Jacob and the preacher: Conversations in context,part II—Jacob talks back

Freeman and the Preacher showed me the story Freeman wrote about the first time me and the Preacher met. I thought it was kind of neat, but there was some things I thought was different. So Freeman said I should tell you the same story from my point of view. I told it to him, actually, and he put it on paper because I still ain't too good at this writing thing, but he and the Preacher are teaching me how to write. I think I'll get better as time goes on. The Preacher, he says I have what's called a “natural ability.” Me. I don't know about that. Anyway, I told my side to Freeman and he wrote it. I read it and I think it's okay, you know. It ain't exactly what I said, but he said it has to be this way so other people can understand it. Like he had to take out some of the language so people don't get turned off. He's okay. I don't think he'll mess with me. Anyway, he said maybe you'd be interested and maybe you wouldn't. Sort of like life, eh? So here it is, Jacob and the Preacher from Jacob's point of view. I ain't as good at this as Freeman or the Preacher, so I just told the story. The talk that the Preacher said happened was real and everything, so I thought I would just tell you what was going on for me when the talk was going on. Freeman said that's what you wanted to know anyway. I guess you know that when me and the Preacher first met, I didn't know all this was going on inside of me. It's only since he has been helping me to be “in touch with myself” that I know that there is always all kinds of stuff going on inside. I'm still not real sure I like knowing this but he says it gets to be less of a problem with time. He says I'll read this in a few years and be surprised by how much I know. Sometimes I wonder, why bother, but he says I'll understand later. Maybe. Anyway, here it is. I would be interested in knowing whether you think it is okay. Like I said, I told it to Freeman and he wrote it out like this.     

Our ASHRM journey continues: ERM for our patients' safety

First and foremost, as your 2013 ASHRM president, I'd like to thank you for all of the significant accomplishments you've helped ASHRM attain this year. And I'll be forever grateful for your support and making my personal and professional dream come true—to serve as your president. Advocating on behalf of all healthcare risk managers and furthering the quest of Getting to Zero for our patients' safety through Enterprise Risk Management, or ERM, has been an honor, because everyone is a risk manager!     

‘Make a new plan,stan’

I don't read the paper any more. I avoid news programs on TV. My 401K statements? They are sitting in a pile on top of the filing cabinet, unopened. There seems to be no end to disheartening stories of economic problems, both business and personal. It's depressing. Denial is a powerful mood‐altering tool, and I've seen it used quite effectively, but that only helps to a degree.     

The Affordable Care Act's insurance market regulations' effect on coverage

Much of the debate surrounding reform of the Patient Protection and Affordable Care Act (ACA) revolves around its insurance market regulation. This paper studies the impact on health insurance coverage of those provisions. Using data from the American Community Survey, years 2008–2015, I focus on individuals, ages 26 to 64, who are ineligible for the subsidies or Medicaid expansions included in the ACA to isolate the effect of its market regulation. To account for time trends, I utilize a differences‐in‐differences approach with a control group of residents of Massachusetts who were already subject to a similarly regulated health insurance market. I find that the ACA's regulations caused an increase of 0.95 percentage points in health insurance coverage for my sample in 2014. This increase was concentrated among younger individuals, suggesting that the law's regulations ameliorated adverse selection in the individual health insurance market.     

Meanings of Being Pregnant and Having Decided on Abortion: Young Swedish Women's Experiences

In-depth interviews about the experience of being pregnant and having decided on abortion were conducted with 10 young Swedish women. A phenomenological-hermeneutic study disclosed a complex life world summarised as “I'm happy about my fertility but I choose not to give life now.” Four themes were revealed: encountering an unexpected understanding of oneself and one's fertility, desiring to be understood by trusted others, trying out different positions in relation to pregnancy and abortion, and approaching planned adult motherhood. The results indicate that addressing young women's concerns about fertility might be important in reproductive care.     

Jacob and the preacher: Conversations in context,part I

“You're the child care worker. Right?” “I'm the child care worker.” “So, wadda you want? I told the old lady I'd see you because she was freaking out. I got ten minutes. Talk.” “I want to buy you a cup of coffee and tell you how to save your life.” “I don't drink coffee.” “So? What about your life?” “What are you, a missionary from the local church? Or are you just an asshole?” “If I gotta make a choice, I'd rather be an asshole. What about you?” “You're fucking crazy, man. Me, I wouldn't make a choice like that.” “That's the problem. You're not making choices. That's why your life is going to hell. And that's why I'm here: to give you the choice of saving your life. Now. Do you want to do it or don't you?” “Are you paying attention here, preacher?” “Sorry, Jacob. I was thinking about your history.” “Who gives a shit? Pay attention. I was asking you if you wanted to go over to the park with me. I got something I gotta do.” “Is it safe for me?” “Sure. Don't worry. I'll look after you. Nobody's gonna touch you if you're with me. The only thing is, you gotta do what I tell you.” “I'm glad you're looking after me, son. It always feels good to know somebody's taking care of you.”     

It happens when the stage sets collapse1

Sally Gadow's tenure as professor of nursing at the University of Colorado Health Sciences Center during my doctoral studies radically changed my view on science, nursing, relationships, and most importantly, the world. In this paper, I use ideas stimulated by Gadow's classes to argue that recognizing ambiguity through an attitude of metaphysical revolt can free nurses to form relationships with patients who are complex subjects rather than objects to be treated. I will first discuss Camus’ ideas of absurdity from the Myth of Sisyphus, comparing the awake passions of Don Juan and the maniacal (and fatal) love of Romeo and Juliet (1955). Merleau‐Ponty's (1962) work on the dialectic of human sexuality sheds light on the intrinsic bodily ambiguity of human existence as seen through sexual attraction. de Beauvoir (1948) further lends insight into ideas of ambiguity, relationship, and freedom. Finally, I will argue that recognition of the intrinsic ambiguity of existence coupled with an attitude of metaphysical revolt may free nurses and patients from external frameworks that limit experience, impose meaning, and in the process, sever human relationship.     

A critique of Paulo Freire’s perspective on human nature to inform the construction of theoretical underpinnings for research

This article presents a critique of Paulo Freire's philosophical perspective on human nature in the context of a doctoral research study to explore “muchness” or nurses’ subjective experience of well‐being; and demonstrates how this critique has informed the refinement of the theoretical principles used to inform research methodology and methods. Engaging in philosophical groundwork is essential for research coherence and integrity. Through this groundwork, largely informed by Freire's critical pedagogy and his ideas on humanization, I recognized the need to clarify my understanding of the concepts of persons and personhood and how this related to Freire's use of the term human beings. This clarification process is essential to ensure congruence between the theoretical principles that I draw from his work and my beliefs about persons, personhood and person‐centredness. The article begins with a brief introduction to the research, followed by an overview of Freire's philosophical perspectives, and subsequently, the critique process is presented and discussed. This process involved engaging with the vast literature and debates about what it means to be a person, to make sense of the often complex and contradictory arguments. Eventually, three headings emerged that helped me to frame my evolving understanding: Our species: human beings; The kind that we are: human nature; and This person that I am: personhood. Through this process of exploration, I recognized that Freire's perspective on human nature (a) foregrounded cognitive rationality, which presented itself as a limitation when considering my ontological beliefs and the focus of my research, leading me to draw on the work of Mark Johnson and his ideas about embodiment to help me to further develop my theoretical principles; (b) focused on the “collective” rather than individuals, which is a shortcoming in relation to person‐centred research that acknowledges the uniqueness of participants.     

Preconception subsidized insurance: Prenatal care and birth outcomes by race/ethnicity

Low‐income pregnant women have been Medicaid eligible since the 1980s, but the Affordable Care Act (ACA)'s expansion of Medicaid to women preconception has the potential to improve pregnancy and birth outcomes by removing delays in Medicaid enrollment. More substantially, the ACA expanded subsidized nongroup maternity coverage. Pre‐ACA, nongroup health insurance had generally excluded maternity coverage and was prohibitively expensive for low‐income individuals, but the ACA's creation of the Marketplace made maternity coverage mandatory and provides income‐based subsidies. I use a simulated eligibility approach to measure how these two aspects of the ACA impacted pregnancy and birth outcomes for first‐time mothers, paying special attention to racial‐ethnic differences. I find expanding Medicaid to women prior to pregnancy significantly improves the share of women with a prenatal care visit in the first trimester for non‐Hispanic Whites and Blacks. Expansions in non‐Medicaid subsidized insurance, such as Marketplace insurance, significantly reduce the share of births paid by Medicaid and increased breastfeeding across all racial and ethnic groups. Neither type of subsidized insurance had significant, robust impacts on birth outcomes.     

Getting into it in the wrong way: Interpretative phenomenological analysis and the hermeneutic circle

This article critically analyses the hermeneutic commitment of interpretative phenomenological analysis (IPA). In the theoretical framework of IPA, the role of preconceptions and prejudices is consistently downplayed; priority is given to the participant's own words. Paley has argued that IPA’s interpretative phase is always and necessarily determined by the researcher's fore‐conceptions, as opposed to the participant's narrative. I demonstrate that IPA’s failure to recognize the importance of an external frame of reference in interpretation may arise from the misunderstanding of the method's hermeneutic underpinnings. I essentially argue that bracketing the researcher's fore‐conceptions during the initial phases of IPA is merely an illusion. While it is beyond the scope of this article to dispute whether IPA is genuinely phenomenological, my claim ultimately poses a challenge to IPA’s phenomenological commitment on its own terms. The article concludes with a proposal to substantially improve IPA’s consistency with hermeneutic tradition and its grounding in phenomenological philosophy.     

Spreading the word about the unique and valuable role of healthcare risk managers

Here I am three‐quarters through my year as president of ASHRM and I am still pinching myself that I am where I am! How has your year been? It has been a tough year for everyone in healthcare. With the Affordable Care Act demands on healthcare and the public, concerns about funding, quality initiatives, and overall potential loss of revenue, it's a wonder we are still in healthcare. But would you be doing anything different? I don't think so. I love that I can help make a difference by assisting staff with a difficult patient or situation or help a patient with a care concern that they are totally frustrated with or explain to a fellow risk manager what I would do in the situation they are dealing with. Although we feel like we are being pulled into new healthcare territories for our insight and recommendations, it is an indication of the value we bring to our organizations. We will get through this and there will be more challenges, but as risk management professionals, we can help solve problems and create value in the upcoming changes in healthcare.     

Storying the world: a posthumanist critique of phenomenological‐humanist representational practices in mental health nurse qualitative inquiry

The purpose of this study was to build on my previously published critique of phenomenological‐humanist representational practices in mental health nursing qualitative inquiry. I will unpack and trouble these practices from an explicitly posthumanist philosophical position on the basis of seminal posthumanist texts and my own single‐ and co‐authored work. My argument will be that researchers in mental health nurse qualitative inquiry, who display a phenomenological‐humanist narrative bent in their writing, continually endorse the validity of the institutional psychiatric assumptions, practices, and ways of representing human psychological distress. These are all explicitly rejected in more critical forms of qualitative inquiry in mental health, including in my own work. I will conclude that the use of phenomenological‐humanist representational practices, in mental health nursing and by implication and extension other healthcare disciplines, is unethical, un‐empathic, and morally compromised. This is because such practices present accounts of the worlds of mental health service users, survivors, and carers that lack necessary and sufficient levels of criticality and context.     

Health insurance enrolment in the Upper West Region of Ghana: Does food security matter?

Toward achieving universal health coverage, Ghana's national health insurance has been acclaimed as a pro‐poor scheme, yet been criticized for leaving the poor behind. Arising from this is how poverty has been operationalized and how poor people are targeted for enrolment into the scheme. We examine the role of food insecurity (not currently considered) as a multidimensional vulnerability concept on enrolment into Ghana's health insurance using binary logistics regression on cross‐sectional survey of household heads (n = 1438) in the Upper West Region of Ghana. Our analyses show that heads of severely food‐insecure households were significantly less likely to enroll in national health insurance scheme (NHIS) relative to households who reported being food‐secure (OR = 0.36, P < .05). We also found education, occupation, and religion as significant predictors of health insurance enrolment. Based on our findings, it is crucial to incorporate food security status in the identification of vulnerable people for free enrolment in Ghana's health insurance.     

Acting out and talking back: negotiating discourses in American early educational settings

As a first‐grade teacher preparing for the upcoming year, I was shocked to learn that George was on my new roll. His previous teacher wrote that George was a ‘behaviour problem’, was defiant, talked back to adults, didn't speak properly, was behind academically and spent over half of kindergarten in detention. George initially gave me negative impressions, using non‐standard English and more direct speech than I expected. Yet by listening closely and employing classroom discourse analysis, I came to recognise George's contributions, consequently working to dispel the myth that African‐American Vernacular English (AAVE) is wrong. I started analysing my own talk, instead of blaming George for misunderstandings. We openly talked about the use of direct and indirect statements. Through this study, I suggest that kidwatching, looking closely at interactions and contexts, and seeing AAVE as a resource in class, can positively affect young children and their teachers.     

Surviving Domestic Violence: Rebuilding One's Life

The purpose of this study was to contribute to occupational therapists' understanding of the experience of domestic violence, its impact on the lives of women, and the needs of these women as they journey towards independent and abuse-free lives. A phenomenological design was used to explore the experiences of five women living at a battered women's shelter and five women who had been at the shelter and were now living on their own, free of abuse. Five themes emerged to describe the women's experiences of rebuilding their lives: (1) “You owe yourself a life,” (2) “It's really all about connecting the dots,” (3) “I don't have an ounce of time to myself,” (4) “It gets hard,” and (5) “That was the road I traveled but this is now the road that I'm on.” The experiences of these women compel the occupational therapists to pause and reflect upon their role in working with survivor's of domestic violence.     

The effect of state dependent mandate laws on the labor supply decisions of young adults

Prior to the Affordable Care Act, the majority of states in the U.S. had already implemented state laws that extended the age that young adults could enroll as dependents on their parent's employer-based health insurance plans. Because of the fundamental link between health insurance and employment in the U.S., such policies may effect the labor supply decisions of young adults. Although the interaction between labor supply and health insurance has been extensively studied for other subpopulations, little is known about the role of health insurance in the labor supply decisions of young adults. I use the variation from the implementation and changes in state policies that expanded dependent health insurance coverage to examine how young adults adjusted their labor supply when they were able to be covered as a dependent on their parent's plan. I find that these state mandates led to a decrease in labor supply on the intensive margin.     

Effects of health insurance on birth weight in Mexico

This paper estimates the effect of mother's insurance coverage on neonatal outcomes in Mexico using hospital‐based administrative data. Using an instrumental variable approach to identify the causal effects of health insurance on infant health, we find that mother's insurance coverage has positive impacts on neonatal outcomes. Children born to insured mothers weighed 108 g higher and had reduced probability of low birth weight by 7.5 percentage points. These effects appear to be stronger for mothers with higher levels of education and in municipalities with a higher development index. Findings indicate that expanding insurance coverage could be helpful in improving neonatal outcomes in resource‐constrained countries.     

The practice of phenomenology: The case of Max van Manen

Since its inception, phenomenological philosophy has exerted an influence on empirical science. But what is the best way to practice, use and apply phenomenology in a non‐philosophical context? How deeply rooted in phenomenological philosophy must qualitative research be in order to qualify as phenomenological? How many of the core commitments of phenomenology must it accept? In the following contribution, I will take a closer look at Max van Manen's work. I will argue that van Manen's understanding of and presentation of phenomenology is quite problematic and that his book Phenomenology of Practice rather than amounting to a clear and accessible presentation of the phenomenological method that would make it do‐able to researchers who are not themselves professional philosophers is in fact both abstruse and excessively complicated. I will then turn to nursing, and by taking that as my example, outline a better way to apply and practice phenomenology.     

The Effect of Medicaid Policies on the Diagnosis and Treatment of Children's Mental Health Problems in Primary Care

Primary care physicians play a substantial role in diagnosing and treating children's mental health disorders, but Medicaid managed care policies may limit these physicians' ability to serve low‐income children. Using data from the universe of Medicaid recipients in three states, I evaluate how Medicaid managed care policies impact primary care diagnosis and treatment of children's mental health disorders. Specific policies examined include the presence of a behavioral carve‐out, traditional health maintenance organization, or primary care case management program. To alleviate concerns of endogenous patient sorting, my preferred identification strategy uses variation in Medicaid policy penetration to instrument for individual plan choices. I show that while health maintenance organizations reduce diagnosis and non‐drug treatment of mental health disorders, primary care case management program policies shift in diagnosis and treatment from within primary care to specialist providers such as psychiatrists, where serious mental health conditions are more likely to be identified. Copyright © 2013 John Wiley & Sons, Ltd.