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. ^

Organizational culture, organizational climate, and collaborative capacity for planning

The objective of this study was to investigate the relationship of organizational culture and organizational climate on participant perceptions of collaborative capacity for planning, within the context of the Florida School Readiness Coalitions (FSRCs). Three hypotheses were proposed for study: First, that organizational culture would be correlated to organizational climate; second, that organizational culture would be correlated to collaborative capacity for planning; and the third that organizational climate would be correlated to collaborative capacity for planning. ^ A cross-sectional survey research design was used to obtain data from participants in 25 Florida School Readiness Coalitions. Pearson product-moment correlations were used to examine the association between the dependent variable, collaborative capacity for planning, and the independent variables, organizational culture and climate. Bivariate analyses revealed a significant level of association for five culture indicators to collaborative capacity for planning: motivation, interpersonal, service, supportive and individualistic indicators, and four climate indicators: cooperation, job satisfaction, organizational commitment, and role clarity. Findings suggest (a) a constructive culture and positive climate were present within the FSRCs during the period of study and (b) participants perceived that the collaborative capacity for planning existed. Hierarchical multiple regression, controlling for effects of participant demographics, were used to examine the degree to which organizational culture and climate predict collaborative capacity. The culture indicators, supportive and individualistic, and the climate indicator job satisfaction accounted for 46% of the variance in collaborative capacity for planning. No other indicators of the independent variables demonstrated significance. The findings suggests that (a) culture and climate should be studied together, (b) culture and climate are two constructs that may provide knowledge about the way community groups work together, and (c) the collaborative capacity of groups planning services such as the FSRCs may benefit through consideration of how culture and climate affect service planners' relationships, communication, and ability to achieve a mission or goal. Culture and climate may offer social workers new information about internal factors affecting the collaborative process. Further investigation of these constructs with other types of groups is warranted. ^

Development of local homeland security networks in the state of Florida: A social network analysis approach

How do local homeland security organizations respond to catastrophic events such as hurricanes and acts of terrorism? Among the most important aspects of this response are these organizations ability to adapt to the uncertain nature of these "focusing events" (Birkland 1997). They are often behind the curve, seeing response as a linear process, when in fact it is a complex, multifaceted process that requires understanding the interactions between the fiscal pressures facing local governments, the institutional pressures of working within a new regulatory framework and the political pressures of bringing together different levels of government with different perspectives and agendas. ^ This dissertation has focused on tracing the factors affecting the individuals and institutions planning, preparing, responding and recovering from natural and man-made disasters. Using social network analysis, my study analyzes the interactions between the individuals and institutions that respond to these "focusing events." In practice, it is the combination of budgetary, institutional, and political pressures or constraints interacting with each other which resembles a Complex Adaptive System (CAS). ^ To investigate this system, my study evaluates the evolution of two separate sets of organizations composed of first responders (Fire Chiefs, Emergency Management Coordinators) and community volunteers organized in the state of Florida over the last fifteen years. Using a social network analysis approach, my dissertation analyzes the interactions between Citizen Corps Councils (CCCs) and Community Emergency Response Teams (CERTs) in the state of Florida from 1996–2011. It is the pattern of interconnections that occur over time that are the focus of this study. ^ The social network analysis revealed an increase in the amount and density of connections between these organizations over the last fifteen years. The analysis also exposed the underlying patterns in these connections; that as the networks became more complex they also became more decentralized though not in any uniform manner. The present study brings to light a story of how communities have adapted to the ever changing circumstances that are sine qua non of natural and man-made disasters.^

The Influence of Social Responsibility Image Relative to Product and Service Quality on Brand Loyalty: An Exploratory Study of Quick-service Restaurants

Social responsibility (SR) is becoming an increasingly significant component of many firms’ strategic planning decisions. Research has shown that consumers tend to reward socially responsible behavior. However, there has been little testing of the construct in the hospitality industry. Additionally, when other important variables that influence consumer brand loyalty are considered, will brand social responsibility image (BSRI) still play a significant role? This study investigates the importance of SR and its impact on brand loyalty, relative to product quality and service quality in the quick-service restaurant industry. The authors were also interested to learn whether BSRI impacted consumers' image of product and service quality. It was found that BSRI had a positive impact on brand loyalty, product quality, and service quality. However, product quality was a significantly stronger predictor of brand loyalty than BSRI. Where the vast majority of studies of SR have utilized scenario analysis of hypothetical firms, this study utilizes consumers' perceptions of a real-world firm.

Hospital discharge planning in the provision of food and nutrition services for older adults post discharge

This descriptive study examined whether discharge planning ensures that food and nutrition services are provided to older adults following hospital discharge. The questionnaire was distributed to discharge planning professionals in 11 South Florida hospitals. Of the 84 respondents (88% response rate), most were female nurse case managers. Almost all reported job barriers including excessive patient loads, too many responsibilities, and limited community services. While physicians, registered nurses, social workers, physical therapists, were deemed "very important" in discharge planning,registered dietitians were not, and almost half consulted them infrequently, if at all. Over 84% said nutrition-related medical conditions/factors, "strongly influenced" discharge planning. Many did not have adequate information about nutrition-related community resources, eg, home delivered meals, food stamps, outpatient registered dietitians. Therewere no universal approaches in meeting the nutrition needs in 6 case scenarios. More communication among community services and hospitals is needed.

GIS-integrated mathematical modeling of social phenomena at macro- and micro- levels—a multivariate geographically-weighted regression model for identifying locations vulnerable to hosting terrorist safe-houses: France as case study

Adaptability and invisibility are hallmarks of modern terrorism, and keeping pace with its dynamic nature presents a serious challenge for societies throughout the world. Innovations in computer science have incorporated applied mathematics to develop a wide array of predictive models to support the variety of approaches to counterterrorism. Predictive models are usually designed to forecast the location of attacks. Although this may protect individual structures or locations, it does not reduce the threat—it merely changes the target. While predictive models dedicated to events or social relationships receive much attention where the mathematical and social science communities intersect, models dedicated to terrorist locations such as safe-houses (rather than their targets or training sites) are rare and possibly nonexistent. At the time of this research, there were no publically available models designed to predict locations where violent extremists are likely to reside. This research uses France as a case study to present a complex systems model that incorporates multiple quantitative, qualitative and geospatial variables that differ in terms of scale, weight, and type. Though many of these variables are recognized by specialists in security studies, there remains controversy with respect to their relative importance, degree of interaction, and interdependence. Additionally, some of the variables proposed in this research are not generally recognized as drivers, yet they warrant examination based on their potential role within a complex system. This research tested multiple regression models and determined that geographically-weighted regression analysis produced the most accurate result to accommodate non-stationary coefficient behavior, demonstrating that geographic variables are critical to understanding and predicting the phenomenon of terrorism. This dissertation presents a flexible prototypical model that can be refined and applied to other regions to inform stakeholders such as policy-makers and law enforcement in their efforts to improve national security and enhance quality-of-life.