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PubMed2002

[Practice of Internal Medicine in Latin America. Role of the internist].

This article explores the causes of the crisis in the role of internists. As in the United States, the progressive specialization of internists lead to a dehumanized, expensive and technical practice of medicine. Aiming to better incomes and prestige, more than 60% of internists practice as specialists. Primary care physicians, with a very low rate of problem solving, cover 75% of consultations. Specialists, with increasing costs, cover the rest of consultations. Patients, medical schools and health organizations are claiming the return of the general internal medicine specialist. To increase the interest for general internal medicine, several strategies are applicable. Medical students interested in general internal medicine could receive a focused training, provided by these specialists. A greater emphasis should be put on primary care. More independent, secondary care diagnostic and treatment centers, should be created. Continuous medical education should be done with periodical re certification of physicians. The public health system should increase its wages and the generalist view should be maintained by physicians when practicing at their private offices.

Certification↗
PubMedDate not supplied

Population policy forum. Women as subjects, not objects.

I very much agree with Marge Berer that feminists must recognize that there needs to be a population policy, worldwide and country by country, that encourages lower birth rates and that it is essential to start talking about population policies that respect and promote women's moral agency. Indeed I think it would be fair to say that the failure to respect and promote women's moral agency is the major reason why government-sponsored population policies have failed in the past. Male population planners habitually think of mass population as objects, rather than subjects, of population policy. This is why they think so readily of "incentives" or even more coercive methods. Birth control is thought of as a "war" to be imposed on the population, not as an integral part of the self-development of the people's own capacity to organize and become decisionmakers. If this is true in relation to the male population, it is even more so in relation to women. Population policy continues the basic male approach to women as bodies under their control, not as self-actualizing subjects. Until population policies take as their starting point women's human development as persons and moral agents in their own right, such policies both will be abusive to women and also will not "work." However, Marge Berer's remarks about oppressive, dehumanizing governments as incapable of promoting any other form of population policy give one pause. If this is the case, then neither national governments nor most international agencies linked to Western hegemonic neocolonialism can be the authentic promoters of feminist population policy. There must be a global effort to build parallel women's health organizations that work on the grassroots level with women, especially poor women, to empower these women themselves to become the leaders in educational and economic development of the women in their communities. Only in and through this larger context can such women both learn how to use and become empowered to use methods of birth control.

Behavior↗
PubMed2003

Sense and reliability. A conversation with celebrated psychologist Karl E. Weick. Interview by Diane L. Coutu.

Most of us see the organizations we operate in--our schools or companies, for instance--as monolithic and predictable, subjecting us to deadening routines and demanding dehumanizing conformity. But companies are more unpredictable and more alive than we imagine, according to Karl Weick, a psychology professor at the University of Michigan and an expert on organizational behavior. Weick says executives can learn a lot about managing the unexpected from organizations that can't afford surprises in the workplace--nuclear plants, firefighting units, or emergency rooms, for instance. In this conversation with HBR senior editor Diane Coutu, Weick examines the characteristics of these high-reliability organizations (HROs) and suggests ways that other organizations can implement their practices and philosophies. The key difference between high-reliability organizations and other companies is the mindfulness with which people in most HROs react to even very weak signs that some kind of change or danger is approaching. For instance, nuclear-plant workers Weick has studied immediately readjust dials and system commands when an automated system doesn't respond as expected. Weick contrasts this with Ford's inability to pick up on weak signs in the 1970s that there were lethal problems with the design of the Pinto gas tank. HROs are fixated on failure. They eschew plans and blueprints, looking instead for the details that might be missing. And they refuse to simplify reality, Weick says. Indeed, by cultivating broad work experiences and enlarging their repertoires, generalist executives can avoid getting paralyzed by "cosmology episodes"--events that make people feel as though the universe is no longer a rational, orderly system.

Decision Making, Organizational↗
PubMed2003

Race consciousness and the health of African Americans.

The historical experience of African Americans in our country has been shaped by the institution of slavery, dehumanization of blacks, segregation, pursuit of civil rights, and racism in contemporary American society. Disparities in health care provide compelling evidence that issues of race or skin color for the descendants of slaves and other ethnic minorities persist in the 21st century. Nurses providing care for African Americans must bridge the racial divide and incorporate culturally relevant content in the health history. As an integral aspect of their professional growth as culturally competent health care providers, they must incorporate the idea of "race consciousness" which is described as an awareness of the historical journey of the group, knowledge of disparities in health care for the people, and a self appraisal of one's attitudes and biases toward the group.

Black or African American↗
PubMed2002

Problems of widowhood: a study of widows in a tertiary institution in Ibadan, south west Nigeria.

This study is part of a larger multi-centre survey on widowhood in Nigeria. Information was gathered using a structured self-administered questionnaire from 42 widows who are working at the University College Hospital and the College of Medicine, in Ibadan, capital of Oyo State in the southwest of Nigeria. The findings reveal that the majority of these widows are middle aged, between 35 and 55 years of age, with little or no prospect of remarriage. Almost half of them had only primary education and are of low professional status; 48% of them earn very low salary, and had a high parity, having 5 or more children. The problems identified by these widows in order of priority include financial/economic hardship (69%), absence of husband's will resulting in the loss of properties to husband's relations (55%), loneliness and depression (41%), poor relationship with in-laws (41%), difficulty in social interaction (21%), and poor housing (17%). Recommendation for alleviating the hardships of widows suggested include encouragement of female education, enhancement of women, economic empowerment, improving availability and effective utilization of family planning services and encouraging men to write their wills early in marriage. Also, through advocacy and public health awareness campaigns, to enlighten the masses about the plight of the widows, in order to eliminate the dehumanizing traditional practices to which Nigerian widows are often subjected.

Adult↗
PubMed2001

[Selected ethical problems of oncologic patients during the terminal period].

Patient suffering from terminal disease is depended on his environment more than any other one. He often suffers from nervous break down, anxiety and fear and he is usually unprotected from the environment. Fast development of medical science and its technicisation can lead towards dehumanization and lack of psychological and spiritual care, which should be based on clear ethical principles. Main lines of ethical principles of Health Service which are included in Deontological Code of Physicians and Collection of ethical principles for a qualified nurse are the main rules how to proceed as to fulfill the rule: "benefit of a patient is the superior law." According to its speciality Palliative Medicine introduces also four general ethical principles: 1. Patient will is a rule of treatment. 2. The principle of proportion--benefits from the treatment should be higher than losses and suffering from iatrogenic acting. 3. The principle of equality--stop taking a cure does not differ from not undertaking treatment. 4. The principle of relativity--life is not an absolute good, death is not an absolute evil. Holistic acts of Palliative Medicine determines also specific ethical attitudes, especially in the following: 1. Communication between a therapist and a patient and his family (interpersonal attitudes). 2. Procedures how to lessen suffering and its interpretation according to culture, tradition and religion ("nonsense and significance of suffering"). 3. Negation of euthanasia. 4. Spiritual, psychological and social care of patients.

Attitude to Death↗
PubMed1976

On deciding the care of severely handicapped or dying persons: with particular reference to infants.

Two philosophies of deciding the care of severely handicapped or dying persons are commonly used. The first is "disease-oriented" which places death in the extreme negative position. The second is "person-oriented" which regards some kinds of severely compromised living as worse than death. The first philosophy is convenient for the development and the use of medical technology but its unbridled application commonly dehumanizes patients and aggravates suffering. The second philosophy may protect persons from the indignities of pointless treatment or the cruelties of disease. But its use in some respects is illegal and may be unwise; also, in caring for infants, children, and incompetent adults, the second philosophy creates special problems since the patient himself cannot participate in decision-making. In deciding which philosophy to follow in a given situation we believe the patient (when able), the sorrowing family, and the concerned physician are the best judges. Since these persons vary widely, they must be entrusted with more freedom to change or to ignore commonly accepted principles if the values of patients and families in the many unique situations of living, illness, and dying are to be protected. We believe with few exceptions that these persons are now worthy of this trust and with experience they would use it with growing wisdom.

Decision Making↗
PubMed1992

The perversion of mothering: Munchausen syndrome by proxy.

Munchausen syndrome by proxy, in which a seemingly caring and concerned mother is simultaneously harming her child, can best be understood in terms of the mother's need for a relationship with a physician that is rooted in a profound sense of early abandonment. This understanding broadens the definition of perversions. The infant in this sadomasochistic interaction is dehumanized and is used as a fetishistic object to control the relationship. The author's literature review and case report provide the basis for his exploration of the historical, cultural, and psychological factors that both contribute to the development of the syndrome and conspire to deny its reality.

Adult↗
PubMed2004

Surrogate motherhood.

A "surrogate mother" is a woman who, for financial or other reasons, agrees to bear a child for another woman who is incapable to conceive herself. In other words, she is a "substitute mother" that conceives, gestates and delivers a baby on behalf of another woman who is subsequently to be seen as the "real" (social and legal) mother of the child. Though the practice of surrogacy has already become a big market in western countries, it has also generated countless challenges for the law because it adds a third dimension to the meaning of motherhood. Like adoption, surrogacy separates the role of rearing mother from what the law has called the natural mother, but gestational surrogacy breaks the latter down into the roles of genetic mother and birth mother, leaving two women with biological connections to the child. Because surrogacy tends to commodify and dehumanize people, and because of all its legal, social, and psychological complications, it is obviously not wise to accept surrogacy as an alternative way of procreation.

Commodification↗
PubMedDate not supplied

Physical and psychological sequelae of female genital mutilation: a case report.

BACKGROUND: One harmful traditional practice that has resisted change in many African countries is female genital mutilation (FGM), otherwise known as female circumcision. This is usually associated with many complications. This report highlights a combination of physical and psychological sequelae associated with female circumcision. METHOD: Case-note of a patient managed for complications of female genital mutilation was used with a review of the relevant literature. RESULT: A 17-year old, married, illiterate farmer who had complete labial fusion following circumcision is presented. She had a total of six failed repairs, with psychological trauma, prior to her presentation in this hospital. A successful vulval reconstructive surgery was preformed and she was able to start a normal life with her husband. CONCLUSION: FGM carries very high morbidity. All supporters [corrected] of reproductive health should initiate programmes to stop this harmful and dehumanizing practice.

Adolescent↗
PubMed2005

Clinical presentation and management of alleged sexually assaulted females at Mulago hospital, Kampala, Uganda.

OBJECTIVE: To determine the presentation and treatment offered to sexually assaulted females attending emergency gynaecological ward in Mulago Hospital, Kampala, Uganda. SETTING: Mulago hospital gynaecological emergency ward. STUDY DESIGN: Prospective descriptive study. PARTICIPANTS: Fifty eight sexually assaulted females were recruited from 1 st March 2000 to 31 st December 2000. They were interviewed, examined, given appropriate treatment and followed up for three months. OUTCOME VARIABLES: Socio demographic characteristics, genital and bodily injuries, relationship to the assailant, and prevalence of sexually transmitted infections. RESULTS: The mean age was 9.5 with a range of 1-35 years. Seventy two percent of the victims were children below 12 years. Fifty percent of the assault occurred at the assailant's home. The majority (79.3%) of the victims knew the assailant and cases of gang rape were only 6.9%. The injuries sustained were extra genital (19.0%), genital (75.4%). The emotional or psychological disturbance was present in 22.4% of the patients. The sexually transmitted infections found included trichomonas vaginalis (1.7%) and syphilis (3.7%). All cases received counseling and prophylactic treatment for sexually transmitted infections. Those in reproductive age group were offered emergency contraception. None of the victims got post exposure HIV therapy because it was not available in the hospital. CONCLUSION: Sexual assault is common in Uganda and is one of the most dehumanizing human crimes against women. It is associated with adverse medical and social problems. There is urgent need to sensitize the community about reporting early for medical treatment after sexual assault.

Adolescent↗
PubMedDate not supplied

Burnout syndrome among Mexican hospital nursery staff.

OBJECTIVE: To identify frequency and related factors to burnout syndrome in the nursing staff at a specialty hospital in the Mexican state of Guanajuato. MATERIALS AND METHODS: A prolective, analytical cross-sectional study was carried out. In 236 randomly selected nurses, a 35-item questionnaire proposed by Cyberia Shink was applied in a blind survey. Seniority, workplace, shift and kind of service, work category, age and marital status were investigated for a link with burnout syndrome. RESULTS: Mean age of nursing personnel was 33+/-11.93 years with 13+/-7.2 years of seniority; 95 (40%) workers showed emotional exhaustion, 78 (32%) felt dehumanized, 148 (63%) had lost interest in their work, and 120 (50%) reported general exhaustion. From the studied nursing personnel, 92 (39%) showed burnout syndrome-compatible data. There were statistical differences with nurses without burnout syndrome age >33 years (p=0.001), seniority (p=0.05), and workplace (p=0.05), but not with kind of medical service (p=0.36), shift (p=0.86), and work category (p=0.96). Questionnaire validity in agreement with alpha Cronbach test was 0.7496. Relation between professional attrition and work environment was r=0.738. CONCLUSIONS: The instrument can be relied upon to identify burnout syndrome and is considered as acceptable. Age, seniority, and workplace are factors linked to nursing staff with burnout syndrome-compatible data. Employers, managers, and supervisors of health care services must promote preventive actions for burnout syndrome to synchronize present work conditions in nursing staff with their biologic characteristics.

Adult↗
PubMed2001

[Euthanasia, catastrophic disease and the moribund patient].

Euthanasia has always constituted a controversial subject, but has recently been revived by a good number of well meaning intellectuals, many of whom, by and large, are not physicians. The present resurgence of this matter is due, primarily, to the prevalence of modern medical technology that makes it possible to maintain a futile life, often vegetative in nature, for an extended and even indefinite period of time. This is a complex situation that must be focused from different angles, one of which can be attributed to the conflict often experienced by physicians who have to deal with the management of catastrophic illness and realize how impotent they may be to achieve such difficult task. Another important aspect is the prospect of the greater degree of dehumanization that can arise from the management of patients with a devastating and incurable sickness. We feel that the ethical and healthy answer to this issue lies on the norm that advises health-care takers to convey optimal palliative care and constant emotional support to the sick persons and their families.

Attitude to Death↗
PubMed2004

Women's mental health in Pakistan.

In Pakistan, societal attitudes and norms, as well as cultural practices (Karo Kari, exchange marriages, dowry, etc.), play a vital role in women's mental health. The religious and ethnic conflicts, along with the dehumanizing attitudes towards women, the extended family system, role of in-laws in daily lives of women, represent major issues and stressors. Such practices in Pakistan have created the extreme marginalisation of women in numerous spheres of life, which has had an adverse psychological impact. Violence against women has become one of the acceptable means whereby men exercise their culturally constructed right to control women. Still, compared to other South Asian countries, Pakistani women are relatively better off than their counterparts.

Journal Article↗
PubMed2006

Information technology and nursing; Emancipation versus control?

The still prevailing lack of attention to and interest in knowledge or educational development about Information Technology (IT) in Nursing may partly be explained by the traditional philosophical distance between humanism and technology. The unease of potential dehumanization of nursing care by technology may be necessary, but often overreacted. By not taking charge and responding to ongoing IT deployment, the nursing community de facto passes on responsibility for developments shaping nursing care to technocrats, other professionals and vendors. In this paper we raise discussion of control or emancipation by IT. The current design and implementation of applications like Electronic Patient Record systems including nursing documentation exemplifies and highlights such positions. We point out values and how the nursing community perceives emerging technologies, particularly in knowledge development related to IT, followed by a question of consciousness and responsibility, recognition of "mind over machine". This is neither a question of emancipation or control, but both. It is by taking the grip of recognition and responsibility in technology development we move towards freedom of choice and empowerment.

Humans↗
PubMed1975

Therapeutic innovation: a model for mental health planning.

Enlightened and progressive care of the mentally ill is closer to reality with the creation of the psychiatric halfway house. The halfway house is not an institutional edifice but a residential facility located in the community and indistinguishable from the other neighboring dwellings. The feature which sets apart the halfway house programmatically is its provision of a housing unit with some services for ex-hospital patients. Human incarceration continues to be a major enforcement instrument for the control of deviant behavior. Mental illness, as one type of poorly understood behavior, is for the most part controlled by institutionalizing the mentally ill person in a large dehumanized total institution such as the state mental hospital. Although major reforms are underway in many total institutions to humanize treatment procedures, innovative alternatives to custodial care are gaining impetus in the community. One such fascinating and rapidly expanding treatment innovation is the psychiatric halfway house. This presentation represents the results and implications of a comparative study of twenty such programs in the United States.

Aftercare↗
PubMed1991

Rehabilitation considerations in the care of the acute burn patient.

To be burned is to suffer one of the most dehumanizing events known. Adult burn patients have gone from independent, healthy individuals to totally dependent patients who may survive but be severely disfigured. The ultimate rehabilitation goal is to provide extensively burned patients with the training necessary for them to resume as much of their preburn lifestyle as possible. Prevention and control of scarring processes are the initial vital phases of the process. Reconditioning continues that process by preparing the patients to function within the limits of their present physical ability. All of the activities of daily living that the patient is able to perform with a minimum amount of assistance or independently with the use of assistive devices also move the patient toward independent living. The rehabilitation process is a critical element in the daily care of the burn-injured patient, and all team members providing that care should be encouraged to view the patient as a whole, giving early consideration to the final rehabilitation outcome.

Bandages↗