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PubMed2005

Negotiating responsibility: case studies of reproductive decision-making and prenatal genetic testing in families facing Huntington disease.

Three case studies are presented to further our understanding of how responsibility is negotiated in families when making decisions about genetic risk. These draw on a model of responsibility generated in a study of reproductive decision-making in families facing Huntington disease (HD) to illustrate the impact of prenatal testing on this process. This involves analyzing: how people present themselves as acting responsibly whether or not they utilize genetic testing; who they feel responsible to in their family and elsewhere; the impact that testing has on these relationships; and, how negotiating responsibility changes over time with repeated use of prenatal testing, changing risk status and maturational changes. Two key findings are: how decision-making is perceived can become as important as what is decided; and, how responsibility is negotiated depends on which of these relationships are prioritized. Implications of the findings for clinical practice are noted and suggestions made for further applications of the model.

Adult↗

PubMed1984

Some limits to the hospital as a negotiated order.

This paper examines issues of freedom and constraint by employing the negotiated order perspective in an analysis of a merger of three health care institutions. The findings give support to the importance of negotiated order considerations in understanding the social organization of health care, for they suggest that there are some limits to negotiations which take place within medically dominated settings.

Attitude of Health Personnel↗

PubMed1992

The negotiation of death: clinical decision making at the end of life.

The ability of medical science to prolong biological life through the use of technology raises the question of how far physicians should go in treating the terminally ill patient. In clinical decision making involving the dying patient, physicians, patients and families bring various perceptions and interpretations to the situation. These different realities must be negotiated in order to define the meaning of the situation and the meaning of various medical technologies. The patient's demise becomes a negotiated death, a bargaining over how far medical technology should go in prolonging life or in prolonging death. A case study of the process of ethical decision making in the foregoing of life-supporting therapy in an intensive care setting is presented and analyzed. The decision making process in this case follows a 'cascade' pattern rather than a controlled, reflective model. While ethicists view the withholding and withdrawing of life-supporting treatment as morally equivalent, physicians tend to make a distinction based on the perceived locus of moral responsibility for the patient's death. In the author's interpretation the moral responsibility for the patient's death by withdrawing treatment is shared with family members, while the moral responsibility for the patient's death by withholding treatment is displaced to the patient. The author suggests that an illusion of choice in medical decision making, as offered by the physician, begins a negotiation of meanings that allows a sharing of moral responsibility for medical failure and its eventual acceptance by patient, family and physician alike.

Aged↗

PubMed1998

Negotiating reproduction and gender during the fertility decline in Turkey.

This paper is concerned with the cultural construction of reproduction and gender in Turkey as it relates to the remarkable decline from high levels of fertility to near-replacement levels. It critiques demographic transition theory and family systems theory as found in the Turkish demographic discourse. A combination of ethnographic and demographic methodologies are used. The ethnographies are from working-class communities in Istanbul. A concept of negotiated conduct is used to interpret family dynamics in matters of reproductive control replacing the family systems models that are based on the assumption of male domination or patriarchy. It is found that the physical characteristics (male or female) of methods of contraception do not directly reveal whose power dominates negotiations. The variety of experience shows that not only women, but also men, negotiate in favor of birth control or, in some instances, to birth more children. The changes in structural conditions that brought fertility from high levels to near-replacement levels in Turkey were effective without very much "empowerment" of women. The proposition that women's status, in terms of education and economic activity, must improve to bring about a fertility decline is questioned by the Turkish experience.

Anthropology, Cultural↗

PubMed2003

Hitting the mark: negotiated marking and performance factors in the communication skills element of the VOICE examination.

INTRODUCTION: Communication skills assessment is complex. Standardised patient use is widespread, but anxiety exists around the use of role players as assessors of competence in high stakes examinations. This study measures the level of agreement between scoring examiners and role players, and considers their influence on each other. Examiner status and question choices are analysed as variables. METHOD: The valid oral interactive contextualised examination (VOICE) is a general practice examination styled as an objective structured clinical examination (OSCE) of six 15-minute stations, which include two role-played consultations with professional role players. The examination candidates are final year medical students. Clinical components are examined by a general practitioner (GP). Communication skills are assessed by these examiners in conjunction with the role players, through a process of negotiation. Descriptive professionalism/attitude bandings are used as percentage-scoring guidelines. Checklists are not used. For this study, the initial (independently) perceived marks of the two scoring groups and their agreed final (awarded) marks were recorded, along with other variables including gender, performance factors, demographics and the nature of the question. Data represents 512 students undertaking 1024 simulated consultations, examined by 28 role players and 46 examiners. Analysis was carried out using SPSS Version 10. RESULTS: Results show that the examination and negotiation process is consistent. Role players have a direct influence on scoring. The examiner's background is a significant variable [F9,1014 = 4.207, P < 0.001]. Students perform less well on questions involving higher degrees of clinical information giving. Question choice is not significant [F30,3039 = 1.397, P=0.074]. DISCUSSION: The variables in the examination do not indicate any discrepancy substantial enough to bias a student's grade. Negotiated marking in this context is considered safe and reliable.

Analysis of Variance↗

PubMed1997

Ability of laying hens to negotiate horizontal perches at different heights, separated by different angles.

1. This paper describes how birds move between horizontal perches at different heights with different angles separating them, using the time to complete the task and the number of birds failing to indicate ability. 2. For the first experiment, 4 groups of 15 birds (ISA Brown) were subjected to each of the experimental treatments (using three perches with angles of 0 degree (horizontal control), 30 degrees, 45 degrees or 60 degrees between them). The birds were required to move upward between the perches for each treatment and then to move downward between the perches, as a second part of the experiment. 3. Birds moving up between the perches took significantly longer at 60 degrees than at any other angle. No birds failed to complete the task. 4. For birds moving downward between the perches, the median time to complete the task increased significantly with angle. Furthermore, the number of birds failing to complete the task increased with angle. 5. A second experiment was conducted to test whether the vertical or horizontal component of distance affected birds' ability to negotiate perches separated by different angles. 6. For the second experiment 4 groups of 10 Lohmann Brown laying hens were subjected to each of the following treatments: two horizontal perches separated by 30 degrees or 60 degrees and either directly, horizontally or vertically separated by a set distance of 50 cm. Birds were required to move both up and down between perches. 7. Birds negotiated horizontally-separated perches more successfully at 30 degrees than at 60 degrees. However, when the vertical distance between the perches was 50 cm there was no significant difference in the ability of birds to move downward at 30 degrees or 60 degrees. For birds moving upward, 60 degrees was easier to negotiate than 30 degrees. 8. The vertical and horizontal separations, as well as the different angles affected the ability of birds to move between perches. There was a general decreasing trend in ability with increasing vertical separation between perches. 9. The findings are important in terms of arrangements of perches to improve bird welfare. To minimise the risk of injury, the angle between perches at different heights should be no more than 45 degrees, and the horizontal and vertical distances between these perches minimised, to allow the birds to be able to move downwards more easily.

Animal Welfare↗

PubMed2002

Socially stable territories: the negotiation of space by interacting foragers.

This article presents a theory of territoriality that integrates optimal foraging and conflict resolution through negotiation. Using a spatially explicit model of a sit-and-wait forager, we show that when resources are scarce, there is a conflict between foragers: there is not enough space for all individuals to have optimal home ranges. We propose that a division of space that solves this conflict over resources is the outcome of a negotiation between foragers. We name this outcome the socially stable territories (SST). Using game theory we show that in a homogenous patch occupied by two interacting foragers, both individuals receive identical energy yields at the socially stable territories; that is, there is economic equity. Economic inequity can arise in a heterogeneous patch or from asymmetries in fighting abilities between the foragers. Opportunity costs play a role in reducing economic inequity. When the asymmetry in fighting abilities is very large, a negotiated division of space is not possible and the forager with lowest fighting ability may be evicted from the habitat patch. A comparison between territories and overlapping home ranges shows that energy yields from territories are generally higher. We discuss why there are instances in which individuals nevertheless overlap home ranges.

Animals↗

PubMed2000

Gait characteristics of young and older individuals negotiating a raised surface: implications for the prevention of falls.

BACKGROUND: Falls in older individuals are a major public health issue because of the financial cost of surgery and re habilitation and the human cost of associated pain and disability. Older individuals are most likely to fall when negotiating an obstacle or obstruction during locomotion. This research was aimed at investigating lower limb motion while a subject negotiated a raised surface. METHODS: The gait of six healthy young (Y) women (mean age 23.1 years) and six healthy older (O) women (mean age 67.6 years) were analyzed with a PEAK motion analyzer and a dual-force-platform system during unobstructed walking and when the subjects were stepping on and off a raised surface of 15 cm. The effect of age on foot clearance and force platform variables was analyzed. RESULTS: During stepping on, the young women cleared the step by the lead foot by a significantly greater margin than the older subjects did (Y = 10.6 cm, O = 9.1 cm; p < .05) but trail-foot clearance was not significantly different (Y 9.4 cm, O = 8.8 cm). Foot clearance in stepping off was low compared with that of ascent, and the older individuals had a significantly higher lead (Y = 1.5 cm, O = 3.3 cm, p < .05) and trail (Y = 1.0 cm, O = 2.1 cm) vertical clearance. Older individuals positioned both the lead and the trail foot relatively farther from the step edge on ascending a raised surface, respectively, Y = 87% and O = 93% of the step cycle and Y = 29% and O = 34%. Foot placement in descent was qualitatively similar for the two groups. The force and the impulse data under the lead and the trail feet confirm modulations consistent with the foot clearance data. CONCLUSION: In negotiating a raised surface older individuals appear to use a nonoptimal foot placement strategy in which, compared with that of young subjects, the trail foot is placed a long way from the edge of the step. The older subjects allowed very little correction time and little latitude in foot placement beyond the edge of the step, suggesting that the approach to the obstacle may be a critical determinant of safety.

Accidental Falls↗

PubMed2005

Age-dependent differences in the attentional demands of obstacle negotiation.

BACKGROUND: Although the attention directed to gait does increase as an impending obstacle nears, it remains unclear whether the allocation of attentional resources differs between the precrossing phase of obstacle negotiation and the crossing phase of this task. This study compared the attentional demands associated with steady-state walking and the precrossing and crossing phases of an obstacle-negotiation task between young and older adults. METHODS: Fifteen younger and 15 older adults participated in this study. Participants were required to perform a verbal reaction time task during three events: (1) steady-state unobstructed gait, (2) precrossing (the final full stride prior to obstacle crossing), and (3) obstacle crossing. RESULTS: The attention directed during precrossing exceeds that of steady-state walking for both younger and older adults. Younger adults direct more attention to gait during precrossing than they do during crossing. However, precrossing is equally attentionally demanding as crossing for older adults, and both of these events require more attention than does steady-state gait in this age group. CONCLUSIONS: The task of obstacle negotiation, from precrossing through obstacle crossing, is attentionally demanding for elderly persons, and fall risk, due to a compromised availability of attentional resources, does occur prior to obstacle crossing in this age group.

Accidental Falls↗

PubMed1994

Conflicts over post-exposure testing for human immunodeficiency virus: can negotiated settlements help?

Health care workers with needlestick exposures to patients' blood often request a test of the patient for evidence of infection with human immunodeficiency virus. If the patient refuses the test, a conflict develops between the interests of the health care worker and those of the patient. Traditional approaches to this dilemma attempt to balance the rights or utilities of abstract patients and health care workers. While these approaches have the advantage of offering clear guidelines in advance of conflict, the interests of the actual participants may differ from those used to create the guidelines. In nonmedical settings, conflicts are often resolved efficiently through negotiation and monetary exchanges. Although negotiated monetary settlements between health care workers and patients may be an impractical way to resolve medical conflicts, models developed from these perspectives provide insights into the individual interests of physicians and patients. Changing existing rules about medical record documentation, or increasing the penalties for the misuse of medical information, may satisfy the interests on both sides of the conflict and so represent integrative bargaining solutions. Even so, as the relationship between health care workers and their patients evolves, more explicit strategies for negotiation may become a reasonable solution to the problem of conflict.

AIDS Serodiagnosis↗

PubMed1989

The essentials of win--win negotiation for the clinical nurse specialist.

Clinical nurse specialists (CNSs) must negotiate conflicts daily as they come in contact with patients, families, and other professionals. To be a successful negotiator, the CNS must understand the process of reaching a satisfactory settlement of differences in a conflict situation. The process involves identifying the problem, collecting facts and analyzing the situation, deciding on goals, and identifying tactics. The use of role play, third party advice, and influence, as well as negotiation strategies is discussed along with a relevant case presentation.

Anger↗

PubMed1977

Evaluation of the initial interview in a walk-in clinic. The clinician's perspective on a "negotiated approach".

A negotiated approach to the conduct of the initial interview has been developed from the need for a more flexible and active exchange between clinician and patient. The setting is the walk-in clinic of the psychiatry service in a large urban general hospital, staffed mostly by first-year residents and staff social workers. These clinicians [26] were asked to evaluate the utility of the negotiated approach. They rated the approach both from their perspective and from that of 136 patients they interviewed. Although the clinicians evaluated the approach positively, they associated their satisfaction much more with the aims of a diagnostic approach than a negotiated one. The clinicians do not perceive that patients share satisfaction in their instrumental objective of understanding (a diagnostic goal), and the clinicians do not perceive that they share satisfaction in the patient's instrumental objective of participating in the treatment planning. The sharpest divergence between the clinician's and perceived patient satisfaction was over two evaluation/outcome measures: the treatment plan being wanted and attainment of symptom relief. These measures correlated much better with perceived patient than clinician satisfaction. Divergence in perspective between clinician and patient was discussed with regard to possible sources, the effect of setting, and the implication for the delivery of services.

Adolescent↗

PubMed2007

Negotiation of mutualism: rhizobia and legumes.

The evolution and persistence of biological cooperation have been an important puzzle in evolutionary theory. Here, we suggest a new approach based on bargaining theory to tackle the question. We present a mechanistic model for negotiation of benefits between a nitrogen-fixing nodule and a legume plant. To that end, we first derive growth rates for the nodule and plant from metabolic models of each as a function of material fluxes between them. We use these growth rates as pay-off functions in the negotiation process, which is analogous to collective bargaining between a firm and a workers' union. Our model predicts that negotiations lead to the Nash bargaining solution, maximizing the product of players' pay-offs. This work introduces elements of cooperative game theory into the field of mutualistic interactions. In the discussion of the paper, we argue for the benefits of such an approach in studying the question of biological cooperation.

Biological Evolution↗

PubMed1992

Examining the process and dilemmas of reality negotiation.

Reality negotiation is the process people use to examine information from their environment and make judgments about the accuracy and importance of that information. Although this process has been found to be inaccurate, nurses often express discomfort when clients hold perceptions of reality that run counter to their own views. Nurses in these circumstances see the client as denying or as having unrealistic hopes. This article examines reality negotiation in light of this clinical dilemma, focusing on three areas: 1) the assumptions made regarding the nature of reality; 2) the potential and real outcomes of different types of reality negotiation; and 3) the process by which reality is redefined and how unrealistic perceptions are threatened and/or abandoned. These issues are explored as they relate to nursing research and practice.

Adaptation, Psychological↗

PubMed2001

Negotiating industry-sponsored clinical trial agreements: a view from the trenches.

A number of possible factors, including issues of cost, enrollment, and time, contribute to the decline in the percentage of industry-sponsored clinical trials conducted in academic institutions as opposed to those conducted at for-profit entities. This piece focuses on the agreement negotiation process. If negotiators were given easier access to the sponsor's decision makers, it is likely that the negotiations would proceed more efficiently. Also noted are reports by academic investigators of difficulty in getting access to unblinded trial data, which are needed for patient care and publication.

Clinical Trials as Topic↗

PubMed1974

Training predelinquent youths and their parents to negotiate conflict situations.

In response to parental requests for assistance in dealing with adolescent problem children, three parent-child pairs were taught negotiation responses to hypothetical conflict situations using behavior rehearsal and social reinforcement. The negotiation process was separated into component behaviors that were practised during simulations by each youth and his parent under the direction of trainers. Results indicated that (a) the procedures were successful in training youths and their parents in negotiation behaviors that produced agreements to conflict situations, and (b) these behaviors generalized to actual conflict situations in subjects' homes.

Adolescent↗

PubMed1991

The board's role in meaningful collaboration. After negotiations are completed, a new round of work begins.

For collaborations that in some way modify involved organizations' assets and organizational or governance issues, negotiations are the responsibility of the congregation and not the healthcare system. Congregational leaders should, however, actively involve the system chief executive officer in the process and should also seek the advice of the system board. The board can be particularly helpful in offering financial, legal, and managerial advice to negotiators. Once an agreement is reached, however, the board must consider whether to approve it. And from this point forward, its involvement in the details of the collaboration will be more active. Because board members must evaluate a proposed collaboration from the perspective of the organization they serve, they may not always take the same view of it as did the congregational leaders. Moreover, what congregational leaders believe to be in the best interests of Catholic healthcare may not be consistent with the legitimate self-interest of some of the many constituencies affected by a collaboration. After negotiators have reached an agreement and the board has approved it, the board must make the necessary financial and organizational changes necessary to achieve the transition to a new corporate entity. In doing so, its goal will be to promote standardization without destroying the member institutions' rich traditions.

Catholicism↗

PubMed1998

Plans established or maintained pursuant to collective bargaining agreements under section 3(40)(A)--Pension and Welfare Benefits Administration. Notice of intent to form a negotiated rulemaking advisory committee.

The Department of Labor (Department) intends to form a Negotiated Rulemaking Advisory Committee (Committee) in accordance with the Negotiated Rulemaking Act of 1990 and the Federal Advisory Committee Act. The Committee will negotiate the development of a proposed rule implementing the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. 1001-1461 (ERISA). The purpose of the proposed rule is to establish a process and criteria for a finding by the Secretary of Labor that an agreement is a collective bargaining agreement for purposes of section 3(40) of ERISA. The proposed rule will also provide guidance for determining when an employee benefit plan is established or maintained under or pursuant to such an agreement. Employee benefit plans that are established or maintained for the purpose of providing benefits to the employees of more than one employer are "multiple employer welfare arrangements" under section 3(40) of ERISA, and therefore are subject to certain state regulations, unless they meet one of the exceptions set forth in section 3(40)(A). At issue in this regulation is the exception for plans or arrangements that are established or maintained under one or more agreements which the Secretary finds to be collective bargaining agreements. If adopted, the proposed rule would affect employee welfare benefit plans, their sponsors, participants and beneficiaries, as well as service providers to plans. It may also affect plan fiduciaries, unions, employer organizations, the insurance industry, and state insurance regulators.

Collective Bargaining↗