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.

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. ^

Blessed are the Peacemakers: Transnational Alliance, Protective Accompaniment and the Presbyterian Church of Colombia

The purpose of this thesis was to explore how Christian networks enable strategies of transnational alliance, whereby groups in different nations strive to strengthen one another’s leverage and credibility in order to resolve conflicts and elaborate new possibilities. This research does so by analyzing the case of the Presbyterian Church of Colombia (IPC). The project examines the historical development of the IPC from the initial missionary period of the 1850s until the present. Specifically, the purpose of the study was to consider how the historical struggle to articulate autonomy and equality vis-à-vis the U.S. Presbyterians (PCUSA) and paternalist models of ecclesial relations has affected recent political strategies pursued by the IPC. Despite the paternalism of the early missionary model, changing conceptions of social transformation during the 60s contributed to a shift in relations. Over time the IPC and PCUSA negotiated relationships in which groups both acknowledge a problematic history and insist upon an ethnic of partnership and respect. Today, PCUSA groups, in concert with the IPC, collaborate on a range of transnational political strategies aimed at strengthening the IPC’s leverage in local struggles for justice and peace. A review of this case suggests that long-established Christian networks may have an advantage over other civil society groups such as NGOs in facilitating strategies of transnational alliance. Although civil society organizations often have better access to important resources needed for international advocacy initiatives, Christian networks, such as the one established between the IPC and U.S. Presbyterian communities, rely on a history of negotiating power-disparity in order to elaborate relationships based on listening and partnership. Such findings prove important not only to how we conceptualize transnational alliance but also to the ways that we think about the history and future of Christian networks.