A comprehensive theory of the human person from philosophy and nursing

This article explores a problem of the articulation of an adequate account of the human person in both philosophical and nursing theory. It follows the lead of philosopher Norris Clarke in suggesting that there has been a significant division in the way philosophers have looked at the human person and goes on to suggest that this division is paralleled in prominent nursing theories. The paper reviews and argues for the synthesis of two contemporary philosophic theories of the person that arise from the traditional philosophical division, and uses Clarke's account to show the ontological need for such a synthesis if we are to have a more adequate account of the human person. Next, accounts of the person identified in a number of the prominent theories of nursing are briefly reviewed revealing the vast complexity of the person encountered in nursing practice. It is suggested that each new theory of nursing is founded, at least in part, on the need to account for attributes of the person missing from prior nursing theories. It will be seen that the synthesized account of the person argued for here more adequately accounts for the various attributes identified in these nursing accounts and it is hoped that this synthesized account will serve as a somewhat more complete basis for a continued exploration of the persons encountered in nursing practice in its many and varied manifestations.     

Rethinking dementia as a queer way of life and as ‘crip possibility’: A critique of the concept of person in person-centredness

The concept of person-centeredness has become in many instances the standard of health care that humanises services and ensures that the patient/client is at the centre of care delivery. Rejecting a purely biomedical explanation of dementia that led to a loss of self, personhood in dementia could be maintained through social interaction and communication. In this article, we use the insights of queer theory to contribute to our current understanding of the care of those with dementia. We critically discuss the concepts of person and personhood that have become the cornerstone values of person-centred care for persons with dementia (PWD). Some critics, using queer theory as a theoretical approach, contend that person-centred care often (unwittingly) reproduces heteronormative roles in trying to sustain life histories. In doing so, they argue, regendering of PWD is sometimes enforced by care providers who try to safeguard this biographical continuity. Cultural theorist Linn Sandberg also mentions that other axes of domination such as race and class are not conceptualised in person-centeredness approaches, and neither are power asymmetries. Thus, in our article, we revisit the concept of person-centred care as a first step in proposing another way to think about ‘beings with dementia’ (to avoid the term person). Believing that queer theorists have fallen short in questioning the idea of person or personhood as such, we will build on and broaden Sandberg's critique by demonstrating that queer and crip theory can be understood as a fundamental critique of the (Western) subject and processes of subjectivation. We argue that dementia can be conceptualised as a radical break not only with gendered roles and embodiments, but with many of the norms that make us recognisable subjects. Conceptualising dementia in this way turns it into what Sandberg called an ‘emancipatory space’ and not merely a pathology     

Albert Mieczysław Krąpiec’s theory of the person for professional nursing practice

This article presents the works of great Polish philosopher, Mieczys?aw Albert Kr?piec, whose creative output can be applied to professional nursing practice. Kr?piec's philosophical heritage is extensive and encompasses many philosophical fields: metaphysics, philosophical anthropology, philosophy of law, philosophy of culture, philosophy of politics and philosophy of language. Kr?piec created an original philosophical synthesis characterized by a realistic approach. In this paper, I present only one of several original philosophical concepts developed by Kr?piec: the theory of the person based on seven essential characteristics, that is the ability for cognition, love, freedom, religion, legal subjectivity, completeness and dignity. I attempt to show how these personal characteristics correspond to various patient needs. I argue that the qualitative deficit of any personal characteristics indicated by Kr?piec corresponds to a patient's real need that must be satisfied. I also stress that the skilful diagnosing of all—not only selected—qualitative deficits of characteristics can be defined as holistic care in the nursing profession.     

What is important to patients in palliative care? A scoping review of the patient’s perspective

Background: The research conducted in palliative care is often medically oriented. There are few studies clarifying the patient’s preferences, priorities and desires in palliative care. The occupational therapy research conducted mostly concerns occupational therapy interventions based on the profession’s experiences. Further knowledge is needed regarding what patients in palliative care want to prioritize.

Aim: The aim was to describe what patients in palliative care describe as important at the end of life.

Methods: A scoping review was conducted using the inclusion criteria: articles published in 2004-August 2015; written in English; participants?>18 years with life-threatening illness without possible cure; focusing on the patient’s experience.

Results: Seventeen articles were included in the review and they were based on interviews. The theme ‘Continuing occupational participation is important for people at the end of life’ was identified. This included five sub-themes: maintaining previous occupational patterns; feeling needed; being involved in the social environment; leaving a legacy; and living as long as you live.

Conclusions: The results show that continued occupational participation is important for people in palliative care. Occupational therapists can contribute to this by taking a highly person-centered approach and gaining information about what matters most for their clients.     

“It’s kind of hard to go to the doctor’s office if you’re hated there.” A call for gender‐affirming care from transgender and gender diverse adolescents in the United States

Research has identified discrimination and a lack of knowledgeable providers as major barriers for transgender and gender diverse (TGD) individuals seeking care, which contributes to greater stress and significant health disparities affecting this population. However, research involving TGD youth is limited. The aim of this study, therefore, was to describe TGD adolescents’ experiences, concerns and needs in healthcare settings, including their feedback on themes previously identified by healthcare providers (i.e. discomfort with gender‐related topics, reasons for not asking patients about gender and previous training regarding gender diversity). The authors conducted semi‐structured interviews with 12 TGD‐identified adolescents aged 14–17, living in Minnesota, USA in 2017–2018. Inductive thematic analysis was used to summarise participant comments into themes and subthemes. Two main themes were directly relevant to concerns and needs of TGD youth in healthcare settings and their views on healthcare providers’ concerns: (a) asking about gender and pronouns and (b) training for healthcare providers. Findings suggest the need for revisions to clinic materials, infrastructure and protocols. Adding training to all general medical and nursing education to increase knowledge, comfort and competence around gender identity would further improve care and ultimately reduce healthcare disparities affecting TGD youth.     

Children’s exposure to second‐hand smoke in the home: A household survey in the North of England

Exposure of children to second‐hand smoke (SHS) leads to increased risk of health and social problems and uptake of smoking in the future. We aimed to assess the prevalence of children’s exposure to SHS in their homes, in a deprived area in the North of England and identify what people thought would help them achieve a smoke‐free home (SFH). We performed a cross‐sectional survey of 318 households with at least one child aged under 16 years in Beeston Hill, a deprived locality in Leeds, England in June 2008. One hundred and seventy‐three households [54%, 95% confidence interval (C.I.) 49–60] had at least one smoker in the house. In 42% (95% C.I. 35–50) of these households (n = 73), smoking took place in the presence of children. The odds of allowing smoking in front of children were 2.2 (95% C.I. 1.1–4.5) times greater in households whose head had less than A‐level (national exams at 18 years) or equivalent qualification than in homes with a more qualified head of household. 92% of respondents were aware that SHS has negative effects on children’s health. However, 71% felt more information about health risks to children would help reduce exposure to SHS in the home. Smoking in the presence of children takes place in a relatively high proportion of households with smoker(s), despite media awareness campaigns regarding the dangers of passive smoking launched alongside the recently enforced smoke‐free public and workplaces legislation. Specific promotion of SFHs is needed to protect the health of children.     

Children’s dietary recalls: the salience of entree and liking for foods on accuracy and order of reporting

This study investigated the impact of entree and liking for foods on the accuracy and order of reporting on children’s school lunch recalls. Data were collected during a series of studies to investigate children’s lunch recalls from a cognitive processing approach to understand better how children remember what they have eaten. Fourth-grade children from four schools were randomly selected, observed eating lunch, and interviewed the same (n = 89) or next (n = 148) day. Foods were classified as matches (observed and reported eaten), omissions (observed but not reported eaten), or phantoms (not observed but reported eaten), and corresponding rates were calculated. Statistical analyses included z tests and permutation tests. For same- and next-day recalls, children were more likely to report entree than other meal components earlier in the interview. For next-day recalls, the phantom rate for the remaining items was lower for children who reported entrees accurately versus inaccurately. For items liked “a lot” compared with items “not liked a lot,” match rates were higher for next-day recalls, and phantom rates were lower for both same- and next-day recalls. Because entree and liking for foods appear to play salient roles in children’s dietary recalls, these results provide guidance regarding the development of specific prompts to increase the accuracy of children’s dietary recalls.     

The Effect of a Web-Based Cervical Cancer Survivor’s Story on Parents' Behavior and Willingness to Consider Human Papillomavirus Vaccination for Daughters: Randomized Controlled Trial

BackgroundProviding adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters.ObjectiveThe aim of this trial is to assess the effect of a cervical cancer survivor’s story on the willingness of parents to get HPV vaccination for their daughters.MethodsIn this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect.ResultsOf 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9%) in the intervention group and 72 (8.7%) in the control group.ConclusionsA cervical cancer survivor’s story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination.Trial RegistrationUMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf     

Genetically modified plants are an alternative to oily fish for providing n‐3 polyunsaturated fatty acids in the human diet: A summary of the findings of a Biotechnology and Biological Sciences Research Council funded project

The n‐3 polyunsaturated fatty acids (PUFA) present primarily in oily fish, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are important components of cell membranes and that are needed for normal development and cell function. Humans have very limited capacity for EPA and DHA synthesis from α‐linolenic acid and so they must be obtained pre‐formed from the diet. However, perceived unpalatability of oily fish and fish oil concerns about contamination with environmental pollutants, dietary choices that exclude fish and animal products, and price limit the effectiveness of recommendations for EPA and DHA intakes. Moreover, marine sources of EPA and DHA are diminishing in the face of increasing demands. Therefore, an alternative source of EPA and DHA is needed that is broadly acceptable, can be upscaled and is sustainable. This review discusses these challenges and, using findings from recent nutritional trials, explains how they may be overcome by seed oils from transgenic plants engineered to produce EPA and DHA. Trials in healthy men and women assessed the acute uptake and appearance in blood over 8 hours of EPA and DHA from transgenic Camelina sativa compared to fish oil, and the incorporation of these PUFA into blood lipids after dietary supplementation. The findings showed that postprandial EPA and DHA incorporation into blood lipids and accumulation in plasma lipids after dietary supplementation was as good as that achieved with fish oil. The oil derived from this transgenic plant was well tolerated. This review also discusses the implications for human nutrition, marine ecology and agriculture.     

Assessment without action; a randomised evaluation of the interRAI home care compared to a national assessment tool on identification of needs and service provision for older people in New Zealand

Comprehensive geriatric assessment (CGA) is considered the cornerstone of good practice, as it identifies need across multiple domains such as social, physical and psychological. The interRAI home care (interRAI‐HC), probably the most well‐researched and supported community‐based CGA has been implemented globally, often at considerable expense. Policy‐makers, managers and clinicians anticipate significant gains in health outcomes following such investment; however, the implementation of CGA is often undertaken in the absence of community service development. This study sought to compare the interRAI‐HC with an existing CGA [the Support Needs Assessment (SNA)] in community‐dwelling older people. A randomised controlled trial was undertaken from January 2006 to January 2007 comparing the interRAI‐HC and the SNA in 316 people (65+) referred for assessment of needs with follow‐up at 1 and 4 months. Outcomes included health‐related quality of life, physical function, social support, cognitive status, mood and health service usage as well as identified need. The study found that significantly more support needs were identified using the interRAI‐HC compared to the SNA. More social and carer support were recommended by SNA and more rehabilitation and preventive health screens were recommended by interRAI‐HC. Despite these differences, the mean healthcare use was similar at 4 months, although interRAI‐HC participants had more Emergency Department presentations and hospital admissions. No statistically significant differences between groups were reported in terms of outcomes. In conclusion, the interRAI‐HC was found to identify more unmet support needs than the SNA though resulted in no favourable outcomes for the older person or their carer. The study highlights the need to invest attention around the service context to maximise outcomes based on identified needs.     

Ethical,legal and social implications of human genome studies in radiation research: a workshop report for studies on atomic bomb survivors at the Radiation Effects Research Foundation

The Radiation Effects Research Foundation (RERF) is the primary organization in Japan dedicated to studying the health consequences of the Hiroshima and Nagasaki atomic bombings in World War II. In December 2020, RERF held a virtual international workshop on the ethical, legal and social implications (ELSI) of genome studies. In this workshop, the ELSI considerations of future human genome studies on radiation research including atomic bomb survivors and their families were discussed. Since genome sequencing (GS) is now practical and affordable, RERF now plans GS of parents/child trios to examine genetic effects of atomic bomb radiation. As such studies may engender some novel risks and benefits, ethics review and engagement with families (including consent) need to be considered. These include protection of individual privacy, use of samples from deceased prior participants, return of results to the participants, public sharing of genome data and advance science and social welfare. Specifically with regard to social welfare, the results of such studies may have implications for public and government decision-making regarding social benefits of victims and other important questions. Based on these broad-ranging discussions we have developed the following concepts to guide this work: “trust,” “compromise” and “relationship building,” inclusive of the concerned stakeholders, scientific aims and Japanese society at large. We conclude that in order to realize, establish and maintain these concepts, it is essential to put procedures into place to ensure the successful, consensus-based implementation of the RERF studies.