The Mediating Effect of Resilience Between Social Support for Exercise and Resident Satisfaction in Assisted Living

This study examined whether residents' level of resilience mediated the relationship between social support for exercise from staff and resident satisfaction in assisted living. This was a secondary data analysis using baseline data from a function-focused care intervention study including 171 residents from four assisted living facilities. Using structural equation modeling, we found that mood and social support for exercise from staff were the only variables associated with resilience. Mood, gender, cognition, and social support for exercise from staff directly influenced resident satisfaction and explained 31% of the variance in the model. Implications for future research and practice are discussed.     

Health insurance literacy: A mixed methods study of college students

Objective: This study examines the health insurance literacy, or the ability to use health insurance effectively, of college students. Participants: A total of 455 students from a large, public university completed an online questionnaire in November 2016. Methods: A questionnaire examined students’ knowledge of commonly encountered health insurance terms and ability to apply that knowledge to determine cost-sharing in a clinical setting. Results: The majority of students were able to correctly identify the most commonly encountered terms, but could not identify terms related to plan types and options. Eighty-eight percent of students could not determine their cost-sharing for two presented scenarios. Approximately half of the students indicated they had been confused about their health insurance plan, with one-quarter of students stopping or delaying medical care due to confusion. Conclusions: Outreach and education for students should target specific deficits in knowledge such as those identified in this study.     

Population aging and long-term care policies in the Gulf region: a case study of Oman

Population aging is a phenomenon occurring across the globe including in countries traditionally exhibiting population dividends and “youth bulges.” The Gulf Corporation Council countries are no exception as they currently experience a process of population aging, albeit at a different stage from many developed countries. However, due to historically high fertility rates and fast-paced epidemiological transition, some of these countries will experience population aging at a higher pace than what has been observed in Europe and the United States. This article reviews recent developments in long-term care policies in the Gulf region with a focus on Oman as an example of a high-income Arab country that is experiencing population aging while still being governed by traditional family aged-care norms. Utilizing existing data and published research complemented by policy analysis and field visits, we analyze the process of population aging in Oman and neighboring countries and its policy implications.     

Everything for the Children: Orphans Growing Up in Informal Adoptive Families in China

Most orphaned children in China are cared for by their extended families or become state wards under the guardianship of child welfare institutions. Some exceptions are children who are found and cared for by families in the community, without a formalized adoption or foster relationship. In some locations, institutions now accept guardianship for these children and support the informal adoptive family to continue to care for them. This article examines the outcomes for these children as they became young adults by comparing these 12 children raised within the system as they approach or have approached young adulthood (now aged 16–40 years-old). Some of the participants were either informally adopted or lived in institutional care. The results of this study found that the family environment was more conducive to the young people’s wellbeing as they approached or entered adulthood. The participants raised in informal care appeared to be treated similar to the biological children in these families. When the institution formalized the state guardianship responsibility, it also meant the families had state resources for support to protect the children’s rights to economic security, education, health care, and social participation. This practice by the institution supported the addition of informal adoption, as one step closer to permanency than foster care. Future implications include considering this option to help promote the family system assisting these children, families, and the state.     

Hypothesis Testing of CNA Perceptions of Organizational Culture in Long Term Care

This commentary for the special issue on research that went wrong describes a study that explored factors that contribute to variability within Certified Nursing Assistants (CNAs) on organizational safety culture. We know from previous research that CNAs provide most direct care in nursing homes and that direct care workers often experience agency culture differently from agency management (Wolf et al., 2014). We were looking for factors that nursing homes could alter to improve the culture for CNAs, and thus, residents. We conducted a secondary analysis of data collected via a multi-component paper survey of CNAs employed in long term care. We used results from the Nursing Home Survey on Patient Safety Culture and primary shift, type of unit, and years as a CNA to identify modifiable characteristics that would explain variability in the perceptions of patient safety culture. The final sample included n = 106 from three nursing homes. Dimension scores were compared using bivariate tests appropriate to the scale and ordinal logistic regression. Despite support in the literature for the hypothesis, we found few significant differences on the total scale within groups. Differences in perceptions have implications for quality of care and the experiences of residents within nursing homes.     

多渠道医疗门诊挂号的时间策略研究

现阶段多种门诊挂号方式并存时,根据患者特性制定不同的等待时间策略尤为重要。本文考虑门诊挂号的三种渠道：直接排队挂号渠道、电话预约挂号渠道与O2O预约挂号渠道。在价格外生前提下,综合考虑患者的渠道偏好程度、时间敏感性与提前支付敏感性,基于效用理论构建患者的渠道选择模型。根据该模型推导得出不同市场条件下医院的需求,医院再据此制定患者的等待时间策略以达到利润最大化的目的。研究发现：当医院仅开通单一挂号渠道时,若患者的时间敏感度越大、渠道偏好程度越小,等待时间均越小;开通某两种挂号渠道时,还需考虑患者对两种渠道的偏好比例,偏好某种渠道的患者比例增加,选择该渠道的患者等待时间增加,选择另一渠道的患者等待时间减小;同时开通三种渠道时,最偏好某渠道的患者比例越大,选择该渠道的患者的等待时间也越大;在所有情况下,患者对提前支付的敏感度均不影响最优等待时间的制定。     

Identity Formation in Children and Young People in Open Adoptions from Out-of-home Care in New South Wales,Australia

Semi-structured interviews were used to explore identity development for nine adoptees (aged 9–23 years) who were adopted by their foster carers in New South Wales, Australia. Adoptions were open, with court-ordered face-to-face contact with birth families. Findings suggest that participants had healthy adoptive identities, with coherent and meaningful narratives about their life histories. Adoption provided a sense of security and belonging. Openness provided information to build a self-narrative and encouraged discussion of adoption issues within adoptive families. Adoptive parents were critical in helping children understand their adoption and facilitating direct contact with birth families, thus laying foundations for positive identity development.     

The sacred and the profane in life science work: The case of assisted reproduction laboratories

Reproductive medicine and assisted reproduction therapies have been developed over the last decades resulting in over five million babies. The handling of human reproductive materials and patients is based on the ability to combine health care work and techno-scientific expertise in both the clinic and the laboratory setting. This study of Swedish assisted reproductive technology clinics demonstrates that the active day-to-day manipulation of human reproductive materials enact both the ‘profane’, through treating the embryos as raw materials in standardized procedures enabling economies of scale, and the ‘sacred’ through enacting a separation, the potential to human life, the patients ordeals, and seriousness. The enactment of the profane and the sacred is mostly balanced but at certain points in the work procedures, their intersecting becomes particularly salient. Such points provide opportunities for the study of the sense making of professionals in organizational grey zones, during techno-scientific activities.     

Affective practices,care and bioscience: a study of two laboratories

Scientific knowledge‐making is not just a matter of experiments, modelling and fieldwork. It also involves affective, embodied and material practices (Wetherell, 2012) which can be understood together as ‘matters of care’ (Puig de la Bellacasa, 2011). In this paper we explore how affect spans and connects material, subjective and organizational practices, focusing in particular on the patterns of care we encountered in an observational study of two bioscience laboratories. We explore the preferred emotional subjectivities of each lab and their relation to material practice. We go on to consider flows and clots in the circulation of affect and their relation to care through an exploration of belonging and humour in the labs. We show how being a successful scientist or group of researchers involves a careful choreography of affect in relation to materials, colleagues and others to produce scientific results, subjects and workplaces. We end by considering how thinking with care troubles dominant constructions of scientific practice, successful scientific selves and collectives.     

The embeddedness of organizational performance: Multiple Membership Multiple Classification Models for the analysis of multilevel networks

We present a Multiple Membership Multiple Classification (MMMC) model for analysing variation in the performance of organizational sub-units embedded in a multilevel network. The model postulates that the performance of organizational sub-units varies across network levels defined in terms of: (i) direct relations between organizational sub-units; (ii) relations between organizations containing the sub-units, and (iii) cross-level relations between sub-units and organizations. We demonstrate the empirical merits of the model in an analysis of inter-hospital patient mobility within a regional community of health care organizations. In the empirical case study we develop, organizational sub-units are departments of emergency medicine (EDs) located within hospitals (organizations). Networks within and across levels are delineated in terms of patient transfer relations between EDs (lower-level, emergency transfers), hospitals (higher-level, elective transfers), and between EDs and hospitals (cross-level, non-emergency transfers). Our main analytical objective is to examine the association of these interdependent and partially nested levels of action with variation in waiting time among EDs – one of the most commonly adopted and accepted measures of ED performance. We find evidence that variation in ED waiting time is associated with various components of the multilevel network in which the EDs are embedded. Before allowing for various characteristics of EDs and the hospitals in which they are located, we find, for the null models, that most of the network variation is at the hospital level. After adding these characteristics to the model, we find that hospital capacity and ED uncertainty are significantly associated with ED waiting time. We also find that the overall variation in ED waiting time is reduced to less than a half of its estimated value from the null models, and that a greater share of the residual network variation for these models is at the ED level and cross level, rather than the hospital level. This suggests that the covariates explain some of the network variation, and shift the relative share of residual variation away from hospital networks. We discuss further extensions to the model for more general analyses of multilevel network dependencies in variables of interest for the lower level nodes of these social structures.