A Steinian approach to an empathic understanding of hope among patients and clinicians in the culture of palliative care

Aim. This article presents a discussion of empathy in the context of human person, reason and hopes in the clinical setting.

Background. Empathy was introduced to nursing as part of an ethical and philosophical foundation for caring. It helped to solve the tension and meet the demands that empathy placed upon nursing practice.

Data sources. This article is based on two studies undertaken between 2008 and 2010 to understand the concept of hope and empathy among people with terminal cancer and doctors who care for them. Doctoral dissertations and theses of Edith Stein (1916–1917), Marianne Sawicki [Body, Text and Science. The Literary of Investigative Practices and the Phenomenology of Edith Stein (1997) Kluwer Academic Publisher, Dordrecht], and Sister M. Judith Parsons (2005) have been used to examine: ‘the essence of acts of empathy’, ‘the constitution of the psycho-physical individual’ and ‘empathy as understanding of intellectual persons’. CINAHL, MEDLINE and PROQUEST have provided further supporting data.

Discussion. Steinian empathy requires that we use affective resonance, cognitive understanding and distance, as we grasp another person’s emotional and situational reality while in the caring role as nurses.

Implications for current nursing. Steinian empathy is about recognizing a lived experience and standing side-by-side with that person. Nurses can transmit this knowledge to enable and support courage and wisdom to reduce feelings of helplessness when caring for people with terminal illness.

Conclusion. Not only is empathy a safe and permissible emotion, it is the linchpin to a caring patient–nurse relationship and we must embrace this.

Diversity and thermal comfort in outdoor places

Sustainable cities should be livable cities where people from different backgrounds and with different aspirations can meet and interact with each other. Public places being the urban stages where the social interactions happen are considered important parts of cities (Thompson, 2002; Varna, 2009). They can contribute to enhance the quality of life within cities, or contrarily increase isolation and social exclusion (Lo et al., 2003). As a consequence of globalization and the development of global cities, the level of international migration has been growing in the last decades creating a plurality of different cultures in global cities and inspiring in such cities a multicultural nature (O'Byrne, 1997; Short and Kim, 1999; Hawkins, 2006). This created new challenges in urban planning or the management of the coexistence of different people that are having different characteristics that shape their unique identity and needs in the shared spaces (Sandercock, 2004). Ideally, in order to invite a diversity of users, urban outdoor places should provide significant functional and physical qualities, and accessibility to them, which induce the fulfillment of physiological, psychological and social needs (Carr et al., 1992; Jacobs, 1993; Sandholz, 2007). Users’ state of comfort as stated by researchers gives a good indication for how successful is the public outdoor places (Rosheidat et al., 2008; Kwong et al., 2009; Aljawabra and Nikolopoulou, 2010). In order to create a successful open space usable by all members of a community, urban designers need to satisfy their comfort needs in its wider meaning according to a variety of different ages, genders and cultural backgrounds (Knez and Thorsson, 2006; Thorsson et al., 2007). The main aim of the research is to examine the influence of culture and environmental attitude on participants’ thermal requirements in outdoor public places. The paper explores the variables that constitute a successful multicultural design, issues of cultural complexity, and the measuring comfort in specific outdoor public place. Qualitative analysis of a case study provides the main research methodology of the research. The conclusion will provide a set of criteria that guide future design and development of a successful shared outdoor public places.

Process and impact evaluation of the romp & chomp obesity prevention intervention in early childhood settings : lessons learned from implementation in preschools and long day care settings

Background: The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children’s dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention.
Methods: Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups.
Results: The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs.
Conclusions: These results provide confidence that obesity prevention interventions in children’s settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.

Non-face to face consultations and communications in primary care : the role and perspective of general practice managers in Scotland

Background Practice managers play an important role in the organisation and delivery of primary care, including uptake and implementation of technologies. Little is currently known about practice managers’ attitudes to the use of information and communication technologies, such as email or text messaging, to communicate or consult with patients.

Objectives To investigate practice managers’ attitudes to non-face-to-face consultation/communication technologies in the routine delivery of primary care and their role in the introduction and normalisation of these technologies.

Methods We carried out a mixed-methods study in Scotland, UK. We invited all practice managers in Scotland to take part in a postal questionnaire survey. A maximum variation sample of 20 survey respondents participated subsequently in in-depth qualitative interviews.

Results Practice managers supported the use of new technologies for routine tasks to manage workload and maximise convenience for patients, but a range of contextual factors such as practice list size, practice deprivation area and geographical location affected whether managers would pursue the introduction of these technologies in the immediate future. The most common objections were medico-legal concerns and lack of perceived patient demand.

Conclusion Practice managers are likely to play a central role in the introduction of new consultation/communication technologies within general practice. They hold varying views on the appropriateness of these technologies, influenced by a complex mix of contextual characteristics.Managers from areas in which the ethos of the practice prioritises personalised care in service delivery are less enthusiastic about the adoption of remote consultation/ communication technologies.

Intellectual property rights in indigenous cultural heritage : basic concepts and continuing controversies

The developments at international level in the debate on what intellectual property (IP) lawyers refer to as traditional cultural expressions (TCEs) have to be seen in the context of the decolonisation movements after the Second World War. Post-war developments saw the formation of the United Nations (UN) and the emphasis on human rights in the UN Charter. With this emphasis came development programmes for indigenous peoples and the recognition of indigenous rights in the ILO Convention No. 107 of the 1957 Concerning the Protection and Intergration of Indigenous and Other Tribal and Semi-Tribal Populations in the Independant Countries. The decolonisation movements also initiated or renewed a parallel debate about the repatriation of items of cultural heritage. There was a remarkable shift in this discussion from 'cultural heritage of mankind' to cultural particularism and an emphasis on 'cultural property' ....

Health care and lost productivity costs of overweight and obesity in New Zealand

Objective: To estimate the costs of health care and lost productivity attributable to overweight and obesity in New Zealand (NZ) in 2006.

Methods: A prevalence-based approach to costing was used in which costs were calculated for all cases of disease in the year 2006. Population attributable fractions (PAFs) were calculated based on the relative risks obtained from large cohort studies and the prevalence of overweight and obesity. For each disease, the PAF was multiplied by the total health care cost. The costs of lost productivity associated with premature mortality were estimated using both the Human Capital approach (HCA) and Friction Cost approach (FCA).

Results: Health care costs attributable to overweight and obesity were estimated to be NZ$686m or 4.5% of New Zealand's total health care expenditure in 2006. The costs of lost productivity using the FCA were estimated to be NZ$98m and NZ$225m using the HCA. The combined costs of health care and lost productivity using the FCA were $784m and $911m using the HCA.

Conclusion: The cost burden of overweight and obesity in NZ is considerable.

Implications: Policies and interventions are urgently needed to reduce the prevalence of obesity thereby decreasing these substantial costs.

The sampling and remix dilemma: what is the role of moral rights in the encouragement and regulation of derivative creativity

The borrowing and rearrangement of musical content, especially in the digital context, raises difficult questions for copyright law. There is significant community support for a loosening of the restrictions on the derivative (and particularly creative) use of copyright material. Law reform is called for. This paper discusses the possible introduction of a new exception to copyright infringement but notes that in the drafting of any such exception not only the economic rights but also the moral rights of the originating author need to be taken into account.