Putting Socrates back in Socratic method: Theory‐based debriefing in the nursing classroom

The term “Socratic method” is so pervasive in education across the disciplines that it has largely lost its meaning, and it has lost its roots in its originator—the historical Socrates. In this article we draw from the original source, Plato's ancient dialogues, to understand the theory and principles behind the questioning used in Socratic method. A deep understanding of Socratic method is particularly timely now as nursing leaders call for increased use of theory‐based debriefing across the nursing curriculum. Socratic questioning is ideally suited as a method for debriefing in nursing classrooms because of its ability to enhance critical thinking and self‐reflection of the learner and because of its basis in care for the learner through a learner‐centred design. We present an analysis of the Socratic method in Plato's works and provide an overview of the key Socratic principles and techniques. We illustrate these principles and techniques with examples of how Socratic teaching can be applied in the nursing classroom, and we address the challenges and rewards for nursing faculty implementing Socratic method. Learning about Socratic method directly from Plato's dialogues can provide a richer and more robust understanding of this key pedagogical technique and help nurse educators practice more intentional and informed Socratic questioning and debriefing.     

Understanding end-of-life caring practices in the emergency department: developing Merleau-Ponty's notions of intentional arc and maximum grip through praxis and phronesis

Abstract   The emergency department (ED) is a fast-paced, highly stressful environment where clinicians function with little or suboptimal information and where time is measured in minutes and hours. In addition, death and dying are phenomena that are often experienced in the ED. Current end-of-life care models, based on chronic illness trajectories, may be difficult to apply in the ED. A philosophical approach examining end-of-life care may help us understand how core medical and nursing values are embodied as care practices and as ethical comportment. The integration of Aristotle's notions of phronesis and praxis with Merleau-Ponty's ontological notions of intentional arc and maximum grip in the context of the culture and practices of the ED offers a unique view of clinical and ethical practice at the end-of-life in the emergency setting. Caring for people at the end-of-life calls us to act virtuously based on previous experience, meanings and local practices. The maximum grip of the ultimate particulars of the situation combined with one's experiential and theoretical knowledge opens up situated possibilities for the expert clinician.     

Emotional knowing in nursing practice: In the encounter between life and death

Patients, next of kin and nurses in surgical wards often raise existential questions in the encounter between life and death. Nurses'' emotional knowing at this encounter is crucial. Consequently, this study''s purpose was to analyse and describe nurses'' emotional knowing to reveal (a) how this knowing is expressed in daily work and (b) what emotions, thoughts and actions this knowing includes. This study used combined ethnographic and hermeneutic methodologies. Data were collected using participant observations, informal conversations and interviews. We found that nurses'' emotional knowing could be interpreted in relation to various rooms of emotions, thoughts and actions. Nurses'' judgements formed these rooms. They strived to do things correctly in the normative room; created a safe, secure milieu for patients and next of kin in the safety–security room; and questioned their actions in the critical room. They created affinity for co-operation that benefitted encounters with patients in their affinity room. And they demonstrated sensitivity and compassion to patients and next of kin; sensitivity and compassion were particularly evident in the closeness room. In our main interpretation, we found that nurses'' judgements in various rooms (emotional knowing) constitute an expression of practical wisdom (phronesis) in nursing practice.     

Assessment of dietary factors,dietary practices and exercise on mental distress in young adults versus matured adults: A cross-sectional study

The importance of the diet in modulating mental health is uncovering as many dietary factors have been described to alter brain chemistry. Brain maturation may not complete until the age of 30 which may explain the differential emotional control, mindset, and resilience between young adults and matured adults. As a result, dietary factors may influence mental health differently in these two populations.

Objectives: To study dietary intake, dietary practices and exercise in young adults (YA) (18–29 years) versus matured adults (MA) (30 years and older) in relation to mental distress. Another aim was to assess whether mental well-being potentially stimulates healthy eating, healthy practices, and exercising.

Methods: An anonymous internet-based survey was sent through social media platforms to different professional and social group networks. Best-fit models were constructed using the backward regression analysis to assess the relationship between dietary variables, exercise, and mental distress in YA versus MA.

Results: YA mood seems to be dependent on food that increases availability of neurotransmitter precursors and concentrations in the brain (such as frequent meat consumption and exercise, respectively). However, MA mood may be more reliant on food that increases availability of antioxidants (fruits) and abstinence of food that inappropriately activates the sympathetic nervous system (coffee, high glycemic index, and skipping breakfast).

Discussion and conclusion: Level of brain maturation and age-related changes in brain morphology and functions may necessitate dietary adjustments for improving mental well-being.     

Nurses,Inc.: Expansion and commercialization of nursing education in the Philippines

Exporting nurses has been a long-standing economic strategy for the Philippine government, despite the fact that the Philippines’ domestic health system is weak and existing supplies of health workers are poorly distributed. This study explores the role of nursing schools as “migrant institutions” in expanding and commercializing nursing education and perpetuating the link between nursing education and migration. Data were collected primarily via in-depth interviews of key informants (nursing school administrators and policymakers) in the Philippines. Results suggest that nursing schools have expanded migration opportunities by making nursing educational available to more students and more diverse student populations. Also, some nursing schools have acted to control the licensure and recruitment processes by establishing commercial relationships with licensure exam review centers and recruitment agencies. These activities perpetuate the culture of migration in the country’s nursing profession and indirectly contribute to declining quality of nursing education, misuse of scarce resources, corruption in the nursing sector, and exacerbation of existing health workforce imbalances.     

Dialectic of the university: a critique of instrumental reason in graduate nursing education

Our analysis in this paper unfolds on two levels: a critique of the 'realities' of graduate nursing education and an argument to sustain its 'ideals'. We open for discussion an aspect of graduate nursing education dominated by instrumental reason, namely the research industry, using an internal critique approach developed by Max Horkheimer and Theodor Adorno of the Early Frankfurt School. As we explain, internal critique arises out of, and relies on, the mismatch between goals, or 'ideals', and existing realities. Thinking about 'ideals' of the academy, we draw on Hans-Georg Gadamer's view of the university as a place to think freely, creatively, and critically. The contemporary realities of the university, on the other hand, that emphasize the market values of the research industry forcefully shape nursing academic scholarship in a particular direction. In our attempt to recognize and disrupt the forces of the research industry with its instrumental reason, we consider Judith Butler's writings on how norms operate in society. We show that our growing involvement in the research industry makes it very difficult to disentangle ourselves from that situation. The values of the research industry actually suppress the very ideals of education and scholarship that we would like to uphold. As a contra-force, the internal critique of the 'existing realities' in the graduate nursing education unmasks the tyranny of the research industry and makes visible the importance of sustaining the higher goals and ideals in nursing scholarship.     

Whither nursing philosophy: Past,present and future

A version of this paper was given as the Inaugural Steven Edwards Memorial Lecture at the 25^th conference of the International Philosophy of Nursing Society 16^th August 2022. Using the literary meaning of ‘whither’, that is ‘to what place’, this paper will explore the role of philosophy in nursing, past, present, and future. The paper will begin with some thoughts on the history of nursing philosophy, its development as a subject and the scholarly activities that have led to where it sits today. The establishment of the journal Nursing Philosophy, the Annual Nursing Philosophy Conference, the International Philosophy of Nursing Society (IPONS) and their influence on nursing both in the academy and in practice will be discussed. The concept of nursing philosophy as a discipline will be considered, and how this fits with nursing theory, and nursing knowledge. Philosophical questions central to understanding contemporary nursing in a globalised world will be explored and the use of analytical philosophy and philosophical method in addressing such questions. The paper will conclude by looking to the future; what the role of philosophy might be in shaping nursing as a discipline and in the preparation of future practitioners.     

张家界市1995-2012年老年人HIV感染者死亡及其影响因素分析

目的 分析张家界市1995-2012年老年人HIV感染者死亡及其影响因素.方法 将全国艾滋病疫情报告系统中1995-2012年户籍和现住址均为张家界市的老年人HIV感染者作为研究对象,结合张家界市的人口数据计算死亡率;采用Kaplan-Meier法估计老年人HIV感染者生存率曲线,用Cox回归模型分析其死亡的影响因素.结果 张家界市老年人HIV年平均死亡率为2.56/10万,并呈逐年上升趋势(x2趋势=164.38,P＜0.001),其中位生存时间为25.00个月.Cox回归模型分析显示:是否进行抗病毒治疗(RR=0.141,95％ CI:0.073～0.271),艾滋病确诊年限(RR=0.468,95％ CI:0.297～0.738)和CD4+T淋巴细胞基线计数数量(RR=0.271,95％ CI:0.162 ～0.454)是HIV感染者死亡的主要影响因素.结论 张家界市老年人HIV死亡率有逐年升高的趋势.是否进行抗病毒治疗、CD4+T淋巴细胞基线计数和艾滋病确诊年限是其死亡的主要影响因素.     

Brazilian children's behavioural differentiation between the mother,unfamiliar adults and professional caregivers

This study took place in two organisations with opposite socio‐economic characteristics which gather children (one to four years), their mothers (or nannies), unfamiliar adults and professional caregivers. Pursuant to attachment theory, the children clearly differentiated their mothers from unfamiliar adults according to proximity indicators and time in oriented behaviours. Children's behaviours towards the professionals were assessed on the same criteria: interactions with the professionals were characterised by availability without great proximity; no difference appeared between mothers and nannies. Children's behaviours towards adults were mirrored by adults' behaviours towards children. Implications in the qualification of the relationship to non‐parental caregivers are discussed.     

Unemployment, job insecurity and life satisfaction: results of a study with young adults in the new German states

Zusammenfassung. Fragestellung: Ausgehend von den zahlreichen Forschungen zu psychosozialen Aspekten des Erlebens von Arbeitslosigkeit untersucht die Studie die Folgen von tats?chlicher Arbeitslosigkeit auf die Lebenszufriedenheit und die Auswirkungen von Bedrohung durch Arbeitslosigkeit und wahrgenommener Sicherheit des Arbeitsplatzes auf die Lebenszufriedenheit. Methoden: Im Rahmen der 17. Welle der S?chsischen L?ngsschnittstudie wurden 2003 N = 419 Personen (193 M?nner, 226 Frauen, Mittleres Alter 30.05 Jahre) mit dem Fragebogen zur Lebenszufriedenheit (FLZ M) untersucht. Der Bogen erlaubt die ?konomische Erfassung von acht spezifischen Bereichen der Lebenszufriedenheit (Freunde, Freizeit, Gesundheit, Einkommen, Beruf, Wohnen, Familie, Partnerschaft). Ergebnisse: Zwei Drittel der Studienteilnehmer hatten bereits Erfahrungen mit Arbeitslosigkeit. Personen, die mehrfach arbeitslos waren, waren signifikant unzufriedener mit ihrem Einkommen, ihrer Wohnsituation, ihrem Beruf und ihrer Gesundheit. Jedoch hatten auch die Sicherheit des derzeitigen Arbeits- oder Ausbildungsplatzes und die subjektiv erlebte Bedrohung durch Arbeitslosigkeit bei derzeit Nichtarbeitslosen deutlich negative Auswirkungen auf deren Lebenszufriedenheit. Dies zeigte sich auch in Bereichen, die nicht direkt mit Erwerbsarbeit in Zusammenhang stehen, wie Freunde/Bekannte oder Familienleben. Schlussfolgerung: Die Studie unterstreicht bekannte Befunde zum Zusammenhang von Arbeitslosigkeit und (negativer) Lebenszufriedenheit. Nachgewiesen wird, dass auch bereits der antizipierte Verlust des Arbeitsplatzes zu einer eindeutig schlechteren subjektiven Lebenszufriedenheit in vielen Bereichen führt.

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Summary. Unemployment, job insecurity and life satisfaction: results of a study with young adults in the new German states Objectives: Based on research about the psychosocial aspects of experiencing unemployment, the present study analyses the effects of actual unemployment and the impact of being at risk of becoming unemployed and the influence of perceived job insecurity on life satisfaction. Methods: In the 17^th wave of the Saxon Longitudinal Study (S?chsische L?ngsschnittstudie) in 2003, 419 people (193 male, 226 female, mean age 30.05 years) were examined with a life satisfaction questionnaire. This questionnaire addresses eight areas of life satisfaction: friends, leisure time, health, income, job, housing, family, partnership. Results: Two-thirds of the participants have had experiences with unemployment so far. People who had been unemployed several times were significantly more dissatisfied with their income, housing, profession and health. Still, considering people employed at the time of survey, the subjective job insecurity and the perceived risk of becoming unemployed had noticeably negative effects on life satisfaction. This could be also shown for areas which are not directly connected to occupation, such as friends and family life. Conclusions: The study emphasizes the known results regarding the connection between unemployment and (poor) life satisfaction. Evidence was provided that even the anticipated loss of the workplace causes a decrease in life satisfaction, affecting many areas of subjective evaluation.

Wir danken der Otto-Brenner-Stiftung (http://www.otto-brenner-stiftung.de) für die freundliche Unterstützung der S?chsischen L?ngsschnittstudie.     

Dietary Intervention Effectiveness,Clinical Outcomes and Nutrient and Salicylate Intakes in Older Adults Living in Long-Term Care Homes: The Results from the Senior’s Plate Project

Optimal nutrition is an important part of the therapeutic process offered to patients in long-term care, as it can significantly influence their nutritional and health status. The aim of this study was to assess the impacts of a dietary intervention on the nutritional status, clinical outcomes and selected nutrient and salicylate intakes among older adults living in a long-term care nursing home. To achieve the research goal, a prospective, non-randomized, baseline-controlled intervention study was conducted. The study was conducted within the framework of the “Senior’s Plate Project”, a project established in 2018 by the Polish Society of Dietetics. Methods: A 3 month dietary intervention, which included one serving of supplementary food, served as a second breakfast (Nestle Sinlac). Energy, nutrients and salicylates intakes were estimated on the basis of the menus. Food and beverage intakes among residents were verified by health care personnel. Anthropometric measurements and clinical examinations were conducted according to standard procedures at baseline and after intervention. Results: Of the 38 residents qualified for the study, 29 completed the program. Residents’ body mass index (BMI) values ranged from 13.3 kg/m² to 34 kg/m². A BMI < 22 kg/m², indicating underweight, was found in 19 subjects. The dietary intervention resulted in increased body weight (57.8 ± 12.3 vs. 59.4 ± 12.6 kg), BMI (22.4 ± 4.0 vs. 23.0 ± 4.1 kg/m²) and body fat (19.2 ± 8.7 vs. 20.6 ± 8.9 kg). Significant changes in the levels of biochemical parameters, including serum calcium (8.7 vs. 9.5 mg/dL), potassium (4.1 ± 0.6 vs. 4.5 ± 0.5 mmol/L) and zinc (74.1 ± 10.9 vs. 109.0 ± 20.4 µg/dL), were observed. Energy, protein, fat and carbohydrate intakes were significantly higher in the third month of the intervention as compared to the baseline. The estimated medial daily intake of salicylates was low and ranged from 0.34 mg to 0.39 mg. Conclusions: The dietary intervention resulted in beneficial and significant changes in the nutritional status, biochemical parameters and nutrition of residents of the long-term care home. These results suggest that practical and individualized approaches are required to improve the nutritional status and clinical outcomes of nursing homes residents.     

Neighborhood environment,social participation,and physical activity in older adults with lower limb osteoarthritis: A mediation analysis

Older adults with lower limb osteoarthritis (LLOA) are highly dependent on their physical and social environment for being physically active. Longitudinal data from 2286 older adults (M_age = 73.8 years; 50.3% female) in six European countries were analyzed using cross-lagged Structural Equation Modeling (SEM) and multi-group SEM. In cross-sectional analyses, neighborhood resources were associated with physical activity (r = 0.26;p < .001) and social participation (r = 0.13;p = .003). Physical activity at follow-up was associated with neighborhood resources, with this relationship mediated by social participation in people with LLOA (β = 0.018;p = .013). To promote future physical activity, opportunities to socially engage in neighborhoods need to be targeted primarily to people with LLOA.     

子女收入、家庭支持与老年人健康

目的：分析子女收入对老年人健康状况的影响及群体性差异,并探究家庭支持在其中的中介效果。方法：使用2011—2018年四期中国健康与养老追踪调查(CHARLS)数据构建非平衡面板,以60岁及以上老年人作为研究对象,基于时间固定效应模型分析子女收入对老年人健康的效应水平,使用倾向得分匹配法对内生性问题进行讨论,并采用Karlson-Holm-Breen(KHB)方法对子女经济转移、时间转移以及二者组合路径的家庭支持方式进行机制检验。结果：子女收入提高分别在0.049和0.033水平上显著改善老年人自评健康和生活满意度,在修正选择性偏差后结论依旧稳健;子女提供经济支持、照料与情感支持在改善老年人健康中发挥重要的中介作用。结论：子女收入对老年人存在健康溢出效应,但在不同年龄、性别和户籍状况老年群体中存在差异;提高青年收入水平,倡导子女提供兼顾经济和时间转移的家庭支持方式有利于改善老年人健康状况,有助于实现健康老龄化战略目标。     

Knowledge,attitudes and practices related to the influenza virus and vaccine among older adults in Eastern China

BackgroundThis study aims to assess the association between socio-demographic and health characteristics of older adults in Eastern China and knowledge, attitudes, and practices (KAP) about the influenza virus and vaccine.MethodsA prospective cohort of 1506 older adults (aged ≥60 years) was enrolled from November to December 2015 in Jiangsu Province. We examined the association between demographics, health and functional status, and cognitive impairment at enrollment with awareness of influenza virus and vaccine and KAP items focused on five Health Belief Model domains. At a 12-month follow-up interview we assessed change in awareness and readiness to be vaccinated.ResultsOne in five older adults was aware of the influenza virus (21%) or vaccine (20%); even fewer reported having at least “a little” knowledge of the virus and vaccine (7% and 4%, respectively); less than 1% reported ever receiving an influenza vaccine. Retirement, higher education and income, and normal cognitive status were consistently associated with both awareness and knowledge of influenza virus. The odds of having at least “a little” knowledge of the vaccine was 2.9-fold (95% CI = 1.6–5.3) higher among older adults with at least some secondary schooling. Among the 108 with knowledge of the virus, 55% said they “worry about getting the flu this season.” Among the 73 with knowledge of the vaccine, 92% believed the vaccine was at least somewhat effective and less than half (43%) thought that influenza vaccination was safe. At a 12-month follow-up interview, 33% (442/1333) increased from no knowledge to at least “a little”.ConclusionsIf and when influenza vaccines become widely available to older adults in China, our results indicate that influenza vaccination campaigns with basic information on the virus and vaccine could be beneficial for all older adults, especially those with less education and/or more cognitive impairment.     

Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients

OBJECTIVE: The objective of this study was to determine if a relationship exists between the presence of anemia and the occurrence of falls during hospitalization in ambulatory older adults from long-term care and community settings. All individuals were hospitalized for acute conditions not related to a fall. PARTICIPANTS: Three hundred sixty-two hospitalized, ambulatory older (59-104 years) adults. MEASUREMENTS: Laboratory values (hemoglobin [Hb], hematocrit [Hct]), routine laboratory tests, pertinent medical history, and demographics. RESULTS: Ambulatory hospitalized patients who fell were compared to controls (no falls during hospitalization) of similar age (P = .283) and gender distribution (P = .554). Patients who fell had significantly lower Hb (P < .00005), lower Hct (P < .00005) and were more likely to be anemic (56% vs 38%, P = .001) than controls. A logistic regression model examined the effect of Hb level and anemia on falls and included the covariates of age, gender, place of residence, and race. The model described a 22% decreased risk of falls for every 1.0 g/dL increase in Hb (P < .0005) and an overall 1.9-fold increased risk of falls in anemic patients (P < .001). Patient age, gender, and place of residence were not related to the risk of falls during hospitalization. CONCLUSIONS: These findings suggest a potentially important link between anemia and the risk of falls during hospitalization in ambulatory older patients. Further studies are needed to determine if the risk of falls can be modified by correction of anemia and to determine the applicability of these findings to older adults in different settings.     

Residential satisfaction, sense of belonging and loneliness among older adults living in the community and in care facilities

The aim of this study was to analyze the influence of residential satisfaction and sense of belonging on loneliness in old age in two different contexts: the community and the residential care facility. We used two surveys of 1106 non-institutionalized and 234 institutionalized older adults, aged 60 years or more in Spain. Results from structural equation modeling and path analysis suggest that residential satisfaction would positively affect sense of belonging and would be negatively associated with loneliness in both residential environments, thus playing a protective role against the experience of loneliness.     

Golf as a physical activity to improve walking speed and cognition in older adults: A non-randomized,pre-post,pilot study

The aims of this non-randomized, pre-post, pilot investigation (ClinicalTrials.gov NCT03916887) were to assess: 1) feasibility, safety, and adherence of a 10-week golf program for non-golfer older adults, 2) estimated effects of the program on single- (ST) and dual-task (DT) walking, and cognition, and 3) whether findings support development of a randomized controlled trial (RCT).Eligible participants included healthy male and female non-golfers, 60–80 years, who could walk independently, swing a golf club, and received medical clearance. The program, conducted at a golf course, focused on improving physical and cognitive function, as opposed to golf performance. ST and DT walking speeds were assessed on a ProtoKinetics Walkway, and cognitive changes using the California Verbal Learning Test II, and NIH Cognitive Toolbox. Of fifteen screened and enrolled participants, fourteen (7F and 7M, 69.5 ± 6.05 yrs) completed the study. One participant sustained a work-related injury and did not complete the study. Average attendance was 94.3%; there were no golf-related adverse events. Estimated increase in physical activity was 25.5% with small Hedges g effect size (ES). Estimated increases in CVLT II composite score (11.2%) and immediate recall (12.6%), and ST (7.2%) and DT (9.1%) walking speeds occurred with medium-large ES. Increases in NIH card sorting (9.3%) and composite (7.3%) scores had small ES's. In an exit survey, participants reported improved physical function, mental and social well-being, and all planned to continue playing golf. ES estimates suggest 50 participants per group will be required to adequately power (β = 0.8; p < 0.05) a future RCT. The study was funded by the Royal & Ancient Golf Association.