Institutional Ethnography and Experience as Data

Experience, as concept, is contested among feminists as to its epistemological status, thus its usefulness in knowledge claims. Institutional ethnography (Smith 1987) is a feminist methodology that nonetheless relies fundamentally on people's experience. Not as Truth, nor the object of inquiry, but as thepoint d'appui for sociological inquiry. This article offers a demonstration of institutional enthnography using observational and interview data that show experience as methodologically central to a trustworthy analysis. A moment in the work lives of nursing assistants in a long-term care setting is captured by a participant observer. The analysis produces two lines of argument. One is methodological; it is argued that nursing assistants' experiences are an entry into the social relations of the setting that, when mapped and disclosed, make those experiences understandable in terms of the ruling arrangements permeating both the organization and their own experiences. The other argument is substantive; the inquiry uncovers how a quality improvement' strategy in a long term care hospital in Canada is reorganizing caregivers' values and practices toward a market orientation in which care appears to be compromised. Use of experience as data in this approach holds the analysis accountable to everyday/everynight actualities in a lived world.     

Homework and domestic work

This study assesses two competing theories about the extent to which homework—paid work in the home—helps integrate work and domestic roles for men and women. Contrasting male and female homeworkers with their counterparts working outside the home, it supports some aspects of both the resource and role overload theories, but predominantly the role overload perspective. Homeworkers, especially in the working class, experience less interference between job and family life, but perform more housework and child care. They have no more leisure time nor greater marital satisfaction than those working outside the home, but receive more family assistance with their paid jobs, suggesting that they combine tasks from their first and second shifts. Working at home does not break down gender roles in domestic life. Despite time saved from commuting, male homeworkers perform no more housework than comparable men working outside the home. Thus, the gender division of unpaid household labor is not simply a matter of resources or spatial logistics.An earlier version was presented at the meetings of the Eastern Sociological Society, Providence, Rhode Island, April 1991.     

Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

The impact of P.L. 93-641, the National Health Planning and Resources Development Act, upon health and mental health programming

Federal legislation regarding health care in the U.S. has increased rapidly in the past few years. A major law with potential far-reaching effects was enacted as a result of increasing legislation and rising health care costs. This law,The National Health Planning and Resources Development Act,has created a network of over 200 local, mostly nongovernment units, called health systems agencies. These agencies are responsible for areawide health planning, plan implementation, review and approval of federal health care expenditures for local programs, and facilities review. They will affect health and mental health programs at the local level. The article is directed to local health and mental health care providers who will, of necessity, deal directly with the local HSA's.     

Mental health program evaluation: Where you start?

Seduced by the elegance, sophistication and jargon characteristic of new developments in applied research, practicing evaluators are in danger of becoming distracted from achievement of their evaluative goal: that of providing timely, reliable and useful data to program management to facilitate rational data-based decision-making. To avoid such seduction, the author advocates adaptation of simple, inexpensive and efficient evaluative methods tailored to organizational needs and presentation of findings in language readily understood by constituent groups. Likewise, insistance by evaluators upon maintenance of a strict role boundary — that is, limiting role functioning exclusively to those tasks considered evaluation — may be dysfunctional. Rather than detract from accomplishment of his goals, the author maintains that such participation allows development of skills, insights and staff relationships which enhance the evaluator's effective functioning within the organizational context and contribute to organizational acceptance and use of his evaluative results.     

The validity of indices for rural health manpower needs assessment

Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.     

On the limiting properties of social indicators

Characteristics of the population and economic measures that constitute traditional social indicators are compared with more recent “quality of life” measures to demonstrate that social indicators are always value statements at the policy level. The possibility of alternative perspectives is illustrated. It is suggested that an awareness of the assumptions implicit in any given indicator is as important as the data they provide.     

精准扶贫与老年贫困消减

精准扶贫是针对以往粗放型扶贫方式提出的扶贫方略。 提高扶贫效率,实现社会公平是精准扶贫的核心要件。 老年贫困人口是贫困群体的主体,要低成本、高效率地消减老年贫困问题,要更多地依靠社会保障制度建设,即更多地依靠制度性力量,更多地依赖市场力量。 只有建立和完善与我国社会发展阶段相契合的“ 普惠+特惠冶 的基本社会保障制度,才能真正实现老年人口精准扶贫的政策初衷,从而提升社会的效率与公平。     

农村老年人日常生活家庭照料与社会照料关系研究——基于多层回归模型的分析

文章利用中国健康与养老追踪调查 2011—2012 年的基线调查数据,运用多层回归模型,通过分析社会照料对农村老年人家庭照料获得的影响,探讨家庭照料与社会照料的关系。 回归估计结果显示,个人层次上的年龄、居住状况、失能情况和社区层次上的老龄补贴、经济状况对农村老年人获得家庭照料有不同程度的影响,而代表社会照料的变量在统计上均不显著。 回归估计结果说明,社会照料并不能对缺位的家庭照料起到补充作用,更不会起到替代作用,两者呈现一种非此即彼的“无关系”。 文章的政策启示是,打破家庭照料与社会照料的壁垒,构建一个“流动”的老年照料体系。     

Nonstandard parental employment schedules and father involvement

This study assesses the impact of nonstandard employment schedules (shift work) on parenting among US fathers of young children in dual-earner couples. The outcomes examined include total caregiving, caregiving without the mother present, and the elements of father involvement proposed by Pleck: positive engagement, warmth, and control. Models with latent variables and with lagged dependent variables are estimated using three waves of nationally representative data from the Early Child Longitudinal Study – Birth Cohort. The results indicate that employment scheduling mainly shapes the context in which involvement takes place. Compared to dual-earner couples who are each employed during the day, fathers in couples in which at least one parent has a nonstandard schedule tend to care for their children more in the mother's absence. To a more limited extent, they also do more caregiving overall. These effects are most conclusively found when the father works during the day and the mother works during the evening, when the mother works during the day but the father works a night, split, rotating, or other shift, and when both parents have nonstandard schedules. Parental work schedules, however, have little impact on father involvement aside from care.