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Must treatment be provided to subjects who acquire HIV during the course of a prevention study? An analysis of ethical foundation, regulation, and recent argumentation provides no basis for the obligation. We outline an alternative approach to the problem based on moral negotiation.
Many state domestic violence intervention standards mandate that treatment for offenders should be separate from any treatment offered to victims. In this article we advocate that in cases of low-level violence, when couples choose to remain together, certain aspects of treatment should be offered conjointly. Specifically, our feedback from victims and offenders suggests that one tool generally taught to offenders-time-out--is often ineffective and can be used abusively when partners are not taught the tool concurrently. We describe the negotiated time-out procedure that we developed and use feedback from our clients to illustrate its usefulness.
OBJECTIVES: Non-depressed and depressed persons were hypothesized to input and recall self-referential information that was consistent with their self theories. DESIGN: Non-depressed and depressed persons were compared. METHODS: Non-depressed (14) and depressed (14) students chose between positive or negative audio statements, and then recalled the statements. RESULTS: Non-depressed relative to depressed participants: (i) listened more to the positive than the negative tapes; and (ii) fabricated (i.e. incorrectly recalled) less negative messages. CONCLUSION: Partial support is given to reality negotiation processes.
The authors describe how to develop and manage a capitated outpatient radiology contract. Aspects of a capitated fee structure and the need to apportion fees between a hospital and its radiology group are discussed. During negotiations with a managed care organization (MCO), certain information and commitments should be obtained. Utilization data should also be obtained from the MCO, but if they are not available (or are thought to be unreliable), certain norms can be used. Once a utilization projection is arrived at, reimbursement calculations can be made and compared with assumed reimbursements under a known fee schedule, such as that of Medicare. This procedure allows one to estimate whether a capitated proposal is financially feasible. Once a contractual agreement is instituted, the radiology group must then track and manage utilization. An understanding of these principles should enable radiologists to deal effectively with both practice and fiscal concerns presented by managed care.
BACKGROUND: Occupational therapists are frequently involved in discharge accommodation decision making with older adults. PURPOSE: The literature regarding this process is reviewed. The ways in which risk avoidance and autonomy promotion philosophies influence decisions are examined and a new approach is proposed. SUMMARY: One approach is based on risk avoidance, where decisional control rests with professionals, but the client is left out of the process. Another is that of autonomy promotion, in which decisional control rests with the client. When risks are high, this can result in ethical dilemmas. The importance of the environment, its relationship to occupational performance, and differing interpretations of client-centred processes are important considerations. PRACTICE IMPLICATIONS: In response to the inadequacy of models grounded in risk avoidance or autonomy promotion, occupational therapists are challenged to move toward a balanced approach to decision making with older people, grounded in partnership, shared power, and negotiation.
This study examines the process of identity negotiation for Israeli female ex-convicts who were separated for extensive periods of time from their children and eventually lost custody over them. The content analysis of in-depth interviews reveals that these women were able to reconstruct their biographies and retrospectively account for their crimes and drug addiction in terms of the sexual, physical, and economic abuse they had endured and by appeal to higher loyalties, their children who they had to provide for. However, when having to account for their fallings as mothers, all biographical reconstruction, external blame, and accusation collapsed. Looking at themselves through their children's eyes, female offenders were simply unable to renegotiate the imputed identity of incompetent mother. They could neither confront their children's anger nor explain to them why they had abandoned them. Permanently alienated from the center of motherhood, these women were doomed to an existential chaos.
A strength of substantive grounded theories is that they are modifiable. Yet, little attention is given in the research literature to the evolution of grounded theories through the process of emergent fit. In this article, emergent fit is discussed, and the evolution of the theoretical understanding of relationships with helping systems is provided as an example. In a feminist grounded-theory study of women's caring, emergent fit with existing inductive research on health care relationships resulted in a framework of negotiating, which includes four strategies: reframing responsibility, becoming an expert, harnessing resources, and taking on more. This explanatory model demonstrates how the use of emergent fit can avoid the generation of isolated theories and contribute to knowledge accumulation by producing a substantive theory with wider applicability.
The authors explored women's strategies for achieving quality of life with multiple sclerosis (MS) through interviews with 27 women, most of whom had lived with MS for more than 5 years. Analysis of the semistructured interviews followed the interpretative phenomenological approach. The women portrayed living with MS as an ongoing process of negotiation and described gaining quality of life through looking after health; maintaining meaningful occupations and roles; establishing mutual relationships; clarifying beliefs, aspirations, and philosophy of life; activism on disability issues; consciously valuing positive life experiences; and finding benefits in adversity. Despite recounting resourceful strategies, many acknowledged ongoing difficulties. Some narratives suggested a mesh or tapestry of coexisting positive and negative experiences. Others portrayed an adversarial relationship, with the positive and negative forces in their lives constantly battling for supremacy. A wide array of flexible, evolving strategies was required to achieve an acceptable quality of life with MS.
Small, low-income board-and-care homes play a critical role in the long-term care system, serving a variety of at-risk groups, including chronically mentally ill individuals, frail elders, and developmentally disabled adults. Unfortunately, the supply of homes available to serve these populations is decreasing. The purpose of this study, based on an in-depth ethnographic case study of one small (13-bed) African American-owned and -operated home in metropolitan Atlanta, was to understand how and why some homes continue to operate despite significant challenges. Grounded theory analysis showed that the survival of this home and residents' ability to remain in it involved a basic social process conceptualized as Negotiating Risks. This survival process often put participants at risk of losing their means of subsistence. Community support emerged as an important protective factor. Findings have implications for community interventions to increase these homes' survival and improve resident care.
This case study explored perceptions of friendship of an adolescent with Asperger syndrome. Data were collected through semi-structured interviews, photographs taken by the adolescent, and quality of life and friendship measures. Data were analyzed using grounded theory principles and organized into three themes: (1) characteristics of a friend, (2) family involvement, and (3) enjoyment of friendships and desire to have them. The adolescent appeared to enjoy having friends, was interested in pursuing friendships, and had a basic understanding of many characteristics of friendships. He described negotiating his own and his friend's focused interests. Family members played important roles in the establishment and maintenance of the adolescent's friendships.
This article analyzes the process whereby physicians and patients set the agenda for medical interviews. Applying a conversation analytic perspective to the analysis of 22 videotapes of primary care interviews at a large, urban, teaching and research hospital, a 3-stage model is developed, consisting of (a) an opening sequence, (b) an initial statement of concerns by the patient, and (c) the negotiation process. The analysis illustrates the critical function of the opening verbal exchanges, showing how patient responses to the physician's first question and subsequent queries and summaries by the physician are intricately interwoven. The interaction at the very beginning of the interview is shown to significantly alter the ensuing interaction. The analysis provides a discursive framework for analyzing problematic communication during the primary care interview.
This article examines pediatrician-parent interaction in the context of acute pediatric encounters for children with upper respiratory infections. Parents and physicians orient to treatment recommendations as normatively requiring parent acceptance for physicians to close the activity. Through acceptance, withholding of acceptance, or active resistance, parents have resources with which to negotiate for a treatment outcome that is in line with their own wants. This article offers evidence that even in acute care, shared decision making not only occurs but, through normative constraints, is mandated for parents and physicians to reach accord in the treatment decision.
This paper describes a decision tool created for the Simcoe County Community Care Access Center (SCCCAC) in Ontario. The tool allows the SCCCAC to quantitatively assess the trade-offs between cost, quality, and waiting time of their home care patients. This information can then be used to negotiate reasonable funding levels with the Ontario government and to appropriately allocate this funding among the various patient groups at the SCCCAC. This work can be expanded to other health care organizations that use prioritized waiting lists.
This article conceptualizes the child as having active agency in the constructions of their social worlds, and reports on a study that understands the twin experiences from the perspectives of the twins. It examines how twins account for their relationships with their co-twins. The study drew on accounts of 60 twin children--10 monozygotic (MZ), 10 dizygotic (DZ) same-sex, 10 DZ opposite-sex pairs--aged 5 to 10 years and their parent (n = 30). The children engaged in a sticker activity in which they represented their friendships, including their friendship with their co-twin. Using the task as a resource, the children were asked about their friends, the attributes of friendship and examples of everyday friendships encounters. These were audio-recorded and transcribed. Further, parents completed a questionnaire that provided demographic information and asked parents about the children's social experiences including twin children's time spent together, shared interests and their co-twin relationship. Using data from the pictorial representation from the sticker task and parent questionnaires, differences in relationship between MZ, DZ same-sex and DZ opposite-sex twins were examined and used to select a smaller sample for detailed study. DZ same-sex twins tended to view their co-twin less favorably and there was a nonsignificant trend in which conflict was elevated, compared to the other two groups. Based on these findings, the transcripts selected for analysis focuses on the DZ same-sex girls. The girls reported that they had differences of thought, activity and self-presentation. Conflict, competition and challenge as types of social interaction were described, suggesting that the everyday relationship of the twin with her co-twin is always being negotiated and realigned. Evident here is the complexity of social interactions in which the twins engaged everyday with each other.
OBJECTIVES: This study examined the consequences of having a physically abusive primary partner on the condom use and sexual negotiation practices of young African-American women. METHODS: Interviews were conducted with 165 sexually active African-American women aged 18 through 29 in San Francisco, Calif. RESULTS: Women in abusive relationships were less likely than others to use condoms and were more likely to experience verbal abuse, emotional abuse, or threats of physical abuse when they discussed condoms. They were more fearful of asking their partners to use condoms, worried more about acquiring the human immunodeficiency virus (HIV), and felt more isolated than did women not in abusive relationships. CONCLUSIONS: HIV prevention programs for women should address domestic violence prevention strategies.
This study examined the relationship between profit achievement and emotional regulation strategies, using Kelley's Negotiation Game to measure profit achievement. The game involves bargaining for the prices of three products. Emotional Regulation Strategies were measured by The Emotional Regulation Questionnaire. Scores were obtained from 104 lower level managers of a bank in Turkey. Their average age was 32.0 yr. (SD=3.7), (39 women and 65 men). A correlation of .65 (p<.01) was obtained between scores on profit achievement with scores on Cognitive Reappraisal strategy and -.50 (p<.01) with scores on Suppression strategy.
The clinical teacher and students in traditional nursing education programs represent a temporary system within the permanent culture of the clinical area in which they teach. Temporary systems are a set of diversely skilled people working together on a complex task over a limited period of time. A member of a temporary system struggles to maintain a differentiated identity within the permanent system, while at the same time seeking a sense of collegiality and belonging. Clinical teachers experience a feeling of being somewhat akin to the nursing staff in the clinical area in which they teach because they are nurses. At the same time, clinical teachers are alienated from the nurses because the staff has developed a permanent structure that excludes clinical teachers from many aspects of nurses' working lives. The focus of research concerning clinical teaching has been the tasks assigned to the clinical teacher rather than the experience of teachers as members of a temporary system. This article presents one aspect of a year-long exploratory and descriptive qualitative research study designed to explore and describe what takes place in the realm of clinical teaching in nursing education. The discussion will focus on the experience of clinical teachers as temporary systems according to the sociological framework of negotiated order.
1. A felony defendant's behavior and thinking prior to and during the commission of the crime are the primary focus of the relationship between the client and the psychiatric forensic nurse. 2. Psychiatric forensic nurses provide competency therapy, and train the defendants in courtroom behavior and how to assist their attorney. Therapy includes mock court-room activities, review of the contents of the police reports, and discussion of plea options. 3. Because the dimensions of practice identified overlap into criminal justice and law enforcement, psychiatric forensic nurses are a valuable resource to hostage negotiation teams.