“She was a little bit unrealistic”: Choice in healthcare decision making for older people

This paper examines autonomy, choice, options, and power in healthcare decision making for older people. Using discourse analysis and a case study from data gathered as part of an ethnographic field study we critique a common conceptualization of healthcare decision making as patients choosing from an array of options offered by healthcare providers. A discourse of “giving options and being realistic” used by healthcare providers is contrasted with the experience of a single patient's transitional care from hospital to home after hip fracture. This illustrates how a wide variety of actors, institutions, values, and resources take precedence in determining a discharge destination. While the accounts given by healthcare providers cast patient choice in respectful terms, an ethnographic approach illustrates that the “choices” are structured by a discourse which simplifies the complexity of what is offered and who gets to choose. In the case study the patient's choice was subjugated by expertise and institutional concerns; her options were largely illusory; and her autonomy was “at risk” due to her age, poor health, and limited resources. We use Foucault's ideas about discourse and governmentality to question the scope of agency in healthcare decision making. We argue that the conceptualization of informed patients making autonomous choices acts as “misdirection” which deflects problem solving and discussion away from a productive examination of the differences between healthcare system offerings and client needs. We conclude by posing questions to reorient the debate surrounding healthcare decision making for older adults and recommend a more participatory approach to designing social services.     

The role of mindfulness in romantic relationship satisfaction and responses to relationship stress

Two studies examined the role of mindfulness in romantic relationship satisfaction and in responses to relationship stress. Using a longitudinal design, Study 1 found that higher trait mindfulness predicted higher relationship satisfaction and greater capacities to respond constructively to relationship stress. Study 2 replicated and extended these findings. Mindfulness was again shown to relate to relationship satisfaction; then, using a conflict discussion paradigm, trait mindfulness was found to predict lower emotional stress responses and positive pre- and postconflict change in perception of the relationship. State mindfulness was related to better communication quality during the discussion. Both studies indicated that mindfulness may play an influential role in romantic relationship well-being. Discussion highlights future research directions for this new area of inquiry.     

Risk Perceptions,Optimism, and Natural Hazards

This article uses the panel survey developed for the Health and Retirement Study to evaluate whether Hurricane Andrew in 1992 altered longevity expectations of respondents who lived in Dade County, Florida, the location experiencing the majority of about 20 billion dollars of damage. Longevity expectations have been used as a proxy measure for both individual subjective risk assessments and dispositional optimism. The panel structure allows comparison of those respondents' longevity assessments when the timing of their survey responses bracket Andrew with those of individuals where it does not. After controlling for health effects, the results indicate a significant reduction in longevity expectations due to the information respondents appear to have associated with the storm.     

The Impact of Economic Shocks on Quality of Life and Social Capital in Small Towns*

Abstract Economic shocks are sudden events causing a significant impact on the local economy. Disaster community literature predicts that community outcomes from shocks will depend on the kind of shock. Consensus crisis shocks will be followed by increases in social capital and quality of life. Corrosive community shocks will result in declines in these factors. Using longitudinal data from small towns, we find that shocks are not associated with declines in quality of life or social capital, however, certain kinds of shocks are followed by increases. The strength of shocks and the net cumulative effects of multiple shocks are related to social capital and quality of life. This analysis advances conceptualizations by unpacking shock events and suggesting that strength and effect of multiple shocks are as important as shock type.     

Parenting schemas and the process of change

Parents' childrearing behaviors are guided by schemas of the caregiving role, their functioning in that role, what children need in general, and what their own children are like in particular. Sometimes, however, parenting schemas can be maladaptive because they are too rigid or simple, involve inappropriate content, or are dominated by negative affect. In this article, we describe parenting schemas and provide an overview of empirical work documenting the characteristics of maladaptive parenting schemas. We review how intervention practices common to multiple therapeutic approaches (cognitive-behavior therapy, family therapy, parent training, attachment-based interventions, and psychoanalytic parent-infant psychotherapy) attempt to modify schemas to promote more optimal functioning among parents. We highlight how research in cognitive science may explain, in part, treatment effectiveness.     

Racing to Theory or Retheorizing Race? Understanding the Struggle to Build a Multiracial Identity Theory

Empirical research on the growing multiracial population in the United States has focused largely on the documentation of racial identification, analysis of psychological adjustment, and understanding the broader political consequences of mixed-race identification. Efforts toward theory construction on multiracial identity development, however, have been largely disconnected from empirical data, mired in disciplinary debates, and bound by historically specific assumptions about race and racial group membership. This study provides a critical overview of multiracial identity development theories, examines the links between theory and research, explores the challenges to multiracial identity theory construction, and proposes considerations for future directions in theorizing racial identity development among the mixed-race population.     

Nurturing life-science knowledge discovery: managing multi-organisation networks

Advancement of knowledge is the seed of the innovation process. As innovations have become more complex, organisations are driven by an increased need to collaborate in order to combine specialist capabilities to meet emerging market needs. The life sciences are one sector where collaborative innovation is highly evident. This article examines the phenomenon of knowledge-generating networks within the life sciences. The study explores the drivers of collaborative endeavours and investigates how knowledge networks linking the capabilities of public research centres and commercially focused pharmaceutical organisations can be managed to deliver the required synergistic benefits for partnering organisations. Three case studies of functioning university–industry knowledge networks are analysed and a model reflecting their network's life-cycle phases is presented. The discussion identifies the specific challenge posed at each of the network's development stages, together with the management process required to secure sustainable knowledge creation and effective transfer of this knowledge into innovation-generating R&D.     

NGOs and rural movements in contemporary South Africa

This article provides a critical examination of relationships between non-governmental organisations (NGOs) and rural movements in post-apartheid South Africa, particularly with regard to the possible subordination of movements to NGOs. In discussing NGOs as a particular organisational form, and in reviewing some arguments pertaining to NGOs and rural movements globally, I explore whether NGOs in South Africa have a progressive role to play in agrarian transformation.     

24-month update on the impact of roundtables on permanency for youth in foster care

Although the number of children in foster care has decreased in recent years (U.S. DHHS, 2012), additional strategies are needed to help youth achieve legal permanency before they age out of foster care. One such strategy is the permanency roundtable, which convenes a team of professionals to facilitate the permanency planning process by identifying realistic solutions to permanency obstacles for youth. Nearly 500 youth went through the initial permanency roundtable process in Georgia in 2009. Just over half were male (57%) and over nine in ten (92%) were African American. At the start of the roundtables, the median age was 13, and the median length of stay in foster care was 52 months. Two years after their roundtable, 50% of the nearly 500 children had achieved legal permanency. Analyses, presented separately for three age groups (0–6, 7–12, and 13–18), examine outcomes and predictors of legal permanency. Recommendations, limitations, and areas for future research are discussed.     

Have You Had Your Lunch Yet? A Case Study on Teaching International Social Work Students

The literature relating to university education is rife with commentary about internationalisation. The rhetoric of positing themselves in the international context appears to have entered the lexicon of most universities. However, the drivers for internationalisation appear largely economic and less has been said about some of the realities involved in moving to an internationalised position. Internationalisation raises many tensions for the university and for academic staff. This discussion reflects on the experience of one Australian university programme offering social work education in a non-Australian context. It seeks to highlight some of the learning from the experience and suggests opportunities for the adoption of a more transformative approach to internationalisation of social work education.