Recently adopted health care practices and policies describe themselves as “patient-centered care.” The meaning of the term, however, remains contested and obscure. This paper offers a typology of “patient-centered care” models that aims to contribute to greater clarity about, continuing discussion of, and further advances in patient-centered care. The paper imposes an original analytic framework on extensive material covering mostly US health care and health policy topics over several decades. It finds that four models of patient-centered care emphasize: patients versus (...) their parts; patients versus providers; patients/providers/states versus “the system”; and patients and providers as persons. Each type is distinguishable along three dimensions: epistemological orientations, practical accommodations, and policy tools. Based on this analysis, the paper recommends that four questions be asked of any proposal that claims to provide patient-centered care: Is this care a means to an end or an end in itself? Are patients here subjects or objects? Are patients here individuals or aggregates? How do we know what patients want and need? The typology reveals that models are neither entirely compatible nor entirely incompatible and may be usefully combined in certain practices and policies. In other instances, internal contradictions may jeopardize the realization of coherent patient-centered care. (shrink)

The precise nature of W. S. Jevons's utilitarianism as a guiding rule for economic policy has yet to be investigated, and that will be the first issue treated in this paper. While J. A. Schumpeter, for instance, asserted that ‘some of the most prominent exponents of marginal utility’, were ‘convinced utilitarians’, he did not investigate the further implications for Jevons's policy analysis.

Poor quality medical care is sometimes attributed to physicians’ unwillingness to act on evidence about what works best. Evidence-based performance standards (EBPSs) are one response to this problem, and they are increasingly employed by health care regulators and payers. Evidence in this instance is judged according to the precepts of evidence-based medicine (EBM); it is probabilistic, and the randomized controlled trial (RCT) is the gold standard. This means that EBPSs suffer all the infirmities of EBM generally—well rehearsed problems with the (...) external validity of research findings as well as the inferential leap from study results in the aggregate to individual patient care. These theoretical weaknesses promise to have a practical impact on the care of patients. To avoid this, EBPSs should be understood as guidelines indicative of average effectiveness rather than standards to be applied in every case. (shrink)

The concept of organizational justice is important to understanding and predicting organizational behavior. A significant development in the research literature has been the separation of distributive and procedural justice. While much of the research has focused on negative outcomes, this research attempted to verify the presence of both forms of justice in the context of positive outcomes. Subjects completed an instrument designed to measure their perceptions of distributive and procedural justice. The subjects also reported their satisfaction and sense of fairness (...) with their salary increases, their belief that the procedures to award the increases had been followed, and their level of information and agreement regarding the salary program. These measures, along with size of salary increase and gender were examined to determine their impact on the subjects' perceived level of justice. The data support the existence of the two distinct forms of justice, but suggest that procedural justice may, in turn, branch out into two aspects. One category involves being informed, and a second appears to deal with acceptance of procedures. A series of relationships are then considered. Significant gender effects were non-existent. (shrink)

This groundbreaking text is the most complete and detailed book devoted to middle-range theories and their applications in clinical nursing research. The book thoroughly explains the process of selecting an appropriate theory for a particular nursing research study and sets forth criteria for critiquing theories. Each chapter includes examples of research using middle-range theories, definitions of key terms, analysis exercises, reference lists, and relevant Websites. Instruments are presented in appendices. New features of this edition include analysis questions for all theories; (...) new chapters on learning theory and physiologic middle-range theories; "Part" introductions to frame the selection process for each middle-range theory chosen; and a glossary of terms. (shrink)

Evidence-based practice (EBP), a derivative of evidence-based medicine (EBM), is ascendant in the United States’ mental health system; the findings of randomized controlled trials and other experimental research are widely considered authoritative in mental health practice and policy. The concept of recovery from mental illness is similarly pervasive in mental health programming and advocacy, and it emphasizes consumer expertise and self-determination. What is the relationship between these two powerful and potentially incompatible forces for mental health reform?This paper identifies four attempts, (...) in the mental health literature, to delineate the role of “evidence” in recovery. One is the strong version of evidence-based practice—an applied science model—and three others address weaknesses in the first by limiting the authority of probabilistic findings. The paper also offers a fifth version, based on the concept of communicative accountability, which is derived from Habermas’ work on communicative action. The fifth version responds to the other four and emphasizes learning, disclosure and respect in clinical and other helping relationships. (shrink)

This essay examines the administrative state as a ubiquitous phenomenon that results in part from the mismatch of incentives. Using two dramatic episodes in the history of economics, the essay considers two types of mismatch. It then examines how economists increasingly endorsed the “general good” as a unitary goal for society, even at the expense of private hopes and desires. More than this, their procedures and models gave them warrant to design mechanisms and advocate for legislation and regulations to “fix” (...) the supposedly suboptimal choices of individuals in service to the overarching goal. The rise of New Welfare Economics dealt an additional blow to the sovereignty of individual motivations, notwithstanding that Hayek and Buchanan warned that this engineering approach allowed social goals to override individual preferences. Throughout, the argument is that it is important to recognize that people within or advising the administrative state are influenced by the same sorts of motivations as actors throughout the economy. (shrink)

Best known for reviving the tradition of classical liberalism, F. A. Hayek was also a prominent scholar of the philosopher John Stuart Mill. One of his greatest undertakings was a collection of Mill’s extensive correspondence with his longstanding friend and later companion and wife, Harriet Taylor-Mill. Hayek first published the Mill-Taylor correspondence in 1951, and his edition soon became required reading for any study of the nineteenth-century foundations of liberalism. This latest addition to the University of Chicago Press’s Collected Works (...) of F. A. Hayek series showcases the fascinating intersections between two of the most prominent thinkers from two successive centuries. Hayek situates Mill within the complex social and intellectual milieu of nineteenth-century Europe—as well as within twentieth-century debates on socialism and planning—and uncovers the influence of Taylor-Mill on Mill’s political economy. The volume features the Mill-Taylor correspondence and brings together for the first time Hayek’s related writings, which were widely credited with beginning a new era of Mill scholarship. (shrink)

In 1935, the British scholar Eliza M. Butler published The Tyranny of Greece Over Germany, in which she explored the appeal of Greek art and poetry to modern German writers. She argued that Hellenism had exerted a baleful influence on German literature and culture, and that Germans were especially—even dangerously—susceptible to the power of ideas. In her view, the most dangerous Hellenic concept to German culture and society was the daimon, which had reached Germany via the work of Winckelmann. Butler's (...) thesis and methods may be problematic, as some reviewers of Tyranny pointed out, but her work is noteworthy as the product of a scholar who had lived in Germany and was a witness to history, familiar with German language, literature, and culture, writing on Germany during difficult times. As a British scholar who began studying German just before World War I and ended her career after World War II, Butler had an ambivalent relationship with Germany and Germans. But in addition to political factors, she was also influenced by her family, her educational and research experiences in Germany, and her preference for 18th- and 19th-century over 20th-century Germans. Moreover, her perception of Germans and Germanness was consistently posed against her perception of England and Englishness, and she defined the two cultural identities in terms of their relation to each other. Writing Tyranny as the National Socialists came to power in Germany, Butler judged Germans and their relationship to the daimon harshly. In 1956, Butler reconsidered the daimonic in a study of Byron and Goethe, and in this work it received a more sympathetic and nuanced analysis. A comparison of these two works is useful for understanding the evolution of Butler's thought in the 20-year interval between their publication. (shrink)

There is a difference between the private and social cost of preserving the past. While it may be privately rational to forget the past, the social cost is significant: we fail to see that Classical political economy is a polemic against racism. The past is a rich source of surprises and debates, and resources on the Web are uniquely suited to teaching such wide-ranging debates. Our ASecret History of the Dismal Science on the web, provides a rich series of windows (...) on the literary and analytical texts, and the artwork, that figured in the debates. Students who read Smith juxtaposed with Whitman, who read the Carlyle-Mill exchange, and who see these images, understand the debate the way a student who reads only the Wealth of Nations, Ricardo's Principles, or John Stuart Mill cannot. (shrink)

Although Occupy Wall Street may no longer appear in news headlines, the international movement provides a rich curriculum on space and protest that are worthy of contemplation in social studies classrooms and research. This paper looks historically at how location and free speech became linked and informed one another during the 20th century in the US. It then looks critically at three sites of Occupy in the US that reflect the contested public representations of occupation. The investigation of these critical (...) incidents enables a discussion of how Occupy expands prior discussion of the linkage between space and protest while indicating how political, economic, and technological shifts change this relationship in the 21st century. (shrink)

ABSTRACTBesides physiological, behavioural, and affective effects, romantic love also has cognitive effects. In this study, we tested whether individual differences in infatuation and/or attachment level predict impaired interference control even in the absence of a love booster procedure, and whether individual differences in attachment level predict reduced adaptive cognitive control as measured by conflict adaptation and post-error slowing. Eighty-three young adults who had recently fallen in love completed a Stroop-like task, which yielded reliable indices of interference control and adaptive cognitive (...) control. We did not observe the predicted negative association between infatuation or attachment level and interference control. It might be that reduced interference control with love only happens when people are actively thinking about their beloved. In addition, we observed only weak evidence for the prediction t... (shrink)

David Hume's sympathetic principle applies to physical equals. In his account, we sympathize with those like us. By contrast, Adam Smith's sympathetic principle induces equality. We consider Hume's “other rational species” problem to see whether Smith's wider sympathetic principle would alter Hume's conclusion that “superior” beings will enslave “inferior” beings. We show that Smith introduces the notion of “generosity,” which functions as if it were Hume's justice even when there is no possibility of contract.

Consumer-operated services organizations (COSOs) are independent, non-profit organizations that provide peer support and other non-clinical services to seriously mentally ill people. Mental health consumers provide many of these services and make up at least a majority of the organization’s leadership. Although the dominant conception of the COSO is as an adjunct to clinical care in the public mental health system, this paper reconceives the organization as a civic association and thereby a locus of citizenship. Drawing on empirical research on COSOs (...) in one state and the citizenship and civic democracy literatures, COSOs are analyzed here as membership organizations with democratic norms and strong ties to local communities. The suggestion is made that by embracing and enhancing their status as civic associations, COSOs may advance the goals of the social movement that spawned them and avoid predictable obstacles to further growth and development. (shrink)

Background:Homeless persons in the United States have disproportionately high rates of illness, injury, and mortality and tend to believe that the quality of their end-of-life care will be poor. No studies were found as to whether nurses or nursing students require moral courage to help homeless persons or members of any other demographic complete advance directives.Research hypothesis:We hypothesized that baccalaureate nursing students require moral courage to help homeless persons complete advance directives. Moral courage was defined as a trait of a (...) person or an action that overcomes fears or other challenges to achieve something of great moral worth.Research design:The hypothesis was investigated through a qualitative descriptive study. Aside from the pre-selection of a single variable to study (i.e. moral courage), our investigation was a naturalistic inquiry with narrative hues insofar as it attended to specific words and phrases in the data that were associated with that variable.Participants and research context:A total of 15 baccalaureate nursing students at a public university in the United States responded to questionnaires that sought to elicit fears and other challenges that they both expected to experience and actually experienced while helping homeless persons complete advance directives at a local, non-profit service agency.Ethical considerations:The study was approved by the Internal Review Board of the authors’ university, and each participant signed an informed consent form, which stated that the study involved no reasonably foreseeable risks and that participation was voluntary.Findings:Before meeting with homeless persons, participants reported that they expected to experience two fears and a challenge: fear of behaving in ways that a homeless person would deem inappropriate, fear of discussing a homeless person’s dying and death, and the challenge of adequately conveying the advance directive’s meaning and accurately recording a homeless person’s end-of-life wishes. In contrast, after their meetings with homeless persons, relatively few participants reported having encountered those obstacles. So, while participants required moral courage to assist homeless persons with advance directives, they required greater moral courage as they anticipated their meetings than during those meetings.Discussion:Our study breaks new ground at the intersection of nursing, moral courage, and advance directives. It might also have important implications for how to improve the training that US nursing students receive before they provide this service.Conclusion:Our results cannot be generalized, but portions of our approach are likely to be transferable to similar social contexts. For example, because homeless persons are misunderstood and marginalized throughout the United States, our design for training nursing students to provide this service is also likely to be useful across the United States. Internationally, however, it is not yet known whether our participants’ fears and the challenge they faced are also experienced by those who assist homeless persons or members of other vulnerable populations in documenting healthcare wishes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ontological and Other AssumptionsLloyd A. Wells (bio) and Sandra J. Rackley (bio)Fahrenberg and Cheetham have conducted an immensely thought-provoking study of the assumptions about human nature made by 800 students and pose a question about the future impact of these assumptions on individuals’ practice in professions including medicine and psychotherapy.This work represents a branch of “philosophical anthropology,” which considers assumptions people make about human nature. The authors used (...) a questionnaire, much of which was newly designed, to assess the assumptions made by university students studying psychology, philosophy, sciences, and other disciplines. Most of the respondents were studying at Freiburg, but some were sampled at several other universities in both the former East and West Germanies. Questions involved consciousness and the brain, evolution, free will, belief in God, the meaning of life, and theodicy.Given the importance of these beliefs and assumptions in so many peoples’ lives, it is quite surprising that there are so few modern data available, and this study ventures an important first step in assessing these assumptions. However, there are many problems inherent in this study (and any like it).The first, for us, is the validity of the questionnaire itself, an issue that was not specifically addressed in the paper. Face validity is a problem even in the few questions quoted directly in the paper. For example, some statements contain two clauses, and one could well agree with one without agreeing with another: “I do not know whether a God exists and I do not believe it is possible to know.” This is the most relevant answer for a true agnostic, but the assumption that “I do not know whether a God exists” does not necessarily link at all with “I do not believe it is possible to know.” Similarly, a theist might have trouble with the two clauses, “I know God really exists” and “I do not doubt this.” (Technically, knowledge does imply a lack of doubt, but belief certainly does not.) Particularly in the trilemmas, where various patterns of response were analyzed, these multiple-clause statements may have led students to respond in a manner inconsistent with their true beliefs and assumptions. Furthermore, many of the questions contain terms that may have been unfamiliar to first-year university students. The authors explain their rationale in not defining terms, but the lack of clarity about definitions may have led some of the students to not fully understand the questions asked and to perhaps influence the answers they chose.Misunderstanding of the questions may account for some of the disparities reported in the results. Other apparent inconsistencies, however, do not seem to be a result of unclear questions. For example, sixty percent of the students agreed with the statement that “I believe in … existence after death,” whereas forty-seven percent agreed with the statement that “when my brain is dead my consciousness and my person cease to be.” These [End Page 203] findings do not add up, and this study has several similar sets of data. People contradict themselves in long and complex questionnaires, and this may be a simple explanation for these findings, but is this the only explanation? How seriously did the students take the questionnaire, often given as part of their class? How honest were their responses?How generalizable are the findings of this study? It is very difficult even to speculate about this. The statistics are incomprehensible in light of the data given, and one must essentially take them on faith, wherever one falls on the God/theodicy questions. The design has many flaws, but we do learn how a subsample of German university students rate important factors about the meaning of life. Statements are made in the paper that the students’ results correlate with similar results for the general population, but this assertion seems to be based on a very few questions. One would like much more delineation of this apparent correlation, because we wonder about the juxtaposition of developmental factors with the answers the students gave to this questionnaire. First-year university students are at a critical developmental point, and it would be fascinating to follow this large cohort of students over time to see whether... (shrink)

James Buchanan often argued that fairness is an obligation toward our equals. If Adam Smith is our equal, then we are under obligation to try to understand him. We see this in Buchanan’s attempts to reformat political economy on the basis of natural equals, a world in which Smith’s street porter does indeed have the same capacity as the philosopher. This shows in Buchanan’s excitement over increasing returns models as well as John Rawls’ Theory of Justice both of which he (...) saw a way to make this view operational. (shrink)

The Virginia School's economics of natural equals makes consent critical for policy. Democracy is understood as government by discussion, not majority rule. The claim of efficiency unsupported by consent, as common in orthodox economics, appeals to social hierarchy. Politics becomes an act of exchange among equals where the economist is only entitled to offer advice to citizens, not to dictators. The foundation of natural equality and consent explains the common themes of James Buchanan and John Rawls as well as Ronald (...) Coase and the Fabian socialists. What orthodox economics treats as efficient racial discrimination violates the fair chance entitlement to which people consent in a market economy. The importance of replication stressed by Gordon Tullock, developing themes from Karl Popper, is another expression of natural equality since the foresight of replication induces care into research. The publication of previously unpublished correspondence and documentation allows the reader to judge recent controversy. (shrink)

This book's importance is derived from three sources: careful conceptualization of teacher induction from historical, methodological, and international perspectives; systematic reviews of research literature relevant to various aspects of teacher induction including its social, cultural, and political contexts, program components and forms, and the range of its effects; substantial empirical studies on the important issues of teacher induction with different kinds of methodologies that exemplify future directions and approaches to the research in teacher induction.

The conduct of prior ethics review of human research projects helps to protect vulnerable groups or populations from potential negative impacts of research. Contemporary considerations in human research considers the concept of vulnerability in terms of access to research opportunities, impacts on the consenting process, selection bias, and the generalisability of results. Recent work questions the validity of using enumerated lists as a check box approach to protect research participants from exploitation. Through the use of broad categories to treat cohorts (...) of human research participants as homogenous classes and label some participants as vulnerable merely because they are members of a particular class, some ethics reviewers have used the National Statement on Ethical Conduct in Human Research to strip individuals of their “ethical equality”. Labelling people as vulnerable does not help researchers or human research ethics committee members develop an understanding of the complexities of applying the principles of respect and of justice in ethical decision-making. Conversely, defining specific cohorts of research participants as needing nuanced ethical consideration, due to their vulnerable nature, may imply that other population groups need not be considered vulnerable. We contend that this assumption is erroneous. This paper explores the way that human research ethics guidance documents treat vulnerability within the Australian context and draws on contemporary discussion to focus an alternative perspective based on the principles in the National Statement on Ethical Conduct in Human Research for researchers and human research ethics committee members to consider. (shrink)

Ample research links mothers’ postpartum depression (PPD) to adverse interactions with their infants. However, most studies relied on general population samples, whereas a substantial number of women are at elevated depression risk. The purpose of this study was to describe mothers’ interactions with their 6- and 12-month-old infants among women at elevated risk, although with a range of symptom severity. We also identified higher-order factors that best characterized the interactions and tested longitudinal consistency of these factors from 6 to 12 (...) months of infant age. We leveraged data from eight projects across the United States (n = 647), using standardized depression measures and an adaptation of the NICHD Mother-Infant Interaction Scales. Overall, these depression-vulnerable mothers showed high levels of sensitivity and positive regard and low levels of intrusiveness, detachment, and negative regard with their infants. Factor analyses of maternal behaviors identified two overarching factors—“positive engagement” and “negative intrusiveness” that were comparable at 6 and 12 months of infant age. Mothers’ ability to regulate depressed mood was a key behavior that defined “positive engagement” in factor loadings. An exceptionally strong loading of intrusiveness on the second factor suggested its central importance for women at elevated depression risk. Mothers with severe depressive symptoms had significantly more “negative intrusiveness” and less “positive engagement” with their 6-month-old infants than women with moderate or fewer depressive symptoms, suggesting a potential tipping point at which symptoms may interfere with the quality of care. Results provide the foundation for further research into predictors and moderators of women’s interactions with their infant among women at elevated risk for PPD. They also indicate a need for evidence-based interventions that can support more severely depressed women in providing optimal care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ethical, Legal, and Social Implications Research Program at the National Human Genome Research InstituteEric M. Meslin (bio), Elizabeth J. Thomson (bio), and Joy T. Boyer (bio)Organizers of the Human Genome Project (HGP) understood from the beginning that the scientific activities of mapping and sequencing the human genome would raise ethical, legal, and social issues that would require careful attention by scientists, health care professionals, government officials, and (...) the public. The establishment of the ELSI (ethical, legal, and social implications) programs at the National Human Genome Research Institute (NHGRI) and the Department of Energy (DOE) was thought to be vital to the success of the HGP in the United States. It also provided a novel approach to the simultaneous study of ethical, legal, and social issues and basic scientific issues. Eric Juengst, the first director of the ELSI program, described its origins in a previous issue of the Kennedy Institute of Ethics Journal (Juengst 1991). Now in its seventh year, the ELSI program has accomplished much. This article summarizes the evolution and goals of the ELSI program at NHGRI, outlines the program’s current research priorities with examples of activities within each priority area, and provides a look to the future, including the initiation of a strategic planning process.Evolution and Goals of the ELSI Research ProgramThe HGP’s “genomic” goals are unique: to map and sequence the entire human genome—some 3 billion base pairs that make up approximately 80–100,000 genes—and the genomes of related model organisms by the year 2005. This goal was particularly ambitious since, when it was proposed, the technologies for mapping and sequencing had yet to be developed. When the HGP was first established, its organizers also elaborated a set of ELSI goals, which they saw as vital to the success of the genome project. The original ELSI goals were: (1) to anticipate and address the implications of the HGP for individuals and society and (2) to examine the ELSI consequences of mapping and sequencing the human genome in order to stimulate public discussion. To meet these goals, the NHGRI created its ELSI research program in 1990. Along with mapping, sequencing, [End Page 291] and mammalian genetics, ELSI was one of four original branches in the NHGRI Division of Extramural Research that funded research in those areas. Although the individual “branches” no longer exist, the mechanisms for funding research remain much the same. While the overall goals of the program have not changed, the specific ways of achieving the goals have continued to evolve. The importance of the ELSI program lies not in the collection of a full set of data that will be valuable in and of itself, but in the value of using and interpreting this new set of information.Early on, the NHGRI described a set of somewhat more specific goals: (1) to develop a program to help understand the ethical, legal, and social implications of the human genome project and (2) to identify and define the major issues of concern and develop policy options to address them. These more specific goals have been largely met. As the most recent biennial NHGRI Progress Report notes, “a robust ELSI research and education program has been established, many of the most urgent ELSI issues have been identified, and many policy options to address these issues have been proposed” (NCHGR 1995, p. 21). Between 1990 and 1996, ELSI provided more than $32.5 million in funding through 128 research and education grants in more than 30 states and in Canada (Table 1). The ELSI research budget is unique in that when originally created, it was specifically tied to the amount of money provided for the overall NHGRI budget. The NHGRI originally devoted 3 percent of its extramural budget to fund ELSI projects, but in FY 1991, it increased the ELSI budget to 5 percent, a figure that remains today. Table 2 lists the expenditures for each fiscal year since 1990 and the cumulative expenditures to date. The ELSI research budget at NHGRI this year will be about $7 million. When other sources of funding—e.g., co-funding arrangements with other institutes and agencies and the funding of ELSI... (shrink)

The ease with which genotyping technologies generate tremendous amounts of data on research participants has been well chronicled, a feat that continues to become both faster and cheaper to perform. In parallel to these advances come additional ethical considerations and debates, one of which centers on providing individual research results and incidental findings back to research participants taking part in genetic research efforts. In 2006 the Industry Pharmacogenomics Working Group offered some ‘Points-to-Consider’ on this topic within the context of the (...) drug development process from those who are affiliated to pharmaceutical companies. Today many of these points remain applicable to the discussion but will be expanded upon in this updated viewpoint from the I-PWG. The exploratory nature of pharmacogenomic work in the pharmaceutical industry is discussed to provide context for why these results typically are not best suited for return. Operational challenges unique to this industry which cause barriers to returning this information are also explained. (shrink)