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PubMed2006

Negotiation of care by children's nurses: lessons from research.

Parental participation and role negotiation are central elements in family-centred care, but research suggests that such negotiation tends to be ad hoc, depending on the relationships developing between the family and health professionals. Lack of effective communication, professional expectations and issues of power and control often prevent open and mutual negotiation between families and health professionals, especially nurses. This article summarises key lessons from a critical review of relevant research literature (Corlett and Twycross 2006) which suggests that nursing staff often control parental participation leaving parents feeling disempowered and deskilled. Poor communication and lack of information sharing exacerbate the situation. Where parents do not comply with nurses' expectations conflict can arise, resulting in more anxiety for already stressed parents. Current health policy requires that health workers listen to children and their families, to actively involve them in the decision-making process and to plan care around their needs and wishes. Nurses need to be aware of the way they interact with parents and the control they may unwittingly exert. A greater emphasis on communication, interpersonal and negotiation skills within nurse education is also needed.

Child↗

PubMedDate not supplied

Negotiating a laboratory information system contract.

The key to successfully negotiating a laboratory information system (LIS) contract is consensus. Before sitting down at the negotiating table, the LIS selection team must reach consensus on a variety of issues--ranging from financial concerns to political considerations. Once a vendor is selected, consensus must be reached regarding the laboratory's needs and the vendor's capabilities. This article discusses the entire LIS negotiating process--from selecting a vendor to writing the final contract. By looking beyond costs and working out problems in advance, the laboratory will have a better chance of negotiating a successful LIS contract.

Clinical Laboratory Information Systems↗

PubMed1996

Power negotiating for physician executives.

Whenever you deal with another person, you use exactly the same techniques that international negotiators use to reach agreement on world problems. Learning to improve your negotiating skills is the highest and best use of your time. You can't make money faster than you can when you're negotiating well. Presented here are negotiating gambits to use to your advantage at the bargaining table.

Humans↗

PubMedDate not supplied

The role of tactical emergency medical support in hostage and crisis negotiations.

The use of tactical medics by members of hostage and crisis negotiations teams has not been examined in the literature or in the field. Usually, negotiations teams are deployed within the confines of the established inner perimeter along with the tactical team and tactical medics. While the likelihood of injuries or performance degrading medical problems for negotiators is less than that expected for Special Weapons and Tactics (SWAT) team members, they may occur and need attention. Additionally, there are other roles that tactical medical personnel can play that are specific to the needs of police negotiators. This article will examine these possible roles.

Emergency Medical Services↗

PubMed1996

Developmental sophistication among adolescents of negotiation strategies for condom use.

Condoms are an important method of reducing the risk of sexually transmitted disease among sexually active adolescents. This study used a developmental approach to examine the negotiation of condom use. The Interpersonal Negotiation Strategy Interview was administered to adolescents using two vignettes that were focused on the negotiation of "safer sex" behaviors. The sample consisted of 196 girls and 92 boys recruited from their primary care clinic or Job Corps. The mean scores for each problem-solving step were at the subjective, unilateral stage, which indicates that problems are resolved through one-way methods. Current educational strategies and the lack of mutuality in adolescents' sexual relationships influence the level of negotiation skills. Interventions need to be at the appropriate developmental level but also need to encourage progress toward collaborative relationships.

Adolescent↗

PubMed1996

20 factors to consider when negotiating a managed care contract.

This article presents a checklist of 20 factors a practice should consider when negotiating a managed care contract. The negotiation of the contractual terms is at least as important as the capitation rate or fee schedule. With the advent of Medicare HMO Risk plans, the last bastion of patient choice is being eroded. Practices now are negotiating fees and terms with almost every plan. It is necessary for all practices to become knowledgeable in the intricacies of managed care contractual negotiation.

Contract Services↗

PubMed2000

Working Together but in Opposition: An Examination of the "Good-Cop/Bad-Cop" Negotiating Team Tactic.

Unlike solo negotiators, members of negotiating teams may for strategic reasons choose to play different roles; the familiar "good cop/bad cop" distributive bargaining tactic is one example of role differentiation designed to enhance a team's success at the bargaining table. In two empirical studies about a hypothetical three-person work group, we examined the cognitive processes underlying this tactic using a social-cognitive decision model (Brodt & Duncan, 1998) that conceptualizes the negotiators' decision tasks and persuasion processes. Results generally supported the model except for an intriguing asymmetry depending on a person's initial inclination (accepting, rejecting). This research extends findings on the tactic and on contrast effects (Cialdini, 1984) and supports the model's usefulness as an approximate representation of negotiator cognition. Copyright 2000 Academic Press.

Journal Article↗

PubMed1988

The role of returns to a prior topic in the negotiation of topic change: a developmental investigation.

Returns to a prior topic occurring in the conversations of small groups of acquainted peers were examined to learn more about how topic is organized in such settings and how it changes with age. Twenty-five discussion groups were formed, five at each of the following grades: second, fifth, ninth, twelfth, and college. The eighth meeting of each group was examined, comprising 13,811 speaking turns total, which includes 502 returns other than those occurring after side sequences. There are three main findings. First, at all ages, returns were frequently used to counter attempts at topic change. This finding warranted the creation of a model for the negotiation of topic change that includes returns. Second, there were no age differences in the means used for negotiating topic change, but there were substantial age differences in the way these means were actually employed. These differences suggest that adolescents and young adults adopt a consensual orientation to topic negotiation. Third, other results suggest that that consensual orientation to topic negotiation is a generalization of the consensus orientation to topic maintenance that is acquired during childhood.

Adolescent↗

PubMed2005

Proactive stability control while carrying loads and negotiating an elevated surface.

In this study, proactive stability control while handling loads and negotiating an elevated surface was examined. Ten young healthy males completed two gait-mode conditions--level walking and negotiating a raised surface. Load-handling conditions were: no load, empty box (reduced visual information), and loaded box (reduced visual information combined with increased inertial load). The lower limb trajectory in the sagittal plane was not modified as a function of reduced visual information or increased inertial load. The step width decreased while stepping over the surface and carrying the loaded box. The trunk pitch angle was biased backwards for both the empty box and the loaded box. When carrying the empty box and negotiating the surface, the trunk pitch range of motion (ROM) increased which may have been a strategy to increase visual exteroceptive information. As increased net trunk pitch could destabilize the system, concurrent stabilizing strategies--decreased gait velocity and reduced net trunk roll velocity--were observed. To meet the equilibrium goals when carrying the loaded box, the trunk pitch ROM and net pitch velocity were reduced during both level walking and surface accommodation. Trunk roll ROM was reduced when carrying the load and negotiating the surface. This study extends our knowledge regarding whole body coordination strategies during anticipatory locomotor adaptations.

Adult↗

PubMed2006

Sexual negotiation, HIV-status disclosure, and sexual risk behavior among Latino men who use the internet to seek sex with other men.

As part of a wider study of Internet-using Latino men who have sex with men (MSM), we studied the likelihood that HIV-negative (n=200) and HIV-positive (n=50) Latino MSM would engage in sexual negotiations and disclosure of their HIV status prior to their first sexual encounters with men met over the Internet. We also analyzed the sexual behaviors that followed online encounters. Our results showed that both HIV-negative and positive men were significantly more likely to engage in sexual negotiation and serostatus disclosure on the Internet than in person. Those who engaged in sexual negotiations were also more likely to use condoms for anal intercourse. Compared to HIV-negative MSM, HIV-positive MSM were significantly less likely to disclose their serostatus, and 41% of them acknowledged having misrepresented their serostatus to a prospective sexual partner met over the Internet. Although similar proportions of HIV-positive and negative men had condomless anal intercourse, HIV-positive MSM were more likely to report lack of intention to use condoms. Pleasure was the reason most frequently cited for lack of condom use. Cybersex was reported by only one-fifth of the sample. We conclude that the Internet, an understudied milieu of sexual networking, may present new possibilities for the implementation of risk reduction strategies, such as the promotion of sexual negotiation prior to first in-person encounter and serostatus disclosure.

Adult↗

PubMed1997

Factors affecting the negotiability of second mesiobuccal canals in maxillary molars.

Factors affecting the negotiability of MB2 canals were evaluated by studying 87 extracted maxillary molars that had undergone previous endodontic treatment in the endodontic technique laboratory. The mesiobuccal roots were resected and radiographed, after which a #08 file was used in an attempt to negotiate those roots with the potential for a second mesiobuccal canal. The file was then intentionally separated in the MB2 canals that could be negotiated. The roots were decalcified, cleared, and observed under a stereomicroscope. Several factors that could interfere with the total or partial negotiation of MB2 canals were identified and included accumulation of debris and sealer that blocked access to these canals, dentinal debris produced with the pathfinding instrument, the presence of anatomical variations, diffuse calcifications, and pulp stones.

Dental Pulp Calcification↗

PubMed1987

Identity negotiation: where two roads meet.

This article traces a program of research on the interplay between social thought and social interaction. Early investigations of the impact of perceivers' expectancies on the actions of target individuals illuminated the contribution of perceivers to the identity negotiation process but overlooked the role of targets. The research discussed here is based on the assumption that targets play an active role in the identity negotiation process. Specifically, just as perceivers strive to validate their expectancies, targets seek to verify their self-views. The nature and antecedents of the processes through which people verify their self-conceptions as well as the relationship of these activities to self-concept change and self-enhancement processes are discussed. This research suggests that perceivers and targets enter their interactions with independent and sometimes conflicting agendas that are resolved through a process of identity negotiation. The identity negotiation process therefore provides a theoretical context in which the interplay between other-perception and self-perception can be understood.

Humans↗

PubMed2003

Negotiating medications: patient perceptions of long-term medication use.

OBJECTIVE: To investigate how adults with one of several chronic illnesses (bipolar disorder, multiple sclerosis, rheumatoid arthritis, schizophrenia/schizoaffective disorder, or systemic lupus erythematosus) perceive their need to take medications during the course of their illness. METHOD: Eighty-three adults, aged 18-64 years, all members of a health maintenance organization, were interviewed. Each participant completed an ethnographic interview that was transcribed verbatim and analysed using grounded theory techniques. RESULTS: Participants described two forms of ongoing efforts to negotiate their need for medications, internal and external. The former category includes struggles over self-identify (e.g. worries about becoming dependent on drugs, feeling like a 'guinea pig'). The latter includes negotiations with health care providers over the type, route, and frequency of medication use. Dimensions of both negotiation types include acceptance and resistance. Specifically, patients with chronic illness must manage not only drug regimens, but also renegotiate their self-identities as formerly well persons. During this dynamic process, patients may accept and/or resist taking prescribed medications. CONCLUSION: Practitioners should recognize that patients experience not only physical, but emotional side effects of medications, and that resistance might be part of a negotiation process rather than a final stance.

Adult↗

PubMed1983

Process analysis of two dimensions of the negotiated approach in relation to satisfaction in the initial interview.

This study examined relationships between patient and clinician satisfaction ratings and the use of a negotiated approach to the initial psychiatric interview. Two dimensions of the negotiated approach were distinguished--mutuality in making treatment decisions and mutuality in communicating explanatory information. Forty-four patients sampled from a larger pool of 158 patients in a walk-in clinic of a large, urban general hospital participated in the study. At the conclusion of clinical interviews, three kinds of satisfaction ratings were obtained--those of patients' satisfaction, clinicians' perceptions of patients' satisfaction, and clinicians' own satisfaction. Transcripts of patients' audiotaped interviews with these clinicians were independently rated on each of the 10 negotiated approach process measures, comprising five measures of each process dimension. Patient satisfaction was found to be associated with explanatory processes--being given clear and complete explanations concerning the recommended treatment plan, its rationale, and its link to the patient's complaints, and with decision-making processes-stating a request before the start of the disposition phase and having the clinician pursue consensus with the patient on the clinician's recommended treatment plan. None of the negotiation variables was significantly correlated with clinician satisfaction. Moreover, clinicians appeared to be inaccurate in their perception of the sources of patient satisfaction. The study's findings suggest that two sources of strain between the clinician and the patient that may adversely affect the outcomes of their initial interview are the divergence in their value systems concerning initial interview processes and the clinician's misreading of the patient's perspective.

Adult↗

PubMed1982

Negotiation and the structure of discourse in medical consultation.

Using audio tape recordings of consultations between mid-level providers and patients in a health maintenance organization, a model of medical negotiation is presented. This model conceptualizes negotiation as a process in which mid-level providers and patients introduce their perspectives on the definition and treatment of medical problems by linking together units of discourse (acts, turns, sequences and phases). This model clearly locates negotiation in observable activities of interactants and demonstrates how the process changes over the course of an encounter as provider and patient participate in the taking of a medical history, the performance of a physical examination, and the discussion of the problem and treatment. Because of the formal yet flexible nature of this model, it lends itself for use in comparative studies of medical practitioner-patient negotiation.

Health Maintenance Organizations↗

PubMed1980

Evaluation of kerb negotiation in a prototype and standard model wheelchair.

This article outlines an evaluatory study of kerb negotiation in a conventional wheelchair and a prototype diamond configuration, lever articulated wheelchair. The kerb negotiation sequence in both models is presented with the results of tests involving users able to negotiate kerbs (N = 16); users unable to negotiate kerbs (N = 15); and non-wheelchair users (N = 20). Results indicate preferences for the prototype amongst the first group, particularly for kerb descent. Free rolling tests of the loaded wheelchairs over various terrains revealed that while the standard wheelchair invariably turned downhill the prototype was relatively insensitive to loss of direction on sideslopes. A significant number of subjects (P = 0.01, N = 20) found the articulated framework of the prototype reduced the difficulties of self propulsion over rough and cambered surfaces. The prototype was found to possess a smaller turning circle (103 cm to 122 cm) and a longer wheelbase (94.7 cm to 39.7 cm) than the standard model though overall dimensions were broadly comparable. The implications of the prototype wheelbase for manual, attendant and powered propulsion are considered.

Ergonomics↗

PubMedDate not supplied

Negotiating with interactive scenarios and strategies.

Physician executives need to negotiate effectively with a wide range of parties. In those negotiations, they should consider the relative importance of both substantive and relationship outcomes in selecting initial negotiation strategies. Of course, these strategies may or may not be successful, depending on the strategies used by the other party. Hence, the physician executive must consider the other party's strategy and how it and his or her initial strategy are likely to interact both before and during negotiations.

Economic Competition↗

PubMedDate not supplied

Negotiating for more than a slice of the pie.

Negotiation is an important way for physician executives to manage conflict and to accomplish new projects. Because of the rapidly changing nature of the health care environment, as well as conflicts and politics within their organizations, managers need to effectively negotiate with a wide range of other parties. Managers should consider the relative importance of both the substantive and relationship outcomes of any potential negotiation. These two factors may guide the executive's selection of initial negotiation strategies.

Conflict, Psychological↗