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PubMed1978

Intangibles facilitating or inhibiting health care delivery systems.

Proponents of general systems theory believed its principles were applicable to a variety of living systems. General systems theory was applied to health care delivery systems and provided a conceptual framework for operation. Intangibles in the health care delivery system may inhibit or facilitate open or closed systems and thereby directly or indirectly influence the quality and quantity of care. This paper reviews and discusses: 1) Basic concepts of general systems theory; 2) Application of general systems theory to health care delivery systems, including the Air Evac system; 3) Intangibles in systems which facilitate or inhibit health care delivery; and 4) Suggestions to facilitate open systems and the delivery of quality care.

Aerospace Medicine↗
PubMed2001

Theoretical frameworks for understanding and investigating the therapeutic relationship in psychiatry.

BACKGROUND: Mental health care is delivered through a relationship between a clinician and a patient. Although this therapeutic relationship is of central importance for mental health care, it appears to be relatively neglected in psychiatric research. Empirical research has for the most part adopted concepts and methods developed in psychotherapy and general medical practice. Hence, unpacking the presuppositions that have informed research on the therapeutic relationship to date may be a useful first step in developing this field. METHOD: A review of the literature was carried out. RESULTS: Six central theories are identified as framing the definitions and methods on this topic: role theory, psychoanalysis, social constructionism, systems theory, social psychology and cognitive behaviourism. To date, role theory, psychoanalysis and systems theory appear to be the frameworks most often applied in research in this field. Each perspective offers a unique emphasis in the analysis of the therapeutic relationship, which is reflected in the empirical work from each perspective discussed herein. CONCLUSIONS: None of the theories identified have been fully specified and comprehensively investigated in psychiatric settings. However, more than one approach may be used for thinking about relationships, depending on the treatment situation. Further specification and testing of the theories in psychiatric practice--taking account of the specific context--is warranted to underpin more pragmatic research. A stronger link between fundamental psychological and sociological research and applied health care research would advance our understanding of which elements of positive therapeutic relationships are instrumental in improving patient outcome and ultimately contribute to improving mental health care.

Humans↗
PubMed1979

Clinical and administrative synthesis in adolescent treatment: search for a sane integration of thought and action.

In working as administrator and clinician (co-director and head psychologist) of a day and residential treatment facility for disturbed adolescents, I have become acutely aware of some of the difficulties of integrating both roles. To keep rooted in the concrete, I have described the program with which I am involved in particular as to crucial client and staff dynamics. By drawing on concepts from systems theory (as system integrity and cross-boundary interactions) and psychoanalytic theory (unconscious testing), I have tried in this paper to sketch a framework for bringing the two separate roles into a single way of thinking and give some examples of how this kind of synthesized approach can be useful and powerful. The two concrete examples focus (1) on the more administrative issue of program design, and (2) on a more clinical case of child abuse.

Adolescent↗
PubMed2005

Practitioner review: approaches to assessment and treatment of children with DCD: an evaluative review.

BACKGROUND: Movement clumsiness (or Developmental Coordination Disorder--DCD) has gained increasing recognition as a significant condition of childhood. However, some uncertainty still exists about diagnosis. Accordingly, approaches to assessment and treatment are varied, each drawing on distinct theoretical assumptions about the aetiology of the condition and its developmental course. METHOD: This review evaluates the current status of different approaches to motor assessment and treatment for children with DCD. These approaches are divided according to their broad conceptual origin (or explanatory framework): Normative Functional Skill Approach, General Abilities Approach, Neurodevelopmental Theory, Dynamical Systems Theory, and the Cognitive Neuroscientific Approach. CONCLUSIONS: Each conceptual framework is shown to support assessment and treatment methods with varying degrees of conceptual and psychometric integrity. The normative functional skill approach supports the major screening devices for DCD and cognitive (or top-down) approaches to intervention. The general abilities approach and traditional neurodevelopmental theory are not well supported by recent research. The dynamical systems approach supports promising trends in biomechanical or kinematic analysis of movement, ecological task analysis, and task-specific intervention. Finally, and more recently, the cognitive neuroscientific approach has generated some examples of process-oriented assessment and treatment based on validated (brain-behaviour) models of motor control and learning. A multi-level approach to movement assessment and treatment is recommended for DCD, providing a more complete representation of motor development at different levels of function--behavioural, neurocognitive, and emotional.

Child↗
PubMedDate not supplied

[Is the "biopsychosocial model" a helpful construct?].

In 1977, G. L. Engel proposed a biopsychosocial model, applicable to all illness and disease. It was based on systems theory which orders the world into a ladder (of systems) from the most elementary particles to social phenomena and the cosmos. Systems theory was proposed to combat reductionism and to deal with complexity and order. Central to that theory is the concept of emergence that the properties of each "higher" or more complex system are not explainable either by their components nor by those at a lower level. However, no one form of complexity exists. Some forms of complexity arise out of the interactions of the components, especially as the result of feed-back, which in turn allows us to understand order, and sudden change. Living systems are characterized by genetic programs, self-replication, self-organization and adaptability. These properties exist at every "level", and thus make systems theory and its hierarchies no longer necessary, and also eliminate the concept of emergence.

Adaptation, Psychological↗
PubMedDate not supplied

The application of the theory of systems in internal medicine. State of the art and perspectives.

The application and contribution of Cartesian methodology to the development of medicine in physiology, pathophysiology and therapy have been overwhelming. The accumulation of knowledge over the last 3 centuries in scientific research is largely attributed to Cartesian methodology. This method, which in the past was used for the acquisition of nosological data is no longer sufficient for the interpretation of complex phenomena which modern science nowadays requires. The solution to these complex problems is only possible by means of the application of the theory of systems especially for the functional evaluation of biological feedback.

Feedback↗
PubMed2003

Personality systems interactions theory and the theory of planned behaviour: evidence that self-regulatory volitional components enhance enactment of studying behaviour.

The role of volitional components specified by personality systems interactions theory in enhancing behavioural prediction was examined in a longitudinal investigation of students' studying. Participants completed measures specified by the theory of planned behaviour and questionnaire measures of 'conscious attention control', 'implicit attention control' and 'self-determination' from the volitional components inventory. Behaviour was assessed 2 weeks later. Regression analyses showed that volitional components increased variance explained in behaviour by 10-18%, after taking into account strength of motivation to study assessed by attitude, subjective norm, perceived behavioural control and intention from the theory of planned behaviour. Moreover, consistent with elements of personality systems interactions theory, moderator effects were obtained. Participants who reported self-determination, conscious attention control and implicit attention control were more likely to enact their intentions. Volitional components were also associated with increased studying among participants who perceived a low subjective norm for studying. Volitional components improved prediction of studying after accounting for past behaviour in the regression models.

Adolescent↗
PubMed1975

The direct analysis of sedimentation equilibrium results obtained with polymerizing systems.

Theory is presented in relation to sedimentation equilibrium results obtained with polymerizing systems, which permits evaluation of the activity of the monomer as a function of total weight concentration. In contrast to established methods, the suggested procedure does not involve the solution of simultaneous equations which are sums of exponentials or the determination of weight-average molecular weights. A major advantage of the method is that it avoids errors inherent in differentiation and integration steps. An extrapolation to infinite filution is involved, but this is to a defined limit and is uncomplicated by the existence of critical points in the relevant plot. The method is capable of detecting possible volume changes inherent on polymer formation, of treating systems where activity coefficients of solute species are functions of total concentration and of describing the system in terms of relevant equilibrium constants. These points and comparisons with existing methods of analysis are illustrated with numerical examples and with results obtained with lysozyme at pH 6.7. The lysozyme results are interpretable in terms of either a non-ideal monomer-dimer system or a monomer-dimer-trimer system.

Binding Sites↗
PubMed2005

Variation and change in the meaning of oral health related quality of life: a 'grounded' systems approach.

Changes in concepts of health and disease have led to increased interest in health related quality of life in medicine. Quality of life measures tend to treat quality of life as a stable construct that can be measured externally. They do not consider people's differing expectations and assume that what quality of life means to people is stable over time. This paper reports on a study which aimed to find out how measures of oral health related quality of life (OHRQoL) vary between and change within individuals. Longitudinal semi-structured open-ended interviews were carried out with twenty people with socially noticeable broken, decayed or missing teeth who were or were not seeking dental treatment. The data were collected and analysed using the iterative processes of grounded systems theory based on Glaserian (Theoretical Sensitivity, The Sociology Press, Mill Valley, CA, 1978) grounded theory and Luhmann's (Social Systems, Stanford University, Stanford, 1984) social systems theory. During the data analysis it emerged that participants' were adopting positions on seven dimensions of oral health relating to the positions that people would adopt with respect norm, attribution, trust, accessibility, commodity, authenticity, and character. The core distinction that accommodated people's varying positions was that people constructed their own margins of relevance of oral health. The margins of relevance indicated a variable from a hypothetical extreme of 'super-relevant' to the other extreme of 'not relevant'. The margins of relevance could shift, meaning that assessments of quality of life would vary. Oral health related quality of life is therefore defined as the cyclical and self-renewing interaction between the relevance and impact of oral health in everyday life.

Adult↗
PubMed1981

The inpatient psychiatric unit as a system.

A university-affiliated psychiatric inpatient unit in a private general hospital is an organization which serves many purposes. However, the primary purpose is quite evident: to provide various psychiatric therapies to patients with diverse psychopathologies. This becomes extremely complicated if the unit attempts an eclectic approach. Thus, the unit must consider: (1) psychopathological frameworks such as genetic, sociocultural, psychoanalytic, behavioral, and biochemical etiologies; (2) therapeutic interventions such as individual, group, and family therapy; insight-oriented, supportive, and behavioral psychotherapy; milieu therapy; and psychopharmacological treatment; (3) the various philosophies, attitudes, and skills of the multidisciplinary team of psychiatrists, psychologists, nurses, aides, social workers, activities therapists, expressive therapists, and administrative support personnel. General systems theory and general living systems models may further the conceptualization and understanding of the inpatient unit. This, in turn, may improve patient treatment. For the inpatient psychiatric unit, we describe the 19 critical subsystems of general living systems theory, with special emphasis on the decider subsystem.

Hospital Bed Capacity, 300 to 499↗
PubMedDate not supplied

The liver as a self-organizing system. I. Theoretics of its representation.

The liver is described as a composite system consisting of a set of operative creodic microunits open to a continuous flow of matter, energy and informations. Its dynamics depend on two interactive and interrelated subsystems with actions described as homopoiesis and homeorhesis, making it an autoisodiasostic system. The system's emergent (equifinal) or emergence states, operative potential, diffusion and reaction phenomena and compensation states are also formally described. For readers not familiar with the language of general system theory, of system dynamics and of categorical analysis, a glossary of some terms is provided.

Diffusion↗
PubMed2002

King's conceptual system and theory of goal attainment: past, present, and future.

Imogene King is universally recognized as a pioneer of nursing theory development. Her interacting conceptual system for nursing and her theory of goal attainment have been included in every major nursing theory text, are taught to thousands of nursing students, form the basis of nursing education programs, and are implemented in a variety of service settings.

Education, Nursing↗
PubMed1985

Effects of intoxication on alcoholics' marital communication and problem solving.

The effects of intoxication on the marital interactions of treatment-motivated alcoholics and their nonalcoholic spouses were studied in eight couples (two of which had an alcoholic wife). In half of the sessions, the alcoholics were given enough alcohol to reach a blood level of 10 mg/dl. Couples engaged in three 10-min conflict-resolution discussions of varying intensity counterbalanced for alcohol and no-alcohol sessions. Couples expressed significantly more positive verbalizations in the alcohol sessions than in the no-alcohol sessions. This was true especially for the nonalcoholic spouses, who doubled their rate of positive verbal behavior when interacting with an intoxicated partner. Alcoholics spoke more and tended to make more problem-describing statements while intoxicated than while sober. The alcoholics made a greater number of problem-solving statements than did their spouses. Alcoholics were significantly more negative and less positive in nonverbal behaviors than were their spouses, but neither self-report of marital satisfaction nor observations of verbal behavior reflected this. The models of both social-learning theory and systems theory for the relationship of marital factors to the etiology and maintenance of alcoholism are supported.

Adult↗
PubMed1975

Mental health organizations in transition.

Many mental health institutions are changing their traditional treatment policies and practices and their organizational structures. Literature is reviewed which provides a model for changing mental health organizations based in general systems theory. The systems organizational model has empirical support in the growing community mental health movement. The strong interaction of technological and ideological factors determining the nature of the new mental health organizations is stressed. Also considered are some of the problems facing those planning and managing changing mental health organizations.

Community Mental Health Services↗
PubMedDate not supplied

An integrative framework for community partnering to translate theory into effective health promotion strategy.

INTRODUCTION: Although there is general agreement about the complex interplay among individual-, family-, organizational-, and community-level factors as they influence health outcomes, there is still a gap between health promotion research and practice. The authors suggest that a disjuncture exists between the multiple theories and models of health promotion and the practitioner's need for a more unified set of guidelines for comprehensive planning of programs. Therefore, we put forward in this paper an idea toward closing the gap between research and practice, a case for developing an overarching framework--with several health promotion models that could integrate existing theories--and applying it to comprehensive health promotion strategy. AN INTEGRATIVE FRAMEWORK: We outline a theoretical foundation for future health promotion research and practice that integrates four models: the social ecology; the Life Course Health Development; the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation-Policy, Regulatory and Organizational Constructs in Educational and Environmental Development; and the community partnering models. The first three models are well developed and complementary. There is little consensus on the latter model, community partnering. However, we suggest that such a model is a vital part of an overall framework, and we present an approach to reconciling theoretical tensions among researchers and practitioners involved in community health promotion. INTEGRATING THE MODELS: THE NEED FOR SYSTEMS THEORY AND THINKING: Systems theory has been relatively ignored both by the health promotion field and, more generally, by the health services. We make a case for greater use of systems theory in the development of an overall framework, both to improve integration and to incorporate key concepts from the diverse systems literatures of other disciplines. VISION FOR HEALTHY COMMUNITIES: (1) Researchers and practitioners understand the complex interplay among individual-, family-, organizational-, and community-level factors as they influence population health; (2) health promotion researchers and practitioners collaborate effectively with others in the community to create integrated strategies that work as a system to address a wide array of health-related factors; (3) The Healthy People Objectives for the Nation includes balanced indicators to reflect health promotion realities and research-measures effects on all levels; (4) the gap between community health promotion "best practices" guidelines and the way things work in the everyday world of health promotion practice has been substantially closed. CONCLUSIONS AND RECOMMENDATIONS: We suggest critical next steps toward closing the gap between health promotion research and practice: investing in networks that promote, support, and sustain ongoing dialogue and sharing of experience; finding common ground in an approach to community partnering; and gaining consensus on the proposed integrating framework.

Canada↗
PubMed2005

Development of a dynamic strategy planning theory and system for sustainable river basin land use management.

Land use management is central to government planning for sustainable development. The main purpose of this study is to develop a novel strategy planning theory and system to assist responsible authorities in obtaining alternatives of sustainable top river basin land use management. The concepts and theory of system analysis, driving force-state-response (DSR) framework, and system dynamics are used to establish the DSR dynamic strategy planning procedure in this work. The integrated management of the land, water, and air resources of a river basin system is considered in the procedure. Two modified land use management procedures combined with the DSR dynamic strategy planning procedure are developed in this work. Based on the DSR dynamic strategy planning procedure, the sustainable river basin land use management DSR dynamic decision support system (SRBLUM-DSRD-DSS) is developed by using the Vensim, MS Excel, ArcView, and Visual Basic software. The concepts of object-orientation are used to develop the system dynamic optimization and simulation models of SRBLUM-DSRD-DSS. Based on the modified land use management procedures, SRBLUM-DSRD-DSS is used to assist decision makers in generating the land use plans of the Nankan river basin in Taoyuan County of Taiwan. Since the decisions of land, water and air resources management are still made at different agencies, the land use management system should be modified based on the innovational procedure to implement the management strategy developed in this work. The results show that the modified land use management procedures can be a guidance for the governments in modifying the systems and regulation of urban and regional plans in Taiwan.

Cities↗
PubMed2006

Psychosocial and psychodynamic factors influencing health care utilisation.

This paper aims to elucidate some dysfunctional aspects of health care utilisation by combining concepts from modern systems theory and from psychoanalysis. Contemporary health care in industrialised countries can be conceived as a social system in terms of modern systems theory. According to this theory, social systems are operating on the basis of a 'guiding difference,' which in the case of health care is the distinction between 'healthy' and 'ill.' Its rigidity in adhering to the healthy-ill dichotomy exposes health care to being collusively entangled in the interpersonal defence arrangements of patients. In the psychoanalytic view, individual conflicts can be warded off from consciousness not only by intrapsychic defence, but also by interpersonal defence mechanisms. These mechanisms involve the patients' close social environment, often including doctors and hospitals. The functioning and the motivational structure of health care itself shows features of neurotic defence: not only its representatives, but health care as a whole act in a rigid, obsessive manner in order to separate the healthy from the ill and to battle against (presumed) diseases. This obsession sometimes results in excessive diagnostic activism and in inconsiderate application of aggressive medical treatments. Both are inappropriate with regard to the salient problem of modern medicine: the increase of chronic nonfatal diseases like depression and chronic pain. The described defence mechanisms are unconscious not only to patients but also to health care professionals (let alone health politicians), and are contributing to dysfunctional health care overuse.

Aggression↗
PubMed2005

Stress and coping among families of patients with traumatic brain injury: a review of the literature.

AIMS AND OBJECTIVES: This literature review aims to structure the available information on the psychological reactions of family members confronted with traumatic brain injury. The stress-coping theory and the systems theory provide the theoretical framework for this review. METHOD: Literature review. RESULTS: The level of stress experienced by the family members of patients who have traumatic brain injury is such that professional intervention is appropriate, even after 10-15 years. Not the severity of the injury but the nature of the injuries determines the level of stress. Partners experience more stress than parents. Children have specific difficulties. Young families with little social support, financial, psychiatric and/or medical problems are the most vulnerable. Coping with traumatic brain injury can be described in phases. The better family members can cope with the situation, the better the patient's recovery. There are functional and non-functional coping mechanisms and coping is influenced by such factors as gender, social and professional support and the possibility to have reciprocal communication or an affective relation with the patient. RELEVANCE TO CLINICAL PRACTICE: Support from professionals reduces the stress being experienced and encourages people to cope effectively. Conflicts with professional carers should be avoided. Every attempt should be made to develop models of long-term support and care that alleviate sources of burden on relatives. Further research is necessary to develop such models.

Adaptation, Psychological↗