Elder care as "frustrating" and "boring": Understanding the persistence of negative attitudes toward older patients among physicians-in-training

ObjectivesThis study explores the attitudes of physicians-in-training toward older patients. Specifically, we examine why, despite increasing exposure to geriatrics in medical school curricula, medical students and residents continue to have negative attitudes toward caring for older patients.MethodsThis study used ethnography, a technique used by anthropologists that includes participant-observation, semi-structured interviews, and facilitated group discussions. Research was conducted at two tertiary-care academic hospitals in urban Northern California, and focused on eliciting the opinions, beliefs, and practices of physicians-in-training toward geriatrics.ResultsWe found that the majority of physicians-in-training in this study expressed a mix of positive and negative views about caring for older patients. We argue that physicians-in-trainings' attitudes toward older patients are shaped by a number of heterogeneous and frequently conflicting factors, including both the formal and so-called “hidden” curricula in medical education, institutional demands on physicians to encourage speed and efficiency of care, and portrayals of the process of aging as simultaneously as a “problem” of inevitable biological decay and an opportunity for medical intervention.DiscussionEfforts to educate medical students and residents about appropriate geriatric care tend to reproduce the paradoxes and uncertainties surrounding aging in biomedicine. These ambiguities contribute to the tendency of physicians-in-training to develop moralizing attitudes about older patients and other patient groups labeled “frustrating” or “boring”.     

“She Got Spoilt”: Perceptions of Victims of Child Sexual Abuse in Ghana

ABSTRACT

International research has commented on social stigma as a key reason for nondisclosure of child sexual abuse. However, the actual components of this social stigma frequently remain unexplored. The present study deals with perceptions of consequences of child sexual abuse among professionals and laypeople in Ghana (N = 44), employing a bystander perspective. As a qualitative study using a grounded theory framework, it considers these consequences in light of their underlying beliefs about child and adolescent development, particularly in relation to gender-based expectations placed on girls and boys. Consequences of child sexual abuse could be divided into sexual health consequences, beliefs about “destroyed innocence” and beliefs about a “destroyed future,” which were strongly related to the sexual nature of the violence perpetrated. These perceived consequences of child sexual abuse hold implications for what surviving child sexual abuse means on a social level. Implications for practice are discussed on the basis of the data analysis.     

What “likes” have got to do with it: Exposure to peers' alcohol-related posts and perceptions of injunctive drinking norms

Objective: Examine 1) whether observed social reinforcements (i.e., “likes”) received by peers' alcohol-related social media posts are related to first-year college students' perceptions of peer approval for risky drinking behaviors; and 2) whether associations are moderated by students' alcohol use status. Participants: First-year university students (N = 296) completed an online survey in September, 2014. Method: Participants reported their own alcohol use, friends' alcohol use, perceptions of the typical student's approval for risky drinking, and ranked 10 types of social media posts in terms of the relative numbers of “likes” received when posted by peers. Results: Observed social reinforcement (i.e., “likes”) for peers' alcohol-related posts predicted perceptions of peer approval for risky drinking behaviors among non-drinking students, but not drinking students. Conclusions: For first-year college students who have not yet initiated drinking, observing peers' alcohol-related posts to receive abundant “likes” may increase perceptions of peer approval for risky drinking.     

Reliability and validity of a new psychometric inventory of childrearing difficulties for evaluating child abuse risk in Japan

Abstract

Child abuse can occur in any family and requires early preventive measures. Here, a new psychometric inventory was developed for detecting child abuse risk based on parental psychological characteristics reported via a self-administered questionnaire by Japanese parents of children below elementary school age (n?=?370). Reliability and validity were tested using factor analysis and examined for correlations with related criteria and Cronbach’s α coefficients. Inventory factors were “Abandonment anxiety” (9 items; α?=?.899), “Anxiety due to lack of confidence” (13 items; α?=?.868), “Suspicion” (5 items; α?=?.832), and “Perfectionism” (7 items; α?=?.793). This inventory will provide a basis for assessing risk of childrearing difficulties and thus child abuse risk for specialists working with Japanese parents.     

Piet Draghoender's Lament

The main purpose of the paper is to provide a context for “Piet Draghoender's Lament, “a most remarkable piece of oral literature composed spontaneously by a 76‐year‐old illiterate Coloured farmer facing eviction from his birthplace. His feelings and attitudes are representative of the entire Kat River community.

The paper explains the claim of the Draghoenders to their land in terms of the concept of “bloedgrond”: the blood which they inherited and the blood which they spilled to “free” the ground and to make it their own. It also analyses the agonised conflict in Draghoender's mind between his innate resentment and his religious conviction that it is his duty to submit to the will of God. The paper concludes by recounting the subsequent history of the Draghoender family, which illustrates the way in which their religious beliefs undermined their ability to fight for their rights.     

Beyond “Dry Drunkenness”: Facilitating Second Stage Recovery Using Wilber's “Spectrum of Consciousness” Developmental Model

ABSTRACT

The usefulness of Wilber's “Spectrum of Consciousness” developmental model in the treatment of substance abuse is demonstrated by a case study that illustrates how underlying emotional pain and intimacy issues can be worked through in the counselling process with a client during the second stage of recovery from addiction. Wilber's model allows for narcissistic, critical self, social, identity, intimacy, existential, and psycho-spiritual issues to be integrated into the counselling process for long-term recovery. This model provides social workers and addictions counselors with a useful map in embracing client recovery.     

Korean American Pastors' Perceptions and Attitudes Toward Child Abuse

Abstract

More than 80 percent of Korean immigrants in the United States attend church on a regular basis. Churches, as informal community organizations, can play a very significant role in protecting children from abuse. This study examines Korean American clerics' knowledge of child abuse, their definition of child abuse, and their familiarity with mandatory child-abuse reporting laws. The study also examines how culture, demographic variables, and individual theological orientation affect their attitudes toward child abuse, mandated child abuse reporting by clergy, and preference of intervention strategies. Major findings include that more than 50 percent of respondents have seen child abuse and neglect among their church members, but the majority who have witnessed child abuse prefer to provide pastoral counseling to the family instead of reporting the case to a child protective agency.     

Understanding Latino Family Attitudes in Relation to Latino Gang Members' Substance Abuse

Abstract

This paper presents a content analysis of ethnographic interviews from long-term Latino gang members whose families have recently immigrated to the United States. Positive relationships within the family, parental support, a consistent and constructive parental discipline style and adult supervision tend to be related negatively to adolescents' deviant behaviors and their association with deviant peers. An expected positive relationship between the parent-child constructs, adolescents' deviant behaviors, and association with deviant peers was not found. Positive family attitudes toward deviance were associated with the number of drug type transactions and greater levels of drug use. This association has been overlooked in previous research.

Our study expands the examination of the influence a family's positive attitudes toward deviance has on the apparent progression of drug use in a sample of Latino gang members with histories of drug use. An analysis of structured interview content differentiated family attitudes toward deviance as: encouragement and tolerance, imitation, and defining norms.     

Response to “A Theoretical Framework”

Abstract

The outcome of social work intervention is often some rearrangement of valuable resources—money, services, power, status—in a family, neighborhood, or community. However, this redistributional effect of social work intervention and the related ethical implications have been largely unexplicated. This paper discusses the nature of distributional questions, examines three alternative approaches to the ethics of distribution—1) classical utilitarianism, 2) intuitionism, and 3) Rawls' “Theory of Justice”—and reviews the criticisms of each. The paper concludes that elements of each of these approaches can apply to social work education and practice and can help guide practitioners to higher levels of ethical consciousness.     

Analysis of perception of training in graduates of the Faculty of Medicine at Universidad de Castilla-Mancha

IntroductionProblem-based learning has been a key component of the teaching method employed at the Faculty of Medicine at the University of Castilla La Mancha (UCLM) in Albacete, Spain since its creation. The aim of this study was to evaluate perceptions of training among residents who graduated from the first three years of the UCLM Degree in Medicine.MethodsUsing the Jefferson Medical College postgraduate rating form, residents rated their performance in four areas of clinical competency (medical knowledge, data gathering skills, clinical judgment, and professional attitudes) at the beginning of residency training in comparison with colleagues from other faculties. The construct validity of responses was evaluated using Cronbach's alpha and exploratory factor analysis.ResultsOver half the respondents (57.8%) considered that they had received better training than peers from other medical schools, and 98.5% felt that their general performance in the four competencies analyzed was similar or superior to that of their colleagues. Factor analysis revealed two major factors: “the physician as scientist” and “the physician as manager and communicator”.ConclusionsOur study shows that graduates from the UCLM Faculty of Medicine perceive their training, which is largely based on problem-based learning, as satisfactory.     

Attitudes of Social Work Students About Substance Abuse: Can a Brief Educational Program Make a Difference?

ABSTRACT

This study examined whether a brief educational program could modify attitudes of master's level social work students about substance abuse. Study methodology involved a two-group pre-test and post-test quasi-experimental design. The Substance Abuse Attitude Survey, a standardized assessment instrument, was used to measure attitudes based on five distinct factors. No significant changes in student attitudes were found after participating in the educational session. Recommendations are offered for how social work schools may enhance their efforts to prepare students to effectively work with substance abusing clients and their families.     

“Family” Support for Family Violence: Exploring Community Support Systems for Lesbian and Bisexual Women Who Have Experienced Abuse

ABSTRACT

“Family” is a euphemistic term that lesbian, gay, bisexual, and transgender (LGBT) people use among ourselves to designate membership in lesbian, gay, bisexual, and transgender communities. Ironically, this “family” may be the most sought, yet least successful, support for dealing with the intimate partner violence that occurs within LGBT families. This study of 11 lesbian and bisexual women's experiences seeking support revealed several tiers of unmet needs within the LGBT community. They rarely used services in the general community, although these services are often the focus of both criticism and efforts to build support systems for LGBT victim/survivors. A model presents the different stages and potential sources of support.     

Diversity-The Competitive Advantage

ABSTRACT

There is increasing pressure on social service agencies to produce “results,” and often agency computer information systems are associated with efforts to do so. The current study explores worker characteristics that may interact with organizational factors in influencing data system utilization. A survey of 245 community social workers serving as field instructors was conducted. Worker skill and experience with computers accounted for a large part of the variance on the utilization of information systems followed by the user-friendliness of the system and the workers' beliefs that data are useful in their work. The findings suggest that organizations seeking to increase worker utilization of information systems will need to focus on enhancing worker's computer skills as well as assuring that the information is easy to use and is perceived as useful by workers.     

Clinical Uses of an Adolescent Intake Questionnaire

Summary

Open dialogue concerning behavioral and environmental risks is key to effective, holistic intervention with urban adolescents. Topics for discussion must include substance use, sexual behaviors and abuse, health concerns, exposure to violence and racism, school performance, and relationships with family and peers. Clinical engagement of adolescents requires focusing the therapeutic relationship on issues of their own choice, at their own pace. This article describes the clinical uses and practice impacts of a comprehensive adolescent self-assessment questionnaire (Adquest). By normalizing sensitive topics and allowing clients to exercise control over the therapeutic agenda and pace, Adquest serves as a “bridge to engagement,” a device for keeping the clinical dialogue open and a mode of induction to the client role. For staff, it represents a way of standardizing and broadening clinical assessment, identifying treatment objectives, and framing psycho-educational interventions.     

Post-Modern Ideas in Substance Abuse Treatment

ABSTRACT

This article describes the use of post-modern ideas in the treatment of substance abusers at a long term residential and day treatment center. It describes some of the changes that ensued as a result of a transformation from a “therapeutic community” (TC) model to a “solution-focused” model. The TC is a deficit model that focuses on a person's flaws and weaknesses. Solution-focused therapy, on the other hand, focuses on what a person has done and is doing right and his or her strengths, assets, and resources. This approach not only improves the quality and effectiveness of substance abuse treatment for clients, but also creates a better working environment for staff.     

Value,Attitude, and Belief Determinants of Willingness to Accept a Facility for the Homeless

Basic values, attitudes toward the homeless, and specific beliefs about a proposed facility were examined, along with the NIMBY (Not In My BackYard) phenomenon, to explore if, and to what degree, these factors affect community acceptance or rejection of a facility for the homeless. Previously designed Protestant ethic (PE) and Humanitarian-Egalitarian (HE) scales were used to measure two basic values (Katz & Hass, 1988). Scales to measure attitudes toward the homeless and beliefs about a planned facility were developed. As predicted, values, attitudes, and beliefs correlated with each other and were related to plan acceptance, so that HE, pro-homeless attitudes, and positive beliefs about the plan were positively related to acceptance, and PE, anti-homeless attitudes, and negative beliefs about the plan were positively related to rejection. Also as predicted, four proximity measures were all related to acceptance of the plan.