Reaching the Sacred Through the Secular: Biblical Elements and the Superiority of Divine Love in Three of Marie de France’s Lais

In the Prologue to her Lais, Marie de France hints that her text possesses multiple layers of meaning: “The custom among the ancients…was to speak quite obscurely / in the books they wrote, / so that those who were to come after / and study them / might gloss the letter / and supply its significance from their own wisdom” (9, 11-16). Critics who study the Lais agree that the tales overwhelmingly focus on romantic love, and most of the existing scholarship overlooks the fact that this theme is merely one layer of the text’s significance. To the contrary, this study examines three particular lais and the biblical elements within them in order to clarify Marie’s true aim in her text: to show divine love is superior to flawed human love. Guigemar, Equitan, and Eliduc all present courtly romances that expose the protagonists’ spiritual deficiencies. Guigemar’s liaison with a married woman is characterized by selfishness and lust; and the lai’s biblical motifs, including talking animals, a ship that rescues, and references to Solomon, hint at the existence of a more profound love than that found in physical affection. Equitan, a king, has an affair with his seneschal’s wife and plots the man’s murder, mirroring the biblical account of David and Bathsheba. Whereas David confesses and finds forgiveness, Equitan dies with his sins, allowing Marie to insist that the type of love that saves David from himself—divine love— is the highest type. Eliduc, torn between two women, is the picture of pride and selfcenteredness. In the end, though, the love demonstrated by his soul-like wife moves both him and his lover to a renewed bond with God that transcends romance. In conclusion, Marie’s depiction of courtly love scenarios consistently shows those relationships to be flawed. In fact, all human relationships in the Lais are imperfect. Only with God can people experience a perfect love, one that moves them to charity and selflessness. By employing elements from the biblical text in her Lais, Marie points her readers to this higher love

Communication and the electronic health record training: a comparison of three healthcare systems

Background The electronic health record (EHR) used in the examination room, is becoming the primary method of medical data storage in primary care practice in the USA. One of the challenges in using EHRs is maintaining effective patient–provider communication. Many studies have focused on communication in the examination room.Purpose Scant research exists on the best methods in educating nurse practitioners and other primary care providers (clinicians). The purpose of this study was to explore various health record training programmes for clinicians.Methods One researcher participated in and observed three health systems’ EHR training programmes for ambulatory care providers in the Pacific Northwest. A focused ethnographic approach was used, emphasising patient–provider communication.Results Only one system had formalised communication training in their class, the other two systems emphasised only the software and data aspects of the EHR.Conclusions The fact that clinicians are expected to use EHRs in the examination room necessitates the inclusion of communication training in EHR training programmes and/or as a part of primary care nurse practitioner education programmes

The Sinister Way to Salvation: Directionality in Dante’s Inferno

PURPOSE: Dante’s Inferno is a tale about a journey; hence, it involves directions, locations, and points relative to other points. This study examined how, just as the character Dante descends through Hell to ascend to Paradise and makes left turns to proceed to the right around the circles of Hell, so also Dante must recognize his own sin in order to repent and be redeemed. PROCEDURES: Careful examination was made of medieval definitions of directional binary oppositions such as sinister and dexter, as well as binary oppositions related to spirituality such as sin and repentance. This word research was combined with the study of critics’ previous work on the significance of left and right in the Middle Ages and other spatial elements of Dante’s work. OUTCOME: This study’s author concluded that in the directionality of Dante’s Inferno, the real issue is not which way Dante turns as he enters each circle of Hell, but rather what direction he ends up traveling and where he finishes his journey. In other words, what is most important is how each person responds to his/her sins. Does he/she continue turning “left,” or is sin used as a motivator to “right” repentance? IMPACT: The value of this study to the field of English literature is that it takes into account elements of Dante’s work that are oftentimes viewed as insignificant to the story and its overall themes. Instead, this paper emphasizes that every detail of a story is important—even its most minor directional terminology

Shoulder Pain Assessment for the Occupational Health Nurse

Shoulder pain is a common complaint in the workplace. A shoulder condition may arise from acute trauma or non-traumatic work-related activities. Shoulder pain falls into three categories: acute, chronic, and referred pain. The occupational health nurse can document detailed health histories and focused complaint-driven physical examinations. Nurses' expert assessments can guide injured workers to necessary treatment, case management, and return to full employment

Shoulder Pain Assessment for the Occupational Health Nurse

Shoulder pain is a common complaint in the workplace. A shoulder condition may arise from acute trauma or non-traumatic work-related activities. Shoulder pain falls into three categories: acute, chronic, and referred pain. The occupational health nurse can document detailed health histories and focused complaint-driven physical examinations. Nurses' expert assessments can guide injured workers to necessary treatment, case management, and return to full employment

RN Prescribing: An Expanded Role for Nursing

PURPOSE: With the implementation of the Affordable Care Act, recommendations of the Future of Nursing Report, and recent regulatory changes by state boards of nursing, registered nurse (RN) roles are expanding. In this article, we advocate for RN prescribing as an expanded role in the United States. METHODS: We reviewed the literature on RN prescribing, the background in both high- and low-resource countries, levels of prescribing, specialized settings for RN prescribing, both RN and patients views/perceptions of prescribing, and evaluation research. From this review, we developed a proposal for RN prescribing. FINDINGS: Due to expansion of RNs into prescribing worldwide to meet unmet healthcare needs in both primary and specialty settings, we propose a role for RN prescribing within both primary care and outpatient specialty settings. The differences between RN and advanced practice RN prescribing are defined, and U.S.-based regulatory challenges are examined. CONCLUSION: Considering unmet healthcare needs and patients' need for medication and medication education, we advocate for RN prescribing as expanded scope and role change for experienced RNs to practice to the highest level of their education

Health Science Qualitative Researchers\u27 Institutional Ethnography Journey: Understanding Power Relations through a Critical Feminist Lens

Institutional Ethnography (IE) is a critical form of sociological inquiry founded by Dorothy Smith- a Canadian feminist sociologist. IE is an alternative sociology-describing the social world (ontology), the knowledge required to understand our social world (epistemology) and how we go about collecting that knowledge (methodology). IE postulates that our social world and our everyday activities are controlled and coordinated textually and discursively by the institutional or ruling relations of our society. Four qualitative health science researchers will describe their journey to collective empowerment through the help of an IE expert; exploring this methodology through analysis of online forums and chats and embracing a critical feminist lens. 1) SK has expertise with numerous qualitative methodologies as a nursing/primary care researcher. She has led a number of focused ethnographies, facilitated analysis in a number of mixed methods studies and utilized a postmodern narrative approach. 2) RS has expertise in quantitative and qualitative research with recent training in engaged scholarship (CBPR approach). As a social pharmacist, understanding social relations and social world through IE fits well with her research identity. 3) EB – a speech-language pathology researcher, who began with quantitative and mixed methods studies, has conducted descriptive qualitative, phenomenology, and CBPR studies. 4) RC’s research focus is on American Indian women’s experiences with polycystic ovarian syndrome. Due to the historical legacy of oppression for these women, RC has pursued this critical feminist methodology. Our professional goal is to enhance learning and further develop our IE skills as part of an interprofessional qualitative collaborative

Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis

PURPOSE Little is known about the effects of the electronic health record (EHR) on physician-patient encounters. The objectives of this study were to identify the factors that influence the manner by which physicians use the EHR with patients. METHODS This ethnographic study included 4 qualitative components: 80 hours of participant observation in 4 primary care offices in the Pacific Northwest; individual interviews with 52 patients, 12 office staff members, 23 physicians, and 1 nurse-practitioner; videotaped reviews of 29 clinical encounters; and 5 focus-group interviews with physicians and computer advocates. The main outcome measures were factors that influence how physicians use the EHR. Researchers qualitatively derived these factors through serial reviews of data. RESULTS This study identified 14 factors that influence how EHRs are used and perceived in medical practice today. These factors were categorized into 4 thematic domains: (1) spatial—effect of the physical presence and location of EHRs on interactions between physicians and patients; (2) relational—perceptions of physicians and patients about the EHR and how those perceptions affected its use; (3) educational—issues of developing physicians’ proficiency with and improving patients’ understandings about EHR use; and (4) structural—institutional and technological forces that influence how physicians perceived their use of EHR. CONCLUSIONS This study found that the introduction of EHRs into practice influences multiple cognitive and social dimensions of the clinical encounter. It brings into focus important questions that through further inquiry can determine how to make best use of the EHR to enhance therapeutic relationships