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PubMed2003

International NGOs and primary health care in Mozambique: the need for a new model of collaboration.

In keeping with the neo-liberal emphasis on privatization, international aid has been increasingly channeled through non-governmental organizations (NGOs) and their expatriate technical experts to support primary health care (PHC) in the developing world. Relationships between international aid workers and their local counterparts have thus become critical aspects of PHC and its effectiveness. However, these important social dynamics of PHC remain understudied by social scientists. Based on three years of participant-observation in Mozambique, this paper presents an ethnographic case study of these relationships in one central province. The Mozambique experience reveals that the deluge of NGOs and their expatriate workers over the last decade has fragmented the local health system, undermined local control of health programs, and contributed to growing local social inequality. Since national health system salaries plummeted over the same period as a result of structural adjustment, health workers became vulnerable to financial favors offered by NGOs seeking to promote their projects in turf struggles with other agencies. It is argued that new aid management strategies, while necessary, will not be sufficient to remedy the fragmentation of the health sector. A new model for collaboration between expatriate aid workers and their local counterparts in the developing world is urgently needed that centers on the building of long-term equitable professional relationships in a sustainable adequately funded public sector. The case study presented here illustrates how the NGO model undermines the establishment of these relationships that are so vital to successful development assistance.

Community Health Services↗
PubMed2003

Job satisfaction among Canadian orthodontists.

Job satisfaction has been well researched for many professions, including general dentistry. The job satisfaction of orthodontists has not been adequately studied. The aims of this study were to describe job satisfaction among orthodontists and to determine characteristics associated with job satisfaction in the profession. A self-administered, anonymous survey was mailed to Canadian orthodontists. It included a modified version of the Dentist Satisfaction Survey, an overall occupational stress score, and items addressing various characteristics of the respondents. Of 654 mailed surveys, 335 were returned, for a response rate of 51.2%. Most orthodontists (79.3%) were classified as satisfied according to the overall job satisfaction scale of the Dentist Satisfaction Survey; however, some (2.5%) were classified as dissatisfied. The facets of orthodontics with the highest degree of satisfaction were patient relations (93%), delivery of care (86%), respect (84%), professional relations (80%), and staff (76%). The most dissatisfaction was associated with personal time (26%) and practice management (15%). Stepwise multiple regression analysis resulted in a model including overall occupational stress, membership in the Canadian Association of Orthodontists, total number of staff, and age to account for 27.1% of the variation in the overall job satisfaction scale. Based on accountable sources of variance, the overall job satisfaction scale seems to be more affected by other variables than the characteristics evaluated by this survey.

Age Factors↗
PubMed1995

Occupational stress and dentistry: theory and practice. Part II. Assessment and control.

Since dentistry has been identified as being a stressful profession, dentists, with the help of the members of the dental team, must attempt to achieve a relatively stress-free working environment. In addition to recognising potential occupational stressors it is important for dentists to be able to assess their emotional responses to the practice of dentistry and to arrange their daily working lives in such a way as to reduce occupational stress. This paper examines the means by which dentists may assess occupational stress as well as person-centred and/or situation-centred strategies of coping with and controlling occupational stress in general dental practice.

Adaptation, Psychological↗
PubMed1998

Enhancing communication by using the Coordinated Care Classification System.

Because of the changes in our healthcare system, some clinical nurse specialists (CNSs) are having to expand their traditional roles of clinician, educator, consultant, leader, and researcher to include case management activities. The CNSs at Promina Gwinnett Health System in Lawrenceville, Georgia, have combined CNS and case manager activities and have adopted the title "CNS/Outcomes Coordinator." The CNS/Outcomes Coordinator is responsible for coordinating patient care, promoting team collaboration, and facilitating communication. To inform the healthcare team of the CNS/Outcomes Coordinator's patient responsibilities, the CNS/Outcomes Coordinators developed a Coordinated Care Classification System. This article describes how coordinating patient care, promoting team collaboration, and facilitating communication can be enhanced by the use of a classification system.

Adult↗
PubMed2026

Communication crossroads: Exploring generational dynamics in nursing from the bedside to the boardroom.

Nurses have up to four times more patient contact than physicians, positioning them as central drivers of communication in health care. Effective communication directly influences patient outcomes, teamwork, staff engagement, and the overall care experience. Today's nurses operate within a highly diverse environment that includes four generations in the workforce and up to eight generations of patients, each with distinct values, expectations, and communication preferences. This article examines how generational differences shape communication across three key relational domains: peer-to-peer, nurse-to-patient, and nurse-to-leader interactions, and offers insights to strengthen collaboration, engagement, and quality of care.

Humans↗
PubMed1995

Strategic marketing in the NHS: Kwik-health NHS Trust.

Unlike managers in most service organizations, hospital managers do not have significant control over the shape or cost of the service product or the manner of its delivery. Hence, the crucial issue for hospital management to address is how to develop the marketing of a service the control of which is divorced from those with the strategic market perspective. While the internal management of hospital care in NHS is in its infancy, initial developments such as clinical directorates point the way forward in creating a market orientation within provider units. Ultimately, it must be considered what degree of influence over clinical decisions affecting hospital services is realistic, ethical and desirable for strategic marketing and business services. Arguably there is a case for the adoption of some middle ground, with both sides moving from their present positions but perhaps with the clinicians moving furthest.

Consumer Behavior↗
PubMed1995

Pandora's Box: clinical directorates and the NHS.

Reports on the research concerning the current debate surrounding the maturity of clinical directorates. Indicates that there is some ambiguity as to how directorates should be structured and strategically managed. Finds evidence that trust executive boards need to involve clinicians in setting strategy and to support clinical directors with suitable business managers to manage the boundary between strategic and operational issues.

Decision Making, Organizational↗
PubMed1998

Psychoanalysis: a dysfunctional family?

The discussion opens with an account of the author's mother's bizarre family in which a strong, charismatic grandmother maintained absolute control over her large family by encouraging a neurotic dependence in them through daily reports of their complaints. Getting interested in psychoanalysis in an effort to understand the dynamics of this dysfunctional family, the author, a biographer, turned to the study of Melanie Klein, becoming entranced by her ideas. Her research also revealed how Klein had discouraged her followers from developing ideas that diverged in any way from her own. Her portrait of the pioneer analyst provoked intense indignation. A similar pattern of absolute loyalty to his person and theories was to be found in Freud's Secret Committee, formed primarily as a means of getting rid of Jung who had been showing disturbing signs of independence. When Ferenczi and Rank began to pursue independent lines of enquiry in their work, they too were though to be undermining the foundations of classical psychoanalysis. Finally, the author concludes that though there have been sorry incidents in psychoanalysis, we should be mature enough to accept both the contributions of the early pioneers and the realizations that new ideas must be permitted to evolve.

Codependency, Psychological↗
PubMed1977

Intensive psychotherapy for the psychiatrist's family.

A series of intensive psychotherapy cases of wives and children of psychiatrists reveals that the special problems they present may be divided into those at the onset of treatment, those in the process of the treatment, and special countertransference problems. Paradoxically, early recognition and acceptance of psychotherapy are a foremost problem involving the psychiatrist as father or spouse. During therapy, narcissistic injuries to the psychiatrist father or spouse and loyalty problems in the patient emerge as special problems. Countertransference revolves around peer relationships and "psychopolitics," as well as referrals of other patients.

Adolescent↗
PubMed2004

Safeguarding the health of dental professionals.

BACKGROUND: A healthy dentist is one of the most important ingredients in a successful dental practice, an ingredient not to be taken for granted. Professionals, dentists included, can and do experience illnesses and problems that can disrupt or impair a practice. CONCLUSIONS: In addition to the vulnerabilities of the human condition--addictive disorders, psychiatric illnesses, infectious disease, family and relationship problems, or the many varieties of human misery--dentists have undergone a powerful process of socialization into their professional role that makes it difficult to seek help for themselves. Stigma about addictive and psychiatric illnesses continues to be a problem despite significant advances in scientific understanding of these disorders. Many people, especially those in positions of community visibility as dentists are, still struggle with shame when they associate problems with personal failure. Dental societies are in an ideal position to provide resources and support, should they choose to take this opportunity, and the ADA has the information and expertise to help them do this. PRACTICE IMPLICATIONS: Dentists can become more aware of their own vulnerabilities and enhance their personal and professional effectiveness, as well as evaluate ways they may support their staff and colleagues.

Adult↗