Purpose
To test a new approach to address moral distress in intensive care unit (ICU) personnel.
Methods
Using principles of participatory action research, we developed an eight-step moral conflict ...assessment (MCA) that guides participants in describing the behaviour that they have to implement, the effects this has on them, their current coping strategies, their values in conflict, any other concerns related to the situation, what helps and hinders the situation, new coping strategies, and the effect of the preceding steps on participants. This assessment was tested with eight ICU providers in an 11-bed community ICU.
Results
During three one-hour sessions, participants described their moral distress that was caused by the use of ongoing life-support for a patient who the team believed did not prefer this course of care, but whose family was requesting it. Participants experienced frustration and discouragement and coping strategies included speaking to colleagues and exercising. They felt that they were unable to take meaningful action to resolve this conflict. Values that were in conflict in the situation included beneficence and patient autonomy. Based on ranking of helping and hindering factors, the team proposed new strategies including improving consistency of care plans and educating patients’ family members and ICU personnel about advance care planning and end-of-life care. After completing this assessment, participants reported less stress and a greater ability to take meaningful action, including some of the proposed new strategies.
Conclusions
We found this new approach to address moral distress in ICU personnel to be feasible and a useful tool for facilitating plans for reducing moral distress.
Conduction slowing of the electric impulse that drives the heartbeat may evoke lethal cardiac arrhythmias. Mutations in SCN5A, which encodes the pore-forming cardiac sodium channel alpha subunit, are ...associated with familial arrhythmia syndromes based on conduction slowing. However, disease severity among mutation carriers is highly variable. We hypothesized that genetic modifiers underlie the variability in conduction slowing and disease severity. With the aim of identifying such modifiers, we studied the Scn5a(1798insD/+) mutation in 2 distinct mouse strains, FVB/N and 129P2. In 129P2 mice, the mutation resulted in more severe conduction slowing particularly in the right ventricle (RV) compared to FVB/N. Pan-genomic mRNA expression profiling in the 2 mouse strains uncovered a drastic reduction in mRNA encoding the sodium channel auxiliary subunit beta4 (Scn4b) in 129P2 mice compared to FVB/N. This corresponded to low to undetectable beta4 protein levels in 129P2 ventricular tissue, whereas abundant beta4 protein was detected in FVB/N. Sodium current measurements in isolated myocytes from the 2 mouse strains indicated that sodium channel activation in myocytes from 129P2 mice occurred at more positive potentials compared to FVB/N. Using computer simulations, this difference in activation kinetics was predicted to explain the observed differences in conduction disease severity between the 2 strains. In conclusion, genetically determined differences in sodium current characteristics on the myocyte level modulate disease severity in cardiac sodium channelopathies. In particular, the sodium channel subunit beta4 (SCN4B) may constitute a potential genetic modifier of conduction and cardiac sodium channel disease.
SAS2: A Guide to Collaborative Inquiry and Social Engagement represents a groundbreaking international effort to support the creation and mobilization of practical, authentic knowledge for social ...change. The guiding principle behind SAS2 (Social Analysis Systems, www.sas2.net) is that group dialogue and social inquiry are crucial for local and global development. Social issues must be addressed socially and in a multistakeholder mode, not by private interests and experts alone, and the insights that emerge must be fully integrated into processes of knowledge production, planning, and decision-making.
Part 1 outlines the concepts and skillful means needed to support multistakeholder dialogue and engagement. It also provides detailed instructions on how to integrate and ground collaborative inquiry in the projects, plans, evaluations and activities of multiple stakeholders. Part 2 presents a selection of techniques for collaborative inquiry and examples of real-life applications in South Asia and Latin America. The examples focus on a range of issues including land tenure, local economic development, agriculture, forestry, fisheries, and organizational development.
This book will be an invaluable resource for researchers, consultants, facilitators and activists working with people to solve problems and support inclusive inquiry and decision-making. It will also be useful to scholars and academics studying and teaching participatory action research in the social sciences.
The hot and the cold Chevalier, Jacques M; Bain, Andrés Sánchez
The hot and the cold,
c2003, 20030321, 2003, 2000, 2003-01-01, 20030101, Letnik:
24
eBook
Examines indigenous worldview and myth to challenge the prevailing notion that hot-cold reasoning of health and illness in Latin America is a product of the Hippocratic humoral doctrine brought by ...the Spaniards in the sixteenth century.
A postmodern revelation Chevalier, Jacques M
A postmodern revelation,
c1997, 19970425, 1997, 1997-01-01
eBook
Chevalier reveals that the Book of Revelation was written as a polemical response to ancient astromythology and shows that concerns with natural and cultural history have supplanted the ...future-oriented visions of astrology and Christian prophecy.
This is the coronal plane that governs the weavings of remembrance and anticipation, recollections of the past and expectations of the future. Chevalier shows that while brain and sign processing ...caters to events that succeed in attracting our attention, it also provides means to produce silence where unawareness is called for. Some inattention to things that are no longer or not yet is a requirement of the plotting of signs of hope and apprehension folding and unfolding in narrative time. The end result is a complex calculus of recollection, anticipation, and hope combined with traces of deferment, forgetfulness, and fear. This intricate "time-machine" built into language and the brain governs the "working memory system, an active memory operating by necessity in the present tense. Chevalier explores these issues in light of what philosophers such as St. Augustine, Kant, Heidegger, and Lévi-Strauss have said about memory and the nature of time. Arguing against all static and apocalyptic conceptions of time, Chevalier applies his own blending of "neurosemiotics" and Ricoeurian hermeneutics to the interpretive analysis of narrative plots ranging from a cat drawn by a child to intriguing speculations on the hot and the cold in Mexican Nahua agriculture. The 3-D Mind 3 also looks at prophecies of demonic scorpions in the Book of Revelation, and signs of the End heralded by the tragedy of Ground Zero.
Half-Brain Fables and Figs in Paradise starts the trilogy on the lateral plane and explores the tendency of each hemisphere to specialize but also to complement or supplement the other hemisphere. ...Brain and sign processing is thus shown to involve bimodal weavings or reticles of right-hemispheric similarities and left-hemispheric differences. Chevalier goes on to illustrate how whole-brain connectivity generates the crisscrossings of oppositions and metaphors in language, using symbolically rich material ranging from Western naming practices to expressions of ethnobotany in the bible (figs in Genesis), poetry (Longfellow's Evangeline), and native Mexican mythology. Three major philosophical implications follow from Chevalier's "theoreticle" perspective on the weavings of signs and synapse. First, the integrative concept of "nervous sign processing" should be substituted for models of the brain and the intellect that separate biology from mental and cultural activity. The subject matter of "semiosis" is both physical and communicational. Second, sign reticles are orderly and chaotic at the same time. They are subject to patterns of convergence but also to lines of divergence that defy simple modeling, whether analytical or dialectical. Third, sign events are governed by the principle of conferencing, not referencing. They do not refer to things or thoughts signified through representational means. Rather they confer meaning through "signaptic" conversations, reticles of fine lines evolving in language and in neural cells alike.
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