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. ^

A decision support framework for infrastructure maintenance investment decision-making

Infrastructure management agencies are facing multiple challenges, including aging infrastructure, reduction in capacity of existing infrastructure, and availability of limited funds. Therefore, decision makers are required to think innovatively and develop inventive ways of using available funds. Maintenance investment decisions are generally made based on physical condition only. It is important to understand that spending money on public infrastructure is synonymous with spending money on people themselves. This also requires consideration of decision parameters, in addition to physical condition, such as strategic importance, socioeconomic contribution and infrastructure utilization. Consideration of multiple decision parameters for infrastructure maintenance investments can be beneficial in case of limited funding. Given this motivation, this dissertation presents a prototype decision support framework to evaluate trade-off, among competing infrastructures, that are candidates for infrastructure maintenance, repair and rehabilitation investments. Decision parameters' performances measured through various factors are combined to determine the integrated state of an infrastructure using Multi-Attribute Utility Theory (MAUT). The integrated state, cost and benefit estimates of probable maintenance actions are utilized alongside expert opinion to develop transition probability and reward matrices for each probable maintenance action for a particular candidate infrastructure. These matrices are then used as an input to the Markov Decision Process (MDP) for the finite-stage dynamic programming model to perform project (candidate)-level analysis to determine optimized maintenance strategies based on reward maximization. The outcomes of project (candidate)-level analysis are then utilized to perform network-level analysis taking the portfolio management approach to determine a suitable portfolio under budgetary constraints. The major decision support outcomes of the prototype framework include performance trend curves, decision logic maps, and a network-level maintenance investment plan for the upcoming years. The framework has been implemented with a set of bridges considered as a network with the assistance of the Pima County DOT, AZ. It is expected that the concept of this prototype framework can help infrastructure management agencies better manage their available funds for maintenance.

A Multi-Criteria Decision-Making Approach to Compare and Contrast the Websites of China-based and U.S-based Hotels

The improvement in living standards and the development of telecommunications have led to a large increase in the number of Internet users in China. It has been reported by China National Network Information Center that the number of Internet users in China has reached 33.7 million in 2001, ranting the country third in the world. This figure also shows that more and more Chinese residents have accepted the Internet and use it to obtain information and compete their travel planning. Milne and Ateljevic stated that the integration of computing and telecommunications would create a global information network based mostly on the Internet. The Internet, especially the World Wide Web, has had a great impact on the hospitality and tourism industry in recent years. The WWW plays an important role in mediating between customers and hotel companies as a place to acquire information acquisition and transact business.

Information systems to support decision-making in *construction owner organizations: A data warehousing approach

Construction organizations typically deal with large volumes of project data containing valuable information. It is found that these organizations do not use these data effectively for planning and decision-making. There are two reasons. First, the information systems in construction organizations are designed to support day-to-day construction operations. The data stored in these systems are often non-validated, non-integrated and are available in a format that makes it difficult for decision makers to use in order to make timely decisions. Second, the organizational structure and the IT infrastructure are often not compatible with the information systems thereby resulting in higher operational costs and lower productivity. These two issues have been investigated in this research with the objective of developing systems that are structured for effective decision-making. ^ A framework was developed to guide storage and retrieval of validated and integrated data for timely decision-making and to enable construction organizations to redesign their organizational structure and IT infrastructure matched with information system capabilities. The research was focused on construction owner organizations that were continuously involved in multiple construction projects. Action research and Data warehousing techniques were used to develop the framework. ^ One hundred and sixty-three construction owner organizations were surveyed in order to assess their data needs, data management practices and extent of use of information systems in planning and decision-making. For in-depth analysis, Miami-Dade Transit (MDT) was selected which is in-charge of all transportation-related construction projects in the Miami-Dade county. A functional model and a prototype system were developed to test the framework. The results revealed significant improvements in data management and decision-support operations that were examined through various qualitative (ease in data access, data quality, response time, productivity improvement, etc.) and quantitative (time savings and operational cost savings) measures. The research results were first validated by MDT and then by a representative group of twenty construction owner organizations involved in various types of construction projects. ^

Assessing the effects of professionals' career decision -making on their participation reasons in continuing education in Taiwan

The purpose of this study was to assess the relationship between working professionals' Career Decision-Making Self-Efficacy beliefs (CDMSE beliefs) and their reasons for participating in in-service master's level programs in Taiwan. ^ The data collection instruments used were Grotelueschen's (1985) Participation Reasons Scale (PRS), and Betz, Klein, and Taylor's (1996) Career Decision-Making Self-Efficacy-Short Form (CDMSE-SF), and a Demographic Data Form (DDF) developed specifically for this study. ^ Surveys were administered to 800 working professionals who participated in inservice master's level programs at 22 Taiwanese universities. The survey was conducted in May 2004. Data were analyzed by simple descriptive statistics, principal component factor analysis, and multiple regression. Four factors of participation reasons were found and five components of CDMSE beliefs were scored. ^ Five components of CDMSE beliefs are structured into the CDMSE-SF instrument: Self-Appraisal, Occupational Information, Goal-Selection, Planning, and Problem Solving. The reasons for participation found in this study were: Professional Improvement and Development, Professional Service, Personal Benefit and Job Security, and Professional Competence and Collegial Interaction. Pearson-product moment correlations revealed significant positive correlations between the five CDMSE subscales and the four factors of participation reasons. Multiple regression analysis revealed that participants' beliefs in their abilities to obtain information about occupations accounted for the preponderance of variance of scores on the Participation Reasons Scale (PRS). ^ This study concluded that professionals who believed that they were efficacious in obtaining information about occupations or professions tended to believe that the four reasons for participation represented by the factors of the PRS were important to them in making the decision to participate in continuing education. Additionally, it was noted that the reasons for participations for professionals who did not feel confident in their abilities to find such information could not be determined. ^ Recommendations are offered to assist those individuals responsible for developing recruiting programs in continuing education for professionals in Taiwan. These recommendations focus only on strategies intended to attract this target population of professionals who believe that they are efficacious in obtaining information about occupations. ^

Deprofessionalization of curriculum decision -making

The purpose of this study was to analyze the evolution of Florida state level policy efforts and to assess the responding educational policy development and implementation at the local school district level. The focus of this study was the secondary language arts curriculum in Miami-Dade County Public Schools. ^ Data was collected using document analysis as a source of meaning making out of the language sets proffered by agencies at each level. A matrix was created based on Klein's levels of curriculum decision-making and Functional Process Theory categories of policy formation. The matrix allowed the researcher to code and classify specific information in terms accountability/high-stakes testing; authority; outside influences; and operational/structural organization. ^ Federal policy documents provided a background and impetus for much of what originated at the State level. The State then produced policy directives which were accepted by the District and specific policy directives and guidelines for practice. No evidence was found indicating the involvement of any other agencies in the development, transmission or implementation of the State level initiated policies. ^ After analyzing the evolutionary process, it became clear that state policy directives were never challenged or discussed. Rather, they were accepted as standards to be met and as such, school districts complied. Policy implementation is shown to be a top-down phenomenon. No evidence was found indicating a dialogue between state and local systems, rather the state, as the source of authority, issued specifically worded policy directives and the district complied. Finally, this study recognizes that outside influences play an important role in shaping the education reform policy in the state of Florida. The federal government, through NCLB and other initiatives created a climate which led almost naturally to the creation of the Florida A+ Plan. Similarly, the concern of the business community, always interested in the production of competent workers, continued to support efforts at raising the minimum skill level of Florida high school graduates. ^ Suggestions are made for future research including the examination of local school sites in order to assess the overall nature of the school experience rather than rely upon performance indicators mandated by state policy. ^

Information systems to support decision-making in construction owner organizations : a data warehousing approach

Construction organizations typically deal with large volumes of project data containing valuable information. It is found that these organizations do not use these data effectively for planning and decision-making. There are two reasons. First, the information systems in construction organizations are designed to support day-to-day construction operations. The data stored in these systems are often non-validated, nonintegrated and are available in a format that makes it difficult for decision makers to use in order to make timely decisions. Second, the organizational structure and the IT infrastructure are often not compatible with the information systems thereby resulting in higher operational costs and lower productivity. These two issues have been investigated in this research with the objective of developing systems that are structured for effective decision-making. A framework was developed to guide storage and retrieval of validated and integrated data for timely decision-making and to enable construction organizations to redesign their organizational structure and IT infrastructure matched with information system capabilities. The research was focused on construction owner organizations that were continuously involved in multiple construction projects. Action research and Data warehousing techniques were used to develop the framework. One hundred and sixty-three construction owner organizations were surveyed in order to assess their data needs, data management practices and extent of use of information systems in planning and decision-making. For in-depth analysis, Miami-Dade Transit (MDT) was selected which is in-charge of all transportation-related construction projects in the Miami-Dade county. A functional model and a prototype system were developed to test the framework. The results revealed significant improvements in data management and decision-support operations that were examined through various qualitative (ease in data access, data quality, response time, productivity improvement, etc.) and quantitative (time savings and operational cost savings) measures. The research results were first validated by MDT and then by a representative group of twenty construction owner organizations involved in various types of construction projects.

Deprofessionalization of curriculum decision-making

The purpose of this study was to analyze the evolution of Florida state level policy efforts and to assess the responding educational policy development and implementation at the local school district level. The focus of this study was the secondary language arts curriculum in Miami-Dade County Public Schools. Data was collected using document analysis as a source of meaning making out of the language sets proffered by agencies at each level. A matrix was created based on Klein's levels of curriculum decision-making and Functional Process Theory categories of policy formation. The matrix allowed the researcher to code and classify specific information in terms accountability/high-stakes testing; authority; outside influences; and operational/structural organization. Federal policy documents provided a background and impetus for much of what originated at the State level. The State then produced policy directives which were accepted by the District and specific policy directives and guidelines for practice. No evidence was found indicating the involvement of any other agencies in the development, transmission or implementation of the State level initiated policies. After analyzing the evolutionary process, it became clear that state policy directives were never challenged or discussed. Rather, they were accepted as standards to be met and as such, school districts complied. Policy implementation is shown to be a top-down phenomenon. No evidence was found indicating a dialogue between state and local systems, rather the state, as the source of authority, issued specifically worded policy directives and the district complied. Finally, this study recognizes that outside influences play an important role in shaping the education reform policy in the state of Florida. The federal government, through NCLB and other initiatives created a climate which led almost naturally to the creation of the Florida A+ Plan. Similarly, the concern of the business community, always interested in the production of competent workers, continued to support efforts at raising the minimum skill level of Florida high school graduates. Suggestions are made for future research including the examination of local school sites in order to assess the overall nature of the school experience rather than rely upon performance indicators mandated by state policy.