“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.     

Satisfaction with Life Scale in Adolescents: Evaluation of Factor Structure and Gender Invariance in a Norwegian Sample

Social Indicators Research - In spite of the significance of life satisfaction (LS) for adolescent health and well-being, the past decades have yielded limited progress in investigating the...     

HIV testing in pregnancy: Using women's voices to inform policy

BackgroundIn Canadian provinces with opt-out policies for maternal HIV screening, pregnant women are told HIV screening is routine and are provided with the opportunity to refuse. In Newfoundland and Labrador an opt-out screening policy has been in place since 1997.PurposeThis research study aimed to (1) obtain an increased understanding of the information women receive about HIV/AIDS during the opt-out screening process and (2) to advance the policy related dialogue around best practices in HIV screening within the province of Newfoundland and Labrador.MethodsTwelve women who were between 14 and 35 weeks gestation participated. Interviews were transcribed verbatim and a thematic analysis was carried out.FindingsThe major themes are that women have difficulty obtaining clear information about maternal HIV screening, are often not told they have the right to refuse maternal screening, and experience paternalism from physicians.ConclusionWe recommend that physicians and other health care providers in be reminded that that current opt-out testing requires women's consent and that women must be given the option to refuse the test.     

The depleted leader: The influence of leaders' diminished psychological resources on leadership behaviors

While much is understood about the outcomes of different leadership styles, less is known about the antecedents of leadership, particularly with regards to how leaders' own psychological well-being impacts leadership behaviors. Using conservation of resources theory as a framework, we investigated the relationship between leaders' depleted resources and their leadership behaviors. Conceptualizing depressive symptoms, anxiety, and workplace alcohol consumption as resource depletion, we predicted that depletion would be associated with lower levels of transformational leadership, and higher levels of abusive supervision, and when taken together, would further exacerbate these effects on leadership behaviors. In a study of 172 leader–subordinate pairs, leaders' depressive symptoms, anxiety, and workplace alcohol consumption separately predicted lower transformational leadership, and higher abusive supervision. Furthermore, partial support was found for an exacerbating effect on transformational leadership and abusive supervision.     

An intensive reunification program for children in foster care

While the Intensive Family Preservation Services (IFPS) model is widely used in preventing out-of-home placement, its application to reunifying foster children with their families has produced mixed results. This pilot project combined elements of the IFPS model with foster care-related services that included foster parent training and support, foster parent-parent linkage, and frequent parental visiting. Of 42 participating foster children, 79% were successfully reunified. At follow-up one year after their exit from the project, 91% of reunified children were still living with their family. Reunification was significantly associated with several characteristics of the families studied.     

Hidden contradictions and conditionality: conceptualisations of inclusive education in international human rights law

The nature of education that children with disabilities should receive has been subject to much debate. This article critically assesses the ways in which the international human rights framework has conceptualised ‘inclusive education’. It argues that the right to education for children with disabilities in international law is constitutive of hidden contradictions and conditionality. This is most evident with respect to conceptualisations of ‘inclusion’ and ‘support’, and their respective emphases upon the extent of individual impairment or ‘deficit’ rather than upon the extent of institutional or structural deficit. It is vital that the new Committee on the Rights of Persons with Disabilities pays close attention to the utilisation of these concepts lest the Convention on the Rights of Persons with Disabilities further legitimises the ‘special needs’ educational discourse to which children with disabilities have been subject.     

Erratum

This paper presents summary statistics of immigration into the West Indies, under indenture or government sponsorship, during the period 1834–1918. The sources reveal a few discrepancies, but are sufficiently consistent to permit the construction of a series for each of the ethnic groups introduced. Most of the problems involved in constructing these series centre around the fact that a variety of sources have to be utilised. Immigration figures of East Indians, Portuguese, Chinese, Europeans and others into the several West Indian colonies have been prepared for each calendar year or season, but to conserve space are presented here in summary form. In the case of African immigration it is possible to give their country of origin. The only group of immigrants who were involved in return movements of any consequence are the East Indians.     

Participatory research and the voice‐centred relational method of data analysis: is it worth it?

Much has been written about participatory approaches in planning and implementing research. The process and practice of participatory data interpretation and analysis is, however, less discussed. This article explores the value of the Voice‐Centred Relational (VCR) method of data analysis and interpretation in the context of participatory research with socially excluded teenagers. Focussing on participatory data analysis, the implementation of the method with teenagers in a West of Ireland town who have left school early is described. Written from the perspectives of academic researchers, members of a research team that included teenagers and a Community Arts artist, this article introduces the VCR method and describes the participatory processes, practices and pitfalls. The challenges of doing participatory interpretation with VCR method are considered.