Practitioners' Documentation of Assessment and Care Planning in Social Care: The Opportunities for Organizational Learning

This paper analyses practitioners’ documentation of socialcare assessments and care plans for disabled adults of workingage. The data were collected in the course of an innovativeproject that introduced new outcome-focused documentation intoroutine social care assessment, care management and review processes.The project aimed to encourage practitioners to focus duringthese processes on the full range of outcomes that individualdisabled adults might seek to achieve; and identify the appropriateservices for realizing those outcomes. Analysis of the new documentationprovides insights into the diverse range of priorities and outcomesthat service users aspire to achieve as a result of receivingservices, and the service inputs that were agreed between practitionersand service users. However, despite the new documentation, themajority of both outcomes and services that were recorded tendedto cluster around a fairly narrow range of conventional socialcare service functions. Moreover, the emphasis of both outcomesand service inputs differed between different groups of socialcare professionals. In the context of current policies to makesocial care services more individualized and outcome-focused,each of these findings has major organizational implications.The opportunities for using routine practitioner documentationto identify areas of organizational and professional changeand learning are discussed.     

Population health performance as primary healthcare governance in Australia: professionals and the politics of performance

ABSTRACT

A range of institutional and financial instruments has been used to drive population health outcomes in primary health care in Australia. However, GP sovereignty and the corporatized nature of general practice have generated major challenges. The core of government reform strategy since 1992 has been the creation and financing of Primary HealthCare Organizations (PHCOs), in various forms, to provide an organizational basis to connect GPs to population health performance, and a closer link between the state and GPs. The shift from Divisions of General Practice, the first PHCO, to Medicare Locals (MLs) in 2011 was notable. The latter constructed the object of performance as a raft of broader population health goals, which were framed in terms of accountability to communities through public reporting. Drawing on interviews with Federal government, health professional associations, ML executives and GPs, this paper examines the ways in which such performance instruments were imagined and understood, and areas of contestation. The findings show the different rationalities at play and how different actors seek control of the policy space. They also demonstrate the political precariousness of PHCOs, and the wider difficulty of steering market-based professionals in the achievement of population health objectives.     

The Joint Action of Parents and Adolescents in Conversation About Career

Analyses of 14 videotaped parent—adolescent career conversations reveal the socially constructed nature of career. These analyses are used to identify joint actions in career conversations, determine their patterns, and address their meaning for the participants. Joint action refers to the action that people take together or that occurs between them. The participants used 3 superordinate joint actions (struggle, exploration, and negotiation) and several subordinate joint actions. Three patterns of joint actions were also identified. The joint actions had particular meaning for both career and the relationship between the participants.     

Failures of the reduction principle in an Ellsberg-type problem

Segal (1987) suggested that the Ellsberg paradox might be explained in terms of individuals mentally representing the decision problem as a two-stage lottery which they evaluated according to a non-expected utility model. This paper describes an experiment involving an explicitly two-stage analogue to an Ellsberg-type problem. This design substantially reduces the frequency of classic Ellsberg behaviour, but reveals other systematic violations of conventional theory. The paper discusses the particular patterns of choice and raises the more general problem of modelling individual decisions when the reduction principle does not hold.     

Perceived risk associated with apparel purchasing in discount stores

Consumer discount store patronage preferences for apparel are investigated using the concept of perceived risk. Apparel items are assigned a type and level of risk: low social, low economic; high social, low economic; and high social, high economic. Females (N=222) responding to a mail survey rate their willingness to purchase each item in a discount store on a scale ofprefer to buy, may buy, ornever buy. Results suggest that consumer preference for purchasing in discount stores declines more sharply when economic risk increases than when social risk increases.Teresa A. Summers is Associate Professor of the School of Human Ecology, Textiles, Apparel Design and Merchandising at Louisiana State University, Baton Rouge, LA 70803. She received her Ph.D. from Texas Woman's University. Her research interest includes rural/urban consumer responses to changes in the marketplace.Frances C. Lawrence is Professor of the School of Human Ecology, Family, Child, and Consumer Sciences at Louisiana State University, Baton Rouge, LA 70803. She received her Ph.D. from Florida State University. Her research interests include family financial decision-making and family time use.Janice L. Haynes is Assistant Professor of the School of Human Ecology, Textiles, Apparel Design and Merchandising at Louisiana State University, Baton Rouge, LA 70803. She received her Ph.D. from Texas Woman's University. Her research interest includes retail patronage of specialized consumer market segments.Patricia J. Wozniak is Associate Professor of the Department of Experimental Statistics at Louisiana State University, Baton Rouge, LA 70803. She received her Ph.D. from the University of Wisconsin-Milwaukee. Her research interests include survey methodology and rural families.     

Do Trade Union Leaders Violate Subjective Expected Utility? Some Insights From Experimental Data

This paper presents the results of two experiments designed to test violations of Subjective Expected Utility Theory (SEUT) within a sample of Italian trade union delegates and leaders. Subjects priced risky and ambiguous prospects in the domain of gains. Risky prospects were based on games of chance, while ambiguous prospects were built on the standard Ellsberg paradox and on event lotteries whose outcomes were based either on the results of a fictional election or on the future results of the 1999 European Parliamentary election in Italy and the U.K. The experiments show that, although risky prospects were priced at their expected values on average, trade union delegates and leaders did violate SEUT when assessing ambiguous prospects. Moreover, their behaviour depended on the source of uncertainty (Ellsberg paradox vs. electoral results; fictional vs. real election; Italy vs. U.K. election outcomes). We discuss the implications of these results for the economic theory of the trade union.     

Fundamentals and asset price dynamics

The relation between fundamentals and asset returns is analyzed by means of Markov-switching regression models with time-varying transition probabilities. By referring to the Italian Stock Exchange over the 1973-2002 period, we find that (i) returns switch between a zero-expected return/low volatility state and a high expected return/high volatility state; (ii) states are persistent and hence state changes can be forecast to some extent; (iii) the probability of state changes can be explained in terms of changes in the fundamentals; (iv) fundamentals do not have a direct impact on the expected returns but they only affect the transition probability matrix. Overall, our results show that a non-linear relation between market price changes and market fundamentals can be caught within the framework of (Markov) switching regession models.A previous draft of the paper was presented at the XL Scientific Meeting of The Italian Statistical Society, Firenze, April 2000. We would like to thank Maurizio Vichi (the editor) and several anonymous referees for important suggestions. A special thank to Lorenzo Sevini for valuable research assistance. Partial financial support by Italian M.I.U.R. grants is gratefully acknowledged.     

What every nurse needs to know about nocturnal sleep-related eating disorder

This article provides information about a bizarre pattern of eating while asleep called nocturnal sleep-related eating disorder. People with this disorder, which has begun to be studied only recently, demonstrate features of both a sleep disorder and an eating disorder. Many clients are reluctant to initiate discussions regarding this condition because of feelings of powerlessness and shame. Other clients do not discuss their symptoms because nurses and other clinicians fail to gather accurate assessment data due to lack of knowledge within the professional community regarding the disorder. This review includes the historical background, definition of terms, and clinical manifestations of nocturnal sleep-related eating. In addition, emphasis on assessment and clinical management are included. Safety issues, the need to educate health care providers, and the role of the nurse in advocating for appropriate diagnosis, treatment, and referral are addressed.     

Risk to Groundlings of Death Due to Airplane Accidents: A Risk Communication Tool

During the period 1975-85 in the United States the 70 year lifetime risk of dying from being hit by an airplane when the individual is on the ground was 4.2 per million people. In contrast to many other risks used for comparison purposes, risk to those on the ground from an airplane crash is not a function of our own skills; is not optional; provides no benefit to anyone involved; and is not an act of nature. As a risk comparison tool it also has the useful characteristics of being something about which we can agree that regulatory action, such as control of airplane use and traffic, is warranted; but that no significant change in personal behavior, such as living in the basement to protect against dying from a plane hitting the home, is commensurate with the extent of risk.     

Managing Work and Family: The Decision to Outsource Child Care in Families Engaged in Family-Owned Businesses

This study investigates the decision to outsource child care among families involved in family-owned businesses. A management framework is used to examine the impact of inputs to the decision (i.e., goals and resources) and level of management activity (i.e., planning and implementing) in these families as predictors of the choice to outsource child care. The data are a sub-sample of the data from a project entitled, Family Businesses: Interaction in Work and Family Spheres (Winter, Fitzgerald, Heck, Haynes, & Danes, 1998) undertaken in 1997. Study findings indicate that household managers who work in the family business are less likely to outsource child care compared to those who work outside the family business. More educated household managers purchased more, and managers in larger families fewer hours of child care. Female household managers purchased significantly fewer hours of child care compared to their male counterparts.