Personal autonomy in discharge planning decision -making in mentally alert hospitalized elderly individuals: The social workers' perspective

This study was conducted to understand (a) hospital social workers' perspectives about patients' personal autonomy and self-determination, (b) their experiences, and (c) their beliefs and behaviors. The study used the maximum variation sampling strategy to select hospitals and hospital social work respondents. Individual interviews were conducted with 31 medical/surgical and mental health hospital social workers who worked in 13 hospitals. The data suggest the following four points. First, the hospital setting as an outside influence as it relates to illness and safety, and its four categories, mentally alert patients, family members, health care professionals, and social work respondents, seems to enhance or diminish patients' autonomy in discharge planning decision making. Second, respondents report they believe patients must be safe both inside and outside the hospital. In theory, respondents support autonomy and self-determination, respect patients' wishes, and believe patients are the decision makers. However, in practice, respondents respect autonomy and self-determination to a point. Third, a model, The Patient's Decision in Discharge Planning: A Continuum, is presented where a safe discharge plan is at one end of a continuum, while an unsafe discharge plan is at the other end. Respondents respect personal autonomy and the patient's self-determination to a point. This point is likely to be located in a gray area where the patient's decision crosses from one end of the continuum to the other. When patients decide on an unsafe discharge plan, workers' interventions range from autonomy to paternalism. And fourth, the hospital setting as an outside influence may not offer the best opportunity for patients to make decisions (a) because of beliefs family members and health care professionals hold about the value of patient self-determination, and (b) because patients may not feel free to make decisions in an environment where they are surrounded by family members, health care professionals, and social work respondents who have power and who think they know best. Workers need to continue to educate elderly patients about their right to self-determination in the hospital setting. ^

The Chef In Society: Origins And Development

In his discourse - The Chef In Society: Origins And Development - Marcel R. Escoffier, Graduate Student, School of Hospitality Management at Florida International University, initially offers: “The role of the modern professional chef has its origins in ancient Greece. The author traces that history and looks at the evolution of the executive chef as a manager and administrator.” “Chefs, as tradespersons, can trace their origins to ancient Greece,” the author offers with citation. “Most were slaves…” he also informs you. Even at that low estate in life, the chef was master of the slaves and servants who were at close hand in the environment in which they worked. “In Athens, a cook was the master of all the household slaves…” says Escoffier. As Athenian influence wanes and Roman civilization picks-up the torch, chefs maintain and increase their status as important tradesmen in society. “Here the first professional societies of cooks were formed, almost a hierarchy,” Escoffier again cites the information. “It was in Rome that cooks established their first academy: Colleqium Coquorum,” he further reports. Chefs, again, increase their significance during the following Italian Renaissance as the scope of their influence widens. “…it is an historical fact that the marriage of Henry IV and Catherine de Medici introduced France to the culinary wonders of the Italian Renaissance,” Escoffier enlightens you. “Certainly the professional chef in France became more sophisticated and more highly regarded by society after the introduction of the Italian cooking concepts.” The author wants you to know that by this time cookbooks are already making important inroads and contributing to the history of cooking above and beyond their obvious informational status. Outside of the apparent European influences in cooking, Escoffier also ephemerally mentions the development of Chinese and Indian chefs. “It is interesting to note that the Chinese, held by at least one theory as the progenitors of most of the culinary heritage, never developed a high esteem for the position of chef,” Escoffier maintains the historical tack. “It was not until the middle 18th Century that the first professional chef went public. Until that time, only the great houses of the nobility could afford to maintain a chef,” Escoffier notes. This private-to-public transition, in conjunction with culinary writing are benchmarks for the profession. Chefs now establish authority and eminence. The remainder of the article devotes itself to the development of the professional chef; especially the melding of two seminal figures in the culinary arts, Cesar Ritz and August Escoffier. The works of Frederick Taylor are also highlighted.

An investigation of the effects of a school-based intervention on feelings of personal expressiveness in multi-problem adolescent youth

This study was conducted to determine the effects of the Changing Lives Program intervention on troubled adolescents' feelings of personal expressiveness, believed to be one domain of positive identity development. Forty-three intervention and twenty nonintervention comparison control participants were given a battery of pre-, post-, and follow-up assessments including the Personally Expressive Questionnaire (Waterman, 1995), which was used to derive participants' feelings of personal expressiveness scores. Using Repeated Measures Analysis of Multivariate Analysis (RMANOVA), a significant four-way interaction of Time X Condition X Gender X Ethnicity was found relative to the Control, Roy's Ɵ = .166, F(2,47) = 3.899, p < .027 indicating that intervention participants' feelings of personal expressiveness did increase significantly relative to the control group. Furthermore, the results suggest differential outcomes based on ethnicity, suggesting the need for future study with respect to specificity of effects and mechanisms of identity formation in differing ethnic subgroups.

Boundary Effects on Benthic Microbial Phosphorus Concentrations and Diatom Beta Diversity in a Hydrologically-modified, Nutrient-limited Wetland

Water flow and flooding duration in wetlands influence the structure and productivity of microbial communities partly through their influence on nutrient loading. The effect of flow-regulated nutrient loads is especially relevant for microbial communities in nutrient-poor settings, where delivery controls nutrient uptake rates and the intensity of microbial interactions. We examined the effect of hydrologic history and proximity to water sources on nutrient enrichment of benthic microbial assemblages (periphyton) and on their diatom species composition, along the artificial boundaries of Taylor Slough, a historically phosphorus-depleted drainage of the Florida Everglades. Concentrations of phosphorus in periphyton declined from the wetland boundary near inflow structures to 100-m interior, with spatial and temporal variability in rates dependent on proximity to and magnitude of water flow. Phosphorus availability influenced the beta diversity of diatom assemblages, with higher values near inflow structures where resources were greatest, while interior sites and reference transects contained assemblages with constant composition of taxa considered endemic to the Everglades. This research shows how hydrologic restoration may have unintended consequences when incoming water quality is not regulated, including a replacement of distinctive microbial assemblages by ubiquitous, cosmopolitan ones.

Clash of identities in South Florida: An examination of the complexity of racial and national identity and their impact on ethnic solidarity between black Americans and Jamaicans

Immigrants from the West Indies and other nations challenge the simple United States dichotomy of blacks versus whites. Many apparently black Caribbean immigrants proclaim that they did not know they were “black” until they arrived in the U.S. They seek to maintain their national identity and resist identity and solidarity with Black Americans. In response, many Black Americans respond that the immigrants are simply being naive, that U.S. society demands simple racial identity. Regardless of one's self-identity and personal history, in the U.S., if you look black, you are black, was their thinking. ^ This study examines the contemporary struggle of identity and solidarity among and between Black Americans and Jamaicans living in South Florida (Broward and Miami-Dade counties). Even though the primary focus of this study is to examine the relationship between Black Americans and Jamaicans, other West Indian nationals will be addressed more generally. The primary research problem of this study is to determine why the existence of common ancestry and physical traits are insufficient for an assumption of ethnic solidarity between Black Americans and Jamaicans. ^ In examining this problem, I felt that depth rather than breadth would provide insight into the current state of polarization between Black Americans and Jamaicans. To this end, a qualitative study was designed. A non-random snowball sample consisting of forty-seven informants was selected for this study. Realizing that such a technique presents problems with generalizations beyond the sample, this approach was, nonetheless, the most suitable for the current research problem. One of the initial challenges of this research was the use of the label “black” in discussing Caribbean immigrants. Unlike America, where distinctions based on skin color were at the bedrock of America's formation, this was not the case in the Caribbean. In the Caribbean skin color was an important marker as an indicator of class, rather than of race. Therefore, I refrained from using the label, “black Jamaicans,” but rather used Jamaicans throughout. ^

The representation of motherhood in contemporary Catalan fiction

This dissertation analyzes four twenty-first-century Catalan novels which present the complex positions occupied by mothers in the last seven decades. Its conceptual framework posits motherhood as both a changing social construction and a political institution in a constant state of flux. In Inma Monsó´s Todo un carácter (2001), Eva Piquer´s Una victoria diferente (2002), Carme Riera´s La mitad del alma (2004), and Najat El Hachmi´s El último patriarca (2008) motherhood is explored as a metaphorical act, a gender-constructing experience, as well as the locus of expression with regard to gender and power relations. During the dictatorship of Francisco Franco (1939–1975), the majority of women were excluded from public spaces, and forced to stay home to care for their husbands and children. Furthermore, the state criminalized abortion, made contraception and divorce illegal, and promoted an ideal of femininity based on silence, sacrifice, and self-denial. The political changes of the late 1970s allowed women greater personal autonomy, and many women writers began to challenge stereotypical views of women’s social roles. Yet in the 70s and 80s, the narratives of Esther Tusquets, Ana María Moix, and Montserrat Roig represent the mother as a repressive figure whom the daughter must reject in order to liberate herself and regain her voice. It is not until the 90s when the novelists Mercedes Abad, Maruja Torres, Carme Riera, Imma Monsó, Eva Piquer, and María Barbal rehumanize the mother figure, recovering their matrilineal heritage. However, far from suggesting a unified trend in representations of motherhood in Catalan fiction, the diverse points of view of the novels under discussion here reveal that differences in attitudes among women authors about mother-daughter conflict are far from resolved. The theoretical background for this dissertation draws mainly on the work of Adrienne Rich, Nancy Chodorow, and Julia Kristeva. It includes psychoanalytic studies as well as sociologically based essays by Anna López Puig, Amparo Acereda, Jacqueline Cruz, Barbara Zecchi, Ángeles de la Concha, and Raquel Osborne, among others.

Beliefs of Icelandic elderly living in the greater Reykjavik area toward autonomy and paternalism in caregiving of the elderly

With the aging population and the increase in health care costs, issues of independence and autonomy will have a greater impact on formal and informal health care. Changes in occupational functioning that accompany increased age has raised the demandfor family assistance to the elderly. It is important for occupational therapists to understand the elderly's perceptions toward autonomy and paternalism in caregiving of the elderly because it is assumed that attitudes and beliefs affect how people interact and care for the elderly. A convenience sample of 57 Icelandic elderly were surveyed regarding their attitudes toward autonomy and paternalism in caregiving of the elderly. Results indicated that Icelandic elderly held strong beliefs toward autonomy but were undecided toward paternalism. Significant differences were found between groups. Elderly living at home indicated stronger beliefs on both autonomy and paternalism compared to those living in senior housing complexes. Elderly women held stronger beliefs in autonomy in contrast to the males, who were more paternalistic, and married subjects held stronger beliefs than did single respondents.