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Biomedical subjects

R J Holden

Publications and source records attributed to R J Holden.

At least 19 recordsLinked to original sources
PubMed1992

Moral philosophy and nursing curricula: indoctrination of the new breed.

A sizable proportion of nursing curricula subtly indoctrinate students with a particular normative ethic. Seldom is there adequate philosophical justification for the ethic, and students are rarely invited to subject that ethic to a rigorous philosophical analysis. Nursing curricula are replete with philosophical positions treated as moral imperatives to which all, students and faculty, owe their allegiance. This unsatisfactory situation warrants urgent attention. One problem is that of failing to justify the school's moral philosophy; another is the question of philosophically indoctrinating students to adhere to an ethic that advocates the individual's freedom and responsibility, a practice inconsistent with the predominant proposition advanced by the ethic.

Curriculum↗
PubMed1991

On applying psychoanalytic explanation in phenomenological research.

In this paper I propose to examine the theoretical underpinnings of phenomenological research which is plagued with the same methodological problems that confronted psychoanalysis at the turn of the century. Some general criticisms levelled at both phenomenological and psychoanalytic research, by philosophers of science, point to: the absence of falsifiable hypotheses; the absence of measurable and observable data; and the absence of an explanatory general theory upon which the study of consciousness may be grounded. The primary task of the present analysis is to articulate the structural similarities that obtain between psychoanalysis and phenomenology in the expectation that the rules of evidence governing psychoanalytic research may also apply in the government of phenomenological research. Finally, I shall offer some procedural suggestions phenomenologists might care to consider.

Humans↗
PubMed1991

In defence of Cartesian dualism and the hermeneutic horizon.

In this paper, the author proposes to consider the intricate interplay between the art and science of nursing. The caring role, intrinsic to the meaning of the word 'nurse' constrains nursing under the rubric of the arts, while nursing that embraces high technology constrains the discipline under the rubric of science. Thus, the traditional dichotomy that obtains between the arts and sciences seriously complicates the notion of nursing. As a science, nursing adopts the materialist theory of the mind that endorses the inseparability of mind and body. However, as an art, nursing is more closely aligned with dualist interactionism which considers the mind and body to be separate, interacting entities. Nursing is a caring profession, the mastery of which rests on the mastery of the therapeutic relationship which, in turn, implies mastery of holistic nursing care. While the concept of holism implies caring for the 'whole' person in body, mind and spirit, such acknowledgement of the mental and spiritual components of personhood, immediately invites the entry of dualism into our theoretical discourse. Thus, rejection of dualism consigns nursing to theoretical impoverishment and therapeutic emasculation. The contentious question is therefore: Is the theoretical destiny of nursing one of theoretical impoverishment, therapeutic emasculation, and permanent consignment to professional ignominy--and all for the sake of an inconvenient soul?

Holistic Health↗
PubMed1991

An analysis of caring: attributions, contributions and resolutions.

This paper presents a study of the particular dynamics within hospitals that act as counterproductive forces to caring. To this end, the insights revealed by Isabel Menzies Lyth, following her observations of a large London teaching hospital, will be explored. She argues that hospitals are environments conducive to the erection of primitive social defence systems that generate internal conflict and persecution anxiety within its staff. These social defence systems, in turn, militate against efforts directed towards caring. This results in feelings of guilt, depression and dependency that rapidly establish a negative cycle of affects. Such negative affections, once set in train, are difficult to terminate and transform into a positive cycle of affections. Following this analysis, it will be argued that the hospital environment is unequal to the task of caring for the caregivers because it is permeated with ontological, spiritual and moral anxiety, all of which act as serious impediments to the caring enterprise.

Anxiety↗
PubMed1991

Responsibility and autonomous nursing practice.

In this paper, the consequences were there greater autonomy in nursing practice, are considered. Autonomous practice implies accountability which entails both personal and professional responsibility: a personal responsibility to endorse ethical conduct consistent with professional practice; and a professional responsibility to exercise discretionary powers to the ultimate benefit of the patient. In this context, discretionary responsibility implies: recognizing a patient's wants may not be consistent with a patient's needs; abstaining from collusion with noncompliant patients; supporting the patient's right to refuse treatment only after full psychological exploration; understanding the psychological ramifications of informed consent from a practitioner and recipient point of view; maintaining appropriate personal and professional boundaries; and fostering collegiate relationships with the medical fraternity grounded on egalitarian principles. The author provides a philosophical and psychological analysis of responsibility in an effort to achieve a deeper understanding of the relationship this has with the concepts of 'freedom' and 'accountability'.

Choice Behavior↗
PubMed1991

Real life learning. Alternative to clinical skills development.

1. Pressure from educational institutions on clinical facilities necessitates the creation of alternative strategies that enable students to develop clinical skills outside the artificial atmosphere of a nursing laboratory or the formal clinical setting. 2. Assignments covering grief and loss experienced by the elderly; problems in performing activities of daily living experienced by the non-elderly; and existential anxieties experienced by the elderly help students to realize that such problems are not confined to those residing in institutional settings. 3. Each of these assignments sensitizes students to the practical reality of a variety of theoretical frameworks, which provides students with the opportunity of applying theory to practice in a nonthreatening environment.

Adaptation, Psychological↗
PubMed1990

Models, muddles and medicine.

The current prevalent attitude of disapprobation towards the medical model, held by nurse practitioners and educationalists alike, stems from a desire to denounce diagnostic reductionism and proselytize holistic care. It is argued, that the medical model encourages the perception that the patient is "essentially and only their medical diagnosis," and to relate to patients 'as if' they are kidney, a broken leg, a gall stone, or an ulcer, is to dehumanize the person. In order to overcome this predilection, the patient must be seen as a 'whole person' and not simply as some extraneous part of their dysfunctional anatomy. But this all too pervasive tendency, to reduce patients to nothing more than their medical diagnosis, is surely not the responsibility of the medical model? On the contrary, it is the responsibility of the individual medical or nurse practitioner who, on formulating a medical diagnosis, proceeds to convert the patient into an object and from there on regards the patient as "essentially and only their diagnosis of illness."

Holistic Health↗
PubMed1987

Familial primary biliary cirrhosis and autoimmune thrombocytopenia.

Primary biliary cirrhosis (PBC) is described in two sisters, one of whom presented with autoimmune thrombocytopenia. Taken together with reports of platelet autoantibodies in PBC this case may indicate a place for immunosuppressive agents in the treatment of thrombocytopenia in PBC.

Autoimmune Diseases↗
PubMed1985

Myocardial infarction in pregnancy.

A young women presented with an anterior myocardial infarction in the first trimester of pregnancy. Her subsequent clinical course was uneventful. Such patients appear to have a good prognosis.

Adult↗
PubMed1979

Effects of age, antigen deprivation, and allograft rejection on epithelial cell kinetics in mouse colon.

A technique of microdissection of colonic mucosa has allowed the study of mitotic activity, measured by metaphase accumulation following colchicine blockade, in individual crypts of mouse colon. The changes occurring during growth and development of normal colon have been studied and compared with changes found in antigen free colon (colonic isografts) and in cell-mediated immune damage of the bowel (allograft rejection). Metaphase accumulation was steady at two metaphases per hour in baby mouse colon until 18 days after birth. Between 18 and 24 days a rapid, and significant increase in mitotic activity occurred (P less than 0.01), reached adult values, and changed no further. Metaphase accumulation in isografts was similar to normal colon for the first two weeks after transplantation but the rise in mitotic activity in the third week did not occur. Allografts of colon showed two- to three-fold increases in metaphase accumulation when compared with both normal colon and isografts (P less than 0.01). When crypt mitotic activity was compared with the length of crypts measured in histological sections of normal colon, isografts, and allografts, no clear relationship was observed. Both changes in the luminal environment of the gut at the time of weaning and cell-mediated immune reactions in the colonic wall appeared to be associated with increased mitotic activity in colonic crypts.

Age Factors↗
PubMed1977

Reduction in peripheral blood K cells and activated T cells in primary biliary cirrhosis.

Lymphocyte subpopulations were measured in the peripheral blood of 13 patients with primary biliary cirrhosis (PBC), 13 with chronic active hepatitis (CAH), and 16 age- and sex-matched normal subjects. A significant, relative and absolute, reduction in activated T cells and K cells, compared with that in normal subjects, was found in PBC but not in CAH. The reduction in K cells observed in PBC was found to be accompanied by a parallel decrease in lymphocyte-mediated antibody-dependent cytotoxicity.

Adult↗
PubMed1976

Histopathology of cell mediated immune reaction in mouse colon--allograft rejection.

Grafts of mouse fetal colon, implanted beneath the renal capsule of adult hosts, have been used to study the growth and development of colonic isografts and the rejection of colonic allografts. Isografts grew normally and maintained a structure similar to normal colon. Grafts between strains with H2 histocompatibility differences were rejected by 13 days after transplantation. Early progressive infiltration of the grafts by lymphoid cells was followed by increasing damage to, and subsequent loss of, the epithelial cell layer and destruction of the underlying muscle, changes which parallel those seen in rejection of skin and small bowel. The increase in survival time which is seen in allografts between strains with H2 identity was longer in the colon than has been seen in the skin or small bowel; none of the allografts of colon were completely rejected before 30 days, and some remained viable at 50 days. Comparison of the appearances of rejection in the colon with those of ulcerative colitis and colonic Crohn's disease does not show the striking similarity which is seen between small bowel rejection and coeliac disease. Many of the individual features of these diseases are, however, present in the course of colonic rejection.

Animals↗