four-principle framework, and individual principles among the four, suffice patients and practitioners in different social and cultural contexts. Using the four-principle model we analyze two accounts of surrogate decision making - one from the developed and one from the developing world - in which the clinician undertakes medical decision-making with apparently little input from the patient and/or family. The purpose of this analysis is to highlight challenges in assessing ethical behaviour according to the principlist model. We next describe cultural expectations and mores that inform both patient and clinician behaviors in these scenarios in order to argue that the principle of respect for persons informed by culture-specific ideas of personhood may offer an improved ethical construct for analyzing and guiding medical practice in a globalized and plural world.
Keywords: Beneficence, Bewertung von sozialem Verhalten (/sozialer Angemessenheit), Clinical Decision-Making/ethics, Cultural Characteristics, culture specific, Decision Making, Developed Countries, Developing Countries, Ethical Analysis, Ethics, Medical, Family/ethnology/psychology, Humans, Internationality, Interviews as Topic, Islam, kulturspezifisch, Medizin, Observablen/Kriterien für sozial angemessenes Verhalten und dessen Bewertung, Pakistan, Personal Autonomy, Personhood, Physician-Patient Relations/ethics, Principle-Based Ethics, respect, Respekt, Transcultural Nursing, United States 2014
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(2014): Medical professionalism. An experimental look at physicians’ Facebook profiles. In: Medical Education Online 19 (1). DOI: 10.3402/meo.v19.23149
DOI: https://doi.org/10.3402/meo.v19.23149 Abstract: BACKGROUND: Use of social networking services (SNS) is on the rise. While many users sign in for personal purposes, it is not uncommon for professionals to connect over SNSs with clients, students, and patients. METHODS: The present study used an experimental approach to examine how medical doctors' SNS profiles impacted potential patients' impressions of professionalism. Participants (N=250 students) were randomly assigned to view one of six Facebook profiles. Profiles were populated with 1) solely professional material, 2) personal material that was strictly healthy, or 3) personal material that included unhealthy behavior. Profiles portrayed a male or female physician resulting in a total of six experimental conditions. Medical professionalism was measured with the First Impressions of Medical Professionalism (FIMP) scale, specifically developed for this study. RESULTS: There was a large and statistically significant main effect for profile type, F(2, 250)=54.77, p<0.001, ηp(2)=0.31. Post hoc tests indicated that personal profiles that contained healthy behavior were rated as most professional followed by profiles with strictly professional content. Personal unhealthy profiles were rated as least professional. Additionally, female profiles consistently received higher professionalism ratings across all three profile types [F(1, 250)=5.04, p=0.026, ηp(2)=0.02]. CONCLUSION: Our results suggest that a physician's SNS profile affects a patient's perception of that physician's medical professionalism. A personal, healthy profile may augment a patient's perception of that physician's character virtues if the profile content upholds the decorum of the medical field.
Keywords: Art des Kommunikationsmediums, Daten, Datenschutz, decorum, doppelter Treffer, Experte-Laie, Information, Kommunikation, Medien, Medienwirksamkeit, Medizin, Mensch-Technik-Relationen (MTR), Professionalität, angemessene Selbstdarstellung, Rolle (Beruf), Social Network, Social Network Einfluss, Soziale Angemessenheit, soziale Medien, Sozialpsychologie, Wahrnehmung angemessener Selbstdarstellung, Facebook 2012
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(2012): Electronic Mail Communication in Health Care. Do Old Fashioned Decorum and Style Still Matter?. In: WORLD NEUROSURGERY 78 (3-4), S. 194-197
Abstract: Electronic mail (e-mail) has dramatically altered human communication and has had a profound impact on how health care professionals interact. Until recently, written letters were integral to patient-physician and physician-physicianrelationships(4).The“art”and rules of writing professional letters were once rigorously taught at almost all levels of education
Keywords: Art des Kommunikationsmediums, decorum, doppelter Treffer, Email, Höflichkeit, Informations- & Kommunikationstechnik, Interaktion, Kommunikation, Medizin, Mensch-Technik-Relationen (MTR), Realtechnik, Rolle (Beruf), Situationsbedingter Kontext, Soziale Angemessenheit, Technik, Umgangsformen, Wandel von Normen -
(2012): Effects of etiquette strategy on human–robot interaction in a simulated medicine delivery task. In: Intelligent Service Robotics 5 (3), S. 199-210. DOI: 10.1007/s11370-012-0113-3
Abstract: The objective of this study was to examine the extent to which a model of linguistic etiquette in human–human interaction could be applied to human–robot interaction (HRI) domain, and how different etiquette strategies proposed through the model might influence performance of humans and robots as mediated by manipulations of robot physical features, in a simulated medicine delivery task. A “wizard of Oz” experiment was conducted in which either a humanoid robot or a mechanical-looking robot was used to present medicine reminding utterances (following different etiquette strategies) to participants, who were engaged in a primary cognitive task (a Sudoku puzzle). Results revealed the etiquette model to partially extend to the HRI domain. Participants were not sensitive to positive language from robots (e.g., appreciation of human values/wants) and such a strategy did not succeed in supporting or enhancing the “positive face” of human users. Both “bald” (no linguistic courtesy) and mixed strategies (positive and “negative face” (minimizing user imposition) saving) resulted in moderate user perceived etiquette scores (PE). However, individual differences suggested such robot linguistic strategies should be applied with caution. Opposite to this, a negative face saving strategy (supporting user freedom of choice) promoted user task and robot performance (in terms of user response time to robot requests), and resulted in the highest PE score. There was also evidence that humanoid robot features provide additional social cues that may be used by patients and support human and robot performance, but not PE. These results provide a basis for determining appropriate etiquette strategies and robot appearance to promote better collaborative task performances for future health care delivery applications of service robots.
Keywords: Anerkennung von Werten/Bedürfnissen, appropriate social interaction, Disziplin, doppelter Treffer, Etikette, Face, Face-Saving, Favoriten, Höflichkeit, Höflichkeitsforschung, Human-robot etiquette, Ingenieurswissenschaft, Interaktionspartner, Linguistik, Medicine delivery, Medizin, Mensch oder Maschine, Mensch-Technik-Relationen (MTR), Mensch-Technische Systeme, Negative face saving, Patient compliance, Patient-robot interaction, Realtechnik, Serviceroboter, Soziale Angemessenheit, Soziale Robotik, Technik, Technikbezug, Volltreffer, Wahlfreiheit (eines Nutzers/Interaktionspartners), Wertendes Sprachverhalten 2010
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(2010): Mental health care and the politics of inclusion. A social systems account of psychiatric deinstitutionalization. In: Theoretical medicine and bioethics 31 (6), S. 411-427. DOI: 10.1007/s11017-010-9155-8
DOI: http://www.ncbi.nlm.nih.gov/pubmed/20711755 Abstract: This paper provides an interpretation, based on the social systems theory of German sociologist Niklas Luhmann, of the recent paradigmatic shift of mental health care from an asylum-based model to a community-oriented network of services. The observed shift is described as the development of psychiatry as a function system of modern society and whose operative goal has moved from the medical and social management of a lower and marginalized group to the specialized medical and psychological care of the whole population. From this theoretical viewpoint, the wider deployment of the modern social order as a functionally differentiated system may be considered to be a consistent driving force for this process; it has made asylum psychiatry overly incompatible with prevailing social values (particularly with the normative and regulative principle of inclusion of all individuals in the different functional spheres of society and with the common patterns of participation in modern function systems) and has, in turn, required the availability of psychiatric care for a growing number of individuals. After presenting this account, some major challenges for the future of mental health care provision, such as the overburdening of services or the overt exclusion of a significant group of potential users, are identified and briefly discussed.
Keywords: Bioethics,, Community Mental Health Services/organization & administration, Deinstitutionalization, Diskriminierung, Ethik, Fehlverhalten, Gesellschaftsprofit, Health Services Accessibility, Hospitals, Psychiatric, Humans, Medizin, Mental Disorders, Mental Health, Pathologie, Patient Care Team, Pflege, Politics, Psychiatry/trends, social systems, ethics, Social Values, Soziale Ordnung, Spain, systems theory, Werte 2008
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(2008): Etiquette-based medicine. In: The New England journal of medicine 358 (19), S. 1988-1989. DOI: 10.1056/NEJMp0801863
DOI: http://www.ncbi.nlm.nih.gov/pubmed/18463374 Abstract: Patients ideally deserve to have a compassionate doctor, but might they be satisfied with one who is simply well-behaved? When I hear patients complain about doctors, their criticism often has nothing to do with not feeling understood or empathized with. Instead, they object that “he just stared at his computer screen,” “she never smiles,” or “I had no idea who I was talking to.” During my own recent hospitalization, I found the Old World manners of my European-born surgeon — and my reaction to them — revealing in this regard. Whatever he might actually have been feeling, his behavior — dress, manners, body language, eye contact — was impeccable. I wasn't left thinking, “What compassion.” Instead, I found myself thinking, “What a professional,” and even (unexpectedly), “What a gentleman.” The impression he made was remarkably calming, and it helped to confirm my suspicion that patients may care less about whether their doctors are reflective and empathic than whether they are respectful and attentive.
Keywords: Disziplin, Education, Medical/methods, Etikette, Etiquette, Fachetiketten, Favoriten, Humans, Medizin, Observablen/Kriterien für sozial angemessenes Verhalten und dessen Bewertung, Patient Care, Physician-Patient Relations, Professional Competence, Rolle (Beruf), Soziale Angemessenheit, Zugeschriebene Kompetenz 2007
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(2007): Ethics of unprofessional behavior that disrupts. Crossing the line. In: Journal of vascular surgery 45 (2), S. 433-435. DOI: 10.1016/j.jvs.2006.11.043
DOI: https://doi.org/10.1016/j.jvs.2006.11.043 Abstract: As chief of surgery, you have been contacted by the managing operating room (OR) nurse about Dr Frank N. Stein’s behavior earlier this morning. Dr Stein, a senior surgeon, has long had a reputation for outlandish behaviors in the OR. He is the impeccable gentleman outside that environment, loved by patients and nonoperating personnel alike. He has an international reputation as a master technical surgeon, operates as efficiently as anyone on the planet, and has the largest practice at the medical center. He has survived beyond the generation of tolerance because he has retained the same OR crew that over the years have calloused enough to regard his scurrilousness as just being Dr S. Today, he crossed the line. Dr. Stein, known for his colorful diatribes, trounced decorum when he ordered the operative team, excepting the anesthesiologist, out of the OR and demanded that a new team be substituted. This resulted from a shouting match with a new circulator when she took issue with a personal insult. The transition was accomplished, causing delays in both Dr Stein’s OR and several other ORs where substitute nurses were commandeered. At least one other faculty surgeon has complained about the inconvenience. In your office, Frank, long a colleague, insists that the nurses involved are assassins and refuses to work with them from this day. What should be done?
Keywords: Agonistic Behavior, Attitude of Health Personnel, Beispiel, Clinical, Clinical Competence, Control, decorum, Disziplin, Employee Discipline, Ethics, Ethik, Fehlverhalten, General Surgery, Grenzüberschreitung, Humans, Medical Errors, Medizin, Patient Care Team, Philosophie, Physician-Nurse Relations, Physicians/ethics, Prevention, Professional Misconduct, Rolle (Beruf), Soziale Angemessenheit, Soziale Hierarchie, Übertretung von sozialen Grenzen/Gewalt, Umgangsformen, Unprofessionel 2006
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(2006): Alcohol and the Jews (again), race and medicine (again). On race and medicine in historical perspective. In: PATTERNS OF PREJUDICE 40 (4-5), S. 335-352
Abstract: The question of why or whether Jews have a resistance to alcoholism is now the subject of genetic research. Parallel to investigations into such perceived resistance in other groups (such as ‘Asians’), the recent work makes global claims that can be shown to have very specific social and historical origins. The accusation that the Jews abused alcohol was rebutted in the eighteenth century as Jews entered into the German-speaking public sphere. The key to such access was adherence to rules of ‘decorum’, and the public consumption of alcohol was central to this project.
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(2006): Psychosocial and psychodynamic factors influencing health care utilisation. In: Health care analysis : HCA : journal of health philosophy and policy 14 (2), S. 69-78. DOI: 10.1007/s10728-006-0013-9
DOI: http://www.ncbi.nlm.nih.gov/pubmed/17195575 Abstract: This paper aims to elucidate some dysfunctional aspects of health care utilisation by combining concepts from modern systems theory and from psychoanalysis. Contemporary health care in industrialised countries can be conceived as a social system in terms of modern systems theory. According to this theory, social systems are operating on the basis of a 'guiding difference,' which in the case of health care is the distinction between 'healthy' and 'ill.' Its rigidity in adhering to the healthy-ill dichotomy exposes health care to being collusively entangled in the interpersonal defence arrangements of patients. In the psychoanalytic view, individual conflicts can be warded off from consciousness not only by intrapsychic defence, but also by interpersonal defence mechanisms. These mechanisms involve the patients' close social environment, often including doctors and hospitals. The functioning and the motivational structure of health care itself shows features of neurotic defence: not only its representatives, but health care as a whole act in a rigid, obsessive manner in order to separate the healthy from the ill and to battle against (presumed) diseases. This obsession sometimes results in excessive diagnostic activism and in inconsiderate application of aggressive medical treatments. Both are inappropriate with regard to the salient problem of modern medicine: the increase of chronic nonfatal diseases like depression and chronic pain. The described defence mechanisms are unconscious not only to patients but also to health care professionals (let alone health politicians), and are contributing to dysfunctional health care overuse.
Keywords: Aggression/psychology, Denken in Kategorien, Health Services/utilization, Humans, Interaktion, Interpersonal Relations, krank vs. gesund, Medizin, Models, Organizational, Motivation, Pathologie, Pflege, Psychoanalytic Theory, psychosozial, Rolle (Beruf), Self Concept, social systems, ethics, soziale Umwelt, systems theory, Wahrnehmungsverzerrungen / Bedeutungszuweisungen -
(2006): Breaking the rules of the game. Ethical implications for nursing practice and education. In: Nursing Science Quarterly 19 (3), S. 207-210
Abstract: Rules in games are fundamental to the ethics of practice. Rules provide a context or space where a game is defined and played. Throughout human life, games may be formalized with written and unwritten rules. Imaginations may be sparked in the creative structuring of new, informal games. Formal and informal rules can serve to provide direction for what may be viewed as decorum and appropriate behavior with professional groups. In this column, the author illuminates possible ethical meanings for rule-making and breaking with implications for nursing practice and education from a nursing theoretical perspective.
Keywords: Berufstechnik, decorum, Fehlverhalten, Gesellschaftsprofit, Gruppenverhalten / Joint Action, Intellektualtechnik, Interaktion, Medizin, Mensch-Technik-Relationen (MTR), Normen, Observablen/Kriterien für sozial angemessenes Verhalten und dessen Bewertung, Pflege, Regel, Regelwerk, Regelwerke, Soziale Rolle, Spiel, Spieltheorie, Technik, Umgangsformen, Verhalten am Arbeitsplatz, Voraussetzungen für sozial angemessenes Verhalten -
(2006): Idiocy in Virginia, 1616-1860. In: BULLETIN OF THE HISTORY OF MEDICINE 80 (4), S. 677-701
Abstract: Like the English, Virginians tended to think that idiocy, a condition analogous to intellectual disability in the twenty-first century, was congenital, untreatable, and incurable, and they adopted legal remedies that corresponded closely to the laws of England. In addition, concepts of idiocy reflected some of the unique aspects of Virginia's social system, which was dominated by a coterie of powerful men. With a need to preserve social order and maintain decorum, the Virginia legislature established in 1769 the Eastern State Hospital to house unruly and objectionable people who were mentally disabled. Although idiots were among the hospital's first patients, they were eventually banished due to their presumed failure to respond to treatment. The social stigma attached to idiocy extended from Virginia's city streets and jails to the private homes of prominent families. Personal reticence regarding shameful family matters hid the identity of people thought to be intellectually disabled. Even Thomas Jefferson, a prolific author, entered only cryptic notes about the limitations of his sister, Elizabeth. In summary, Virginians' response to idiocy suggests a two-tiered approach: public disclosure and disdain of poor and dependent people with intellectual disabilities, and silent avoidance of the problem in prominent families. In both situations, idiocy represented images of shame and humiliation that threatened the social order.
Keywords: Beeinflussung sozial angemessenen Verhaltens, Beispiel, chemisch / neurologisch / medikamentös / durch Substanzen, decorum, Diskriminierung, Fehlverhalten, Geschichte, Gesellschaftsprofit, "idiocy", Medizin, Mental Health, Observablen/Kriterien für sozial angemessenes Verhalten und dessen Bewertung, Soziale Ordnung, Sozialer Raum / Kultureller Kontext 2005
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(2005): Social discord and bodily disorders. Healing among the Yupno of Papua New Guinea. Durham, NC: Carolina Academic Press (Carolina Academic Press medical anthropology series)
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(2005): Doing criticism in ’symbiotic niceness’. A study of palliative care nurses’ talk. In: SOCIAL SCIENCE 60 (9), S. 1949-1959
Abstract: This paper examines how palliative care nurses do criticism of other professionals in talk within settings for care of the dying (two hospices and one general hospital). Strategies for the production of moral identities include the use of direct criticism, indirect criticism and quoted speech, hence 'inverted comma criticism'. Criticism is done through the construction and reconstruction of 'atrocity stories'. Atrocity stories are used as a medium by nurses to express their opinions and feelings about doctors who might have behaved insensitively. At the same time, it allows doctors to redeem themselves. The analysis of talk reveals that the voices of absent patients are reactivated and co-opted into the nurses' talk. The stories serve to produce an image of nurses as caring, morally responsible patient advocates and loyal characters to their medical colleagues. Through the analysis of talk, the communication skills and strategies for the maintenance of interactional order are made visible and displayed. Skills for the production of the palliative care team work are also made visible. Emotional labour is analysed as a project for the production of particular kinds of niceness which in turn require particular types of emotional labour. This paper argues that educators should aim to identify and make conscious use of nurses' own available interactional skills, and focus on valuable cultural (rules of decorum) and material resources (the disease process) which are readily available and accessible for nurses, as a starting point in communication training. The theory of an account of co-production of niceness which benefits each other, hence, symbiotic niceness, reveals that being nice to each other can be rewarding and therapeutic in that it helps to smooth, distance and ameliorate problems occurring in the reality of palliative care nurses' and their patients' life-worlds.
2002
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(2002): Ethics of practicing medical procedures on newly dead and nearly dead patients. In: Journal of General Internal Medicine 17 (10), S. 774-778. DOI: 10.1046/j.1525-1497.2002.11139.x
DOI: https://doi.org/10.1046/j.1525-1497.2002.11139.x Abstract: OBJECTIVE: To examine the ethical issues raised by physicians performing, for skill development, medically nonindicated invasive medical procedures on newly dead and dying patients. DESIGN: Literature review; issue analysis employing current normative ethical obligations, and evaluation against moral rules and utilitarian assessments manifest in other common perimortem practices. RESULTS: Practicing medical procedures for training purposes is not uncommon among physicians in training. However, empiric information is limited or absent evaluating the effects of this practice on physician competence and ethics, assessing public attitudes toward practicing medical procedures and requirements for consent, and discerning the effects of a consent requirement on physicians' clinical competence. Despite these informational gaps, there is an obligation to secure consent for training activities on newly and nearly dead patients based on contemporary norms for informed consent and family respect. Paradigms of consent-dependent societal benefits elsewhere in health care support our determination that the benefits from physicians practicing procedures does not justify setting aside the informed consent requirement. CONCLUSION: Current ethical norms do not support the practice of using newly and nearly dead patients for training in invasive medical procedures absent prior consent by the patient or contemporaneous surrogate consent. Performing an appropriately consented training procedure is ethically acceptable when done under competent supervision and with appropriate professional decorum. The ethics of training on the newly and nearly dead remains an insufficiently examined area of medical training.
Keywords: Beeinflussung der Bewertung moralischer Urteile, Beispiel, Bewertung von sozialem Verhalten (/sozialer Angemessenheit), Consent, decorum, Einwilligung, Ethik, medical procedures, Medizin, Moral, Observablen/Kriterien für sozial angemessenes Verhalten und dessen Bewertung, Operation an frisch Verstorbenen, Respekt, Soziale Angemessenheit, Tod, Übung, Utilitarismus 2001
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(2001): Mistakes as a Social Construct. An Historical Approach. In: Kennedy Institute of Ethics Journal 11 (2), S. 117-133. DOI: 10.1353/ken.2001.0016
Abstract: The Institute of Medicine (IOM) published To Err is Human: Building a Safer Health System in November 1999. The report focused public attention on the errors that occur within the medical system that cause death and harm to patients. It outlined a series of changes for health care that are aimed at reducing these errors by 50 percent over the next five years. This paper examines the problem of medical mistakes historically. It documents how legal, scientific, and medical trends during the years 1890-1934 intersected to effect the reporting of mistakes in the subspecialty of neurosurgery. At the start of this time frame, mistakes were reported openly in journal articles as an educational tool. By its end, however, mistakes had gone "underground" and were buried amid a more objective, scientific reporting system. Using this historical perspective as a baseline, the paper concludes by re-examining the IOM's suggestions for change and comments on what they mean for the culture of medicine.
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