Health challenges changed over the course of the twentieth century to produce a population with growing care needs. As healthcare systems attempt to minimize the cost of this care, they have incentivized families to become informal caregivers for their loved ones. However this change has led to strain on caregivers. Caregiver burden has far ranging consequences on the health and wellness of the caregiver. In this paper I explore how the application of traditional medical ethics is insufficient to address these challenging dynamics, and that a relational ethics lens may elucidate more sustainable care practices. / Urban Bioethics

Background: Decisions about potentially life-sustaining treatment are often not raised with patients and families until end of life (if at all), and are influenced by their many relationships. Objective: Understand how patients and families' relationships impacted their experiences of making these decisions, and how healthcare philosophies impacted authors' portrayal of these experiences. Methods: Qualitative metasynthesis design. Purposeful sampling was used to select the 19 qualitative studies included. Relational ethics and meta-study (an approach to metasynthesis) guided data collection and analysis. Findings: 1) Closeness in relationships was valued. Healthcare professionals' (dis)honesty and (lack of) empathy affected closeness with patients/families; 2) Patients' identity and quality of life was considered in decisions, and was maintained through close relationships; 3) Reliance on relationships occurred for information, care and support; 4) Decision makers felt a sense of responsibility to consider their relationships when deliberating treatments; 5) Normative discourses were reflected in authors' writing.

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L’incertitude du contexte économique et la pression concurrentielle placent au coeur des préoccupations RH des grandes entreprises la question de la mobilité. L’objet de la thèse est d’analyser les effets de la communication managériale appliquée à celle-ci, sur la construction identitaire des cadres. Cette recherche montre les limites et les risques inhérents au processus de communication mis en place, en particulier chez Orange France avant la crise sociale de 2009. Elle s’intéresse au concept de mobilité et à la façon dont les entreprises s’en sont emparées pour construire une véritable doxa au service de leurs politiques. Un travail d’aller-retour entre l’analyse des écrits institutionnels et la parole des cadres, met en lumière les procédés argumentatifs, narratifs et sémiotiques mobilisés. Les conclusions de ce travail réinterrogent la notion d’éthique relationnelle dans la conduite du changement en entreprise. / The uncertainty of economic environment and competitive pressure put the issue of mobility at the center of HR concerns in major companies. This work consists in analyzing the effects of managerial communication, applied to mobility, on the building of managers identity. This research shows limits and risks specific to communication process, especially in Orange France, before the social crisis of 2009. It focuses on the concept of mobility and on the way companies have seized it to build a real doxa to serve their policies. Working back and forth between the analysis of institutional written messages and managers words, this approach highlights the argumentative, narrative and semiotic involved processes. The conclusions of this work raise a further concern about the concept of relational ethics in companies.

“Mindfulness gets thrown around all the time, but what does it actually mean in practice?” I interpreted this question posed by a nurse in this inquiry, as a statement of curiosity and concern. As conceptualizations, practices, and programs of mindfulness continue to diversify, there is a call to understand mindfulness as a socially and culturally embedded practice. Some critiques suggest mindfulness is moving too far from its ethical orientation and becoming instrumentalized as a tool. Therefore, the pervasive presence of ‘mindfulness’ across work and educational settings renders the question what does mindfulness actually mean in practice? an important one for nursing as a discipline, and within palliative care nursing practice. Mindfulness is proposed broadly here as an approach to meet therapeutic and relational aims for nurses within palliative care practice. What it means to be mindfully present and compassionate in the midst of suffering, strong emotion and profound uncertainty is rarely discussed. Grounded in conversations with nine palliative care nurses (their words italicized), I explored how mindfulness shapes relationally engaged ways of being while caring for people with terminal disease and existential distress. Using a contemplative dialogical narrative approach, I analyzed nurses’ stories as units of data to explore multilayered narratives with personal, social, and cultural storylines. Using an emergent and iterative design, I dialogued across various aspects of the research process enacting an integrative approach. Metaphorically, this dissertation is structured as a contemplative walk within a classical seven-circuit labyrinth; readers are invited to walk a circuitous path while following along as stories take the lead. Seven turns in the labyrinth outline a path conveying key recursive narratives of mindfulness. Turning in various directions three guiding story threads are woven together to create the path: 1) palliative care nursing as mindfulness is an embodied ethic creating space(s) for creativity and ‘connection’ through the ‘big stuff’; 2) such ‘space’ can be generated and accessed through somatic practices of ‘self-awareness’ and ‘self-care’; and 3) spaces of caring are continuously transforming within the communities in which they are practiced. Nurses’ stories foreground ways organizational and educational systems support or constrain how mindfulness as an embodied ethic of care can be enacted. This study adds to the ongoing conversation of mindfulness and its value when practiced/understood as palliative care nursing. As the historical Buddha was quoted to have said “of all mindfulness meditation, that on death is supreme.”

Moral experiences are experiences where there are values at stake. All people live moral experiences, from the mundane to the extraordinary. Undergraduate nursing students (UNS) have moral experiences during their clinical placements yet little is known about these experiences. Research that acknowledges and accounts for the range of moral experiences that UNSs have when providing patient care better reflects the diversity of these experiences, from the good to the bad, the right to the wrong, and the just to the unjust. Understanding their moral experiences can foster a greater awareness of UNSs as moral beings who live meaningful experiences that affect them as learners and future professionals. The purpose of this research study was to examine clinical placement-related moral experiences of UNSs and the ways in which these moral experiences shape them as learners. The research questions were 1) What are the moral experiences of undergraduate nursing students in the context of clinical placements?; 2) What are the relational dimensions of undergraduate nursing students' moral experiences in the context of clinical placements?; and 3) How do undergraduate nursing students incorporate their moral experiences into their learning process? This study is a constructivist grounded theory as articulated by Charmaz. Twenty-three semi-structured interviews with UNS participants were conducted and retained for analysis. All participants were recruited from the Bachelor of Science in Nursing program at a bilingual university in Ontario, Canada. In keeping with constructivist grounded theory, the data analysis process was iterative and evolving to construct a theory that was grounded in the data. As a result of data analysis, three categories were developed: 1) having a moral experience; 2) learning in motion; and 3) navigating relational contexts. In brief, the first category, having a moral experience, represents the moral experiences described by the participants; these are the stories participants shared that unfolded during or in relation to clinical placements. The second category, learning in motion, describes the participants' learning process. The third category, navigating relational contexts, represents the interconnected relationships that framed the participants' moral experiences. Overall, the findings of this study provide insights into the range of moral experiences that UNSs have during their clinical placements, the relational dimensions at play, and the learning process that UNSs experience as they navigate clinical placements as learners.

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The main purpose of the present study is to explore how the ethical relationship between teacher and student in the classroom can be described and understood from the approach of the French philosopher Emmanuel Lévinas. I also examine the theoretical concepts that can be derived from Lévinas’ ideas in order to be able to interpret the manner in which this ethical relationship manifests itself in the classroom. The empirical data was generated through observation of the kind often found in ethnographical studies like microanalyses using a variety of digital techniques. I also made use of direct observation and stimulated recall interviews in close connection with the classroom events. The study was carried out at two Swedish schools and the focus was placed on classroom practice and ethical communication in the classroom. Facial expressions, eye contact, gestures and other non-verbal communication was of great interest. Through microanalysis of classroom interaction I have attempted to uncover what exists under the surface of the classroom communication in more detail. According to Lévinas, ethics is understood as a relation of the infinitive responsibility to the Other person. In a pedagogical context, we may speak of the ”first meeting” face-to-face before any categorization of the other individual is formulated. The key concepts are Saying (in relation to the Said), the Other, the Face, asymmetrical relationships and alterity. In their encounter with the empirical data collected, the concepts have been freighted with edagogical significance. These original ethical thoughts of Lévinas, much of which challenge what has previously been taken for granted, can provide new insight into educational work. This investigation has provided other insights into the ethical dimension of education, especially as the teacher-student relationship is concerned. The close connection between vulnerability and interdependence in the teacher-student relationship, and communication as self-exposure, are important findings that can help teachers and pedagogues to understand the ethical dimension of the educational encounter with the student. Throughout the study, a relational ethical perspective has been developed as an alternative interpretative tool for analyzing and reflecting upon the teacher-student relationship.

Ce mémoire s’intéresse au dualisme hiérarchique en philosophie de l’enfance et ses implications dans la crise climatique. L’objectif principal est de démontrer qu’il est nécessaire de repenser le dualisme hiérarchique entre l’enfant et l’adulte afin que l’enfant puisse avoir une agentivité reconnue par la société, en particulier au sujet de la question environnementale. Nous croyons que la philosophie écoféministe est susceptible de contribuer à la réflexion par sa critique du dualisme hiérarchique. Pour atteindre cet objectif, nous examinons, dans la première partie, trois conceptions occidentales de l’enfance : deux conceptions dominantes dans lesquelles le dualisme enfant/adulte est présent et une conception opposée sans dualité ni hiérarchie. La seconde partie du mémoire se concentre sur la philosophie écoféministe en exposant un bref historique pour comprendre le problème du dualisme. Puis, nous analysons deux théories écoféministes pour connaitre les structures de domination et du dualisme ainsi qu’une troisième théorie pour envisager les avantages de surpasser le dualisme. Dans la troisième partie, nous présentons les liens possibles entre le dualisme en philosophie de l’enfance et le dualisme en philosophie écoféministe : le système patriarcal et le cadre conceptuel oppressif. Ces liens nous mènent à la conséquence majeure du dualisme hiérarchique, le manque d’agentivité de l’enfant, la femme et la nature; nous démontrons de quelle manière les théories écoféministes peuvent contribuer à rejeter le dualisme hiérarchique enfant/adulte afin de donner une agentivité à l’enfant. Il s’agit alors de proposer une éthique relationnelle écoféministe comme cadre normatif dont nous exposons également les limites. / This master’s thesis focuses on hierarchical dualism through the philosophy of childhood and its implications for the climate crisis. The main objective is to argue that it is necessary to rethink the hierarchical dualism between the child and the adult in order for the child to gain a socially recognised agency, particularly in relation to environmental issues. We believe that ecofeminist philosophy can contribute to this reflection through its critique of hierarchical dualism. To achieve this goal, first, we examine three Western conceptions of childhood: two dominant conceptions in which child/adult dualism is present and an opposing conception without duality or hierarchy. Second, we focus on ecofeminist philosophy by providing a brief history to understand the problem of dualism. Then, we analyse two ecofeminist theories to understand the structures of domination and dualism and a third theory to consider the benefits of overcoming dualism. Third, we present the possible links between dualism in philosophy of childhood and dualism in ecofeminist philosophy: the patriarchal system and the oppressive conceptual framework. These links lead us to the major consequence of hierarchical dualism, the lack of agency of the child, the woman and nature; we demonstrate how ecofeminist theories can contribute to rejecting the hierarchical child/adult dualism in order to restore agency to the child. The aim is to propose an ecofeminist relational ethic as a normative framework, whose limits are also exposed.

Aim: The overall aim of this thesis was to illuminate experiences of relatives of persons with severe mental illness, and their need for support from formal care. Furthermore, to illuminate nursing support of relatives of persons with severe mental illness. Methods: A mixed methods design was used. In study I, data was collected with a questionnaire responded by 226 relatives and analysed with statistics. In study II, data was gathered with interviews with a strategic sample of 18 relatives, analysed with phenomenography. Study III gathered data from 216 relatives using open-ended questions in the questionnaire (I), analysed with qualitative content analysis. In study IV, data was collected by means of focus-group interviews with 4 groups of nurses, working in mental healthcare and analysed with phenomenography. Main findings: The relatives experienced that their lives were intertwined with the life of their severely mentally ill next of kin. The relatives experienced burden and a poor health, and there were associations between burden and health (I). The relatives had to balance between multiple concerns and make choices on behalf of others and themselves, constantly struggling between opposing feelings and between reflections (II). Relatives’ encounters with mental health personnel were mainly negative, although some had positive experiences. They strived for involvement in mental healthcare for the sake of their severely mentally ill next of kin, and wanted inclusion and support for their own sake, but mostly felt left alone with straining but inescapable responsibilities (III). The nurses conceived that their responsibility was first and foremost the patient and to develop an alliance with him or her. The nurses often felt they had to exclude relatives, but were sometimes able to support them (IV). Conclusions: Relatives’ lives are intertwined with the life of their severely mentally ill next of kin. Relatives’ overall demanding life situation means that the mental health services must involve relatives for the sake of the severely mentally ill person but also include them for their own sake. They need practical and emotional support. Guidelines must be designed to address relatives’ needs, and support must be adapted to the individual relative. / Hensikt: Avhandlingens overordnete hensikt var å belyse erfaringer med å være pårørende til personer med alvorlig psykisk lidelse, og deres behov for støtte fra helsevesenet. Videre å belyse støtte fra sykepleiere til pårørende til personer med alvorlig psykisk lidelse. Metode: Mixed methods design ble benyttet. I studie I ble data samlet med spørreskjema besvart av 226 pårørende, og analysert med statistikk. I studie II ble data samlet ved hjelp av intervju med et strategisk utvalg av 18 pårørende, analysert med fenomenografi. I studie III ble data samlet gjennom åpne spørsmål i et spørreskjema (I), besvart av 216 pårørende og analysert med kvalitativ innholdsanalyse. I studie IV ble data samlet ved hjelp av fokusgruppeintervju med 4 grupper sykepleiere fra psykisk helsevern, analysert med fenomenografi. Hovedfunn: Pårørende opplevde at deres liv var sammenvevd med livet til den som hadde en alvorlig psykisk lidelse. De pårørende opplevde byrde og dårlig helse, og det var sammenheng mellom byrde og helse (I). De pårørende måtte balansere en rekke hensyn, gjøre valg på vegne av andre og seg selv, og samtidig kjempe med motstridende følelser og motstridende tanker (II). Pårørendes erfaringer med møter med helsepersonell i psykisk helsevern var hovedsakelig negative, men noen hadde positive opplevelser. De strevde for å bli involvert i behandlingen for familiemedlemmet med den alvorlige psykiske lidelsen sin del, de ønsket å bli inkludert og motta støtte for egen del, men følte seg overlatt med strevsomt ansvar som de ikke kunne unnslippe (III). Sykepleierne anså at deres ansvar først og fremst var overfor pasienten, og å skape en allianse med vedkommende. Sykepleierne opplevde ofte at de måtte ekskludere pårørende, men var noen ganger i stand til å støtte dem (IV). Konklusjoner: Pårørendes liv er sammenvevd med livet til den som har en alvorlig psykisk lidelse. Pårørendes krevende livssituasjon innebærer at psykisk helsevern må involvere dem for den som har den alvorlige psykiske lidelsen, samt inkludere pårørende for deres egen del. De har behov for praktisk og emosjonell støtte. Retningslinjer må på plass for å ivareta pårørendes behov, og støtten må tilpasses den enkelte pårørende