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PubMed1984

Paraplegic energy expenditure during negotiation of architectural barriers.

Long-leg braces are often used by persons with paraplegia to negotiate architectural barriers, and thereby increase their wheelchair mobility. Such barriers include ramps, stairways, and narrow corridors requiring multiple turns. This study was designed to measure the energy expenditure during such activities for two long-leg orthoses: standard braces without a dorsiflexion stop and Scott-Craig braces. Energy expenditure was measured in eight subjects by indirect spirometry using Douglas bag collection and Haldane analysis. Data obtained were used to calculate oxygen consumption per minute, volume of oxygen per turn, step, or meter, and calories per minute during each activity. Using Scott-Craig braces on one day and standard braces on another day, each subject negotiated five 90 degrees turns and two 180 degree turns, ten 15.24 cm steps, both up and down, and an 11.9 m ramp inclined 12 degrees, both up and down. Milliliters of oxygen consumed per kilogram of body weight per turn, step, or meter were recorded for Scott-Craig braces, standard braces, and normal walking. All of these activities required a high expenditure of energy. No significant difference was apparent between the standard and the Scott-Craig braces for any activity.

Adult↗

PubMed1983

Negotiating cooperative agreements between health organizations.

Comprehensive care and continuity of care are often dependent upon cooperation and coordination between organizations. Nursing administrators who understand the process through which cooperative agreements between health care organizations are negotiated can plan, direct, and monitor the process. This article covers four major aspects of the negotiations process and their implications for nursing administrators.

Administrative Personnel↗

PubMed1984

Bid solicitation and contract negotiation.

The process of soliciting bid prices for drug products and of negotiating contracts with pharmaceutical vendors is reviewed. The primary purpose of bid purchasing is to obtain drugs at the lowest price and to have these prices remain fixed for a predetermined period of time. A successful bid-purchasing process depends on the institution's implementation of a formulary brand-standardization policy, prior identification of acceptable vendors and drug products, and establishment of criteria for evaluating drugs under a bid-purchasing system. Specific information to be included in the invitation to bid and useful data other than drug prices that may be solicited from vendors are outlined. Manual and computerized systems for organizing bid-request data are described. Bid evaluations should maintain the confidentiality of bid and contract prices. Selection of winning bids is based on lowest price or, in cases where prices are identical, on selected vendor characteristics or services. Negotiation of unacceptable bid prices should be conducted with a thorough knowledge of the needs and goals of the institution and the vendor. Procedures for establishing contracts and the timing of various phases of the bid process are discussed. An optimal bid-purchasing system is achieved only when the system is carefully planned and designed and when each prospective vendor is given an equal opportunity to establish a contractual relationship with the institution.

Commerce↗

PubMed1981

Research in practice: a process of collaboration and negotiation.

Because practice-research conflicts confront nurses and investigators in clinical settings, our department of nursing research section found the need for collaboration and negotiation to be the major characteristic of practice setting research. Moreover, in the process of collaboration and negotiation, a number of problems arise for which alternative solutions need to be considered and tried. These problems include risk taking, vested interest, the rights of research subjects, and the need to produce both scientific and practical knowledge. The challenges faced when conducting research in practice settings are only partially predictable and only partially resolvable, but they are always exciting. The potential contributions are considerable since the basic challenge is to produce relevant, accurate information for immediate practice decisions, as well as to construct design and analysis methods that allow the project to contribute to nursings' general body of knowledge.

Arizona↗

PubMedDate not supplied

Family caregivers of people with AIDS: negotiating partnerships with professional health care providers.

The purpose of this grounded theory study was twofold: (a) to examine AIDS family caregivers' interactions with professional health care providers, and (b) to evaluate the applicability of Swanson's middle-range theory of caring to characterize these interactions. The sample consisted of 12 family caregivers including gay partners, friends, and parents. Negotiating Partnership, defined as working out care with one another for the common good of the person with AIDS, was the basic social process explaining interactions between family caregivers and health care providers. Dimensions of negotiating partnership included conveying information, knowing, being accessible, and maintaining belief.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Redefining empowerment and sexual negotiation for women living with HIV.

The HIV/AIDS epidemic has presented many challenges to both: researchers and care providers. In addition, the concepts and models of human behavior needed a re-examination in response to this pandemic. We are redefining both empowerment and sexual negotiation for women living with HIV. Empowerment is defined as a process of awareness throughout which women recognize their capacity to achieve individual and social changes. This process involves a mental and spiritual awareness that will enable them to focus on their physical, psychological and social aspects. For women living with HIV, this is also a strategy for survival. For women living with HIV, sexual negotiation is a straightforward issue: it is either safer sex or nothing. Safer sexual practices then are a consequence or by-product of the process of empowerment. To facilitate this process our approach is directed to the individual, in an attempt to reach the inner power source that all human beings share.

Attitude to Health↗

PubMed1998

"When you carry condoms all the boys think you want it": negotiating competing discourses about safe sex.

With the advent of HIV, sexual health campaigns and formal sex education in schools have worked to instil the concept of safe sex into the collective minds of Australia's youth. However the concept in its present guise is a fairly limited one. We argue in this paper that the predominant emphasis in education programmes on safe sex as condom use may be counter-productive for some young heterosexuals for two reasons. First, this strategy is male-focused and may not extrapolate well to young women who face special risks around pregnancy and rigid societal gender norms which govern sexual behaviour. Second, health promotion strategies aimed at young heterosexuals are based on an assumption of rational decision-making in sexual encounters and obscure the non-rational nature of arousal and desire, and the unequal power relations that exist between young men and women engaging in sex. Five hundred and twelve senior rural students participated in the study which included group discussions about sexuality and survey items which focused on the meanings of safe sex and the accessibility and use of condoms. The results showed that though most students identified condoms with safe sex, many were ambivalent about using them. Reasons given related to problems of negotiation, difficulties of access, and the risks which condoms gave no protection from, such as a sullied reputation. Perhaps, partly because of this, some students were looking to less secure methods of protection such as informal history-taking and monogamy. It is argued that successful sexual health promotion strategies must address the broad spectrum of concerns facing young men and women when they become sexually active and that consideration be given to the social context in which young people conduct their sexual lives.

Adolescent↗

PubMed2006

The negotiation of identity among people with mental illness in rural communities.

Integration and normalization are goals within the community-based care of people with mental illness. The implementation of this care policy has led to increased contact between people with mental illness and so-called normal people and society at large. But we know little about how this change affects the former patients' identity and experience of stigma and stereotyping. This study is based on qualitative interviews with people with mental illness (N=15) living in rural communities in four different municipalities. The focus in the study is on the informants' subjective experiences and the results show that they adapt in different ways, depending on how they negotiate their identity. Those who accept their role as "mental patients" seem to have easier access to services, they experience less stigmatization and fewer conflicts with their surroundings than those who oppose the patient role. Seem from our informants' perspectives there seems to be a simple definition of integration: Being integrated is feeling accepted as yourself. Some implications for policy and mental health services are discussed.

Adult↗

PubMed1993

Negotiating autism: relations between parents and treatment staff.

This study examines the relationship between parents of autistic children and the treatment centre staff at a state autistic association. There are three main points of disagreement between parents and staff including: the prospect of a cure, the nature of the child's affection, and the uniqueness of the child and how this is related to the possibility of institutionalisation. The nature of these disagreements, and the means by which they are negotiated, are examined and discussed.

Adult↗

PubMedDate not supplied

Social role negotiation skills for substance-abusing adolescents: a group model.

A group model for therapeutic early intervention (secondary prevention) with nonaddicted adolescent substance abusers is proposed, based on a Social Role Negotiation model of substance abuse integrating concepts form role theory and cognitive developmental theory. The description of the group model, a structured short-term approach, includes a variety of exercises which promote developmental improvement in the essential skills of role-taking, role-making, and definition of the situation. An individualized intervention strategy is proposed for each group member, based on a theory-based taxonomy of substance-related problems. Strategies for using family involvement to support an adolescent group are described.

Adolescent↗

PubMed2005

Negotiating participation: understanding the "how" in an ergonomic change team.

In participatory ergonomic (PE) interventions, "how" effective participation by workplace parties can be achieved remains unclear. We conducted a case study of the dynamics of an ergonomic change team (ECT) process in a medium-sized (175 employees) automotive foam manufacturing plant. We present analyses of observer field notes and post-intervention interviews from which key elements on the dynamics of the "how" emerged: (1) impacts of facilitators' involvement and interests; (2) tensions in delimiting the scope of ECT activities; issues around (3) managing meetings and (4) realizing labour and management participation; and (5) workplace ECT members' difficulties in juggling other job commitments and facing production pressures. We highlight the ongoing negotiated nature of responses to these challenges by labour, management and ergonomic facilitator members of the ECT. We argue for greater examination of the social dynamics of PE processes to identify additional ways of fostering participation in ergonomic project implementation.

Adult↗

PubMed2005

Negotiating mothering against the odds: gastrostomy tube feeding, stigma, governmentality and disabled children.

Using the findings of a small-scale qualitative investigation based on in-depth interviews with mothers attending a tertiary paediatric referral centre in London, this paper explores professional and parental discourses in relation to gastrostomy tube feeding and disabled children. Detailed accounts are given of women's struggles to negotiate their identities, and those of their children, within dominant discourses of mothering and child-centredness. Constructions of feeding practices as coercive conflict with normative expectations of 'good mothering' and the 'idealised autonomous' child. Although notions of 'stigmatised identities' featured in women's accounts of feeding children, both orally and by tube, stigma fails to explain why mothers are rendered culpable within expert discourses. Prevailing theories of stigma and coping are interrogated and judged to be more descriptive than explanatory. Felt stigma is posited as an aspect of governmentality.

Adult↗

PubMed1995

The power of social judgement: struggle and negotiation in the nursing process.

In this paper we discuss an alternative view of the nursing process as it is experienced by both patients and nurses. The current conception of the nursing process is that it is a benevolent activity which aims to render care more individualized or person-centred. Its rhetoric usually includes notions of mutuality in goal setting, openness and collaboration between patients and nurses. We will suggest that such a view is idealized and has little basis in empirical reality as it is experienced by both nurses and patients. Rather, nurse-patient relations are beset by conflict and struggle, frequently resulting in the acquiescence of patients to the nursing and the medical goals of care. On the basis of an ethnography of a hospital medical ward, we will describe a process of social judgement and set it into a discussion of the social context where an unequal balance of power is integral to provider-recipient relations. Our account will focus upon four categories through which judgemental labelling may be analysed. These are assessing, negotiation, struggling and acquiescing. Of special interest to us are strategies which nurses used to maintain excellent care in the context of negative social judgements, and the place social judgement may play in moral decision-making. We emphasize the strengths which rich qualitative data have in relation to previous survey approaches of this phenomenon, whilst recognising the limitations of so focused a study.

Humans↗

PubMed2003

Negotiating palliative care expertise in the medical world.

This paper explores the relationship between palliative medicine and the wider medical world. It draws on data from a focus group study in which doctors from a range of specialties talked about developing palliative care for patients with heart failure. In outlining views of the organisation of care, participants engaged in a process of negotiation about the roles and expertise of their own, and other, specialties. Our analysis considers the expertise of palliative medicine with reference to its technical and indeterminate components. It shows how these are used to promote and challenge boundaries between medical specialties and with nursing. The boundaries constructed on palliative medicine's technical contribution to care are regarded as particularly coherent within orthodox medicine. In contrast, its indeterminate expertise, represented by the 'holistic' and 'psychosocial' agendas, is potentially compromising in a medical world that prizes science and rationality. We show how the coherence of both kinds of expertise is contested by moves to extend palliative care beyond its traditional temporal (end-of-life) and pathological (cancer) fields of practice.

Focus Groups↗

PubMed1998

Negotiating the new health system: purchasing publicly accountable managed care.

The transformation to managed care is one of the most important and complex changes ever to take place in the American health system. One key aspect of this transformation is its implications for public health policy and practice. Both public and private buyers purchase managed care; increasingly, public programs that used to act as their own insurers (i.e., Medicare, Medicaid and CHAMPUS) are purchasing large quantities of managed care insurance from private companies. The transformation to managed care is altering the manner in which public health policy makers conceive of and carry out public health activities (particularly activities that involve the provision of personal health services). The degree to which managed care changes public health and in turn is altered by public health will depend in great measure on the extent to which public and private policy makers understand the implications of their choices for various aspects of public health and take steps to address them. Because both publicly and privately managed care arrangements are relatively deregulated, much of the dialogue between public health and managed care purchasers can be expected to take place within the context of the large service agreements that are negotiated between buyers and sellers of managed care products. This is particularly true for Medicaid because of the importance of Medicaid coverage, payment and access policies to public health policy makers, and because of the public nature of the Medicaid contracting process. A nationwide study of Medicaid managed care contracts offers the first detailed analysis of the content and structure of managed care service agreements and the public health issues they raise. Four major findings emerge from a review of the contracts. First, most of the agreements fail to address key issues regarding which Medicaid-covered services and benefits are the contractor's responsibility and which remain the residual responsibility of the state agency. Second, most contracts fail to address the legal and structural issues arising from the relationship between the managed care service system and the public health system, including such key matters as access to care for communicable diseases and contractors' relationship to state public health laboratories. Third, many contracts are silent on health agencies' access to data for surveillance and community health measurement purposes. Finally, many contracts may be developed with only a limited understanding of the key public health-related issues facing the community from which the members will be drawn. The CDC and state and local public health agencies must expand their activities in the area of managed care contract specifications. For several years the CDC has been involved in an ongoing effort to develop quality of care measures to be collected from all companies through the HEDIS process. As important as this effort is, it represents only an attempt to measure what managed care does rather than an a priori effort to shape the underlying policy and organizational structure of managed care itself. Integrating managed care with public health policy will require this type of affirmative effort with both Medicaid agencies as well as other managed care purchasers.

Contract Services↗

PubMed1997

Managed care contracts and negotiations.

This article examines the key provisions which should be focused on when reviewing managed care contracts. It offers guidance on how gastroenterologists can negotiate more favorable terms and avoid common contracting pitfalls. The article also highlights specific issues applicable to capitated and other risk-sharing arrangements.

Contract Services↗

PubMedDate not supplied

Negotiation of HIV preventive behaviors in divorced and separated women reentering the sexual arena.

The purpose of this study was to understand divorced and separated women's experience of negotiating human immunodeficiency virus (HIV) preventive behaviors when resuming sexual activity following long-term monogamous relationships. A little-studied but large group, these women are at risk for sexually transmitted diseases, have low rates of protective behaviors, and have not been targeted for prevention education. Seven women entering a sexual milieu altered by the presence of HIV after at least a 10-year period of monogamy comprised the sample. A descriptive phenomenologic methodology incorporating Colaizzi's method for data analysis revealed four themes: (a) keeping the magic, (b) Am I an adolescent or an adult? (c) holding on to self, and (d) gender perspectives. These women's words help to illuminate their issues regarding HIV prevention, guiding further nursing research and HIV preventive educational interventions.

Adult↗

PubMed2000

Influence of social motives on integrative negotiation: a meta-analytic review and test of two theories.

A meta-analysis of 28 studies examined support for the Theory of Cooperation and Competition (M. Deutsch, 1973) and Dual Concern Theory (D. G. Pruitt & J. Z. Rubin, 1986). Effects of social motive (prosocial vs. egoistic) and resistance to yielding (high vs. low vs. unknown) on contenting, problem solving, and joint outcomes were examined. Consistent with Dual Concern Theory, results showed that negotiators were less contentious, engaged in more problem solving, and achieved higher joint outcomes when they had a prosocial rather than egoistic motive, but only when resistance to yielding was high (or unknown) rather than low. The authors also explored the moderating effects of study characteristics and found effects for participation inducement (class exercise, participant pool), for publication status, and for treatment of no-agreement dyads.

Humans↗