Exploring the development of a cultural care framework for European caring science

The aim of this paper is to discuss the development of a cultural care framework that seeks to inform and embrace the philosophical ideals of caring science. Following a review of the literature that identified a lack of evidence of an explicit relationship between caring science and cultural care, a number of well-established transcultural care frameworks were reviewed. Our purpose was to select one that would resonate with underpinning philosophical values of caring science and that drew on criteria generated by the European Academy of Caring Science members. A modified framework based on the work of Giger and Davidhizar was developed as it embraced many of the values such as humanism that are core to caring science practice. The proposed caring science framework integrates determinants of cultural lifeworld-led care and seeks to provide clear directions for humanizing the care of individuals. The framework is offered to open up debate and act as a platform for further academic enquiry

Difficult situations and moral questions raised during moral case deliberations in Swedish childhood cancer care – A qualitative nationwide study

Purpose: To describe performed moral case deliberations and present a nationwide study of difficult situations and moral questions raised by healthcare professionals during moral case deliberations in Swedish childhood cancer care. Methods: Written reports (n = 72) about difficult situations and moral questions were completed by healthcare professionals, trained as facilitators, who implemented moral case deliberations at all paediatric oncology centres in Sweden. A qualitative systematic text condensation was used for data analysis. Results: A pattern of biopsychosocial factors was found in the difficult situations, including medical, psycho-social, and religious/cultural information. Three different themes of moral questions emerged. The first, “What is the limit of healthcare professionals' responsibilities?”, included whether, and to what degree, healthcare professionals should depart from professional values, and whether/when to interfere with parents’ choices in care. The second theme, “Who has a mandate to decide on care?”, covered conflicting perspectives on care related to decision making. The third theme, “What is the right care action to take?”, concerned the best interest of the child and moral questions about whether the chosen care action would promote a better or worse outcome. Conclusions: This study contributes to increased understanding of difficult situations and moral questions raised during moral case deliberations in Swedish childhood cancer care. Biopsychosocial factors are important to take into account in order to achieve a holistic view of the situation. Although several moral questions concerned medical treatment and life and death, others were related to everyday clinical practice and the differing perspectives of children, parents, and healthcare professionals

Migrant-friendly hospitals: a paediatric perspective--improving hospital care for migrant children.

BACKGROUND: The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. METHODS: Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. RESULTS: Paediatric care can be complex, usually involving both the patient and the patient's family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. CONCLUSIONS: International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care for PMs at both policy and service levels is an investment in the future that will benefit native and migrant families

To change or not to change - translating and culturally adapting the paediatric version of the Moral Distress Scale-Revised (MDS-R)

BACKGROUND: Paediatric cancer care poses ethically difficult situations that can lead to value conflicts about what is best for the child, possibly resulting in moral distress. Research on moral distress is lacking in paediatric cancer care in Sweden and most questionnaires are developed in English. The Moral Distress Scale-Revised (MDS-R) is a questionnaire that measures moral distress in specific situations; respondents are asked to indicate both the frequency and the level of disturbance when the situation arises. The aims of this study were to translate and culturally adapt the questionnaire to the context of Swedish paediatric cancer care. In doing so we endeavoured to keep the content in the Swedish version as equivalent to the original as possible but to introduce modifications that improve the functional level and increase respondent satisfaction. METHODS: The procedure included linguistic translation and cultural adaptation of MDS-R's paediatric versions for Physicians, Nurses and Other Healthcare Providers to the context of Swedish paediatric cancer care. The process of adjustment included: preparation, translation procedure and respondent validation. The latter included focus group and cognitive interviews with healthcare professionals in paediatric cancer care. RESULTS: To achieve a Swedish version with a good functional level and high trustworthiness, some adjustments were made concerning design, language, cultural matters and content. Cognitive interviews revealed problems with stating the level of disturbance hypothetically and items with negations caused even more problems, after having stated that the situation never happens. CONCLUSIONS: Translation and cultural adaptation require the involvement of various types of specialist. It is difficult to combine the intention to keep the content as equivalent to the original as possible with the need for modifications that improve the functional level and increase respondent satisfaction. The translated and culturally adapted Swedish MDS-R seems to have equivalent content as well as improved functional level and respondent satisfaction. The adjustments were made to fit paediatric cancer care but it could be argued that the changes are relevant for most areas of paediatric care of seriously ill patients.Funding agencies: Swedish Childhood Cancer Foundation [PR2014-0116, FoAss 13/07]</p

Peer-to-Peer-Insurance on private risks: An empirical exploration on the example of claims caused by wild animals

Der vorliegende Beitrag geht der Frage nach, inwieweit Geschäftsmodellentwicklung eine Strategie zur Überwindung von Marktversagen in der Assekuranz darstellt. Insbesondere soll gezeigt werden, dass eine Abkehr von der klassischen Beziehung zwischen Versichertem und Versicherer auf Basis eines bilateralen Vertrags neue Märkte eröffnet und mit neuartigen P2P-Geschäftsmodellen bislang nicht-versicherbare Risiken abgesichert werden können. Als empirisches Feld wurde die Absicherung von Wildschäden gewählt, da es sich aktuell um einen Bereich handelt, in dem Marktversagen vorliegt. Auf Basis von 16 episodischen Interviews mit Vertretern der Gemeinschaft der Jäger werden Bedürfnisstrukturen und relevante Kontextfaktoren aufgedeckt und im Hinblick auf Risikoabsicherung und Schadenmanagement zwischen den Communitymitgliedern analysiert. Dieser Beitrag stellt somit eine Gegenposition zum traditionellen Versicherungsgeschäft dar, bei der die Absicherung auf einem großen und diversifizierten Risikokollektiv beruht