Reflective Debriefing: A Social Work Intervention Addressing Moral Distress among ICU Nurses

ABSTRACT

Health-care workers may experience moral distress when they are unable to act as they believe is ethically appropriate in their clinical work. A social worker-facilitated protocol called Reflective Debriefing was developed and tested for alleviating moral distress through regular debriefings with nursing staff on an intensive care unit (ICU). Forty-two ICU nurses completed a Moral Distress Scale-Revised (MDS-R) at the beginning and end of a 6-month period, during which time regular debriefings were offered. The overall level of moral distress on the ICU surveyed was found to be low to moderate. The top three most frequent situations causing moral distress reported by most nurses in this study were related to the provision of nonbeneficial care in the ICU. Participants reported gaining the most benefit from feeling empowered to constructively confront other staff members about truth-telling in giving a prognosis. Nurses’ overall response to the intervention was positive, with 100% of participants requesting to continue the Reflective Debriefing sessions either on a monthly or on an as-needed basis. The response to the intervention emphasized the importance of interprofessional collaboration to successfully combat moral distress among health-care workers and may protect them from burnout, detachment, and even quitting their profession.     

Empowering Battered Women by Validating Their Decision-Making Skills

Abstract

Objective: The purpose of this study was to investigate levels of moral reasoning among a sample of battered women and compare them with a national normative sample.

Method: The study involved collecting Defining Issues Test (DIT) data from 50 women (age, M = 33, SD = 10) beginning their stay at a shelter for battered women. Unlike the original method of assessing moral reasoning involving a lengthy interview, the DIT is a multiple-choice test. Consequently, it is easy to administer and score and, over the last 20 years, it has become the most widely used instrument for assessing moral reasoning.

Results: Analysis indicated that the battered women comprising the sample were employing levels of moral reasoning comparable with the national normative sample.

Conclusion: Implications of the findings for countering arguments that battered women are morally immature in the way in which they approach the stay/leave decision were explored and discussed.     

Early and Middle Adolescents' Reasoning About Moral and Personal Concerns in Opposite‐sex Interactions

This study examined how adolescents coordinate personal and moral concerns in reasoning about opposite‐sex interactions. Sixty‐four early and middle adolescents (Ms = 12.74, 16.05 years) were individually interviewed about two hypothetical situations involving opposite‐sex interactions (commenting on appearance, initiating a date), presented in four conditions that varied the salience of personal vs. moral concerns. Overall, participants viewed opposite‐sex interactions as harmless and acceptable in personal conditions, but as moral concerns became more salient, they were viewed more negatively, as less contingent on the target's response, and as entailing humiliation, coercion, and victimization. Age differences occurred primarily in reasoning about conditions entailing mixed‐personal and moral concerns. Implications for adolescents' understanding of harassment and victimization are discussed.     

Experiencing Civil Unrest: Elder Voices on Ferguson

ABSTRACT

Ferguson, Missouri became the center of the nation’s attention when an unarmed African American teenager was killed by a Caucasian police officer. Civic unrest continued for weeks. The aim of this study was to learn how older adults experienced the social unrest. Ten focus groups were conducted with 73 participants. Eight themes were identified. Issues related to safety were most commonly discussed. Participants reported a breakdown in intergenerational communications and expressed a desire for more exchange. Findings are being discussed with relevant organizations to increase the involvement of older adults in on-going community development efforts and to provide opportunities for intergenerational dialogue.     

Transformation of Social Care Services for the Elderly in Slovakia

ABSTRACT

The main objective of this article is to present a theoretical framework for the relevant historical, economic, demographic, and political factors influencing the transformation of social care services for the elderly in Slovakia. A major restructuring of the social care services for the elderly is necessitated by the aging of the Slovak population (demographic reason), the path dependency of the current Slovak elderly care system (historical reason), the growing purchasing power of older people and the general population (economic reason), and new requirements formulated by the European Union and the general public (political reason). Historical documents, legislative acts, strategic documents, international project documents, and statistics were reviewed, and 34 open-ended interviews within the framework of two case studies were carried out in order to obtain qualitative and quantitative data. The theoretical framework and the results based on those interviews indicate that the Slovak social care service for the elderly may turn out to become more similar to the advanced Central European systems, but also that prompt legislative and financial changes are required. Nevertheless, the future direction can only be more precisely identified when more case studies can be compared with one another.     

Pathways to age-friendly communities in diverse urban neighborhoods: Do social capital and social cohesion matter?

ABSTRACT

Using a social capital and social cohesion lens, we reposition the concept of civic engagement among older adults to examine pathways for building age-friendly communities. We analyzed data drawn from a Community-Based Participatory Research study in the Southern U.S. that explored lived experiences of older adults, age 55 and above, who participated in individual interviews (n = 15) and six focus group discussions (n = 45) to examine their perceptions of social identity, social connectedness, and civic engagement geared toward an age-friendly city. Findings indicated that several older adults had access to social networks and socially invested resources, thereby having opportunities for civic engagement and building age-friendly neighborhoods. However, social, cultural, linguistic, and structural barriers were more evident among certain diverse ethnic populations. Marginalized low-income minorities and immigrants, such as Hispanic participants, felt the lack of social cohesion among the larger society limited their ability to give back, thus decreasing their civic engagement activities. In contrast, Caucasian and African-American older adults were able to contribute to the political process through more civic participation activities. We provide implications for examining the role of social capital and social engagement to bolster civic engagement among older adults in building age-friendly communities.     

Science resource inequalities viewed as less wrong when girls are disadvantaged

In response to some resource inequalities, children give priority to moral concerns. Yet, in others, children show ingroup preferences in their evaluations and resource allocations. The present study built upon this knowledge by investigating children's and young adults’ (N = 144; 5–6-year-olds, M_age = 5.83, SD_age = .97; 9–11-year-olds, M_age = 10.74, SD_age = .68; and young adults, M_age = 19.92, SD_age = 1.10) evaluations and allocation decisions in a science inequality context. Participants viewed vignettes in which male and female groups received unequal amounts of science supplies, then evaluated the acceptability of the resource inequalities, allocated new boxes of science supplies between the groups, and provided justifications for their choices. Results revealed both children and young adults evaluated inequalities of science resources less negatively when girls were disadvantaged than when boys were disadvantaged. Further, 5- to 6-year-old participants and male participants rectified science resource inequalities to a greater extent when the inequality disadvantaged boys compared to when it disadvantaged girls. Generally, participants who used moral reasoning to justify their responses negatively evaluated and rectified the resource inequalities, whereas participants who used group-focused reasoning positively evaluated and perpetuated the inequalities, though some age and participant gender findings emerged. Together, these findings reveal subtle gender biases that may contribute to perpetuating gender-based science inequalities both in childhood and adulthood.     

Exploring the Concept of Moral Distress with Community-Based Researchers: An Australian Study

ABSTRACT

Community-based research (CBR) refers to an applied research methodology that is conducted in community settings in partnership between academic and nonacademic participants in research. This article reports on a series of in-depth interviews conducted with 11 Australian CBR researchers between 2008 and 2009. The interviews were designed to explore whether university-employed CBR researchers experience the particular phenomenon of “moral distress,” or feelings of helplessness to act in accordance with one's moral values due to systemic or institutional constraints. Study results found that the CBR researchers experienced unavoidable moral distress at varying levels of intensity related to blurred boundaries between settings, participants, and stakeholders. Based on the outcomes of this study, further research and enhanced professional development and training practices are recommended.     

Effects of a Solution-Focused Program on the Reduction of Aggressiveness and the Improvement of Social Readjustment for Korean Youth Probationers

ABSTRACT

The purpose of this investigation was to explore appropriate intervention methods for helping Korean youth probationers reduce their aggressiveness and increase their social adjustment. This study examined the effectiveness of solution-focused group treatment with Korean youth probationers using a pre- and post-test control group design. The researcher randomly assigned the consented 40 participants either to an experimental group that received the solution-focused session or to a control group that took individual supportive sessions on a needed basis. The pre- and post-test scores of each group were compared using the Aggressiveness and Social Readjustment Questionnaire to confirm the levels of statistical significance between the two groups. Results indicate that solution-focused group treatment was followed by positive changes with the participants' aggressiveness and social adjustment problems. This study also suggests that a solution-focused program is an appropriate short-term intervention for Korean probation youth.     

Mindfulness-based forgiveness groups for older adults

ABSTRACT

Interventions that enable individuals to be more forgiving toward themselves and others are important for older adults. This article describes a group intervention for adults aged 60 or older that integrates forgiveness-related skills with a mindfulness approach. The Mindfulness-based Forgiveness Group was designed to meet for eight sessions. The skills taught included: recognizing one’s own expectations and unenforceable rules, broadening one’s perspectives about the context of the transgression, and discovering positive intentions through exercises as well as a variety of meditations to cultivate mindfulness, self-compassion and forgiveness. Data from five Mindfulness-Based Forgiveness Groups were collected. Based on pre- and post-test measures, analyses indicate that participants improved significantly in relation to forgiveness, mindfulness/self-compassion, and mental health. Using qualitative post-test data from participants, we identify elements of the intervention that appear to be helpful. Suggestions are provided for social workers seeking to replicate and build upon this promising intervention.     

Bidirectional relations among empathy‐related traits,prosocial moral reasoning,and prosocial behaviors

This study examined the longitudinal links among empathic concern, perspective taking, prosocial moral reasoning, and prosocial behaviors. Four hundred and seventeen adolescents (225 girls; M_age = 14.70 years) from public schools in Spain completed measures of those constructs in three successive years. Path analyses showed support for the notion that empathic concern and prosocial moral reasoning accounted for the relations between perspective taking in earlier adolescence and later altruistic and public forms of helping. Moreover, there was support for a reverse causal model such that empathic concern and prosocial moral reasoning mediated the relations between altruistic (but not public) helping behaviors in earlier adolescence and later perspective taking. The implications for cognitive developmental and social cognitive theories of prosocial development were discussed.     

Building a Latino Youth Program: Using Concept Mapping to Identify Community-Based Strategies for Success

ABSTRACT

In this study, a mixed methodology called concept mapping was used to bring 233 community members together to identify culturally relevant intervention strategies that could be used in developing a program for Latino youth. Three phases of data collection were completed to generate and rank 66 desirable strategies clustered around three goals: 1) staying in school, 2) developing positive social and family roles, and 3) bridging American and Latino cultures. An analysis of the rankings revealed differences in priorities between youth and adults. The results indicate that concept mapping can be useful in the development of community-based programs.     

Barriers to the Use of Mental Health Services by African-American and Hispanic Elderly Persons

Abstract

This study discusses barriers to the utilization of community-based mental health services by African-American and Hispanic elderly persons. The study sample consists of “key Informants,” chosen because they were knowledgeable about the mental health needs and use of mental health services by African-American or Hispanic elderly persons. Principal component analysis using orthogonal rotation was conducted on the 23 item barrier scale and identified three levels of service barriers for the entire sample and for each subsample of African-American and Hispanic informants. Based upon the study findings, a number of strategies are offered to improve Utilization and overcome service delivery barriers.     

Enriching our understanding of vulnerability through the experiences and perspectives of individuals living with mental illness

ABSTRACT

Vulnerability is a central concept in research ethics and typically serves to identify individuals or groups whose participation in research prompts specific concerns or warrants special consideration. While theoretical discussions on vulnerability have contributed valuable insights to discussions of mental health research and care, they have not been enriched thus far by stakeholder perspectives. This oversight has important consequences for the ways in which we frame vulnerability. It misses the far-reaching insights and experiential knowledge of mental health research participants whose experiences this ethics concept ultimately seeks to capture. In view of this gap, our study combines a pragmatist ethics framework and interpretive phenomenological analysis of qualitative interviews to explore user perspectives on the notion of vulnerability through the lived experiences of mental health research participants and patient-advocates. Importantly, these perspectives offer essential clues to address the difficulties of operationalizing concerns for vulnerability in concrete and practical ways. They help refine our understanding of this key ethics concept.     

Impacts of child development accounts on parenting practices: evidence from a randomised statewide experiment

ABSTRACT

This study examines the impact of Child Development Accounts (CDAs) on parenting practices of mothers with young children in a statewide randomised experiment conducted in the United States. The experiment included 2704 primary caregivers of children born in Oklahoma during 2007: 1358 were randomly assigned to the treatment group and 1346 to the control group. Structural equation modelling suggests that the punitive-parenting score among treatment participants was .12 standard deviations smaller than that among control participants (p < . 05). Findings indicate that CDAs reduce punitive parenting, and may serve as an additional tool for positive parent–child interactions.     

A theoretical model of religiosity and drug use with reciprocal relationships: A test using structural equation modeling

Abstract

This study of 1093 adolescents from 6 public high schools was designed to test a hypothesized model formulated by theoretical elaboration of control theory with elements from social learning theory using structural equation modeling procedures. The primary purpose was to establish that religion is relevant to illicit drug use when its direct, indirect and reciprocal effects are tested within a more complete system of relationships than found in existing studies. Most aspects of the model were supported by data and religion had direct inverse effects on illegal drug use for all adolescents studied. However, the feedback effects of drug use on religion were significant only among younger adolescents and females. Other age and gender differences were observed when the hypothesized model was tested with structural equation modeling procedures. The implications of these findings were discussed in regard to future conceptual work and intervention.     

Japanese Children's Reasoning about Conflicts with Parents

Ninety-five Japanese children (aged 6–12) were interviewed using hypothetical stories to examine their reasoning about parent–child conflicts. Participants were most likely to reject parental authority and to support child's discretion in conflict situations where the parent interfered in the child's personal choice and gave the child commands that violated moral and conventional principles. However, participants were most likely to accept parental authority when the child's wish conflicted with the parent's moral concern. Participants' reasoning was more varied when the child's wish went against the parent's conventional demand. Consistent with their cultural values, participants considered harmonious relationships in evaluating conventional and personal conflicts, but not moral conflicts. Age differences were observed in the endorsement of personal choice. Results suggest that children do not simply act upon their cultural values but also show resistance to parental authority for reasons beyond meeting selfish needs and form differentiated judgments about parent–child conflicts.     

Community Responses to Chronic Technological Disaster

SUMMARY

A case study method was used to examine factors that contribute to community response to chronic technological disaster and to consider the dynamics that evolve within these communities. The Social Process Model (Edelstein, 1988) provided a theoretical framework for the study. Findings provided evidence of multiplicity of impacts regarding the pollution of water resources. Factors influencing community response include history, environmental awareness, economics, and community participation. Considering the longevity of disaster, communities may be forced to try different strategies to minimize its impacts. Community activism represents the most significant strategy in responding to the disaster.     

Do Marginalized Youth Experience Strengths in Strengths-Based Interventions? Unpacking Program Acceptability through Two Interventions for Sexual and Gender Minority Youth

ABSTRACT

Strengths-based interventions have potential to improve the wellbeing of sexual and gender minority youth (SGMY). This study examined the youth program acceptability of two strengths-based programs tailored for SGMY: ASSET (group counseling), and strengths first (SF) (care coordination). A mixed-methods approach was applied to secondary data extracted from client files (n = 247). Most participants were aged 15–18 (89%). Gender identities included woman (66%), man (30%), and transgender (<1%). Sexual orientations included bisexual (32%), lesbian (26%), gay (23%), and queer/pansexual (14%). Most participants identified as White, Hispanic (47%), Black, Non-Hispanic (17%), and Hispanic, No other race (19%). Program acceptability was measured using the 11-item Youth Acceptability and Strengths Scale. Quantitative analyses indicate program acceptability was high for SGMY participants and did not significantly differ across program type, gender identity, sexual orientation, or ethnoracial identity. There were no differences between strengths enhancement or client satisfaction between intervention types. Compared to group counseling, care coordination significantly increased problem-solving skills. Qualitative analysis identified that strengths-based interventions provided: (a) social support; (b) community; (c) confidence; and (d) positive mentors. Findings demonstrate the acceptability of strengths-based programming for SGMY. Strategies are provided to incorporate intervention program acceptability, yet future research is needed to explore youth acceptability.