The nature, extent and determinants of violence against psychiatric personnel

Violence against psychiatric staff seems to be on the increase. Such abuse can lead to mental health consequences for the staff and a reluctance to be closely involved with patients. Few Swedish investigations have examined violence against mental nurses and psychiatrists, or undertaken comparative studies between them. In this study we examined the extent, nature and determinants (i.e. risk factors) of violence against psychiatric nurses (n = 731) and psychiatrists (n = 320) working in the eight health care districts of Stockholm. These caregivers were assessed cross-sectionally by means of a questionnaire covering various areas (e.g. violence and work environment). The majority of the participants (85%) reported having been exposed to violence during their careers, with 57% being victimized in the past 12 months. Physical violence was common, and factors such as negative attitudes to work and diminished sense of autonomy were associated with an increased vulnerability to violence. Nurses and psychiatrists did not differ in violence variables. In spite of the weaknesses of the design (cross-sectional self-selecting sample), this study corroborates previous findings and identifies personal factors associated with violence that have received little attention in the literature (e.g. lack of respect for the organization of care).     

Maternal mortality: What can we learn from stories of postpartum haemorrhage?

Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality.Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring.This article will identify some of the lessons that can be learnt from the recent Australian and UK maternal death reports. This paper presents an overview of the process and systems for the reporting of maternal death in Australia. It will then specifically focus on obstetric haemorrhage, with a focus on postpartum haemorrhage, for the 12-year period, 1994–2005. Vignettes from the maternal mortality reports in Australia and the United Kingdom are used to highlight the important lessons for providers of maternity care.     

Questioning textbook truth: Suicide rates and the Hawthorne effect

Advocacy and interest groups routinely make fantastic and shocking claims in an effort to motivate the public to respond to what these groups perceive to be important but neglected social problems and/or incipient “crises.” When closer scrutiny impeaches these claims, these groups lose a measure of credibility, and the general public grows increasingly cynical of them and of the social sciences whose data and research presumably support the claim. Similar temptations and dangers may face sociology. I raise the possibility that the teaching of discredited findings and discoveries and the use of gimmicks that challenge conventional wisdom and common sense may turn our students off and trigger the same distrust and cynicism engendered by advocacy groups. Ironically, giving in to the temptation to shock and surprise rather than to inform and enlighten may foreclose the very real opportunities that exist for engaging our students and the public in the enterprise of sociology. He has been teaching introductory sociology for nearly thirty years, has published a number of articles on macrosociology and ecological-evolutionary theory, and is coauthor of the sixth, seventh, eighth, and ninth editions of Human Societies: An Introduction to Macrosociology. I thank Sang-moon Kim for his help in assembling and analyzing the introductory texts, and Paul Nisbet for his help in reviewing recent research on religion and suicide. A preliminary version of this paper was presented at the session, “Philosophical Foundations of Sociological Knowledge and Applied Sociology,” Joseph Gittler, organizer and présider, at the Annual Southern Sociological Society Meetings in 1995, in Atlanta, G A.     

Measuring Social “Informatization”: A Factor Analytic Approach*

Some scholars have argued that we are witnessing a new social revolution—social “informatization”—that is comparable in scope and impact to that of the Industrial Revolu‐tion of the eighteenth century. Others have argued that it is a much more modest phase in the ongoing development of communication and information‐processing technology. While there are a number of reasons for disagreement about what exactly “informatization” is, and what its impact will be, two are paramount: (1) conceptual imprecision, and (2) issues of measurement. Using factor analysis, this study aims to clarify its conceptualization, and, then, rather than focusing on a single dimension (e.g., technological or economic), it will develop a comprehensive multiple‐indicator measure that captures the economic, technological, and size (stock) dimensions of social informatization. We find that this measure of social informatization strongly correlates with the general level of socioeconomic development. This result implies that social informatization may be a more continuous and cumulative process than a disjunctive or discontinuous “revolution.”     

From Hospital to Home with NDIS Funded Support: Examining Participant Pathway Timeframes Against Discharge Expectations

ABSTRACT

For patients with disability who require funded supports to leave hospital, the introduction of the National Disability Insurance Scheme (NDIS) represents opportunity and challenges. At a time of major reform, timely and supported discharge is reliant on overcoming interface complexities. The purpose of this study was to examine the NDIS participant pathway timeframes against discharge expectations for hospitalised adults with spinal cord injury (SCI) or acquired brain injury (ABI) and interrogate delays for the two groups. Administrative data on 54 participants (ABI?=?18 and SCI?=?36) were analysed. Both groups experienced delays to discharge and significant variability in timeframes between NDIS pathway processes and extent of delays. Group differences were identified regarding inefficiencies across the continuum, with type of support a factor to investigate further. This study has uncovered critical points in the NDIS pathway that could impact discharge of participants and where collaboration and adaptive strategies could be targeted to improve processes.

IMPLICATIONS

• Ensuring the National Disability Insurance Scheme (NDIS) pathway operates effectively in the hospital setting is critical to the timely discharge of people with complex needs who require funded supports.

• Monitoring implementation of the NDIS in the health setting is important to avert interface problems that impede timely discharge and access.

     

Sociology’s <Emphasis Type="Italic">Suicide</Emphasis>: A Forensic Autopsy?

For decades Durkheim’s theory of suicide has been tested and found wanting. Yet, rather than being consigned to the dust-bin of history, it lives on and is pointed to as an exemplar of the powers of sociological theory and research. If this rationalizing and/or dismissal of so many falsifications of the theory were an isolated phenomenon, it might be evidence of some lemming-like propensity for suicide or a disciplinary death-wish, among a few sociologists. But it appears to be a much more widespread and common occurrence. In this paper we explore some possible explanations of this ‘falsification denial’—‘The Social Misconstruction of Reality’ (Hamilton 1996), ‘When Prophecy Fails’ (Festinger et al. 1956), ‘Underdetermination’ (Duhem 1954; Quine Journal of Philosophy 67:178–183, 1970, Erkenntnis 9:313–328, 1975; Lakatos 1970), and ‘Boundary Maintenance’ (Erikson 1966), and we outline some of the more important and pernicious consequences of this falsification denial for the discipline and future of sociology.     

Aggregation and Optimization with State‐Dependent Pricing: A Comment

A key argument in Caplin and Leahy (1997) states that the correlation between monetary shocks and output is falling in the variance of the money supply. We demonstrate that this conclusion depends on solving for the correlation in the nonstationary state of the model. In the stationary state, that correlation is initially rising.     

Official conceptualizations of person-centered care: Which person counts?

Numerous studies have indicated that a “psycho-social” person-centered care approach, involving the delivery of a compassionate, respectful model of care, leads to a high quality of life, particularly for older people living in residential care. This has prompted policy-makers to endorse this approach. Yet, some commentators have argued that the model of person-centered care in official government policies equates to a “consumer-based” rather than a psycho-social approach, as it focuses solely on offering service-users more choice and on promoting independence. However, as such arguments are made in the absence of any empirical analysis, it is unclear both whether such a distinction exists in practice, and, if so, how this alternative model developed. This study explores the development of minimum standards for residential care settings for older people in Ireland in order to address this gap in our understanding of person-centered care. Findings confirm that a consumer-driven model of person-centered care underpins the Irish Standards; residential care is portrayed as a hotel-like service and residents as discerning consumers, which may be unsuitable for older people in residential care with limited capacity to make key choices. Analysis indicates that this model can be seen both as an extension of consumer-driven policies endorsed by many neo-liberal governments, and also of policy-makers' fears of losing their autonomy when they reach the “Fourth Age”. This study is particularly illuminating, given the similarities between the Irish care system with England, Scotland, Wales, Northern Ireland and Australia.     

Polarization or “Squeezed Middle” in the Great Recession?: A Comparative European Analysis of the Distribution of Economic Stress

This paper analyses variation in the impact of the Great Recession on economic stress across income classes for a range of advanced European countries. Our analysis shows Iceland, Ireland and Greece to be quite distinctive in terms of increases in their multidimensional income, material deprivation and economic stress profiles. Between 2008 and 2012 these countries moved from being predictably located within anticipated welfare regimes to becoming clear outliers. For this set of counties, each of which was exposed to different but severe forms of economic shock, trends in income class polarisation versus middle class squeeze were variable. Each exhibited substantial increases in levels of economic stress. However, changes in the pattern of income class differentiation were somewhat different. In Iceland a form of middle class squeeze was observed. For Ireland income class polarization did not exclude middle class squeeze. Greece came closest to fitting the polarization profile. Changes in the distribution of household equivalent income had no effect on stress levels once the impact of material deprivation was taken into account. Changes in levels of material deprivation played a significant role in accounting for changing stress levels but only for the three lowest income classes. These findings bring out the extent to which the impact of the Great Recession on the distribution of economic stress across classes varied even among the hardest-hit countries. They also serve to highlight the advantages of a multidimensional approach that goes beyond reliance on income in seeking to understand the impact of such shocks.