Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.     

Caring for the caregivers

National Family Caregivers month is a reminder of the invaluable contributions of family caregivers--contributions that are too often unrecognized when addressing the costs of health care. Unpaid caregivers spend a substantial percentage of each week "helping out," often with older relatives, which requires major changes in their work patterns. It is clear that these caregivers may need help balancing their work and caregiving responsibilities, and it is tempting to want to help them by "taking over" some of the seemingly overwhelming tasks they face daily. Yet, it is also important to recognize the ways in which these tasks may enrich caregivers' own quality of life. Through listening to caregivers, nurses and other health care professionals can better understand the embedded values, goals, joys, and disappointments that connect their lives with those for whom they care.     

Relationship of interpersonal behaviors and health-related control appraisals to patient satisfaction and compliance in a university health center

OBJECTIVE: The authors' aim was to evaluate patient-provider relationships in a college health center. PARTICIPANTS: Eighty student patients and their health-care providers. METHODS: Patients completed a measure of perceived health competence before a consultation and measures of provider participatory behavior and interpersonal behavior before and after the consultation. They evaluated their satisfaction with care and compliance after the consultation and again 2 weeks later. Providers completed measures of their participatory behavior and patients' interpersonal behavior after the consultation. RESULTS: Patients preferred to be well informed and to have their preferences taken into account, and generally felt competent at managing their own health affairs. They indicated they obtained the high level of participation they desired. Patients desired and actually experienced friendly and submissive providers. Degree of match between patients' desired and actual level of involvement in their care was associated with greater satisfaction. A greater match between the extent to which they desired the provider to be affiliative and the provider's actual affiliative behavior was associated with more satisfaction. No variables were predictive of patient compliance. CONCLUSION: The authors discuss results in terms of the influence of situational factors characteristic of a college health center.     

Making Sense of Organizational Change: Voices of Older Volunteers

The role of voluntary and community sector organizations in the delivery of public services is increasing and these changes bring new responsibilities and benefits to organizations that have the capacity to participate. There are concerns within the sector about the implications for citizenship and participation. The sector is highly dependent on volunteers yet little is known about how organizational change in response to new relationships with the statutory sector impact upon the commitment and well-being of people who volunteer. This paper addresses that gap in knowledge for older volunteers. Drawing upon collaborative research with a voluntary organization in the north of England, the authors explore the meanings and aspirations of volunteering for older people, and explain how and why changes associated with closer engagement with public service delivery and less grant dependency can be disempowering for them.

Strengths-Based Approach and Coping Strategies used by Parents Whose Young Children Exhibit Violent Behaviour: Collaboration Between Schools and Parents

This research study explores the strategies adopted by 60 parents of children between 3 and 9 years of age considered to have engaged in violent behaviour, within the meaning of the Safe Schools Act (Ontario Ministry of Education, Canada, 2000). This legal framework requires parents to be involved in the decisions concerning their children. Parents’ perceptions of their involvement lead them to develop coping strategies enabling them to play a more active role in such decision making. This article analyzes their perceptions according to a strengths-based approach and seeks to provide a mediation perspective to social work practice with families.

Pearls and pitfalls in evaluating a Student Assistance Program: a five-year case study

This article presents data from a five-year evaluation-research case study of a large urban schools district's internal Student Assistance Program (SAP). The district employed specially trained and licensed school-based counselors to implement an internal SAP expanded to include tertiary prevention, and modeled after an employee assistance program established for adults. From the population of more than 10,000 students who received some type of program assistance for at-risk behaviors, a stratified random sample of 2,238 cases, over a five year period, were reviewed. Results indicate a statistically significant decline (p < .05) in students' drug use and a significant improvement in internal locus of control occurred each year. While not statistically significant, the average number of student discipline referrals was less than the year prior to program admission; however, there was no significant change in academic performance. A significant correlation between students' drug use and the amount of time in program, the type of assistance received, and the student's custody status was also found.     

The making of US monetary policy: Central bank transparency and the neoliberal dilemma

This article explores the implications of the Federal Reserve’s shift to transparency for recent debates about neoliberalism and neoliberal policymaking. I argue that the evolution of US monetary policy represents a specific instance of what I term the “neoliberal dilemma.” In the context of generally deteriorating economic conditions, policymakers are anxious to escape responsibility for economic outcomes, and yet markets require regulation to function in capitalist economies (Polanyi 2001). How policymakers negotiate these contradictory imperatives involves a continual process of institutional innovation in which functions are transferred to markets, but under the close control of the state. Thus, under transparency, Federal Reserve officials discovered innovations in the policy process that enabled “markets to do the Fed’s work for it.” These innovations enlisted market mechanisms, but did not represent a retreat from the state’s active role in managing the economy.

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The critique of intelligent design: Epicurus,Marx, Darwin,and Freud and the materialist defense of science

A new version of the age-old controversy between religion and science has been launched by today’s intelligent design movement. Although ostensibly concerned simply with combating Darwinism, this new creationism seeks to drive a “wedge” into the materialist view of the world, originating with the ancient Greek philosopher Epicurus and manifested in modern times by Darwin, Marx, and Freud. Intelligent design proponents thus can be seen as challenging not only natural and physical science but social science as well. In this article, we attempt to explain the long history of this controversy, stretching over millennia, and to defend science (especially social science) against the criticisms of intelligent design proponents – by defending science’s materialist roots.

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