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PubMed1976

Eyelid conditioning and intellectual deficit: role of CS duration, US intensity and US mode.

When two separate and independent organizations must work together to accomplish a mutual task, difficulties often arise which remain poorly understood. The analysis of intergroup phenomena involves an exploration of interaction within and between groups; such relationships include problems arising from differences in tasks, structure, and culture of the two groups, definition of the intergroup task, choice of group representatives, and the possibilities and problems of dual group membership for the negotiators. While the literatures on group process and organization development contain some work on intergroup phenomena (e.g., Aldrich, 1971; Baker and O'Brien, 1971; Klein et al., 1971; Mills, 1975; Walton, 1972), much conceptual work remains to be done. We will focus upon one type of intergroup relationship--that between a traditional human service organization and a social movement group--in which dual membership is a particular problem, and in which conflict may be neutralized by the form of the negotiations. A case example of an interaction between a mental health center and a women's liberation group will provide one example of such negotiations. The analysis is presented within the framework of the open system model of Miller and Rice (1967) and Ric's general model of intergroup relations (1965, 1969).

Adolescent↗
PubMed1985

Sibling deidentification in the clinic: devil vs. angel.

A four-member family structure consisting of two siblings contrasting in personality (sibling deidentification) and each identified with a different parent (split-parent identification) was recently reported (15). In well-functioning families, this tetrad or quadrangle is wide-spread in the first pair of siblings in the family and tends to be more common in same-sex pairs, suggesting that sibling deidentification is designed to mitigate the relatively intense sibling rivalry characteristic of these pairs and hence to maintain family harmony. In this collated case report, deidentification is found to follow the same pattern in 39 clinic first pairs. However, contrasting attributes are varied and nonevaluative in nonclinic pairs but mainly "good-bad" in clinic pairs, with polarization extreme. Results suggest that nonclinic siblings negotiate their identity (being) much as they negotiate about possessions (having) and that negotiations are blocked in clinic pairs, freezing mythic devil or angel identity. Intervention is directed at dislodging this block.

Adolescent↗
PubMed2006

Pregnancy and chronic progressive pulmonary disease.

Progressive pulmonary disease may preclude the option of pregnancy for a number of women in their child-bearing years due to the severity of the disease. For a subset of women with chronic lung disease including cystic fibrosis, pregnancy is possible, but can have a devastating effect both on the prospective mother and fetus. The potential hazards of pregnancy in cystic fibrosis or other progressive pulmonary diseases may trigger a moral conflict between physician and patient. The female patient may argue that her autonomy cannot be circumscribed and that the physician is obliged to assist her reproductive efforts. The physician can counter that his/her participation in potentially harmful interventions is not consistent with professional norms requiring adherence to the principles of beneficence and nonmaleficence. Whenever possible, the ethical conflict between physician and patient should be resolved before initiation of pregnancy. We propose that this best be done through structured negotiations between physician and patient with the goal of constructing an ethical framework for reducing the moral tension between the two. Steps in the negotiating process include defining the therapeutic alliance, information exchange, dialog, and deliberation. As part of the information exchange, it is important to discuss alternatives to pregnancy such as adoption and surrogacy, especially when there are strong contraindications to pregnancy. If negotiations reach a satisfactory conclusion for both sides, there should be a well-delineated consensual agreement to commence the pregnancy with the full support of the medical team.

Chronic Disease↗
PubMed1987

Psychological concepts useful in the building of political foundations between nations: Track II diplomacy.

There are two phases in the process of negotiating for peace with antagonistic national groups. The leader (or leaders) of one such group will not negotiate with his opposite number until political foundations to support such negotiation are laid down, and obstacles to peace identified and dealt with; at least some measure of success is anticipated by both sides. Accordingly, the first phase requires the building of bridges between those representing opposing nations. The activities in this preliminary phase are sometimes called Track II diplomacy; they differ from those of official or Track I diplomacy. I suggest two kinds of concepts that may be useful in Track II diplomacy, and present them in the hope of initiating further discussion, and exploration of metapsychological underpinnings of each concept. As Mitscherlich (1971) suggested, the psychology of international politics may be better understood if psychoanalysts are willing to engage in interdisciplinary work with others engaged in such endeavors.

Ceremonial Behavior↗
PubMedDate not supplied

Factors associated with sexually transmitted diseases among prostitutes in Singapore.

From June to December 1990, 806 prostitutes registered with the STD programme in Singapore for regular screening for sexually transmitted diseases (STD) were investigated for factors associated with STD incidence in the preceding year. The majority were foreigners (92.7% Malaysians and 3.1% Thais). Anal sex (0.4%) and intravenous drug use (0.9%) were rare. The overall STD incidence rate was 47.7 per 100. None was human immunodeficiency virus (HIV) positive. The crude and age-adjusted risk of STD was found to increase significantly with client load. An inverse relationship between condom use and STD risk was also observed. Mean condom use among clients was reported as 56.1% for spontaneous use and estimated as 75.4% following negotiation for condom use by prostitutes. Although the prostitutes negotiated for condom use with majority of the clients (85.5%) who did not use condoms spontaneously, they were successful with only about half of them (54.4%). Health education should be targeted at clients on the protective effects of condom use and at the prostitutes on skills in negotiating condom use.

Adult↗
PubMed2003

Labor costs incurred by anesthesiology groups because of operating rooms not being allocated and cases not being scheduled to maximize operating room efficiency.

UNLABELLED: Determination of operating room (OR) block allocation and case scheduling is often not based on maximizing OR efficiency, but rather on tradition and surgeon convenience. As a result, anesthesiology groups often incur additional labor costs. When negotiating financial support, heads of anesthesiology departments are often challenged to justify the subsidy necessary to offset these additional labor costs. In this study, we describe a method for calculating a statistically sound estimate of the excess labor costs incurred by an anesthesiology group because of inefficient OR allocation and case scheduling. OR information system and anesthesia staffing data for 1 yr were obtained from two university hospitals. Optimal OR allocation for each surgical service was determined by maximizing the efficiency of use of the OR staff. Hourly costs were converted to dollar amounts by using the nationwide median compensation for academic and private-practice anesthesia providers. Differences between actual costs and the optimal OR allocation were determined. For Hospital A, estimated annual excess labor costs were $1.6 million (95% confidence interval, $1.5-$1.7 million) and $2.0 million ($1.89-$2.05 million) when academic and private-practice compensation, respectively, was calculated. For Hospital B, excess labor costs were $1.0 million ($1.08-$1.17 million) and $1.4 million ($1.32-1.43 million) for academic and private-practice compensation, respectively. This study demonstrates a methodology for an anesthesiology group to estimate its excess labor costs. The group can then use these estimates when negotiating for subsidies with its hospital, medical school, or multispecialty medical group. IMPLICATIONS: We describe a new application for a previously reported statistical method to calculate operating room (OR) allocations to maximize OR efficiency. When optimal OR allocations and case scheduling are not implemented, the resulting increase in labor costs can be used in negotiations as a statistically sound estimate for the increased labor cost to the anesthesiology department.

Anesthesiology↗
PubMed2000

Reality and discourse: a critical analysis of the category of 'delusions'.

Delusions are seen in psychiatric research and practice as central indicators of the psychotic loss of contact with reality. In this paper the psychiatric concept of 'delusions' is critically examined both theoretically and through the analysis of extracts from interviews with individuals diagnosed as 'delusional'. The diagnostic criteria for delusions, implausibility, idiosyncrasy, conviction and incorrigibility, are scrutinized, and the notion of reality that underlies the concept of delusions is deconstructed through the use of social constructionist approaches. The main arguments pursued in the paper are: first, that delusions are meaningful, not because they express something about the world or the speaker, but rather because they employ culturally available discourses and discursive strategies for their construction; second, that delusions are claims which are argued and negotiated in speech with similar strategies to those used by 'non-delusional' individuals; and third, that delusions are statements about the self and the world whose truth and falsity cannot be definitely settled in speech. All three claims are discussed through the analysis of extracts from two interviews with 'delusional' individuals, which focuses on the assumptions underlying the negotiation of claims on reality, the discursive strategies adopted in this negotiation and the way disputes on reality are conversationally produced and settled.

Delusions↗
PubMedDate not supplied

Perceived vulnerability to heart disease in patients with familial hypercholesterolemia: a qualitative interview study.

PURPOSE: Knowledge about the ways patients perceive their vulnerability to disease is important for communication with patients about risk and preventive health measures. This interview study aimed to explore how patients with a diagnosis of heterozygous familial hypercholesterolemia understand and perceive their vulnerability to coronary heart disease. METHODS: We did a qualitative study of 40 patients with familial hypercholesterolemia who were recruited through a lipid clinic in Norway. We elicited participants' perceptions about their vulnerability to heart disease in semistructured interviews. Data were analyzed by systematic text condensation inspired by Giorgi's phenomenological method. RESULTS: We found that participants negotiated a personal and dynamic sense of vulnerability to coronary heart disease that was grounded in notions of their genetic and inherited risk. Participants developed a sense of their vulnerability in a 2-step process. First, they consulted their family history to assess their genetic and inherited risk, and for many a certain age determined when they could expect to develop symptoms of coronary heart disease. Second, they negotiated a personal sense of vulnerability by comparing themselves with their family members. In these comparisons, they accounted for individual factors, such as sex, cholesterol levels, use of lipid-lowering medications, and lifestyle. Participants' personal sense of vulnerability to heart disease could shift dynamically as a result of changes in situational factors, such as cardiac events in the family, illness experiences, or becoming a parent. CONCLUSIONS: Patients with a diagnosis of familial hypercholesterolemia negotiate a personal and dynamic sense of vulnerability to coronary heart disease that is grounded in their understanding of their genetic and inherited risk. Doctors should elicit patients' understanding of their family history and their personal vulnerability to individualize clinical management.

Adolescent↗
PubMedDate not supplied

Raising the bar: the use of performance guarantees by the Pacific Business Group on Health.

In 1996 the Pacific Business Group on Health (PBGH) negotiated more than two dozen performance guarantees with thirteen of California's largest health maintenance organizations (HMOs) on behalf the seventeen large employers in its Negotiating Alliance. The negotiations put more than $8 million at risk for meeting performance targets with the goal of improving the performance of all health plans. Nearly $2 million, or 23 percent of the premium at risk, was refunded to the PBGH by the HMOs for missed targets. The majority of plans met their targets for satisfaction with the health plan and physicians, as well as cesarean section, mammography, Pap smear, and prenatal care rates. However, eight of the thirteen plans missed their targets for childhood immunizations, refunding 86 percent of the premium at risk.

Adult↗
PubMed2004

Behavioral and cognitive barriers to safer sex between men in steady relationships: implications for prevention strategies.

Steady partners are a major source of HIV infection among gay men. To better understand sexual risk taking in steady relationships, we examined characteristics of the first incident of unprotected anal intercourse (UAI) between steady male partners. We also examined cognitive barriers to safer sex by way of associating beliefs regarding UAI with protective behavior. Questionnaires assessing sexual behavior and related cognitions were completed by 324 gay men, aged 18-34. Of the men who had UAI with their steady partners, 55% (103/189) did so within the first 3 months of the relationship, and 46% did not discuss having UAI with their partner before it occurred. Analyses revealed that perceiving UAI as a symbol of trust and believing that the partner desired UAI were associated with less condom use but also with a higher likelihood that men established HIV-negative seroconcordance and made sexual agreements (i.e., practiced negotiated safety). Perceiving UAI as more gratifying was associated with having risky UAI. Our findings suggest that interventions can make use of beliefs regarding trust and partner's desire for UAI to promote negotiated safety. In relationships where negotiated safety cannot be implemented, HIV prevention should regard the above beliefs, in particular the perception that UAI is more gratifying, as important barriers to safer sex. Furthermore, our findings regarding the early onset of risk in relationships emphasize how little time is at hand to prevent sexual risk before it occurs. One solution could be to target single gay men for promoting safer sex with future steady partners.

Adolescent↗
PubMed1976

Nurses and trade unions in Britain.

The nature of the negotiating body for pay and conditions of nurses in Britain and some of the reasons for the body's past failure to negotiate a substantial pay increase for nurses are described in this article. A description is given of a series of events, including strike action by nurses during 1974, which led to a substantial pay raise. The pay award, however, represented only a partial success for the trade unions and the negotiating body. Methods of nurses' organization and the roles of their representative unions and professional body indicate some of the reasons for only a partial success. The lack of unity between the National Health Service trade unions and the reactionary role of the professional body were notable. However, many important political and organizational lessons were learned by nurses in this struggle. We are now facing savage cuts in National Health Service expenditure, leading to a reduction in the number of nurses employed. These lessons are clearly useful for the nurses and their organization with the labor movement in fighting these cuts in National Health Service expenditure.

Economics, Nursing↗
PubMed1989

Social psychology, contexts of aging, and a contextual world view.

Two world views-mechanism and organicism-have dominated the youthful history of social psychological study of adult development and aging. Despite differences, both assume a stable, universal, transhistorical structure underlying social psychology; the goal of research is to discover and delineate such universals. A third world view, contextualism, begins with an assumption that action and thought are developed within relationships, which form the contexts for particular actions. It stresses the negotiated, constructed nature of "reality,"the historical embeddedness and unique quality of action as it unfolds, and the importance of negotiation making use of multiple perspectives. The approach and contextualist goals are significantly different from more typical approaches. Three areas of research in social gerontology and social psychology-environmental relations, attribution, and social relations in a social reconstruction/social breakdown model-illustrate a contextualist approach. Control and a "voice" in a negotiation of relationships and the characteristics of one's contexts are central to a contextual approach to all three.

Aging↗
PubMed1991

Ethics consultation: skills, roles, and training.

A clinical ethics consultant gathers information firsthand at the patient's bedside. The consultant's special clinical skills include the ability to identify and analyze ethical problems; use reasonable clinical judgment; communicate effectively; negotiate and facilitate negotiations; and teach others how to construct their own ethical frameworks for medical decision making. Appropriate roles for the consultant include those of professional colleague, negotiator, patient and physician advocate, case manager, and educator. The training necessary for an ethics consultant includes substantial patient care experience, instruction in health care law and moral reasoning, and preparation in medical humanism. We favor a clinical model for ethics consultation. When urgent care is needed, other consultants promptly see the patient; the clinical ethics consultant can be expected to do the same.

Certification↗
PubMedDate not supplied

Higher level practice in community nursing: part two.

AIM: To establish whether or not community nurse practitioners were able to achieve a 'higher level of practice', as articulated by the United Kingdom Central Council. METHOD: Grounded theory was used as a framework for the research. Data were gathered using primary observation with some participation, and by interviewing community nurse practitioners and clinical managers. FINDINGS: 'Negotiation for autonomy' is the core category at the centre of the overall theoretical framework that emerged from the research data. Those working at a higher level of practice had the ability to negotiate for autonomy with GPs and other doctors. This ability gave them the opportunity to practise with the autonomy required to hold consultations, as first point of access, with patients with undifferentiated diagnoses, providing care through to discharge or referral to others. CONCLUSION: The research highlights that unless community nurse practitioners can negotiate their role with GPs and hospital doctors, they are unable to achieve a 'higher level of practice'.

Community Health Nursing↗
PubMed1996

Setting limits through global budgeting: hospital cost containment in Rhode Island.

In 1974, hospitals in Rhode Island have participated in annual negotiations with state officials and representatives from Blue Cross to determine the allowed increase in statewide hospital costs (the "Maxicap") for the next fiscal year, based on projected increases in hospitals' revenues, changes in patient volume and operating expenses. Individual hospital budgets may be above or below the Maxicap as long as the total increase in hospital costs for all hospitals in the state does not exceed the negotiated amount. At a time when regulatory solutions are increasingly under fire, continued support for Rhode Island's approach to hospital cost containment from third party payers, providers and public officials stands in stark contrast to other states where rate setting was either dismantled or discredited as a cost control strategy. A negotiated global cap on hospital expenditures offers an alternative to formula-based state rate-setting methodologies which could be incorporated as part of an all-payer reimbursement methodology or as an incremental step towards more comprehensive reform.

Blue Cross Blue Shield Insurance Plans↗
PubMed1999

Constraints facing the female medical practitioner in private family practice in the Western Cape.

OBJECTIVES: To assess the existence and extent of employment-related problems facing female family practitioners in the context of a rapidly growing number of female doctors in South Africa. SUBJECTS AND METHODS: A descriptive survey was conducted using bilingual questionnaires. These were posted to all 280 female family practitioners in private practice in the Western Cape. RESULTS: Of the 280 questionnaires posted 169 were returned, but 45 of these were missampled. A response rate of 53% was obtained. The largest age category was 30-39 years. Of those not in solo practice, 68 (75%) were able to negotiate the terms of their working hours, 13 (19%) negotiated sick leave on commencing work, and only half had paid leave. Vacation leave was negotiated by 34 (50%), while only 6 (9%) discussed maternity leave with employers or colleagues. Of the 124 practices included in the survey, 6 (5%) had formal arrangements to cope with maternity leave. One hundred and seven respondents (86%) felt there was a need for maternity leave guidelines in the private sector in South Africa. Regarding practice-related problems, 33 female family practitioners (27%) reported some incidents of sexual harassment by patients. Despite these constraints, 88 respondents (71%) planned to continue working in this field. CONCLUSION: Definite obstacles exist in private family practice with regard to working conditions, in particular the lack of national regulations regarding maternity leave and the absence of legislation on pregnancy discrimination. This has important implications for the inclusion of female doctors in group practices and managed health care organisations--private primary health care of the present and future!

Adult↗
PubMed1981

The use of break-even analysis in long-term care facilities.

For the most part, long-term care facilities operate in a negotiated rate environment. Under Public Law 92-603, these facilities are compensated for rendering care to Medicaid patients on a "cost-related" reimbursement formula. Therefore, there is a limit on the ability of the owners of these facilities to pass increased costs for their services on to the consumer on a current basis, as is done in most other industries. The owners attempt to negotiate an annual rate based on anticipated increased costs of operation, and then normally have to live with the rate for the remainder of the year. In some cases the increased costs exceed the increase in the negotiated rate on an annual basis. Since there is, in effect, a lid on the revenue per patient, the opportunities to increase net income are limited either to reducing costs, or increasing the number of patients served in the facility. In this industrial setting, it would be particularly meaningful to the owner of a facility to be aware of the profitability of the operation at different occupancy levels. Also, the feasibility of expanding his facility should perhaps be explored to determine the impact of an expansion on net income retention. Break-even analysis can be employed to help address these issues. In this paper, the author briefly discusses break-even analysis as a management tool and develops a model to illustrate and apply the analysis of a long-term care facility.

Costs and Cost Analysis↗
PubMedDate not supplied

Information technology: 1. Planning and developing a human resources information system.

for the unwary, planning and implementing an HRIS can present a variety of pitfalls. Author Albert L. Lederer, who spent ten years installing such systems before joining the faculty of the University of Pittsburgh (as assistant professor of business administration), is fully cognizant of the pitfalls involved and the problems that personnel departments encounter in the process. After discussing what an HRIS can accomplish, he gives a thoroughgoing, detailed approach to developing such a system--from cost justification, to the personnel department's relationship with the data-processing department at each step, to deciding between buying a packaged system and developing a new system internally. Most important, he emphasizes, is to define requirements precisely and completely at the outset--those who don't are in for a lot of costly headaches. Much more is covered in this comprehensive approach--not the least of which is (for packaged systems) vendor analysis and contract negotiation (the contract stipulates the vendor's responsibilities in terms of software, installation service, maintenance, training, and documentation). One popular strategy for negotiating a contract is to choose the best two vendors and compare their offers throughout the negotiation; this results in a contract with excellent leverage for the buyer.

Computers↗