Coming together and pulling apart: Exploring the influence of functional status on co-resident relationships in assisted living

Social relationships can have considerable influence on physical and mental well-being in later life, particularly for those in long-term care settings such as assisted living (AL). Research set in AL suggests that other residents are among the most available social contacts and that co-resident relationships can affect life satisfaction, quality of life, and well-being. Functional status is a major factor influencing relationships, yet AL research has not studied in-depth or systematically considered the role it plays in residents' relationships. This study examines the influences of physical and mental function on co-resident relationships in AL and identifies the factors shaping the influence of functional status. We present an analysis of qualitative data collected over a one-year period in two distinct AL settings. Data collection included: participant observation, informal interviews, and formal in-depth interviews with staff, residents, administrators and visitors, as well as surveys with residents. Grounded theory methods guided our data collection and analysis. Our analysis identified the core category, “coming together and pulling apart”, which signifies that functional status is multi-directional, fluid, and operates in different ways in various situations and across time. Key facility- (e.g., admission and retention practices, staff intervention) and resident-level (e.g., personal and situational characteristics) factors shape the influence of functional status on co-resident relationships. Based on our findings, we suggest strategies for promoting positive relationships among residents in AL, including the need to educate staff, families, and residents.     

Health technology assessment: trying to bring empirical and ethical inquiry together

A comprehensive assessment of a health technology requires that a wide variety of questions are addressed. These range from whether the use of a technology results in achievement of its intended effects (e.g., better tumour control, pain relief, improved mobility, etc.) at acceptable costs and without incurring undue risks to the patient, to whether its use may challenge existing social arrangements and values (e.g., individual responsibility for preserving good health, the value of human life, etc.). Clearly, this is a major challenge, since it requires the use of quite different methods of inquiry. In the past decades, we have rarely witnessed assessments where both types of questions were addressed in a balanced way. Rather, a wide gap exists between inquiries with a strong empirical focus and an almost complete neglect of underlying normative issues, and inquiries which are largely discursive, but with a serious disregard of relevant empirical data. The complex interplay between normative frameworks and empirical data in the assessment of health technologies is illustrated in two case studies: the assessment of surgical management of children with glue ears, and the assessment of Extra Corporeal Membrane Oxygenation in neonates.

---

Zusammenfassung Die unfassende Beurteilung einer Medizintechnologie erfordert das Angehen einer Vielfalt ganz verschiedener Fragen. Das Spektrum reicht von der Frage, ob der Einsatz einer Technologie die angestrebten Ergebnisse zeitigen wird (z. B. verbesserte Tumorkontrolle, Schmerzlinderung, bessere Beweglichkeit etc.), ob dies zu akzeptablen Kosten möglich ist, und ohne übermäßige Risiken für den Patienten, bis zu der Frage, ob ihr Einsatz bestehende gesellschaftliche Übereinkünfte und Werte bedroht (z. B. die Verantwortung des Individuums für die Erhaltung seiner Gesundheit, der Wert menschlichen Lebens etc.). Dies ist offenbar eine große Herausforderung, da die Beantwortung dieser Fragen den Einsatz verschiedenster Untersuchungsmethoden erfordert. In den vergangenen Jahrzehnten ist nur selten eine Beurteilung erschienen, in der beide Fragentypen auf ausgewogene Weise berücksichtigt waren. Das Bild ist eher das einer weiten Kluft zwischen in hohem Maße empirisch orientierten Studien, in denen die zugrunde liegenden normativen Fragen fast vollkommen vernachlässigt bleiben, und solchen, die weitgehend diskursiv gestaltet sind, dabei jedoch die relevanten Erfahrungsdaten sträflich missachten. Das komplexe Zusammenspiel zwischen dem normativen Rahmen und empirischen Daten in der Beurteilung von Medizintechnologien wird anhand zweier Fallstudien dargestellt: die Beurteilung des chirurgischen Managements von Kindern mit Mittelohrentzündung und die Beurteilung der extrakorporalen Membranoxygenation in Neugeborenen.

---

Résumé Lévaluation complète dune technologie de la santé exige daborder un grand nombre de questions. Celles-ci vont de la question de savoir si la mise en oeuvre dune technologie aboutira aux résultats escomptés (p. ex. meilleure maîtrise des tumeurs, atténuation de la douleur, meilleure mobilité, etc.), à des coûts acceptables et sans risques excessifs pour le patient, à la question de savoir si son utilisation menace le consensus et les valeurs sociales (p. ex. responsabilité de lindividu pour la préservation de sa santé, valeur de la vie humaine, etc.). Ceci est certes un défi de taille, qui exige différentes méthodes détude. Au cours des décennies écoulées, nous avons rarement assisté à des évaluations dans lesquelles ces deux types de questions étaient pris en compte de façon équilibrée. Au contraire, il existe plutôt un profond fossé entre les études mettant fortement laccent sur les aspects empiriques et négligeant presque entièrement les questions normatives sous-jacentes, et les études largement discursives, mais qui ignorent superbement les données empiriques pertinentes. Linteraction complexe entre cadres normatifs et données empiriques dans lévaluation des technologies médicales est illustrée par deux études de cas : lévaluation de la gestion chirurgicale des enfants souffrant dotites, et lévaluation de loxygénation extracorporelle chez le nouveau-né (ECMO).

     

Mexican American women: impact of culture and education on work patterns

The lives of women of Mexican descent are being profoundly affected by their changing workforce participation. They are expected to make up the majority of the female workforce in service occupations by 2010. Based on the literature and personal clinical interactions two factors -- cultural values and education attainment -- consistently appear to have a strong impact on the occupational choices of Mexican American women. This article will explore the interdependence of work, culture, and education on women of Mexican origin.     

Physical aggression and control in heterosexual relationships: the effect of sampling

This study investigated the proposition by Johnson (1995) that there are distinct patterns of physical aggression within relationships, characterized as common couple violence and patriarchal terrorism. The present samples comprised students (N = 113), women from a domestic violence refuge (N = 44), and male prisoners (N = 108). Participants completed measures of physical aggression, controlling behavior, fear of injuries, and injuries. Reports of these measures were entered into a Discriminant Function Analysis (DFA). With the exception of self-reported use of controlling behavior, the variables showed univariately significant differences between the groups. The DFA produced two significant functions which together correctly classified 75% of cases. These results support the view that there are distinct patterns of aggressive relationships corresponding to those identified by Johnson (1995).     

Marriage and immigration enforcement: The impact of Secure Communities on immigrant women

We investigate if increased deportations under the Secure Communities (SC) program impacted the marriage patterns of immigrant women in the United States. We focus on country of origin-MSA deportation rates, arguing this is appropriate given the dominance of endogamous marriage among immigrants and large heterogeneity in removal rates. We find that rising deportations increased marriage rates and endogamous marriage, decreased exogamous marriage to immigrants from other countries, and had no impact on marriage to native-born men. This is striking because SC likely reduced same ethnicity partners in marriage markets. We find some evidence that increased network effects may explain these results.     

Men,women, and clergymen: opinion and authority in a sacred organization

The Church of England faces a potential crisis over the ordination of women to the priesthood. This article presents survey and interview evidence of patterns of clerical opinion on the problem, showing that the trend of clerical opinion is in favour. However, the organizational context of clerical life means that whereas a clergyman's opinion is fateful for women it may have little consequence for the man himself. Clergymen have an assured status conferred by their priest's orders; they are integrated into professional structures and social networks; they exercise an authority which is seldom openly challenged, and they enjoy a high degree of autonomy and freedom from accountability. Since they are able, if they wish, to insulate themselves from women's ministry, they are often indifferent to its future course. It is not, therefore, a matter of material concern in the working lives of most parish clergymen. Yet women's admission to the priesthood is symbolically momentous. Clerical ambivalence about women priests reflects conflict within the sacred organization between the forces of tradition, charisma and rational-legality.     

New technology and its impact on well being

Great changes have come about in the last decade regarding the organization of work. High technology and the steadily increasing ideology of technocracy has produced a profound effect on the organization of work in some workplaces. This effect has made the psychosocial and physical working environment tougher, especially for women. The results we are presenting here show that when dividing fishing factories into three technological stages; low technology, middle technology and high technology, the job strain was highest and the decision authority by the employee was lowest in the high technological factories. This even had an impact on health and on the atmosphere at the workplace, where the employees in the high technological factories were more likely to complain about several health problems as well as about low degrees of cheerfulness at the workplace and tiresome jobs. However, these same people were the most positive towards the implementation of the high technology and the new way of organizing their job that the technology introduced.     

Appliances and their impact: the ownership of domestic technology and time spent on household work

Ever since the appearance of Vanek's pioneering article in 1974, there has been a controversy about whether 'labour saving' domestic appliances actually save labour time. Vanek argued that time spent in housework had barely changed since 1926, despite the diffusion of practically every known domestic appliance over this period. Gershuny and Robinson challenge Vanek's 'constancy of housework' thesis, arguing that, between 1965 and 1985, domestic technology has significantly reduced the weekly hours of women's routine housework. Although there is much talking past each other, none of the protagonists in this dispute have any direct data about which households own or do not own domestic appliances. Instead, they all rely on the passage of the years as a proxy for ownership of domestic appliances, since a higher proportion of contemporary households now own domestic appliances. The Australian 1997 Time Use Survey (Australian Bureau of Statistics 1998b) is rare among official surveys, as it simultaneously provides detailed information on time spent in housework and an inventory of household appliances. The analysis of this data show that domestic technology rarely reduces women's unpaid working time and even, paradoxically, produces some increases in domestic labour. The domestic division of labour by gender remains remarkably resistant to technological innovation.     

Violence and trauma: predicting the impact on the well-being of African American women with severe mental illness

Exposure to violence and trauma has become a major mental health and public health problem in the United States. This study assesses the rates of exposure to traumatic events of 55 adult African American women receiving treatment in an urban community mental health clinic. The study examined three research questions. First, what is the rate of exposure to violence and trauma among African American women in an urban community mental health clinic? Second, what effect does violence and trauma exposure have on mental health? Finally, does exposure to violence and trauma have an effect on well-being as measured with the Medical Outcomes Survey (MOS/SF-36)? A significant negative relationship between diagnostic burden and well-being was found. A negative nonsignificant relationship was found between Posttraumatic Diagnostic Scale (PDS) and wellbeing. Study findings suggest that use of a screening and assessment tool for violence and trauma exposure may have important clinical implications in providing appropriate mental health services to African American women.     

Physical and social barriers to social relationships: voices of rural disabled women in the USA

Through exploring the lived experiences of disabled women, this study investigates how physical and social barriers affect their social relationships. In‐depth tape‐recorded interviews investigating a variety of social and interpersonal issues were conducted with 24 women with physical or visual impairments who lived in a rural region of the midwestern USA. Using content analysis, the researchers examined interview data for common themes and patterns relating to social relationships. The findings indicate that physical barriers, related to the physical environment and personal physicality, along with social barriers, involving preconceptions of others about impairment and restrictions in personal networks, hamper the initiation and maintenance of social relationships. Further, the experiences of this group of disabled women corresponded most closely with the premises of a social relational understanding of disability.     

The money laundering control act and proposed amendments: Its impact on the casino industry

In their efforts to track unreported income, Congress passed the Money Laundering Control Act in 1985. Because they are often involved in large cash transactions, casinos were required to report on cash transactions in amounts of $10,000 or more in much the same manner as banks and other financial institutions. However, because of the unique nature of cash and chip transactions within modern casinos, the Act, or state variants of it, have created significant compliance costs for casinos. This analysis examines the implications of the Act for the casino gaming industry, and evaluates some of the recent suggested Amendments to the Act.     

Coming out of the Shed: Reflections on Men and Fathers

This paper is based upon a keynote address I delivered to the 2000 Australian Family Therapy Conference. The address invited conference participants to reflect on the functional or ‘provider’ roles so often assigned to men as partners and fathers. I link socio‐historical observations about the construction of gender‐based roles, with personal experiences of three generations of men from my own family of origin. I suggest that a continuing division of roles along gendered lines is not serving men well. Nor does it offer many benefits to men's female partners or their children. Practices within family law provide one illustration of persistent gender‐laden attitudes that, in the light of solid experimental evidence on men and fathering over the past twenty years, need to be challenged. Therapists, too, are challenged to reflect on how to engage men in ways that avoid the reinforcement of gender stereotypes.     

Exploring negative peer communication of companies on social media and its impact on organization-public relationships

This study examined whether and how the publics’ negative peer communication (NPC) about companies on social media could influence the quality of organization-public relationships (OPRs) through the theoretical lens of socialization and social learning theory. Through an online survey and a structural equation modeling analysis, results showed that NPC about companies on social media negatively influenced the quality of OPRs. Publics who were more dependent on social media and who had stronger ties with their peers tended to engage more in NPC about companies. Publics who perceived a favorable reputation of the company were less likely to engage in NPC.