Validering av Alberta Context Tool (ACT) för bruk inom svensk kommunal äldrevård : Ett verktyg för implementering av evidensbaserad vård

The aim of this study was to conduct an instrument test of the Canadian questionnaire Alberta Context Tool (ACT) version Long-Term care for Swedish conditions. ACT is designed in order to measure the context in the care environment and different behaviours related to the changes in clinical practice. In total, 159 Licensed Practical Nurses (LPNs) and Registered Nurses (RNs) within municipality care of the elderly were included in the survey. The test included the instrument's reliability and face validity.The reliability test was implemented through calculation of Cronbach´s Alpha, and showed internal consistency for five of the scales of the ACT-instrument with Cronbach´s Alpha values ranging between 0,728 and 0,873. However, three dimensions got lower values (0,558 - 0,683).The analysis was carried out with content analysis and carried out for LPNs and RNs in separate groups. The majority of LPNs expressed that it was easy to respond to the questions (56%), while nine percent considered it as difficult. Eleven comments were given about questions that were perceived to be unclear, complicated or contained difficult words. In the RN group only 30 percent considered that the questions were easy to respond to. One third of the RNs considered that part of the questions were unclear, and six RNs expressed also which questions they experienced as unclear. In general, the questions in the ACT were perceived as relevant. The instrument's relevance as a tool to measure contextual factors that influence the implementation of evidence based nursing can also be considered to be determined. By modifying the content in the questionnaire in accordance with what appeared in this survey and to implement yet another test, the instrument should be considered to be relevant for use within Swedish municipality care of the elderly. ACT can be used both as a tool in the work on improvement of clinical practice and as a tool for further research about implementation of evidence based nursing.

Dissonant Voices : Philosophy, Children's Literature, and Perfectionist Education

Dissonant Voices has a twofold aspiration. First, it is a philosophical treatment of everyday pedagogical interactions between children and their elders, between teachers and pupils. More specifically it is an exploration of the possibilities to go on with dissonant voices that interrupt established practices – our attunement – in behaviour, practice and thinking. Voices that are incomprehensible or expressions that are unacceptable, morally or otherwise. The text works on a tension between two inclinations: an inclination to wave off, discourage, or change an expression that is unacceptable or unintelligible; and an inclination to be tolerant and accept the dissonant expression as doing something worthwhile, but different. The second aspiration is a philosophical engagement with children’s literature. Reading children’s literature becomes a form of philosophising, a way to explore the complexity of a range of philosophical issues. This turn to literature marks a dissatisfaction with what philosophy can accomplish through argumentation and what philosophy can do with a particular and limited set of concepts for a subject, such as ethics. It is a way to go beyond philosophising as the founding of theories that justify particular responses. The philosophy of dissonance and children’s literature becomes a way to destabilise justifications of our established practices and ways of interacting. The philosophical investigations of dissonance are meant to make manifest the possibilities and risks of engaging in interactions beyond established agreement or attunements. Thinking of the dissonant voice as an expression beyond established practices calls for improvisation. Such improvisations become a perfectionist education where both the child and the elder, the teacher and the student, search for as yet unattained forms of interaction and take responsibility for every word and action of the interaction. The investigation goes through a number of picture books and novels for children such as Harry Potter, Garmann’s Summer, and books by Shaun Tan, Astrid Lindgren and Dr. Seuss as well narratives by J.R.R. Tolkien, Henrik Ibsen, Jane Austen and Henry David Thoreau. These works of fiction are read in conversation with philosophical works of, and inspired by, Ludwig Wittgenstein and Stanley Cavell, their moral perfectionism and ordinary language philosophy.

Perfectionist Philosophy as a (an Untaken) Way of Life

I am honored to respond to Paul Guyer’s elaboration on the role of examples of perfectionism in Cavell’s and Kant’s philosophies. Guyer’s appeal to Kant’s notion of freedom opens the way for suggestive readings of Cavell’s work on moral perfectionism but also, as I will show, for controversy. There are salient aspects of both Kant’s and Cavell’s philosophy that are crucial to understanding perfectionism and, let me call it, perfectionist education, that I wish to emphasize in response to Guyer. In responding to Guyer’s text, I shall do three things. First, I shall explain why I think it is misleading to speak of Cavell’s view that moral perfectionism is involved in a struggle to make oneself intelligible to oneself and others in terms of necessary and sufficient conditions for moral perfection. Rather, I will suggest that the constant work on oneself that is at the core of Cavell’s moral perfectionism is a constant work for intelligibility. Second, I shall recall a feature of Cavell’s perfectionism that Guyer does not explicitly speak of: the idea that perfectionism is a theme, “outlook or dimension of thought embodied and developed in a set of texts.” Or, as Cavell goes on to say, “there is a place in mind where good books are in conversation. … [W]hat they often talk about … is how they can be, or sound, so much better than the people that compose them.” This involves what I would call a perfectionist conception of the history of philosophy and the kinds of texts we take to belong to such history. Third, I shall sketch out how the struggle for intelligibility and a perfectionist view of engagement with texts and philosophy can lead to a view of philosophy as a form of education in itself. In concluding these three “criticisms,” I reach a position that I think is quite close to Guyer’s, but with a slightly shifted emphasis on what it means to read Kant and Cavell from a perfectionist point of view.

'In Charge of the Truffula Seeds' : On Children's Literature, Rationality and Children's Voices in Philosophy

In this paper I investigate how philosophy can speak for children and how children can have a voice in philosophy and speak for philosophy. I argue that we should understand children as responsible rational individuals who are involved in their own philosophical inquiries and who can be involved in our own philosophical investigations-not because of their rational abilities, but because we acknowledge them as conversational partners, acknowledge their reasons as reasons, and speak for them as well as let them speak for us and our rational community. In order to argue this I turn, first, to Gareth Matthews' philosophy of childhood and suggest a reconstruction of some of his concepts in line with the philosophy of Stanley Cavell. Second, in order to examine more closely our conceptions of rationality and our pictures of children, I consider the children's books, The Lorax and Where is My Sister? and Henrik Ibsen's play, The Wild Duck.

The Philosophy of Dissonant Children : Stanley Cavell's Wittgensteinian Philosophical Therapies as an Educational Conversation

Education is often understood as a process whereby children come to conform to the norms teachers believe should govern our practices. This picture problematically presumes that educators know in advance what it means for children to go on the way that is expected of them. In this essay Viktor Johansson suggests a revision of education, through the philosophy of Stanley Cavell, that can account for both the attunement in our practices and the possible dissonance that follows when the teacher and child do not go on together. There is an anxiety generated by the threat of disharmony in our educational undertakings that may drive teachers toward philosophy in educational contexts. Here Johansson offers a philosophical treatment of this intellectual anxiety that teachers may experience when they, upon meeting dissonant children, search for epistemic justifications of their practices—a treatment whereby dissonant children can support teachers in dissolving their intellectual frustrations.

Therapeutic Discourse and the American Public Philosophy: On American Liberalism's Troubled Relationship with Psychology

I explore the main currents of postwar American liberalism. One, sociological, emerged in response to the danger of mass movements. Articulated primarily by political sociologists and psychologists and ascendant from the mid-fifties till the mid-seventies, it heralded the "end of ideology." It emphasized stability, elitism, positive science and pluralism; it recast normatively sound politics as logrolling and hard bargaining. I argue that these normative features, attractive when considered in isolation, taken together led to a vicious ad hominem style in accounting for views outside the postwar consensus. It used pseudo-scientific literature in labeling populists, Progressives, Taft conservatives, Goldwaterites, the New Left and others "pathological," viz. mentally ill. Hence, "therapeutic discourse." I argue that philosophical liberalism, which reasserts the role of political theory in working out norms and adjudicating disagreement, is a more profitable way of thinking about and defending from critics liberalism. I take the philosopher John Rawls as the tradition's modern representative. This inquiry is important because the themes of sociological liberalism are making a comeback in American public discourse, and with them perhaps the baggage of therapeutic discourse. I present a cautionary tale.

Ethics in a capitalistic society

The problem of semantics is inherent in any discussion of ethics. The general term "ethics" is itself commonly confused. In addition, systems of ethics must be built upon assumptions, and assumptions are necessarily subject to lengthy debate. These two problems are encountered in my investigation of the ethical practices of the modern business community and to remedy the situation I have taken two steps: the first being an attempt to clarify the meaning of terms used therein;-and the second being a clear description of the assumptions utilized to further my analysis. To satisfy those who would disagree with these assumptions, I have attempted to outline the consequences of differing premises. The first assumption in my discussion is that the capitalistic economy is powered by the motivation supplied by man's self-interest. We are conditioned to basing our courses of action upon an orientation toward gratifying this self-interest. Careers are chosen by blending aptitude, interest, and remuneration. of course, some people are less materially inclined than others, but the average member of our capitalistic society is concerned with the physical rewards derived from his employment. Status and happiness are all-important considerations in pursuing a chosen course of action, yet all too often they are measured in physical terms. The normal self-interest natural to mankind is heightened in capitalism, due to the emphasis placed upon material compensation. Our thinking becomes mechanistic as life devolves into a complex game played by the rules. We are accustomed to performing meaningless or unpleasant duties to fulfill our gratifications. Thought, consequently, interferes with the completion of our everyday routines. We learn quickly not to be outspoken, as the outspoken one threatens the security of his fellow man. The majority of the people are quite willing to accept others views on morality, and indeed this is the sensible thing to do as one does not risk his own neck. The unfortunate consequence of this situation has been the substitution of the legal and jural for the moral and ethical. Our actions are guided by legal considerations and nowhere has this been more evident than in the business community. The large legal departments of modern corporations devote full time to inspecting the legality of corporate actions. The business community has become preoccupied with the law, yet this is necessarily so. Complex, modern, capitalistic society demands an elaborate framework of rules and regulations. Without this framework it would be impossible to have an orderly economy, to say nothing of protecting the best interests of the people. However, the inherent complexities, contradictions, and sometimes unfair aspects of our legal system can tempt men to take things into their own hands. From time to time cases arise where men have broken laws while acting in good faith, and other cases where men have been extremely unethical without being illegal. Examples such as these foster the growth of cynicism, and generally create an antagonistic attitude toward the law on the part of business. My second assumption is that the public, on the whole, has adopted an apathetic attitude toward business morality. when faced with an ethical problem, far too many people choose to cynically assume that, if I don't do it someone else will. "The danger of such an assumption lies in that it eliminates many of the inhibitions that normally would preclude unethical action. The preventative factor in contemplating an unethical act not only lies in it going against the "right course of action", but also in that it would display the actor as one of the few, immoral practitioners. However, if the contemplator feels that many other people follow the same course of action, he would not feel himself to be so conspicuous. These two assumptions underly my entire discussion of modern business ethics., and in my judgment are the two most important causal factors in unethical acts perpetrated by the business community. The future elimination of these factors seems improbable, if not futile, yet there is no reason to consider things worse than they ever have been before. The heightened public interest in business morality undoubtedly lies in part in the fact that examples of corporate malpractice are of such magnitude in scope, and hence more newsworthy.