Negotiating Boundaries: The Nurse Family Member Caring for Her Own Relative in Palliative Care

<p>This research illuminates the challenges of living well within one's own family as a nurse caring for her own relative who is dying of a cancer-related illness. Developing a deeper awareness of the consequences of this caring work has been the central focus for inquiry in this research. Nursing requires epistemologies that encompass new ways of understanding how we live within our own families and communities and practice as nurses. The theoretical framework that guides this research interprets the French Philosopher Michel Foucault's (1926-1984) critical history of thought as an ethical project for nursing. It uses conceptual tools developed in his later writing and interviews to draw attention to how discursive knowledge and practices constitute subjectivity in relations of truth, power and the self's relation to the self. The first aspect of the analysis, landscapes of care examines the techniques of discourse as relations of power and knowledge that constitute nurse family members as subjects who have relationships with their own families and other health professionals. The second aspect analyses care of the self and others as self work undertaken to form the self as a particular kind of subject and achieve mastery over one's thoughts and actions. Nurses are called to care because they are present within their families with knowledge and expertise that makes a difference to how a dying relative experiences palliative care. Caring discourse positions nurses with responsibilities to their own; responsibilities that require sensitivity in knowing how to negotiate the relational spaces that constitute relationships with other family members and health professionals. Family discourse calls nurse family members to care as daughters, daughters-in-law, wives or mothers within normative understandings about the obligations that families have to care for their ill or dependent members. The discourse of expertise in knowing as a nurse positions nurse family members as interpreters of information for their families and observers who use their inside knowledge of how the health system works to watch over the ill person's clinical care. This expertise, which becomes visible as the exercise of professional authority in practising nursing, challenges the normative frameworks that classify and demarcate professional and lay roles in caring for the dying person. As an exploration of the complex and contradictory subjectivities of the nurse family member, this research illuminates the forms and limits of nursing practice knowledge. It shows how nursing is practised, and the identity of the nurse is created, through intellectual, political and relational work, undertaken on the self in relation to others, as modes of ethical engagement. Within this ethical engagement, nurse family members work to transform the self into discursive subjects, with the knowledge, skills and other capacities that are necessary to honour their commitments and responsibilities for care of another person. The experience of caring for their own relative transforms nurse family members' previously held values about how nurses ought to be with others in their professional work, creating a deeper sense of interest in and concern for the vulnerability of other people in palliative care.</p>

Negotiating Boundaries: The Nurse Family Member Caring for Her Own Relative in Palliative Care

<p>This research illuminates the challenges of living well within one's own family as a nurse caring for her own relative who is dying of a cancer-related illness. Developing a deeper awareness of the consequences of this caring work has been the central focus for inquiry in this research. Nursing requires epistemologies that encompass new ways of understanding how we live within our own families and communities and practice as nurses. The theoretical framework that guides this research interprets the French Philosopher Michel Foucault's (1926-1984) critical history of thought as an ethical project for nursing. It uses conceptual tools developed in his later writing and interviews to draw attention to how discursive knowledge and practices constitute subjectivity in relations of truth, power and the self's relation to the self. The first aspect of the analysis, landscapes of care examines the techniques of discourse as relations of power and knowledge that constitute nurse family members as subjects who have relationships with their own families and other health professionals. The second aspect analyses care of the self and others as self work undertaken to form the self as a particular kind of subject and achieve mastery over one's thoughts and actions. Nurses are called to care because they are present within their families with knowledge and expertise that makes a difference to how a dying relative experiences palliative care. Caring discourse positions nurses with responsibilities to their own; responsibilities that require sensitivity in knowing how to negotiate the relational spaces that constitute relationships with other family members and health professionals. Family discourse calls nurse family members to care as daughters, daughters-in-law, wives or mothers within normative understandings about the obligations that families have to care for their ill or dependent members. The discourse of expertise in knowing as a nurse positions nurse family members as interpreters of information for their families and observers who use their inside knowledge of how the health system works to watch over the ill person's clinical care. This expertise, which becomes visible as the exercise of professional authority in practising nursing, challenges the normative frameworks that classify and demarcate professional and lay roles in caring for the dying person. As an exploration of the complex and contradictory subjectivities of the nurse family member, this research illuminates the forms and limits of nursing practice knowledge. It shows how nursing is practised, and the identity of the nurse is created, through intellectual, political and relational work, undertaken on the self in relation to others, as modes of ethical engagement. Within this ethical engagement, nurse family members work to transform the self into discursive subjects, with the knowledge, skills and other capacities that are necessary to honour their commitments and responsibilities for care of another person. The experience of caring for their own relative transforms nurse family members' previously held values about how nurses ought to be with others in their professional work, creating a deeper sense of interest in and concern for the vulnerability of other people in palliative care.</p>

Introduction

The introduction begins with how memory for Augustine gives expression to any coherent understanding of the self in time as well as how the self might encounter God. Though scholars have examined memory extensively in his treatises, particularly Confessions and the Trinity, these studies neglect that the greatest volume of memory language and musing in Augustine occurs in his preaching. The introduction sets out the book’s argument for how memory that is limitedly interiorizing is transformed in Augustine’s preaching into a communal work of the whole Christ. This new approach to memory intends to provide a renewed memory for Augustinian studies and a renewed Augustine for memory studies. For Augustinian studies, this includes debates about selfhood, interiority and exteriority, Augustine’s preaching, and the centrality of Christology to Augustine’s work. For memory studies broadly, the introduction explains how the book relates to phenomenologies of self in relation to God, theories of collectivity and political theology, ethics of remembering, forgetting, and forgiveness, and places Klee’s painting Angelus Novus in relation to Augustine’s Idithun the leaper as contrasting icons of memory. The introduction concludes with a brief outline of the chapters.

On knowing who you are and who you are from

Engaging with poetic inquiry as a way of being and knowing, the author uses autoethnography and poetry to explore identity and to lay open the ideas of self in relation to culture and biculturalism. In this paper the author explores her immediate Western cultural contextual understandings in relation to the ancestral, historical context that has shaped her, and how these might be revealed in the bicultural context of Aotearoa-New Zealand. The invitation to deepen these understandings begins with her encounters with te Ao Māori. The paper and the poems unfold how mātauranga Māori might foster an expanded horizon such that the author can no longer consider her Pākehā (non-indigenous) ‘self’ an isolated ‘I’, but rather as deeply embedded in the world. The kōrero tracks her shift to consider herself in relationship to her ancestors (whakapapa) and her place(s) in the world (tūrangawaewae) where she is most connected to those ancestors and the earth. Supporting and woven throughout the text is the spine of a poem. Written over the course of a decade the poem, Pepeha, continues to grow and evolve as the writer’s understandings change and develop.

How Does It Feel to Be Online? Psychotherapists’ Self-Perceptions in Telepsychotherapy Sessions During the COVID-19 Pandemic in Italy

Aims: The COVID-19 pandemic and consequent extreme restrictions imposed by governments across the world forced psychotherapists to abruptly change their working modality. The first aim of the current study was to assess psychotherapists’ self-perceptions (i.e., affective and cognitive perceptions about their self and their self in relation to clients) when providing telepsychotherapy during the first peak of the COVID-19 pandemic in Italy. The second aim was to explore the associations between psychotherapists’ self-perceptions, characteristics, and clinical practices.Method: An online survey was administered to 281 Italian licensed psychotherapists (Mage=45.15; SD=10.2; 83.6% female) between April 5 and May 10, 2020. The survey comprised ad-hoc questions that were designed to collect sociodemographic details and information related to working practices. Moreover, a semantic differential (SD) scale was developed to assess psychotherapists’ self-perceptions, and a factor analysis was performed from the SD items.Results: The SD scale showed an overall trend of positive psychotherapist self-perception during telepsychotherapy, despite reports of greater fatigue and directive and talkative behavior during sessions. Four SD factors accounted for 45% of the variance: “Affective Availability,” “Attitude Predisposition,” “Well-being,” and “Interventionism.” Scores on the first three factors were indicative of psychotherapists’ Positive vs. Negative self-perception. A comparison of the Positive and Negative attitudinal profiles using the chi-squared test with Yates’s correction and a Monte Carlo simulation found that psychotherapists with a Positive profile reported greater satisfaction with the telematic modality and were more likely to perceive that their clients were able to maintain privacy during sessions.Conclusion: The results suggest that Italian psychotherapists have been able to promptly adapt to the imposed telematic modality during the COVID-19 pandemic. However, they may have attempted to compensate for their physical distance from clients by intervening more during sessions. These findings may support psychotherapists who are currently practicing and inform future practitioners who are considering the use of telematic treatment as a routine component of psychotherapeutic care.

Reflection

Contemporary psychology has explored the concept of the self in relation to the second order characteristics of metacognition. On the dominant theoretical framework, cognitive processes are taken to be split into two specifically interrelated levels called the object level and the metalevel, with the latter monitoring and controlling the former. The metalevel is thought to be self referential. For example, retrieving an answer to a question, or making a response to a cue, at the object level, does not involve reflection and is not self-referential. By contrast, judgments about whether the response was or was not true, or about whether one would be able to remember the response later entails second-order or metalevel processing, and it thought to be self-referential and to involve consciousness. This Reflection presents some of recent work on self-referential thought in humans. It also reviews studies of the neurological basis of these judgments, and investigations which have sought to determine whether any animals other than humans have this capacity.

Ancient Wandering and Permanent Temporariness

To move towards an understanding of displacement from within, and the forms of its overcoming, the following chapter brings into dialogue the ancient experience of wandering and the 21st century condition of permanent temporariness. It explores whether these are the same or different phenomena, and whether the latter is a uniquely modern experience. In particular, it is interested in the turning points that lead to the defiance of the condition and its regime. It traces modes of existence that subvert the liminal state and allow for possibilities of living beyond the present moment through returns and futures that are part of everyday practices, even if they are splintered. Such actions, it is argued, allow for the repositioning of the self in relation to the world, and thus the exposition of cracks within the status quo. The investigation confronts experiences that appear to be uniquely those of the present day—such as non-arrival and forced immobility. In its exploration it engages current responses to de-placement by those who have experience of the condition first hand. It is a dialogue between the work of such creators as the architects Petti and Hillal, the poets Qasmiyeh and Husseini, and the community builders of Dandara, with ancient discourses of the outcast that are found in Euripides’ Medea, the experience of Xenophon and such philosophers as Diogenes the Cynic. In so doing, it seeks to expose the way seemingly exceptional forms of politics and existence, instead, reveal themselves as society’s ‘systemic edge’.

“The Day I Die Is The Day I Will Find My Peace”: Narratives of Family, Marriage, and Violence Among Women Living With Serious Mental Illness in India

In India, there is limited research on the nature of familial relationships and domestic violence that women living with serious mental illness (SMI) experience. Using the self-in-relation theory and through 34 in-depth interviews, I explored narratives related to family, marriage, and violence in familial relationships among women living with SMI at a psychiatric institution in an urban city in India. These narratives are critical because they highlight how the presence of mental illness exacerbates the violence women experience. Informed by participants’ narratives, I offer specific recommendations on creating gender-sensitive mental health care that is mindful of women’s social realities.