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PubMed1998

SAMHSA philosophy and statement on ethical principles.

As the major federal agency responsible for improving the delivery and effectiveness of substance abuse and mental health services to the American public, the Substance Abuse and Mental Health Services Administration (SAMHSA) is aware that its programs deal with especially sensitive issues. As a national leader in advancing effective services to persons with addictive and mental disorders, SAMHSA has stewardship over important interventions affecting personal, community, institutional, and social values. Inherent in SAMHSA's mission and goals is a commitment to protect and promote the human, civil, and legal rights and moral freedoms of those individuals and groups who participate in SAMHSA-funded activities and to demonstrate that Agency policies and procedures are congruent with publicly acceptable ethical principles and standards of conduct. A foundation of mutual trust between SAMHSA officials and participants as well as sensitivity to issues of public accountability will hasten and strengthen progress toward this shared vision.

Alcoholism↗
PubMed2001

Postmodern midwives in Japan: the offspring of modern hospital birth.

Although childbirth is fundamentally involved with the issue of women's bodies, it is also involved with such social values as politics, economics, medicine, and other phenomena characteristic of a particular time and culture. In this article I divide Japanese society and childbirth into pre-modern, modern, and postmodern phases, with special emphasis on the postmodern phase. I use the word "postmodern" to denote visible changes in childbirth and midwifery that began to occur around 1990 - changes that distinguish it from modern hospital birth. I conclude that postmodern midwifery is a reaction to and a consequence of modern hospital birth, which failed to satisfy a large number of women's needs. In this sense, postmodern midwifery could rightly be said to be the offspring of modern hospital birth.

Adult↗
PubMedDate not supplied

Is the person trade-off a valid method for allocating health care resources?

The Person Trade-Off (PTO) is a methodology aimed at measuring the social value of health states. It is claimed that other methods measure individual utility and are less appropriate for taking resource allocation decisions. However, few studies have been conducted to test the apparent superiority of the method for this particular kind of decision. We present a pilot study to this end. The study is based on the results of interviewing 30 undergraduate students in economics. We compare two well known techniques, the Standard Gamble and the Visual Analogue Scale, with the PTO. The criterion against which the performance of the methods is assessed is the directly obtained preference about how to establish priorities among hypothetical patients waiting for treatment. Apparently the PTO performed better than the others. We also compare three different frames for the PTO. One of them seems to predict people's preferences.

Attitude to Death↗
PubMed1997

Would it work for us? Learning from quality improvement in Europe and beyond.

DEVELOPING QUALITY TRANSFER TECHNOLOGY AND TRANSFERABILITY ASSESSMENT: Transferring a method or an approach that works in one organization to another organization may not produce the same effect. The result in one setting is an effect of the method or approach working within that system, not just an effect of the method or approach alone. THE CONTEXT FOR QUALITY IMPROVEMENT (QI): To better understand QI activities in a particular country, five aspects of the QI context need to be considered--the health care system, social values, health reform, history of quality assurance, and the language and politics of quality. For example, differences in terminology, even within one region of a country, undermine transferability of quality approaches and methods. LEARNING FROM OTHERS' SOLUTIONS AND STRATEGIES: The methods used to learn from others can be improved by seeking out reports describing the context of the improvement, by carefully deciding which facilities to visit and which conferences and networking events to attend, and by developing skills in judging transferability and in adapting others' strategies. CONCLUSION: Similar changes in health care in most countries are creating a climate more conducive to QI methods than in the past, and there is more experience with these methods and there are more examples of their successful application. Learning from others has more benefits than finding solutions to one's own quality problems. By examining others' approaches to QI one may become aware of issues that have been ignored or that are latent problems in one's own organization.

Delivery of Health Care↗
PubMed1996

Behavior, attitudes, and expectations regarding the use of life-sustaining treatments among physicians in Israel: an exploratory study.

The use of life-sustaining treatments (LST) for prolonging lives of terminally ill patients without being able to improve the quality of life is a source of ethical, medical, economic and legal dilemmas for physicians. Although physicians in all Western countries face these dilemmas, they are unique in each society due to the special combination of its dominant religion, and its priorities regarding social values and legislation. This paper presents opinions, attitudes, expectations and behavior regarding the use of LST among 25 physicians attached to one teaching hospital in Israel. The data, which was collected by in-depth, semi-structured interviews, indicate that all of the physicians agree that life does not always have to be artificially prolonged. The general message that the physicians conveyed was that they deal quite effectively with these issues. They are not at all bothered by economic considerations and found ways to deal with the legal, ethical and medical dilemmas. It is suggested that in Israel the core issue is not the current law, but lack of communication among physicians and between physicians and patients/families. The relevance of the dominant model of the doctor-patient relationship and applications for medical education and practice are discussed. A list of hypotheses derived from this exploratory study for future intra-societal and inter-societal research is presented.

Adult↗
PubMedDate not supplied

Difficult dialogues: impact on nursing education curricula.

Efforts to raise consciousness and heighten sensitivity toward the issues of races, class, ethnicity, and gender are being espoused throughout society today. Within higher education there is currently a national debate over whether or not curricula are exclusive of certain ethnic and cultural perspectives. The National League of Nursing (NLN) in 1989 resolved that innovative nursing curricula be developed that (1) enhance caring practices through faculty-student relationships and faculty-faculty relationships that are egalitarian and humane and characterized by cooperation and community building; (2) incorporate social values that recognize diverse life-styles and multicultural and multiracial perspectives; and (3) include contact with or participation by persons at risk including disenfranchised populations such as women, poor, elderly, and homosexual persons. The purpose of this article is to share two faculty members' experience of creating a "difficult dialogue" in a doctoral nursing education course. Generally speaking, difficult dialogues are encountered when academia attempts to include the experiences of white women, women of color, and men of color in the curriculum. The dialogues are difficult because engagement in this type of discourse may lead to feelings of discomfort and uneasiness among faculty and students. Although these feelings were experienced by class participants, the end result was a constructive and powerful learning experience. The willingness of the black students and faculty in the course to share their lived experiences of discrimination and oppression in a white society and the willingness of the white students and faculty to hear a different lived experience from their own was education at its best.(ABSTRACT TRUNCATED AT 250 WORDS)

Communication↗
PubMed2001

Proposal for including what is valuable to ecosystems in environmental assessments.

Assessment scientists and managers depend on social values to identify the goals that will be used to guide environmental assessments. These goals are commonly identified by examining the vested interests of the various social groups that are stakeholders in a region. However, knowledge about what people value represents only part of the information needed to identify comprehensive assessment goals for environmental systems that include both economic and ecological components and processes. All parties also need to understand what is valuable to ecosystems because that determines the ecological patterns and processes that prevail in the long run. The competition among alternate system designs for available energy determines the viability of the choices that people make for their environment. Ecosystems that prevail in competition use the process of self-organization to create system designs that maximize the use of ever-changing sources of available energy. The efficacy of ecosystem designs can be evaluated using the maximum empower principle, which states that ecosystems evolve toward designs that maximize empower (energy use per unit time). Energy is an accounting quantity that normalizes the different kinds of energy developed in a system so that they may be compared. The counter-intuitive and sometimes controversial results that come from energy analyses are illustrated by examining three environmental problems on the interface between ecology and economics. A process for identifying and using social and ecosystem values to guide environmental assessments is proposed using a conceptual energy systems model that shows how these processes might interact within a region. The probability of realizing a given change in system empower production is suggested as a decision criterion that can be used by managers to evaluate the efficacy of alternatives.

Animals↗
PubMed2006

Likelihood of home death associated with local rates of home birth: influence of local area healthcare preferences on site of death.

OBJECTIVES: We tested whether local cultural and social values regarding the use of health care are associated with the likelihood of home death, using variation in local rates of home births as a proxy for geographic variation in these values. METHODS: For each of 351110 adult decedents in Washington state who died from 1989 through 1998, we calculated the home birth rate in each zip code during the year of death and then used multivariate regression modeling to estimate the relation between the likelihood of home death and the local rate of home births. RESULTS: Individuals residing in local areas with higher home birth rates had greater adjusted likelihood of dying at home (odds ratio [OR]=1.04 for each percentage point increase in home birth rate; 95% confidence interval [CI] = 1.03, 1.05). Moreover, the likelihood of dying at home increased with local wealth (OR=1.04 per $10000; 95% CI=1.02, 1.06) but decreased with local hospital bed availability (OR=0.96 per 1000 beds; 95% CI=0.95, 0.97). CONCLUSIONS: The likelihood of home death is associated with local rates of home births, suggesting the influence of health care use preferences.

Adult↗
PubMed1998

From selfish individualism to citizenship: avoiding health economics' reputed 'dead end'.

Recent interpretations of citizenship are firmly rooted in the value of social membership and social participation. Citizens are described as having a moral right to draw upon the support of the community, but at the same time have a responsibility to contribute to the provision of social services such as health care. In contrast, contemporary health economics has been criticised for taking a narrow and individualistic view of human behaviour. This paper examines the extent to which economic theory and practice have been developed to accommodate a more 'civic' view, namely, the notions of mutual concern for community members, social participation and social rights. It is argued that because the provision of health care is often linked to feelings of compassion and social responsibility and not just to individual well-being, this sort of insight may enrich economic analysis and, in turn, provide a way around health economics' reputed 'dead end'.

Altruism↗
PubMedDate not supplied

Acute threat to the social self: shame, social self-esteem, and cortisol activity.

OBJECTIVE: Our Social Self Preservation Theory asserts that situations which threaten the "social self" (ie, one's social value or standing) elicit increased feelings of low social worth (eg, shame), decrements in social self-esteem, and increases in cortisol, a hormone released by the hypothalamic-pituitary-adrenal axis. To test our theoretical premise, cognitive, emotional, and physiological responses to the performance of laboratory stressor tasks were compared in participants who performed these tasks in the presence or absence of social-self threat. METHODS: Pre- and poststressor emotion, self-esteem, heart rate, blood pressure, and salivary cortisol were compared in 81 participants randomly assigned to complete speech and mental arithmetic stress tasks with social evaluation present (n = 41) or absent (n = 40). RESULTS: As hypothesized, participants in the social evaluation condition exhibited greater increases in shame and greater decrements in social self-esteem. Other psychological states (eg, anxiety, performance self-esteem) did not show differential changes as a function of the social context. Salivary cortisol increased in social evaluation condition participants but did not increase in participants who performed the same tasks in the absence of social evaluation. Cortisol increases were greater in participants who experienced greater increases in shame and greater decreases in social self-esteem under social-self threat. CONCLUSION: Threat to the social self is an important elicitor of shame experience, decreases in social self-esteem and cortisol increases under demanding performance conditions. Cortisol changes may be specifically tied to the experience of emotions and cognitions reflecting low self-worth in this context.

Adolescent↗
PubMed1992

Unanswered questions about the criminalization of therapist-patient sex.

Even though much has been written about the issue of criminalization of therapist-patient sex, many questions about the issue remain unanswered, raising doubts about the wisdom of nationwide adoption of criminalizing legislation. From a philosophical standpoint, we need to understand more fully what thoughts, emotions, and behaviors constitute consent. Furthermore we must determine how much value to give consent in relation to other social values and goals. From a clinical standpoint we still need a better understanding of what constitutes the therapist-patient relationship: what it is and when it is over. We must also examine more carefully the nature of power within a psychotherapeutic relationship. From a legal standpoint we must determine how criminalization affects constitutional privacy rights, as embodied both in state constitutions and the federal Constitution. From an empirical standpoint we need to assess the efficacy of current criminalization statutes and determine their effect on tort compensation for patient victims. We also need to assess the practical application of these statutes by juries. Without more thorough analysis of all the issues raised, the criminalization of patient-therapist sex by state legislatures may in fact cause more harm than good.

Civil Rights↗
PubMed1986

[Deinstitutionalization : community-orientated services and training of workersts.].

The "deinstitutionalization" of services and their community uses imply important modifications in our professional practices. The citizen, the parent and the community resources become necessary partners in the care of the person maladjusted to his family and community environment. This change means that our social values have to undergo important modifications so that parents and citizens are recognized the abilities and resources to assist the actions of the professional services'networks. We have to study what professional abilities need to be developed in the different community environment to respect and give value to these new resources of the human and social ecology. A pedagogy of services has to be thought of in order to prepare both parent and citizen to be responsible for certain needs in the family and community. The training and the specialization of the personnel is in need of pedagogical strategies that will trancend the theoretical knowledge and will take account the environment's know how. In other words, strategies that will blend the theoretical knowledge with the Empirical one. Two training experiences are presented: one implies the initial training (Research project and in the house intervention) and the other is involved with the training of network's helpers (Community integrated services). Those experiences are two among others which illustrate the need to define the relationship between power and knowledge in order to help the growth of true institutional alternatives in education, psychiatry, social work. Finally, we should ask what type of society facilitates the collaboration between alternative professional resources and mutual aid?

English Abstract↗
PubMed1975

Sexuality in Samoan art forms.

This article explores the manifestations of sexuality in Samona as they are revealed through songs, poetry, dance, gestures, verbal expressions, stories, and games. For each of these art forms, texts, and translations of original material are presented, as an aid to discerning the uses and functions of sexuality as they are applied by Samoans for Samoans; to this end, formulalized joking of various types is seen as the medium through which the humorous element of sexuality is expressed. Elsewhere, sexuality functions to achieve and sustain individual attention. The explicitly sexuality functions to achieve and sustain individual attention. The explicitly sexual references in duneral and marriage songs, on the other hand, constitute affirmations of social values, incorporated in long-established rites. In what is tantamount to artistic license, performance of song, poetry, and dance containing sexual elements or references that would be prohibited in other contexts is constituted as acceptable behavior. In marked contrast to nineteenth-century writings, and the opinions of the popular press, sexuality in Samoa is far from free in its modes of expression, but rather adheres to traditional formalized patterns which determine its occasions, participants, and verbal and kinetic limits. Although not indispensable as a means of personal expression, it generally provides additional opportunities for the creative and aggressive individual to demonstarate his artistic talents and therby contribute to his own social elevation. As an element of verbalized group sentiment, it is a positive assertion of Samoan values, astatement of social solidarity.

Adolescent↗
PubMedDate not supplied

The relationship of education to critical thinking ability and values among nurses: socialization into professional nursing.

Exposure to faculty is assumed to positively influence critical thinking ability and professional values; therefore, faculty must be assumed to be superior in these characteristics. As a first step toward testing these assumptions, this study used a cross-sectional survey technique to compare critical thinking ability and values in ADN-prepared (n = 32) and BSN-prepared (n = 32) registered nurses, nursing faculty (n = 32), and sophomore college students (n = 32) beginning a baccalaureate degree program in nursing. The critical thinking ability of faculty was not significantly higher than that of sophomore nursing students when the influence of age was controlled statistically. The values of all three groups of nurses were strikingly similar, although faculty valued achievement most highly (P = .0001), while sophomore students valued goal orientation most highly (P = .001). All subjects valued support highly, but only sophomore students valued benevolence highly.

Adolescent↗
PubMed1977

[Poverty in old age (author's transl)].

The legitimate claim on social assistance riveted in the Federal Legislation on Social Welfare and deduced from the welfare-state-postulate of the Constitution is only partially valid (obligatory assistance only). Applying this claim substantially is legally tied to discretionary decisions of the administration. Handling such estimates in a restrictive way makes the legitimate claim invalide. Social values are significantly determined by equivalent-maxims. Claims on social assistance, however, are not being deduced from preperformances (in a judical sense in regard of pensions) but are being derived from a diffuse claim on a social state incured with the odium of statutory relief for the necessitous. It is empirically provable that the causes for need of social assistance are of a social kind. Therefore, the claim on social assistance can only be a claim to "reparation". This understanding could be seen as an adequate basis for a progressive administration of social welfare.

Age Factors↗
PubMedDate not supplied

Cultural negotiation: a constructivist-based model for nursing practice.

Combining abstract concepts from grand theories with the pragmatics of nursing practice presents a dilemma for nursing that is being addressed with the emphasis on middle-range theory. The philosophical perspective of constructivism is the foundation for a middle-range theory that links the nursing process to holism through the respective worlds and knowledge of the nurse and client. The nursing process is situated in the context of the cultural worlds of the nurse, client, and health care system and in the greater social context. This model allows the nursing process to be recast in new language that captures the interdependence of the client-nurse interaction. This model accommodates the social values and beliefs of both the health care system and the social context.

Culture↗