JCI, SKS için bir dizi standart ve gösterge önerisive HIMSS-EMRAM kalite degerlendirme modelleri.

Objective: The Joint Commission International (JCI) and the Health Information Management System Society (HIMSS) are global accreditation groups for healthcare. JCI focuses on overall care quality, while HIMSS-Electronic Medical Record Adoption Model (EMRAM) looks at digital processes. Meanwhile, the Health Quality Standards (SKS) is Turkey's own system. It aligns with JCI and evaluates healthcare similarly. When a health institution wants to be accredited with one of these models, similar scope, process and criteria are repeatedly reviewed from different perspectives. However, it is not known whether the scope, process and criteria included in these models are related to the postmodern management approach (PMMA), which is one of today's business approaches. It is observed that today's businesses are dominated by PMMAs. Similarly, healthcare organizations are also influenced by PMMAs since they are qualified as businesses. Yöntemler: This study investigated the compatibility of the concepts, processes and criteria covered by SKS, JCI and HIMSS-EMRAM models with PMMAs. Using the Delphi technique, PMMAs were explained to subject-matter experts (SMEs) in the form of written texts delivered. SMEs evaluated whether the standards/criteria are compatible with PMMAs. During this evaluation, they examined whether the standard/criteria included in the relevant model are directly or indirectly indicative of these approaches. SMEs developed their standards/criteria for the approaches which no standards/criteria could be matched with. The binary pairwise comparison method was used to determine the weighted value of the proposed standards/criteria. Sonuçlar: SMEs proposed a total of 24 standards and 18 indicators for nine postmodern organizational management approaches. Conclusion: The literature presented a proposal for new standards and indicators. They would be unique. They would address how well these three models fit the PMMA.

The intersection between logical empiricism and qualitative nursing research: a post-structuralist analysis.

PURPOSE: To shed light on and analyse the intersection between logical empiricism and qualitative nursing research, and to emphasize a post-structuralist critique to traditional methodological constraints. METHODS: In this study, a critical examination is conducted through a post-structuralist lens, evaluating entrenched methodologies within nursing research. This approach facilitates a nuanced exploration of the intersection between logical empiricism and qualitative nursing research, challenging traditional methodological paradigms. RESULTS: The article focusing on the "what abouts" of sample size, analytic framework, data source, data analysis, and rigour and methodological considerations, challenging the predominance of semi-structured interviews and the reliance on spoken voice as primary data sources, and re-evaluating the conventional notion of "rigour". CONCLUSIONS: I advocate for a shift from qualitative positivism towards more interpretive and post-qualitative inquiries, this work proposes new trajectories through interpretive, critical, post-qualitative, and artistic turns in nursing research, aiming to transcend positivist limitations and foster a plurality of perspectives and research as praxis. Implications emphasize the need for nursing researchers to expand methodological horizons, incorporating visual and artistic methods to enrich understanding and representation of health experiences, moving beyond positivist norms towards a more inclusive and ethically sound research paradigm.

Modernidade líquida e paradigma emergente: reflexões sobre estilo de vida dos estudantes de enfermagem / Liquid modernity and emerging paradigm: reflections on the lifestyle of nursing students / Modernidad líquida y paradigma emergente: reflexiones sobre el estilo de vida de los estudiantes de enfermería J

Objetivo: refletir sobre o estilo de vida dos estudantes de enfermagem no paradigma emergente da modernidade líquida. Conteúdo: ensaio reflexivo alicerçado em 20 artigos sobre o tema discutido criticamente em diálogo com os conceitos de paradigma emergente e modernidade líquida. A discussão se organizou em duas categorias: estilo de vida dos estudantes de enfermagem no contexto da modernidade líquida: da realidade social ao sofrimento psíquico; e estilo de vida dos estudantes de enfermagem e o paradigma emergente: dos paradigmas dominantes à individuação. Considerações finais: os tempos líquidos reverberam no estilo de vida e na saúde dos estudantes de enfermagem, agravando as doenças da pós-modernidade. Destaca-se a maneira como esses estudantes apreendem as dificuldades e o aprendizado que deduzem dessas oportunidades. O estilo de vida destes estudantes deve ponderar o alcance da perspectiva singular e profunda do ser inserido no paradigma emergente(AU)

Objective: to reflect on the lifestyle of nursing students in the emerging paradigm of liquid modernity. Content: reflective essay based on 20 articles on the subject critically discussed in dialogue with the concepts of emerging paradigm and liquid modernity. The discussion was organized into two categories: nursing students' lifestyle in the context of liquid modernity: from social reality to psychic suffering; and lifestyle of nursing students and the emerging paradigm: from dominant paradigms to individuation. Final considerations: liquid times reverberate in the lifestyle and health of nursing students, aggravating postmodern diseases. It is worth highlighting the way in which these students apprehend the difficulties and the learning they deduce from these opportunities. The lifestyle of these students must consider the scope of the singular and profound perspective of being inserted in the emerging paradigm(AU)

Objetivo: reflexionar sobre el estilo de vida de los estudiantes de enfermería bajo el prisma del paradigma emergente de la modernidad líquida. Contenido: ensayo reflexivo basado en 20 artículos sobre el tema, discutido críticamente en diálogo con los conceptos de paradigma emergente y modernidad líquida. La discusión se organizó en dos categorías: el estilo de vida de los estudiantes de enfermería en el contexto de la modernidad líquida: de la realidad social al sufrimiento psíquico; y estilo de vida de los estudiantes de enfermería y el paradigma emergente: de los paradigmas dominantes a la individuación. Consideraciones finales: los tiempos líquidos repercuten en el estilo de vida y la salud de los estudiantes de enfermería, agravando las enfermedades de la posmodernidad. Se destaca la forma cómo estos estudiantes entienden las dificultades y los aprendizajes que deducen de estas oportunidades. El estilo de vida de estos estudiantes debe considerar el alcance de la singular y profunda perspectiva de estar insertos en el paradigma emergente(AU)

Razor sharp: The role of Occam's razor in science.

Occam's razor-the principle of simplicity-has recently been attacked as a cultural bias without rational foundation. Increasingly, belief in pseudoscience and mysticism is growing. I argue that inclusion of Occam's razor is an essential factor that distinguishes science from superstition and pseudoscience. I also describe how the razor is embedded in Bayesian inference and argue that science is primarily the means to discover the simplest descriptions of our world.

The "Creativity Crisis" as a Mind in Crisis: A Cultural-Historical Activity Theory Position.

Creativity is considered a global ability and crucial for ordinary-daily and special (e.g., science, aesthetic) activities. In this paper, from the position of Cultural-Historical Activity Theory (CHAT), we expand the debate about the creativity crisis and hypothesize that the noted crisis is only the tip of the iceberg represented by the crisis of the postmodern' incoherent mind, reflecting the crisis of self-realization as a leading activity in the individualistic epoch. By investigating creativity as an original functionality of the mind, two key titles are stressed. One is the halting of the activity system; two, it is the inconsistency between the objective meanings sphere and the subjective sense-making sphere. Both titles represent the epistemological rupture embedded in the mainstream culture and praxis rooted in the internal contradictions of individualism and post-modernism as worldview and practices, leading the mind to close its eyes on the contradictions which are the crucial source of grasping the internal content (abstraction and generalization) of the given experience, hence, a crucial source of creativity. Thus, it is considered that not only creativity is in crisis, but also the coherence of the mind as well, as an extreme result of the shattered postmodern existence.

Patient Safety in Palliative Care at the End of Life from the Perspective of Complex Thinking.

Actions for patient safety at the end of life must be aligned with the principles of palliative care, such as promoting comfort and quality of life. Faced with this complex process, health professionals need to seek the central relationships of the concepts of safety and palliative care to the end of life, in line with the wishes and expectations of the person and family members/caregivers, as well as with available resources and the capacity of services but, above all, reinforcing the importance of a non-reductionist care approach, which encompasses the various aspects inherent to humans. Hence, we present a new vision of patient safety in palliative care at the end of life based on the complex thinking of Edgar Morin, scientific evidence, and health policies in the global context. We discuss the deficiencies and disjunctions in thought and practice of palliative care at the end of life and patient safety, as well as the challenges for the conjunction of these complex themes, to finally present potential ways to apply complex thinking in the safe care of the patient at the end of life. The problematization of different aspects for the interposition of knowledge about patient safety in palliative care at the end of life portrays the existence of intersubjective connections and the multidimensionality that permeate the guidelines, actions and relationships that sustain the disciplines.

Researching what we practice-The paradigm of systemic family research: Part 1.

This is part 1 of two articles that focus on the ideological and philosophical preference regarding how to relate to and conduct research in the field of systemic couple and family therapy. Thus, this article outlines the theoretical groundwork for part 2 of "Researching what we practice" in the same journal. Research in certain areas of systemic couple and family therapy (CFT), such as that influenced by social constructionism and postmodernism, has a different epistemological tradition than in the natural sciences. Thus, only research from a narrow, selected spectrum of epistemologies has been incorporated as a key source in the knowledge base of systemic CFT. The consequence is that the field of postmodern systemic CFT risks promoting only a limited range of research designs and knowledge while excluding other designs and knowledge types, reasoning that these are less useful in clinical practice. The rationale behind this perspective is derived from ideology and philosophy rather than scientific criteria. Accordingly, in our field of study, different epistemological perspectives are easily viewed as dichotomous, thus causing professional gaps in our field. This tendency constrains the mutual exchange and development that are needed. We present a possible way out of this dichotomized deadlock, first and foremost by acknowledging - and encouraging the use of - the great variety and breadth of existing research and knowledge. Referring to the guiding principles of evidence-based practice, we argue that this would endow the systemic CFT therapist and researcher with a greater knowledge base and range of research methodologies. This could help improve the quality of treatment provided to our clients and enhance the legitimacy of postmodern systemic CFT as a branch of psychotherapy.

Prophets, puppets, and pinheads: Contesting the authority of science in the COVID-19 era.

This article studies resemblances between academic postmodernism and today's popular contestations of the authority of science by means of a qualitative content analysis of 657 critical online comments on a Belgian newspaper article about the COVID-19 crisis that features a prominent Belgian virologist. The comments portray scientists as (1) prophets who pretend their knowledge to be superior to competing understandings of the world; (2) puppets who figure in hidden schemes that cannot stand the light of day; and (3) pinheads who lack the intellectual competence to give solid scientifically informed advice. While the first two critiques do at first sight resemble academic postmodernism, they are in fact informed by the markedly modern understanding that objective and neutral scientific knowledge is as feasible as it is desirable. What we find, then, are not contestations of the authority of science per se, but indeed of practices deemed deviant aberrations of science.

Creencias contemporáneas y consumo de sustancias psicoactivas / Contemporary beliefs and the issue of drug abuse and related disorders

Resumen Existe un creciente consumo de sustancias psicoactivas a pesar de que genere múltiples efectos perjudiciales para la salud y problemáticas psicosociales. Se propone que múltiples creencias sociales de la filosofía contemporánea promueven el consumo de estas sustancias, especialmente en la juventud y adolescencia. Se reflexiona sobre la sinergia entre múltiples ideas postmodernas y los efectos desinhibitorios, sedativos, anestésicos, psicoestimulantes y disociativos de las sustancias psicoactivas para el desarrollo de conductas socialmente esperadas. La diversión como valor fundamental, la búsqueda de excesos, el consumismo, la relativización del conocimiento, la moral estadística, la filosofía de la inmediatez, la digitalización de las interacciones sociales y las relaciones líquidas serían algunos de los factores implicados. La baja percepción de riesgo sobre las sustancias, la publicidad dirigida a jóvenes, el aumento de la prevalencia de la depresión, el estigma sobre la patología psiquiátrica y los servicios de atención de salud mental deficitarios serían otros aspectos que en conjunto con la ideología predominante podría acrecentar estas problemáticas sociales y de salud. La morbi-mortalidad temprana, los incidentes viales, los embarazos adolescentes y conductas violentas son algunas de las consecuencias que se ven potenciadas por el consumo de sustancias. La promoción de estas sustancias está especialmente dirigida a adolescentes que por razones biológicas y sociales se encuentran en la etapa de la vida más vulnerable para iniciar estas conductas de riesgo. Como conclusión se destaca la necesidad de conversar con los más jóvenes a edad temprana sobre estas creencias para prevenir el consumo problemático de sustancias psicoactivas y sus consecuencias sociales.

Summary A steady growth in the use of psychoactive substances is being observed, despite the multiple harmful health and psy-chosocial effects associated with their consumption. The present paper argues that a host of social beliefs emerging from the current zeitgeist or life philosophy encourage substance abuse, especially during youth and adolescence. It analyses the synergy between post-modern life views and the disinhibiting, sedative, anesthetic, psychostimulant and dissociative effects of psychoactive substances in the development of current social standards of behavior. Fun and enjoyment held as core values, the pursuit of excess, consumerism, the relativization of knowledge, a statistical view of morality, the quest for in-stant gratification, the digitalization of social interactions and liquid relationships are some of the contributing factors. Low risk percep-tion about substance use, mass-media campaigns directed at the young, the rise of depression, the stigma associated with mental illness and deficiencies in mental health services further compound this issue. Premature morbidity and mortality, traffic incidents, teenage pregnancy and violent behaviors are some of the consequences exacerbated by substance abuse. The situation is compounded by media promotion of such substances, targeted at teenagers who owing to social and biological reasons find themselves at a higher probability of incurring risky behaviors. As a conclusion, the present study underscores the need to hold early discussions with the young regarding current belief systems in order to mitigate the detrimental social and health effects of substance abuse.

Against the Turn to Critical Race Theory and "Anti-racism" in Academic Medicine.

Medical academics are increasingly bringing critical race theory (CRT) or its corollaries to their discourse, to their curricula, and to their analyses of health and medical treatment disparities. The author argues that this is an error. The author considers the history of CRT, its claims, and its current presence in the medical literature. He contends that CRT is inimical to usual academic modes of inquiry and has obscured rather than aided the analysis of social and medical treatment disparities. Remedies for racism suggested by CRT advocates will not work and some of them will make things worse. Academic medicine should avoid the embrace of CRT and should maintain an allegiance to rigorous empirical inquiry and to treating patients not as essentialized ethnic group members but as individual human beings in need of care.

Perspective: Decolonizing postmodernist approaches to mental health discourse toward promoting epistemic justice.

Currently, it is possible to observe a slowly (but surely) growing volume of claims seeking to disprove Foucauldian ideas about knowledge and power as overlapping basic theories of epistemic justice. Prompted by these claims, alongside adopting tenets of Critical Race Theory to address injustices inflicted upon people facing mental health challenges, I propose applying decolonizing deconstruction to Foucault's terminology, toward identifying opportunities to enhance epistemic justice, primarily in direct interventions in mental health services.

The Tragedy of Liberal Democratic Governance in the Face of Global Threats.

In hindsight, the early response of liberal governments to the SARS-CoV-2 pandemic was chaotic and generally inefficient. Though one might be tempted to attribute these failures to the incompetence of certain political decision-makers, we propose another explanation. Global threats require a coordinated international response, which is only possible if the threat is perceived in the same way by all, and if government priorities are similar. The effectiveness of the response also relies on massive adhesion of citizens to the measures imposed, which in turn requires trust in government. Our hypothesis is that certain fundamental features of liberalism complicate such global and collective responses: neutrality of the state and primacy of the individual over collective society. Liberalism considers that institutions and public policy must not be designed to favor any specific conception of the common good. That which is best for all is usually determined by a "competition of opinions," which frequently leads to scientific expertise being considered as only one opinion among many. Liberalism also imposes strict respect for individual freedoms and private interests and tends to reject any form of collectivism or dictate imposed by the common good. In order to solve these structural problems and improve society's management of global threats, we make several proposals, such as the introduction of a minimal and consensual definition of the common good and the promotion of a health policy guided by One Health-like concepts. Overall, our analysis suggests that because political ideologies provide their own definitions of the common good and the place of scientific knowledge in the governance process and can thus affect the response to global threats, they should be urgently taken into consideration by public health experts.

Response-The Multiple Understandings in the Clinic Do Not Always Need to be Resolved.

This article reflects on the assumption underlying the argument of Little et al. that "contested understandings" in the clinic are susceptible to reconciliation within a liberal framework described as "pragmatic pluralism". It is argued that no such reconciliation is possible or desirable because it is of the nature of the clinic that it provides a forum for multiple voices, ethical and cultural perspectives, and conceptual frameworks, and this is the source of its fecundity and creativity. Medicine itself cannot be represented by a single discourse, precisely because it is itself an unruly collection of practices that, despite their heterogeneity, are able to engage in productive dialogues with each other. The heteroglossia of the clinic, therefore, is not a problem to be overcome. Rather, it is a rich resource to be mobilized in accordance with its multiple inherent purposes.

Political identities of Chinese international students: Patterns and change in transnational space.

Amid the ongoing international tensions surrounding China, Chinese international students (CISs) in Western countries have become targets of political suspicion. Against discriminatory voices that make sweeping generalisations about CISs, this research argues that their political identities are in fact diverse and malleable. Using theories of postmodernism and transnationalism, this study applies thematic analysis and discourse analysis to interviews with 28 CISs, yielding four major findings. First, it identifies three distinct patterns of political identity: Chinese nationalists who endorse conservative politics in the West; advocates of liberal democracy; and transnational neoliberals who avoid political participation. Second, it argues that CISs undergo identity changes depending on a range of individual and social characteristics. Among these characteristics, third, it highlights the role of socioeconomic status in shaping the political identities of CISs, and in so doing, reflects on the inadequacy of race and nationality as identity markers. Fourth, it suggests that the political identities of CISs are transnationally hinged on both China and the host countries. On the practical front, the study may inform professions working with CISs such as education and policymaking. Theoretically, it suggests that the political identities of CISs are heterogenous, impressionable and transnationally contingent.

Agency: What Does It Mean to Be a Human Being?

This paper will look at the results of what has been termed "the crisis of modernism" and the related rise of postmodern perspectives in the 19th and 20th centuries. It concentrates on what is arguably the chief casualty of this crisis - human agency - and the social science that has developed out of the crisis. We argue that modern and postmodern social science ultimately obviate human agency in the understanding of what it means to be a human being. Attention is given to the contemporary intellectual world and the way in which it has been deeply informed by neo-Hegelian and other postmodern scholarly trends, particularly in accounting for how agency has come to play little role in social science understanding of human action. The paper also offers an alternative conception of human agency to the commonly endorsed libertarian model of free choice. Finally, the paper argues that this view of agency preserves meaning and purpose in human action and counters the pervasive social science worldview that sacrifices agency and meaning to powerful invisible abstractions.

Unbridled! Thoughts on times of self-begetting and violence.

Mind is multi-levelled displaying an eons-long prehistory, while as Freud well knew civilization is new and frail: in biological evolution Thanatos long antecedes Eros. Complex intraspecies interchanges in higher animals proceeding by analogic communication give a firm place to Freudian Dingvorstellungen. Self-recognition and reflective thought come exceedingly late, in apes, requiring affectionate baby-mother mirroring. Deriving from inquiry on ego-dystonic neuroses, psychoanalysis must in the Age of Media deal with ego-syntonic pathologies sporting a demise of self-observation and self-reflection: borderline, autistic and autistoid disturbances. The 'epidemy of autism' offers fertile ground for very early psychoanalytic intervention, here briefly illustrated clinically. But on the other side, adolescent and post-adolescent disturbances cover a range going from autistoid retraction to more and more defiant if not violent protagonistic self-begettings, often propelled by overriding feelings of victimhood: filio-parental violence is the offshoot. Postmodernist ideologies accompany and fuel such trends.

Posthumanism: Creation of 'New Men' Through Technological Innovation.

The posthumanist project proposes directing the evolution of human beings by promoting their improvement through technological means to create a variety of entities that will have few or no common characteristics with current humans. Its agenda is extremely broad and this study mostly addresses enhancement of the human organism through genetic modification techniques. An overview of posthumanist values and a brief discussion of its philosophical background provide a framework to understand its ideals. Genetics and ethics are employed to assess some claims of the posthumanist program of creating evolved humans; in particular, the capabilities and limitations of techniques for somatic and germline genome editing. Consequences of the creation of posthumans are discussed in relation to accepted current human beings and values. It is concluded that the posthumanist program rests on a large number of hypotheses without sufficient evidence and with little or no consideration of the consequences of its implementation.

The New Totalitarians: The Swedish COVID-19 strategy and the implications of consensus culture and media policy for public health.

AIMS: The aim is to discuss implications of consensus culture in combination with media policy in Sweden with regard to the Swedish COVID-19 strategy in the spring of 2020. METHODS: Investigation of prerequisites for scrutiny by the Swedish mass media of the Swedish strategy in the spring of 2020 based on discussion regarding consensus culture, media structure and postmodernism in science, politics and administration. RESULTS: The Swedish strategy entailed strong initial confidence in herd immunity (although not officially stated), individual responsibility, evidence based medicine and substantial neglect to cooperate internationally. The strategy may be regarded partly as a result of the postmodern view of science and society predominant in Sweden. A tradition of top down consensus culture combined with mass media's financial and partly structural dependence of the state may help explain the comparative lack of critical questions regarding the strategy at the press conferences in the spring of 2020. CONCLUSIONS: Mass media in Sweden should become more financially and structurally independent of the state. The reporting by Swedish media in the spring of 2020 should be subject to peer-reviewed research.

Desamparo contemporâneo e violência fundamental: uma leitura psicanalítica / Contemporary helplessness and fundamental violence: a psychoanalytic reading / Desamparo contemporâneo y violencia fundamental: una lectura psicoanalítica

O artigo propõe uma reflexão acerca da violência e do desamparo na Contemporaneidade, por meio do referencial psicanalítico. Parte de considerações sobre a inserção moderna da crítica freudiana sobre a civilização para atestar o desamparo fundamental da condição humana, demandando um trabalho de gestão do laço social. Apresenta os modelos freudianos da estrutura social e de grupos em sua relação com os ideais para discutir sua dinâmica na Contemporaneidade, a partir da falência dos referenciais simbólicos. Caracteriza as condições de enfraquecimento institucional e de mudanças temporais nas relações intersubjetivas para definir um quadro social de deficiência da narratividade e historicidade. Discute os mecanismos subjetivos para lidar com o desamparo e as implicações de violência e negação da diferença. Defende o resgate da condição alteritária por meio da violência fundamental como condição ética para instituição de laços sociais e saída coletivas para a gestão do desamparo.

The paper proposes a reflection about contemporary violence and helplessness by a psychoanalytic perspective. It begins with considerations on the modern insertion of the Freudian civilization critique to attest the fundamental helplessness of the human condition, demanding an effort on the management of the social bond. It presents the Freudian models of social structure and groups in their relation with ideals to discuss their dynamics in the contemporaneity, starting from the decay of symbolic references. The paper characterizes the conditions of institutional weakening and temporal changes in the intersubjective relations to define a social framework of deficiency of narrativity and historicity. It discusses the subjective mechanisms for dealing with helplessness, the implications of violence and denial of difference. It defends the recovery of the alteritary condition through fundamental violence as an ethical condition for the institution of social bonds and collective ways for the management of helplessness.

El artículo propone una reflexión acerca de la violencia y del desamparo en la contemporaneidad a través del marco psicoanalítico. Parte de consideraciones sobre la inserción moderna de la crítica freudiana sobre la civilización para atestiguar el desamparo fundamental de la condición humana, demandando un trabajo de gestión del lazo social. Presenta los modelos freudianos de la estructura social y de grupos en su relación con los ideales para discutir su dinámica en la contemporaneidad, a partir de la quiebra de los referentes simbólicos. Caracteriza las condiciones de debilitamiento institucional y de cambios temporales en las relaciones intersubjetivas para definir un cuadro social de insuficiencia de la narratividad e historicidad. Discute los mecanismos subjetivos para lidiar con el desamparo y las implicaciones de violencia y negación de la diferencia. Defiende el rescate de la condición de alteridad por medio de la violencia fundamental como condición ética para el establecimiento de lazos sociales y la salida colectiva para la gestión del desamparo.