The tidal model. The healing potential of metaphor within a patient's narrative

1. The human experience of growth and development is a fluid phenomenon, occurring in small, barely visible changes. 2. The Tidal Model embraces a patient's expression of his or her experience by focusing on the lived experience of the narrative and its personally meaningful metaphors and symbols. 3. To re-empower a patient, the Tidal Model assessment is written in the patient's own voice and all care planning is conducted conjointly. 4. The Tidal Model was developed from empirical studies of the perceived need for nursing and the process of empowerment in clinical nursing practice.     

Net migration and migration effectiveness: A comparison between Australia and the United Kingdom, 1976–96 Part 1: Total migration patterns

A nation’s population is redistributed through migration flows and counterflows between its constituent subnational areas, resulting in a geographical pattern of net migration gains or losses which may change from one time period to another. Migration effectiveness is the indicator commonly used to measure net migration as a proportion of gross migration turnover for any territorial unit. This paper explores the effect of net migration in two different countries, Australia and the United Kingdom, using measures of migration effectiveness computed from period-age migration data sets for a system of city regions assembled for four consecutive five-year periods in each country. While the evidence suggests that the overall effectiveness of net migration has declined over the 20-year period in both countries, marked similarities and contrasts are apparent in the spatial patterning of migration that together provide useful analytical insights into the changing space economies of the two countries.     

The impact of high-calorie-expenditure exercise on quality of life in older adults with coronary heart disease

The acceptability of a high-calorie-expenditure (HCE) exercise program in older coronary heart disease patients participating in a behavioral weight-control program was evaluated. Seventy-four overweight patients (median age 63 yr) were randomly assigned to a 5-mo intervention of HCE exercise (3,000-3,500 kcal/wk daily walking) or standard cardiac-rehabilitation (CR) exercise (700-800 kcal/wk). Both groups received counseling to achieve a dietary caloric deficit of 3,500 kcal/ wk. Assessments at baseline and 5 mo included self-reported measures of quality of life and psychosocial variables. The HCE group experienced significantly greater weight loss (8.2 ± 4 vs. 3.7 ± 5 kg, p < .001). Changes from baseline to 5 mo on scores of physical, emotional, and social functioning were greater for the HCE than CR group (p < .05). HCE exercise also resulted in greater positive change in exercise enjoyment (p = .05), which was mediated by weight change. Even high-risk older adults can be successful in an HCE exercise program and experience no adverse physical or emotional changes.     

Job Strain, Effort-Reward Imbalance and Mental Distress: a study of occupations in general medical practice

There is increasing evidence to support the predictive power of social epidemiological models such as Effort-Reward Imbalance (Siegrist, 1996) and the Job-Strain Model (Karasek, and Theorell, 1990) for explaining occupational stress, although it has been suggested that the models may have distinctive contributions towards explaining work stress in specific work settings. Alternatively, it has been suggested that the explanatory power of the different models might be enhanced if they were combined. The aim of this paper is to explore these questions by examining the power of the two different models both separately and in combination for explaining job satisfaction and mental distress in general medical practice. This analysis was based on data collected from a postal survey of the members of staff (N=1089, response rate = 70%) of 81 practices, which were randomly selected from all general practices in the National Health Service Executive South East region. The results show that while both models were predictors of mental distress and job satisfaction the models that combined different dimensions were the strongest predictors.     

Contextualizing Business Ethics: Anomie and Social Life

The objective of this paper is to explore howthe current interest in Business Ethics can be locatedwithin an analysis of contemporary society which takesinto account the prevalence of moral uncertainty along with the concomitant desire to(re)establish some form of normative order. As such,Business Ethics may be seen as a socially constructedfield of study which reflects broaderchanges and controversies within society. Yet as a body of knowledge,Business Ethics articulates epistemological doubts. Twodistinctive themes in Business Ethics discourse areconsidered — the modernist/rationalist and thepostmodernist/relativist. It is argued that in different ways, each canbe seen as both an expression of, and a reaction to, theincreasing incidence of anomie in society. Theimplications for organizational practices are thenconsidered through the example of Corporate Codes ofEthics and the problem of establishing consensus wherethe grounds for any claim to moral authority areproblematic.     

Positivism: paradigm or culture?

Much post-positivist policy theory implies that positivism exists as a self-protecting paradigm. Inspired by a one-sided reading of Kuhn, this understanding suggests that policy positivism must be overcome as a whole. This approach is problematic. In particular, there are important contradictions between various elements commonly said to be part of the positivist paradigm, contradictions that make it difficult to believe that the paradigm can be embraced as a whole. An alternative approach views positivism as a culture. Since components of any culture can evolve independently of each other, a cultural approach would focus its critique on specific dimensions of positivism. This approach would provide more rigor to policy critique, and push post-positivists to overcome weaknesses in their own theories, in particular those concerning the question of truth.