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PubMed2004

Talking about STD/HIV prevention: a look at communication online.

Little is known about the quality and usability of online health information. This analysis evaluated STD prevention websites' content quality and usability. Thirty-six sites were analyzed to determine their adherence to established sexual health guidelines and their accessibility, usability, credibility and currency. The objective of this study was to determine what communication skills are available to teenagers through STD prevention websites. Only two (6%) addressed safe sex negotiation; seven (19%) addressed basic communication skills; and slightly more than half (53%) addressed at least one sexual decision-making message. Most sites displayed consistent template design and two-thirds had working hyperlinks. But few (19%) of the sites offered a site map, while only one-third (36%) provided an internal search engine. These results indicate that health educators need to include tips on how to negotiate safe sex and improve interactive design features when creating STD websites for teenagers.

Adolescent↗
PubMedDate not supplied

STD/HIV prevention for teenagers: a look at the Internet universe.

The objective was to determine how the Internet is used to promote sexual health among adolescents. Six key words were entered into three search engines producing 87,180 results. Three percent (n = 36) were educational Web sites targeted at teenagers and covered a range of sexually transmitted diseases (STDs). These were content analyzed using sexuality education and usability guidelines. All sites addressed some STD information, but only two covered negotiation. Navigability results were mixed; only one third offered a site map. Sexual health educators may need to include more information on how to negotiate safe sex and improve Web navigability for teenagers.

Adolescent↗
PubMed2001

Co-operation and conflict in a hospital: interprofessional differences in perception and management of conflicts.

This article presents a case study of a Norwegian hospital, analysing how health professionals manage conflicts related to work co-operation. Altogether, 29 health professionals working in the hospital were interviewed, and data was analysed according to a grounded theory approach. When in conflict, health professionals seem to use three major approaches to handling the situation: avoidance, forcing and negotiation, and usually in that order. Avoidance behaviour or suppression is the most common reaction to an emerging conflict. If the use of power does not re-establish a balance between the participants, one negotiates. These conflict styles seem to be determined by two major factors: the perceived interdependence between parties and the perceived urgency of doing something about the situation. Nurses and physicians in particular seem to differ considerably in their perception of what is a conflict and when to do something about it. Such differences in perceptions and the extensive use of avoidance represent important challenges to managers and clinical leaders when it comes to advancing interprofessional co-operation.

Conflict, Psychological↗
PubMedDate not supplied

Public mental health. III: Hatred and reconciliation.

In today's often crazily chaotic conflicts it is particularly important to consider the aftermath of direct violence. Although a ceasefire may have been arranged-or imposed as in Bosnia-the emotions of anger and hatred may still dominate the minds of most people. It is therefore vital to pay great attention to the process of reconciliation. This has not been given the same attention as diplomacy and negotiation in arranging the ceasefire that ended the fighting-but often not the conflict of interests. Health workers are particularly suited for this work for three main reasons. Firstly, their altruistic humanitarian function is very widely appreciated; there is little need for them, as there is for others, to prove their good will and impartiality. Secondly, their work brings them into contact with all levels of society. This is particularly important, since experience shows that arrangements made by leaders are by no means always accepted by the people, upon whom ultimately the creation of a peaceful society depends. Thirdly, the relationships they form are often more long-lasting than those of peace-making negotiators or mediators, and therefore more likely to lead to constructive changes of perception.

Altruism↗
PubMed1999

Managing external resources in the health sector: are there lessons for SWAps (sector-wide approaches)?

Drawing on the case studies presented in this issue, from Bangladesh, Cambodia, Mozambique, Zambia and South Africa, and examples from other countries, this paper asks what general conclusions can be drawn about the management of external resources, and specifically what lessons could inform the future implementation of sector-wide approaches (SWAps) in the health sector. Factors constraining the management of aid by ministries of health are grouped under three themes: context and timing, institutional capacities and the interplay of power and influence in negotiations over aid. Two factors, often underplayed, were found to be important in facilitating management of resources: the inter-relationship of formal and informal relationships, and the extent to which incremental changes are tolerated. The main conclusion is that coordination and management of external resources is inherently unstable, involving a changing group of actors, many of whom enjoy considerable autonomy, but who need each other to materialize their often somewhat different goals. Managing aid is not a linear process, but is subject to set-backs and crises, although it can also produce positive spin-offs unexpectedly. It is highly dependent on institutional and systemic issues within both donor and recipient environments. In promoting sector-wide approaches the key will be to recognize context-specific conditions in each country, to find ways of building capacity in ministries of health to develop and own the future vision of the health sector, and to negotiate a realistic package that is explicit in its agreed objectives. The paper ends with identifying crucial actions that will enable ministries of health to take the lead role in developing and implementing SWAps.

Developing Countries↗
PubMed2003

Utilizing role theory to help employed parents cope with children's chronic illness.

Role theory is utilized to detail a six-step process for developing balanced coping through role negotiation. As applied in this paper, the role theory framework provides health educators with a useful tool for helping employed parents cope with a child's chronic illness. The emphasis is on partnering with parents or primary caregivers to identify, understand and manage the multiple role demands of working parents with chronically ill children. Role theory suggests ways health educators can support balanced coping by educating families about the demands of a child's illness, and helping to reduce those demands, helping to increase family resources, supporting parents and facilitating role negotiation. The ultimate goal is the development of balanced coping strategies that (1) meet the medical and emotional needs of the ill child, (2) allow parents to maintain their physical and mental health, and (3) enable parents to meet the demands of their other roles (e.g. paid employment).

Adaptation, Psychological↗
PubMed1994

Factors influencing the implementation of the CNS role in a private practice.

Factors to be considered by the CNS before implementing the role in private practice with a physician are discussed. Four CNSs were interviewed regarding their experiences in such a practice. The CNS subroles of expert practitioner, educator, consultant, and researcher are described as they apply in private practice with a physician. A four-step process is proposed to guide the CNS considering entry into private practice. The steps discussed are: self-assessment, evaluation of the legal and financial aspects, development of marketing and cost-justification strategies, and negotiating for a position. A method for cost justification is proposed, and some elements of marketing and negotiating are reviewed.

Financial Management↗
PubMed2001

Hospital policy on appropriate use of life-sustaining treatment. University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force.

OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment.

Hospital Administration↗
PubMed2000

What's a trauma surgeon worth? A salary survey of the Eastern Association for the Surgery of Trauma.

BACKGROUND: Professional compensation is an important consideration for all physicians. Few objective data specific to trauma surgery are available to those seeking employment or contract renegotiation in the United States. National benchmark salary data should assist trauma surgeons in securing fair and equitable compensation. The purpose of this study was to survey trauma surgeons who are members of the Eastern Association for the Surgery of Trauma regarding current salary levels, benefits, contract arrangements, practice descriptors, and opinions on professional reimbursement. METHODS: Anonymous self-report questionnaires were mailed to active members of the Eastern Association for the Surgery of Trauma. Only general surgeons practicing in the United States were included. Data were maintained in a confidential database. RESULTS: Of 385 surveys mailed, 207 (53.7%) were returned. There were 172 usable questionnaires, for an overall response rate of 44.6%. Nearly 93% of respondents worked in states east of the Mississippi River. Mean age was 42.4 years (range, 33-50 years) and 94.7% were male. Over 66% of the surgeons were fellowship trained in trauma, and 44% were chiefs of trauma services. The mean years of experience was 8.8 years (range, 1-17 years). Most respondents worked at teaching institutions (88%) and Level I centers (66%). The mean annual compensation was $229,142+/-$78,045 (range, $90,000-$528,000). These salaries were comparable to ranges from academic surveys of general surgeons. Few surgeons had professional guidance negotiating their compensation. Survey respondents were aware of few objective data specific to trauma surgery. CONCLUSION: This preliminary survey provides a unique benchmark for trauma surgeon salaries. Trauma surgeons should benefit from a more informed and structured approach to salary negotiations. Detailed trauma surgeon-specific data obtained periodically are essential to ensuring fair and equitable compensation in this specialty.

Adult↗
PubMedDate not supplied

Electronic managed care: the utilization of information technology in a managed care environment.

Health care managers must use information technology in managed care negotiations with all players in the managed care model-employers, managed care organizations, providers, and patients. Information technology effectuates these negotiations, provides a value added to all those involved in terms of efficiency and communication, and helps managers remain within regulations. This article describes each phase of the managed care model and how information technology is used. It also provides an operational overview of how to integrate the technology into health care settings.

Health Facility Administrators↗
PubMed2002

Bargaining health benefits in the workplace: an inside view.

Before contract negotiations in 1999, the author served on an "issue-based" health benefits committee of faculty union representatives and university administrators. Although the committee solicited estimates from health insurers regarding the impact of higher copayments on monthly premiums, in subsequent negotiations, the projected cost savings did not lead to changes in coverage or copayments. The explanations offered are (1) national or regional employers may be reluctant to raise employees' health benefit copayments when labor markets are tight; (2) collective bargaining, particularly when other, nonmonetary issues are being bargained, may lead to results different from those from a strictly competitive model; and (3) employers with market power in the product market may shift these highest costs to consumers through higher prices.

Administrative Personnel↗
PubMed2006

Expressing and responding to pain and stoicism in home-care nurse-patient interactions.

Addressing pain and suffering are critical issues for home-care nurses. Pain is frequently experienced by people living at home with chronic illnesses, as well as acutely ill people discharged early from hospitals. The purpose of this qualitative ethology study was to explore and describe the interactions and experiences expressing and responding to pain in home-care nurse-patient interactions. A qualitative video ethology design was appropriate to inductively describe micropatterns of communicative behaviour in natural settings. Ten home-care nurse-patient dyads were videotaped over multiple visits. Data consisted of 31 videotaped visits (over 19 hours) and accompanying participant interviews. Recursive and cyclical qualitative analysis was used to describe the patterns of communication with which stoicism or endurance of pain and suffering was supported or challenged. Dominant patterns of interaction were concerned with: negotiating appropriate forms of stoicism; negotiating ways to express, understand and measure pain and suffering; and dealing with intractable or inflicted pain. The methodology of this study allows an in-depth view of typical nurse-patient interactions. It explores the subtle communicative expertise of nurses by investigating the types of communication used in nursing encounters and by explicating behavioural patterns of expressing and responding to suffering. Observational research of interaction-as-it-occurs must continue to better understand how nurses and patients co-construct personal identities of suffering and stoicism.

Adaptation, Psychological↗
PubMed2006

Women in developing countries and benefit sharing.

The aim of this paper is to show that any process of benefit sharing that does not guarantee the representation and participation of women in the decision-making process, as well as in the distribution of benefits, contravenes a central demand of social justice. It is argued that women, particularly in developing countries, can be excluded from benefits derived from genetic research because of existing social structures that promote and maintain discrimination. The paper describes how the structural problem of gender-based inequity can impact on benefit sharing processes. At the same time, examples are given of poor women's ability to organise themselves and to achieve social benefits for entire communities. Relevant international guidelines (e.g. the Convention on Biodiversity) recognise the importance of women's contributions to the protection of biodiversity and thereby, implicitly, their right to a share of the benefits, but no mechanism is outlined on how to bring this about. The authors make a clear recommendation to ensure women's participation in benefit sharing negotiations by demanding seats at the negotiation table.

Biodiversity↗
PubMed1999

The therapist's inner conversation in family therapy practice: some ideas about the self of the therapist, therapeutic impasse, and the process of reflection.

In this article, a distinction is made between the outer therapeutic conversation and the therapist's inner conversation. The therapeutic conversation is a circle of meaning in which both the therapist and the clients play a part. The therapist's inner conversation is described as a negotiation between the self of the therapist and his role. In this process of negotiation the therapist has to take seriously, not only his observations, but also what is evoked in him by these observations, that is, images, moods, emotions, associations, memories, and so on. Furthermore, therapeutic impasse is conceptualized as a paralysis of the circle of meaning and of the therapist's inner conversation. A process of reflection is proposed as a way out of the impasse. In that process, the inner conversation of the therapist is externalized with the help of an outsider. In the final part of this article, a case study illustrates the importance of these ideas for the family therapy practice.

Communication↗
PubMed1993

A place to be yourself: empowerment from the client's perspective.

This article describes a focused ethnography of a group of chronically mentally ill clients who were involved in a client-run drop-in center. Spradley's (1979) Developmental Research Sequence guided the research. Data were obtained from interviews, participant-observation and documents review. The qualitative analysis identified the major theme of empowerment, which had four process domains: participating, choosing, supporting and negotiating. These domains represented four levels of empowerment for this group. From the client's perspective, empowerment meant they participated more in the community, their choices were increased, they provided support for each other and they negotiated on a more equal basis with staff. A fifth domain, personal significance, described the effects of empowerment for each individual.

Community Mental Health Services↗
PubMed2005

Contextual factors influencing research use in nursing.

BACKGROUND: Contextual factors are perceived to be significant barriers to research-utilisation-related activity, but little is known about how context impacts on specific research-based decisions, or how the individual interacts with the organisation in the requirement for research-based change. AIM: This study describes the impact of contextual factors on the practical reasoning of nurse specialists in the construction of policy for practice. METHODS: Three groups of clinical nurse specialists were observed during a series of meetings convened to construct evidence-based guidelines for nursing practice. Transcripts of the meetings were analysed to identify and categorise the physical, social, political, and economic influences on 31 nursing issues. FINDINGS: Multiple contextual factors influenced each decision made, with decisions about nursing practice bounded by setting and system considerations, relationships with others in the care team, and resource constraints. Practitioners were involved in weighing up alternative scenarios, contexts, and contingencies for each decision, requiring strategies to adapt and reconstruct the nature of care, to influence others, and to affect organisational decision-making processes. DISCUSSION: The practical accomplishment of evidence-based practice required diverse skills: translating between evidence and practice; mediating the values, preferences, and working practices of multiple stakeholders; negotiating organisational complexity and the management of boundaries; and coordinating inter-organisational and inter-agency working. Nurse specialists in this study had a significant role in instigating, fuelling, and coordinating policy review, predominantly by communication across professional and organisational boundaries. IMPLICATIONS/CONCLUSIONS: Clinical specialists acting as organisational boundary spanners require skills in the informal cultural work of organising, facilitating, and maintaining links across professional, team, and organisational boundaries. If their role in the negotiation of evidence-based practice patterns across professional and organisational boundaries is to be successful, wider skills than information management need to be recognised and their development and enactment supported.

Decision Making, Organizational↗
PubMed2003

Accessing the community: gaining insider perspectives from the outside.

Accessing participants for research projects is often treated as unproblematic. However the experience outlined here of negotiating access to participants within a community setting illustrates the inherent difficulties of recruitment. The authors describe the techniques used and practical challenges faced when accessing participants within a socially deprived community for a qualitative research project on social capital. They used a number of different strategies to generate a diverse sample including advertising, snowballing, accessing gatekeepers, and street surveys. The value of a stakeholder analysis is described alongside issues surrounding the use of gatekeepers. Rather than acting as outsiders seeking participants at every available opportunity, a more fortuitous strategy involved the ethnographic approach of "being there" as active contributors to community life. Here, the cornerstones of credibility and trust were addressed in a process of continually negotiating access from a semi-insider position.

Adult↗
PubMed2004

Moral argumentation in talk about health and old age.

This study examines the ways in which people aged 90 or over construct and negotiate meanings of health in research interviews. Detailed analyses of two interview cases illustrate the flow of these negotiations within interviews, and how the interviewees balance different moral arguments. First, the interviewees try to manage the face-threat posed by the questioning about health. Second, their health accounts move on the axis of advocating good health and activity and conceding impaired health and diminished activity. They apply various rhetorical devices to challenge the traditional discourse of old age as decline. On the other hand, aligning oneself with the category of 'old' makes ill-health and inactivity legitimate, but brings along other kinds of moral obligations. Finally, the results are discussed in relation to cultural discourses of old age and health, and their moral implications.

Aged↗