bluuebunny/crossref_metadata_2025 huggingface dataset:
The importance of being `Indian': Identity centrality and work outcomes in an off-shored call center in India
Authors: Das Diya , Dharwadkar Ravi , Brandes Pamela
Published: October 2008

Existing studies of identity dynamics have shown that employees embody multiple social identities, and have multiple foci of identifications at work that shape their attitudes and behaviors. However, limited research has examined these frameworks in the new, emerging contexts of global workplaces. In this article, we focus on one such significant example of contemporary globalization: transnational service work in the international call center industry in India. Our findings indicate that national identity centrality is indeed negatively associated with employee performance and positively associated with intention to leave. Furthermore, national identity centrality also moderates the relationship of organizational identification with performance and burnout. While we reinforce the importance of organizational identity and occupational identity centrality, we highlight the hitherto ignored consequences of national identity centrality in our study context.
Should I stay or should I go? The role of risk in employee turnover decisions
Authors: Vardaman James M. , Allen David G. , Renn Robert W. , Moffitt Karen R.
Published: October 2008

The decision to leave a job has long been infused with risk for the worker deciding whether or not to leave the organization. However, the role of risk in employee turnover decisions has been largely unexplored in the turnover literature. This article integrates concepts from the turnover and risk literatures to better understand the decision processes of workers contemplating the decision to leave a job. The article offers two studies that investigate the impact of risk perceptions and turnover risk propensity on that decision. Study 1, a field study based on a sample of 155 US service workers in the gaming industry, shows that risk perceptions and propensity for risk moderate the relationship between turnover intentions and turnover behavior. Study 2, a laboratory experiment based on a sample of 222 working students, explores the role of framing and social influences on perceptions of risk and individual tendencies for risk-taking in a turnover context. Findings from Study 2 suggest that positive framing impacts on an individual's propensity for risk-taking when considering leaving a job, but does not impact on individual perceptions of risk, thus supporting the predictions of prospect theory in a turnover context. Taken in concert, these studies provide insight into how risk influences the decision processes of workers considering whether to sever an employment relationship. The implications and limitations of the research are discussed, and the relevance for future research is highlighted.
Judgments about knowledge importance: The roles of social referents and network structure
Authors: Wong Sze-Sze
Published: October 2008

As division of labor in a group can often lead to differences in perceptions about the importance of different knowledge bases to a group task, these differences can hinder the integration of different knowledge to solve task problems in a group. This study examines the social referents that group members turn to for judgments about knowledge importance, and the extent to which the relative influence of each referent depends on the group-level social network structure. The findings indicate that group members are more likely to have shared judgments with their cohesive and structurally equivalent referents within their advice network, and the strength of social influence from their cohesive and structurally equivalent referents is likely to depend on the advice network density at the group-level. However, there was no significant association in judgment similarity between group members and their central referents within the advice network. Overall, this study suggests that while social influence (in its most straightforward form) occurs between pairs of individuals, the strength of influence of a social referent is dependent on how social cues are distributed within the group's network structure. Theoretical and managerial implications for research on shared mental models and network theory of social influence are discussed.
The role of transformational leadership in enhancing team reflexivity
Authors: Schippers Michaéla C. , Den Hartog Deanne N. , Koopman Paul L. , van Knippenberg Daan
Published: October 2008

Team reflexivity, or the extent to which teams reflect upon and modify their functioning, has been identified as a key factor in the effectiveness of work teams. As yet, however, little is known about the factors that play a role in enhancing team reflexivity, and it is thus important to develop theorizing around the determinants of reflexivity. From an applied perspective, leadership is a very relevant factor. The current study is a first step in the development of such a model, and addresses this important gap in our understanding of team reflexivity by focusing on the role of leader behavior. We examined the extent to which transformational leadership influences team reflexivity, and in turn, team performance, in a field study conducted among 32 intact work teams from nine organizations. Team members rated reflexivity and leadership, while external managers rated team performance. We hypothesized and tested a mediational model proposing that transformational leadership is related to the adoption of a shared vision by the team. This in turn relates to team reflexivity, which leads to higher team performance. Results support this model.
Variability as a source of stability: Studying routines in the elderly home care setting
Authors: Essén Anna
Published: October 2008

While it is agreed that there can be a difference between the routine as inscribed in artefacts, the ostensive aspect of the routine and its performative aspect, little is known about the relationship between these parts of the routine. Further, while authors acknowledge that there is variability in routines as performed, the contemporary literature says less about the sources of this variability. Using empirical data from the Swedish community care setting, the present article explores the workings of and relationship between the different aspects of `the home-help delivery routine'. The article also explores the sources of variability in workers' execution of this routine in situ. The article provides rich illustrations of the differences between the routine as inscribed in artefacts, as `articulated patterns' and the workers' performance of the routine in specific situations. In contrast to the argument that alignment between these aspects contributes to stability in the routine, this article claims that divergences between them promote stability. The article highlights how factors in the local context, including exceptions created by technology, constitute sources of variability in the routine. It further shows how values in the contemporary society, adopted by individuals as emotional-ethical principles, shape individuals' performance of the routine and thereby generate variability in the routine. In general, the article underlines the importance of considering the cultural context in which the routine is situated, at micro- and macro-level, when analysing its operation. Indeed, factors beyond the routine influence individuals' conception of and execution of the routine.
Exploring the history of social work as a human rights profession
Authors: Healy Lynne M.
Published: October 2008

English

The IFSW has declared that social work is a human rights profession. This historical review explores social work contributions to human rights. The compatibility of principles, accomplishments of individual leaders and professional organizations' actions are examined, with particular focus on the period of adoption of the Universal Declaration of Human Rights.

French

La FITS a déclaré que le travail social est une profession des droits de l'homme. Cette revue historique explore les contributions du travail social aux droits de l'homme. La compatibilité des principes, les réalisations des leaders en tant qu'individus, et l'organisation professionnelle des actions sont examinées en portant une attention particulière à la période d'adoption de la Déclaration Universelle des Droits de l'Homme.

Spanish

La IFSW ha declarado que el trabajo social es una profesión de derechos humanos. Esta visión histórica explora las contribuciones del trabajo social a los derechos humanos. La compatibilidad de principios, los logros de líderes individuales y las acciones de la organización profesional son examinados con un énfasis particular en el período de adopción de la Declaración Universal de los Derechos Humanos.
Social work occupations in England, 1900—39
Authors: Burt Mike
Published: October 2008

English

Between 1900 and 1939 the aims, roles and tasks of social work occupations changed in England. The changes reflected the significance attached to people's social environment, compared with the more individualistic approach of 19th century provision. These changes are discussed in the context of developments in Europe and America during this period.

French

Entre 1900 et 1939, les finalités, rôles et tâches des professions du travail social en Angleterre subirent des modifications. Les changements reflétaient l'attention portée à l'environnement social des gens par rapport à l'approche plus individualiste du travail social du dix-neuvième siècle. Ces changements sont discutés dans le contexte des développements en Europe et aux États-Unis durant cette période.

Spanish

Entre 1900 y 1939 los objetivos, roles y tareas de las ocupaciones del trabajo social cambiaron en Inglaterra. Los cambios reflejaron el significado adherido al entorno social de la gente comparado al acercamiento más individualístico de la provisión del siglo XIX. Estos cambios fueron discutidos en los contextos de desarrollo en Europa y América durante este período.
The welfare state in cross-cultural perspective
Authors: Aspalter Christian
Published: October 2008

English

This article sets out to strengthen the cross-cultural perspective in comparative and general welfare state theory, by applying a cross-cultural perspective in both historical and international welfare state analysis. The author puts forward the conclusion that cultural traits and causal determinants can add critical value to the existing body of welfare state theories.

French

Cet article vise à renforcer la perspective interculturelle dans la théorie comparative et générale de l'état providence, en appliquant une perspective interculturelle dans l'analyse tant historique qu'internationale de l'état providence. L'auteur avance la conclusion que les traits culturels et les déterminants causaux peuvent ajouter une valeur critique au corpus existant de théories de l'état providence.

Spanish

Este ensayo busca fortalecer la perspectiva intercultural en la teoría general y comparativa del estado del bienestar social a través de la aplicación de una perspectiva intercultural tanto en el análisis histórico del estado del bienestar social como en su análisis internacional. El autor adelanta la conclusión de que los rasgos culturales y los determinantes casuales pueden agregar un valor crítico al cuerpo existente de teorias del estado del bienestar social.
Establishing international cooperation in social work education
Authors: Kniephoff-Knebel Anette , Seibel Friedrich W.
Published: October 2008

English

This article draws on records from the period to illustrate some of the themes and concerns of social workers present at international welfare conferences from 1928. In doing so it identifies some of the significant actors engaged in the early stages of establishing an international association for schools of social work.

French

Cet article tire les enseignements de la période pour illustrer certains des thèmes et préoccupations des travailleurs sociaux présents aux conférences internationales de travail social et de sécurité sociale depuis 1928. Ce faisant il identifie quelques acteurs significatifs engagés dès les premiers instants dans l'établissement d'une association internationale des écoles de travail social.

Spanish

Este ensayo analiza los registros del período para ilustrar algunos de los temas y preocupaciones de los trabajadores sociales que asistieron a conferencias internacionales de bienestar social desde 1928. Esto permite identificar a algunos de los actores más significativos que participaron en las primeras fases del establecimiento de una asociación internacional de escuelas de trabajo social.
What kind of social justice does social work seek?
Authors: Solas John
Published: October 2008

English

One of social work's most important practice values is social justice, as cited in the IFSW Code of Ethics. This article deconstructs what the term 'social justice' represents, since it is essential for social work - and the IFSW Code - to be clear about the type of social justice it seeks to uphold.

French

L'une des plus importantes valeurs du travail social est la justice sociale, telle que citée dans le Code d'éthique et de Déontologie de la FITS (2005). Cet article déconstruit ce que le terme de 'justice sociale' représente, puisqu'il est essentiel pour le travail social - et le Code de la FITS - afin d'être clair sur le type de justice sociale qu'il vise à promouvoir.

Spanish

Uno de los valores de práctica más importantes del trabajo social es la justicia social, como está descrita en el Código de Ética (2005) del IFSW. Este ensayo describe lo que el término 'justicia social' representa, ya que es esencial en el trabajo social - al igual que el Código del IFSW - para clarificar el tipo de justicia social que se busca mantener.
Six Turkish Personality Factors and the HEXACO Model of Personality Structure
Authors: Arzu Wasti S. , Lee Kibeom , Ashton Michael C. , Somer Oya
Published: October 2008

This article examines the six largest dimensions of the Turkish personality lexicon, as derived from the personality-descriptive terms of Goldberg and Somer's (2000) data set. The six Turkish lexical factors show close correspondences of content to all six dimensions observed in several other languages. In a new data set, the authors then correlate factor scores representing these indigenous Turkish dimensions with the scales of the HEXACO Personality Inventory, which operationalize the six cross-language factors. Results show a pattern of strong convergent and weak discriminant correlations. Overall, findings suggest that the cross-language six-dimensional structure of personality description does generalize to the Turkish lexicon. The Turkish structure also reveals some interesting emic features, particularly with regard to the content of the Openness to Experience factor.
Paradox Lost
Authors: Ramírez-Esparza Nairán , Gosling Samuel D. , Pennebaker James W.
Published: October 2008

Simpatía is a cultural script that characterizes Hispanics as agreeable, friendly, sympathetic, and polite. However, on self-reports Hispanics score lower on Simpatía/Agreeableness than do non-Hispanics. This study reveals that it is the modesty within Simpatía that accounts for these paradoxical findings by driving down scores on Hispanics' self-reports. To test this idea, this study assesses Simpatía/Agreeableness in Mexican American bilinguals using (a) self-reports of Simpatía in English and Spanish and (b) behavioral manifestations of Simpatía in a social interaction task conducted in English and Spanish. As predicted, on self-reports bilinguals score lower on Simpatía when the assessment is in Spanish than when it is in English, but they show more Simpatía-related behaviors in the social interaction task in Spanish than in English. Follow-up analyses show that the results cannot be explained by translation artifacts on the questionnaire, response-style biases, or reference-group effects. The paradox sheds light on the complex interplay between culture and language.
A Longitudinal Study of the Adaptation of International Students in the United States
Authors: Cemalcilar Zeynep , Falbo Toni
Published: October 2008

The authors conducted a longitudinal study of international students ( N = 90) attending a U.S. university to examine the effects of the initial cross-cultural transition on their psychological well-being and social and academic adaptations. The results indicate a significant decline in self-reports of psychological well-being, increased identification with the host culture, and stable identification with home cultures. Students who exhibit a separation strategy previous to their sojourn have the lowest level of social adaptation to the host culture.
Personal and Collective Culpability Judgment
Authors: Manchi Chao Melody , Zhang Zhi-Xue , Chiu Chi-Yue
Published: October 2008

This research takes a functional perspective and examines the psychological processes underlying personal and collective culpability judgments in European Americans and Chinese in mainland China (Experiment 1), and in European Americans and Asian Americans (Experiment 2). Results indicate that when determining personal culpability for negative events, all three cultural groups consider behavioral causality. However, Chinese and Asian American participants tend to make more extreme collective culpability judgments than do European American participants. Furthermore, activating the goal of delegated deterrence strengthens Chinese and Asian American participants' collective culpability judgments only, whereas activating the goal of group harmony increases the strength of collective culpability in all three cultural groups. These findings suggest that collective culpability serves different functions in different cultural contexts.
The Three-Component Model of Occupational Commitment
Authors: Snape Ed , Lo Carlos Wing-hung , Redman Tom
Published: October 2008

The authors find some support for the cross-cultural validity of the Meyer, Allen, and Smith (1993) three-component model of occupational commitment in samples of Chinese and British accountants. Normative and affective commitments are higher in the Chinese sample, and continuance commitment is higher in the British sample. There is some support for hypotheses on the consequences of the components of occupational commitment (occupational withdrawal cognitions and the intention to participate in professional activities). However, contrary to the hypotheses, the authors' analysis suggests that there are no significant differences in these relationships between the two samples. The authors find a significant interaction between affective and continuance commitment in the analysis of occupational withdrawal cognitions, such that the relationship between each of these components and withdrawal cognitions is stronger where commitment on the other component is low.
The Process of Immigrant Adjustment
Authors: Markovizky Gila , Samid Yuval
Published: October 2008

This study examines the role played by length of residence in determining the psychological adjustment of 382 new immigrants from the former Soviet Union during their first 2 years in Israel. Psychological adjustment was evaluated using longitudinal ( n = 133) and cross-sectional ( n = 382) designs. The findings partially support the U-curve 3-stage social adjustment model (Lysgaard, 1955). The first stage, occurring from the first days up to 5 months in the new country, is the deterioration stage. The second stage, occurring between 5 and 11 months, is the low well-being stage. The third stage, occurring after more than 11 months, is the recovery stage. Significant differences in psychological adjustment exist between the first and second stages.
Interpreting GLOBE Societal Practices Scales
Authors: McCrae Robert R. , Terracciano Antonio , Realo Anu , Allik Jüri
Published: October 2008

Some of the Global Leadership and Organizational Behavior Effectiveness (GLOBE) Societal Practices scales ask for descriptions of typical personality traits that might be interpreted as judgments of national character. Ratings of national character reflect cultural identities and social dynamics, but previous research suggests that they are unrelated to the mean personality traits of the culture's members. Analyses at the culture level comparing GLOBE scales with aggregate assessed personality traits ( n = 34) and with measures of perceived national character ( n = 33) showed that these GLOBE scales are better construed as unfounded stereotypes than as actual depictions of the society members' personality traits.
Gaze Display When Thinking Depends on Culture and Context
Authors: McCarthy Anjanie , Lee Kang , Itakura Shoji , Muir Darwin W.
Published: October 2008

In three experiments, the roles of culture and social factors in individual's eye gaze displays when thinking were examined. Canadian and Japanese participants answered questions requiring thinking to derive the answers in social and nonsocial contexts. Canadian participants looked up when thinking but only when they were aware of being observed. They looked down when they knew they could not be seen. In contrast, Japanese participants looked down when thinking even when they knew they were being observed. These results are inconsistent with the view that eye movement patterns when thinking are driven solely by endogenous brain activities and consistent with the view that thinking-related gaze behaviors are modulated by cultural display rules and social contexts.
Cultural Differences and Similarities in Request Rejection
Authors: Cheng Cecilia , Woo Young Chun
Published: October 2008

Using global measures, most studies have shown that Caucasian Americans were more assertive than Chinese. Adopting a situational approach, three studies were conducted to examine situational differences and similarities in request rejection, and its underlying mechanisms for Caucasian Americans and Chinese. Results revealed that (a) Caucasian Americans were more likely to reject requests of moderate legitimacy than Chinese; (b) both cultural groups were similar in request rejection in high- and low-legitimacy situations; (c) both cultural groups were more likely to reject a request when considering their needs and rights, but less likely to reject a request when considering their relationship with the requester; and (d) the self-model of request rejection was more salient for Caucasian Americans but the relational model of request rejection was more salient for Chinese in moderate-legitimacy situations.
Caught Up in the System
Authors: Mageehon Alexandria
Published: October 2008

This article discusses the results of a qualitative study of nine women who had been incarcerated and how they negotiated power structures in both the prison system and the educational systems of public schools prior to incarceration and adult education classrooms both during and after incarceration. Findings focus on how the women defined the system and how they responded to the power issues inherent within the penal system, how the women brokered power in their education experiences, and how the women negotiated the resource management of powerful others.
Career Ambitions
Authors: Kortering Larry J. , Braziel Patricia M. , McClannon Terry W.
Published: October 2008

Participants with and without specific learning disabilities (SLD) provided responses as to background and school features, postschool plans, dream career, and most likely job after completing school. Findings suggest that participant groups are similar across most background and school features, with apparent differences for grade level and repeating of a grade (participants with SLD older and more likely to have repeated a grade), and gender (those with SLD more likely to be male). Participants without SLD reported a pattern of postschool plans that proved significantly different, including higher rates for postsecondary education, than did participants with SLD and a lower rate for direct employment and for being “unsure.” Both groups were comparable in terms of reported “dream or ideal” job, but the pattern proved significantly different for “most likely” job. Implications for future research and practice are noted.
Measurement of Nutrition Status in Crohn's Disease Patients Receiving Infliximab Therapy
Authors: Wiese Dawn , Lashner Bret , Seidner Douglas
Published: October 2008

Aim: There is limited information on the nutrition impact of antitumor necrosis factor‐α treatment in adult Crohn's disease (CD). This study was performed to examine the effect of a 6‐month course of infliximab on enterocyte function, nutrient status, metabolism, and body composition in these patients. Methods: Seven CD patients were assessed for disease activity, enterocyte function, and body composition prior to, after 6 weeks, and after 6 months of infliximab treatment. Measurements included (1) disease activity: Inflammatory Bowel Disease Questionnaire, Harvey Bradshaw Index, and C‐reactive protein; (2) enterocyte function: folate, homocysteine, vitamin B12, citrulline, vitamin D,β ‐carotene, d‐xylose absorption; (3) Prognostic Inflammatory and Nutritional Index (PINI); and (4) body composition and metabolism: body mass index (BMI), fat and lean body mass, resting energy expenditure (RRE), and respiratory quotient. Results: Most patients had improvement in disease activity with infliximab. PINI decreased in all patients (–3.35, P = .04). Plasma folate concentration significantly increased. There was an increase in BMI, fat mass, and lean body mass. The respiratory quotient increased in most patients. Changes in citrulline level and REE were inconsistent. Conclusions: Crohn's disease patients have improvements in an index that measures both inflammation and nutrition (PINI) with infliximab therapy. Increases in plasma folate suggest improvement in enterocyte function and/or increased oral intake. The increase in respiratory quotient suggests decreased lipolysis and the lack of a starvation state. It was unclear whether weight gain was predominantly fat or lean muscle mass. These finding also support the use of PINI in Crohn's patients as an overall marker of inflammation and nutrition, and as a measure of response to infliximab therapy.
Nutrition Support Challenges in Hematopoietic Stem Cell Transplant Patients
Authors: Thompson Jennifer L. , Duffy Jennifer
Published: October 2008

Hematopoietic stem cell transplant (HSCT) patients can present a number of nutrition challenges despite recent advancements in medical care. Several areas of controversy exist, including whether probiotics can be safely used; the use of probiotics continues to expand but efficacy and safety is a concern in immunocompromised patients, including HSCT recipients. Second, parenteral nutrition continues to be the primary avenue for nutrition support despite growing evidence that enteral feedings can be successfully administered. Last, tight glycemic control has been associated with positive clinical outcomes in hospitalized patients. However, whether tight glycemic control can be achieved and is of benefit in this patient population continues to be debated. This article will discuss the current challenges facing clinicians regarding these 3 issues—probiotics, enteral nutrition support, and glycemic control—and future directions in HSCT.
Chyle Leaks: Consensus on Management?
Authors: Smoke Addy , DeLegge Mark H.
Published: October 2008

Lymphatic injury leading to leakage of chyle is a potential complication that may arise from trauma or surgery in the chest, abdomen, or neck. Although the incidence of chyle leak post surgery is low (1%‐4%), this complication can present significant challenges. Multiple approaches to the treatment of chyle leak have emerged, including nutrition, surgical, and pharmacological therapies. Although there are strong feelings among clinicians about the use of bowel rest, parenteral nutrition, or a low‐fat enteral formula for the treatment of chyle leak, definitive evidence supporting one nutrition therapy over another does not exist. The lack of a clear consensus on the optimal management of chyle leaks makes this an area that is ripe for prospective analysis.
Anemia in Cystic Fibrosis: Incidence, Mechanisms, and Association With Pulmonary Function and Vitamin Deficiency
Authors: von Drygalski Annette , Biller Julie
Published: October 2008

Background: Anemia is associated with increased morbidity and mortality in many chronic diseases. Little is known about anemia in cystic fibrosis (CF). Because the majority of patients with CF die of lung disease, the objective of this study was to identify the frequency, severity, and mechanisms of anemia in CF and to determine if there was an association between anemia and poor lung function in these patients. Vitamin deficiency was used to assess the association of malabsorption and anemia. Methods: Charts of 218 CF patients (ages >1 month to 61 years) were reviewed. Information extracted included medical history, complete blood counts, iron studies, pulmonary function tests, vitamin levels, serum creatinine levels, and medications. Results: As patients aged, anemia increased from 12% in those <16 to 58.3% ≥age 40. Anemic patients had poorer lung function than nonanemic patients. Mean forced expiratory volume (FEV1) and forced vital capacity (FVC) were 51.6% (SEM ± 10.3) and 69.7% (SEM ± 9.3) in anemic and 82.5% (SEM ± 9.2) and 95% (SEM ± 8.3) in nonanemic patients, respectively (P < .001). Of vitamin‐deficient patients, 90% were anemic whereas only 59.5% of nonvitamin‐deficient patients were anemic (P = .02). Complete iron studies were only available in 17 of 48 anemic patients and 11 were diagnosed with iron deficiency. Conclusions: Anemia in CF is associated with poor lung function and vitamin deficiency. Although anemia was often incompletely evaluated, iron deficiency was common. Recognition and complete evaluation of anemia might be important for continued improvement of care in CF.
Nutrition Considerations in Esophagectomy Patients
Authors: Kight Cassandra E.
Published: October 2008

The primary indication for an esophagectomy is esophageal cancer or Barrett's esophagus with high‐grade dysplasia. Patients undergoing esophagectomy often present with dysphagia, side effects from chemotherapy, decreased appetite, and weight loss. Esophagectomy is a major surgery involving the abdomen, neck, and/or chest requiring 5 to 7 days of NPO status to allow healing of the anastomosis between the upper esophagus and new esophageal conduit (usually the stomach). Placement of a feeding jejunostomy preoperatively or at time of surgery provides enteral access for patients who will experience eating challenges and a slow transition back to a normal diet, challenges that often lead to weight loss in the postoperative period. Supplemental tube feeding given nocturnally can provide a consistent intake while appetite, swallowing, and diet advancements improve during the convalescent period. The postesophagectomy diet advances from liquids to soft solids with restrictions to reduce discomfort and aid swallowing and digestion. The esophagectomy patient will experience physical, dietary, and social adaptation for several months postoperatively. Attention to nutrition throughout the process of diagnosis, treatment, and postoperative care is essential for optimal care of the esophagectomy patient.
Nutrition Risk Factors in Older Coronary Artery Bypass Graft Patients
Authors: DiMaria‐Ghalili Rose Ann
Published: October 2008

Coronary artery bypass grafting surgery is increasingly performed in adults aged 65 and older. Older adults are vulnerable to undernutrition, and as they undergo coronary artery bypass grafting surgery, their nutrition status must be considered carefully. The present review focuses on nutrition risk factors unique to older adults who undergo coronary artery bypass grafting surgery.
The Heart Failure and Sodium Restriction Controversy: Challenging Conventional Practice
Authors: Beich Katherine R. , Yancy Clyde
Published: October 2008

Optimal care of patients with heart failure requires a multifaceted approach that includes guideline‐driven, evidence‐based therapies, intensive patient education, careful initial and follow‐up assessment, and appropriately constructed nutrition prescriptions. Central to the construct of the nutrition prescription is advice regarding sodium consumption. It is intuitively and generally agreed upon that sodium restriction is appropriate for patients with heart failure, despite the lack of evidence‐based research studies. Whereas limiting sodium is most appropriate for the hypertensive patient at risk for developing heart failure and the patient who is overtly volume overloaded, less certainty exists regarding the sodium prescription for patients with diagnosed heart failure that is well compensated. Sodium intake is only 1 component of medical nutrition therapy, and prescription must be individualized according to nutrition assessment and priority of needs. However, in the absence of new compelling data, sodium restriction remains the most appropriate dietary intervention in general for patients with heart failure.
Characteristics of Thiamin and Its Relevance to the Management of Heart Failure
Authors: Wooley Jennifer A.
Published: October 2008

Heart failure (HF) is a major public health problem in the United States that puts a significant burden on both patients and the healthcare system. The prevalence of malnutrition in HF patients is well‐known and correlates with a dramatic decline in quality of life and disease progression, and is associated with high morbidity and mortality rates. The implication of HF on micronutrient status is underrecognized in the quest to offer “best practice” medical, device, and surgical interventions to this population. The micronutrient thiamin is of particular interest in the management of HF for several reasons: (a) HF is a disease of the elderly whose micronutrient status is in need of attention; (b) HF patients tend to have inadequate nutrient intake, which has been associated with thiamin deficiency; (c) thiamin deficiency (wet beriberi) impairs cardiac performance and can mimic the signs and symptoms of HF thereby potentially exacerbating the underlying disease; (d) use of loop diuretics to manage fluid and sodium imbalances associated with HF may cause the hyperexcretion of thiamin, thereby increasing the risk of deficiency; and (e) the prevention of thiamin deficiency should be a routine component in the overall management of this disease.
The Patient With Circulatory Shock: To Feed or Not to Feed?
Authors: Cresci Gail , Cúe Jorge
Published: October 2008

Controversy continues to surround the appropriate form and timing of nutrition support for the patient with circulatory shock. Clinical studies have demonstrated improvements in outcome with the administration of enteral nutrition to critically ill patients; however, the provision of enteral nutrition to critically ill patients with ongoing shock remains controversial. This article reviews gut perfusion during normal states and during circulatory shock as well as alterations in perfusion when enteral feeding is provided. Pharmaconutrients studied during ischemia and reperfusion are discussed.
Prospective Randomized Control Trial of Intermittent Versus Continuous Gastric Feeds for Critically Ill Trauma Patients
Authors: Hacker Robert , Harvey‐Banchik Lillian P.
Published: October 2008

Background: This study compared an intermittent feeding regimen (one‐sixth of daily needs infused every 4 hours) with a continuous (drip) feeding regimen for critically ill trauma patients. There were two outcome variables: time to reach goal volume and the days on 100% of caloric needs via an enteral route in the first 10 days of the intensive care unit stay. Adverse events were also tallied. Methods: A prospective randomized trial was conducted in the trauma intensive care unit in a university Level I trauma center. A total of 164 trauma patients, 18 years of age and older were admitted to the trauma intensive care unit with a noninjured gastrointestinal tract and required more than 48 hours of mechanical ventilation. Patients were randomized to receive enteral nutrition via an intermittent feeding regimen versus a continuous feeding regimen. A single nutritionist calculated caloric and protein goals. A strict protocol was followed where hourly enteral intake, interruptions and their causes, diarrhea, and pneumonia were recorded, as well as standard guidelines for intolerance. Results: A total of 164 patients were randomized and 139 reached their calculated nutritional goal within 7 days. There were no statistical differences in complications of tube feeding. The patients intermittently fed reached the goal faster and by day 7 had a higher probability of being at goal than did the patients fed continuously (χ= 6.01, p= 0.01). Intermittent patients maintained 100% of goal for 4 of 10 days per patient (95% CI = 3.5–4.4) as compared with the drip arm goal for only 3 of 10 days per patient (95% CI = 2.7–3.6). Conclusions: Patients from both the intermittent and continuous feeding regimens reached the goal during the study period of 7 days but the intermittent regimen patients reached goal enteral calories earlier. The intermittent gastric regimen is logistically simple and has equivalent outcomes to a standard dripfeeding regimen.
Creating Trust in an Acute Psychiatric Ward
Authors: Helene Hem Marit , Heggen Kristin , Ruyter Knut W
Published: October 2008

The ideal of trust pervades nursing. This article uses empirical material from acute psychiatry that reveals that it is distrust rather than trust that is prevalent in this field. Our data analyses show how distrust is expressed in the therapeutic environment and in the relationship between nurse and patient. We point out how trust can nonetheless be created in an environment that is characterized by distrust. Both trust and distrust are exposed as `fragile' phenomena that can easily `tip over' towards their opposites. Trust is not something that nurses possess or are given; it is rather something that they earn and have to work hard to achieve. Regarding themselves as potential causes of distrust and active wielders of power can contribute to nurses developing a more realistic view of their practice. Assuming a realistic middle-way perspective can help to manoeuvre between the extremities of excellence and resignation, which in turn can lead to processes that create trust between psychotic patients and nurses.
Professional Challenges of Bedside Rationing in Intensive Care
Authors: Halvorsen Kristin , Førde Reidun , Nortvedt Per
Published: October 2008

As the pressure on available health care resources grows, an increasing moral challenge in intensive care is to secure a fair distribution of nursing care and medical treatment. The aim of this article is to explore how limited resources influence nursing care and medical treatment in intensive care, and to explore whether intensive care unit clinicians use national prioritization criteria in clinical deliberations. The study used a qualitative approach including participant observation and in-depth interviews with intensive care unit physicians and nurses working at the bedside. Scarcity of resources regularly led to suboptimal professional standards of medical treatment and nursing care. The clinicians experienced a rising dilemma in that very ill patients with a low likelihood of survival were given advanced and expensive treatment. The clinicians rarely referred to national priority criteria as a rationale for bedside priorities. Because prioritization was carried out implicitly, and most likely partly without the clinician's conscious awareness, central patient rights such as justice and equality could be at risk.
Ethical Behaviours in Clinical Practice Among Mexican Health Care Workers
Authors: Valdez-Martínez Edith , Lavielle Pilar , Bedolla Miguel , Squires Allison
Published: October 2008

The objective of this study was to describe the cultural domain of ethical behaviours in clinical practice as defined by health care providers in Mexico. Structured interviews were carried out with 500 health professionals employed at the Mexican Institute of Social Security in Mexico City. The Smith Salience Index was used to evaluate the relevance of concepts gathered from the free listings of the interviewees. Cluster analysis and factor analysis facilitated construction of the conceptual categories, which the authors refer to as `dimensions of ethical practice'. Six dimensions emerged from the analysis to define the qualities that comprise ethical clinical practice for Mexican health care providers: overall quality of clinical performance; working conditions that favour quality of care; use of ethical considerations as prerequisites for any health care intervention; values favouring teamwork in the health professional—patient relationship; patient satisfaction scores; and communication between health care providers and patients. The findings suggest that improved working conditions and management practices that promote the values identified by the study's participants would help to improve quality of care.
A Cross-Cultural Comparison of Nurses' Ethical Concerns
Authors: Wadensten Barbro , Wenneberg Stig , Silén Marit , Ping Fen Tang  , Ahlström Gerd
Published: October 2008

The aim of this study was to compare Swedish and Chinese nurses' experiences of ethical dilemmas and workplace distress in order to deepen understanding of the challenges neuroscience nurses encounter in different cultures. Qualitative interviews from two previously performed empirical studies in Sweden and China were the basis of this comparative study. Four common content areas were identified in both studies: ethical dilemmas, workplace distress, quality of nursing and managing distress. The themes formulated within each content area were compared and synthesized into novel constellations by means of aggregated concept analysis. Despite wide differences in the two health care systems, the nurse participants had similar experiences with regard to work stress and a demanding work situation. They were struggling with similar ethical dilemmas, which concerned seriously ill patients and the possibilities of providing good care. This indicates the importance of providing nurses with the tools to influence their own work situation and thereby reducing their work-related stress.
Perception of Palliative Care and Euthanasia Among Recently Graduated and Experienced Nurses
Authors: Brzostek Tomasz , Dekkers Wim , Zalewski Zbigniew , Januszewska Anna , Górkiewicz Maciej
Published: October 2008

Palliative care and euthanasia have become the subject of ethical and political debate in Poland. However, the voice of nurses is rarely heard. The aim of this study is to explore the perception of palliative care and euthanasia among recent university bachelor degree graduates and experienced nurses in Poland. Specific objectives include: self-assessment of the understanding of these terms, recognition of clinical cases, potential acceptability of euthanasia, and an evaluation of attitudes towards palliative care and euthanasia. This is an exploratory study. A convenience sample of 206 recent graduates and 252 experienced nurse practitioners were interviewed. A structured questionnaire was used for collecting and interpreting data. Subjective perception of the terms `palliative care' and `euthanasia' was high and consistent with the recognition of clinical cases. The majority of the nurses excluded euthanasia from palliative care. They recognized personal philosophy of life as the most influential factor affecting attitudes towards euthanasia. The importance of the law was valued more highly by the experienced nurses.
Therapeutic Discourse Among Nurses and Physicians in Controlled Clinical Trials
Authors: Instone Susan L , Mueller Mary-Rose , Gilbert Tari L
Published: October 2008

An ethnographic field study about the informed consent process in investigational drug trials for seriously ill persons with hepatitis C suggests that nurses and physicians referred to these trials as giving treatment, even though they involved placebos. Interview data and informed consent documents contained frequent references to the term `treatment trial' or `treatment'. Although these findings were unexpected and not the original focus of our study, we consider them in the light of an extensive literature on the `therapeutic misconception' that has been described among physicians and patients with AIDS and other serious illnesses. We also suggest that certain organizational and professional characteristics of nursing and medicine reinforce this tendency to refer to the trials as treatment. Implications for further research are provided.
When Is Patient Education Unethical?
Authors: Redman Barbara K
Published: October 2008

Although patient education is central to the ethical practice of nursing, it can be practiced in an ethically contested or unethical way. It is sometimes used to: forward a societal goal the individual might not have chosen; assume that patients should learn to accommodate unjust treatment; exclude the views of all except the dominant health care provider group; limit the knowledge a patient can receive; make invalid or unreliable judgments about what a patient can learn; or require a patient to change his or her identity to meet a medical ideal. Both health promotion education and manipulating patient beliefs in situations of uncertainty are ethically contested. Nussbaum's capabilities approach is used here as a moral framework through which to view the goals and practice of patient education. This provides better guidance than the current conception of patient education as an instrument to carry out the directives of medical practice.
Being With That: The Relevance of Embodied Understanding for Practice
Authors: Todres Les
Published: October 2008

In this keynote presentation, I consider one way of articulating a more intimate relationship between the findings of qualitative research and the practice of care in health-related contexts. Drawing on the writings of Gadamer and Gendlin, I consider the kind of understanding that might be particularly relevant to everyday practice. I call this “embodied relational understanding.” I further pursue the question of how the findings of qualitative research can become a rich resource for sensitizing practitioners to engage with the complexities of practice. I argue that providing such a resource requires us to pay more attention to the evocative power of our findings and their potentially transformational power for personal and professional development.
Women's Narratives on Quality in Prenatal Care: A Multicultural Perspective
Authors: Wheatley Robyn R. , Kelley Michele A. , Peacock Nadine , Delgado Jaime
Published: October 2008

Although significant progress has been made to increase prenatal care access, national organizations concerned with health equity emphasize that eliminating disparities will require greater attention to quality of care, assessed from both the biomedical and patient perspectives. In this study, we examined narratives about pregnancy experiences from low-income primiparous African American, Mexican American, Puerto Rican, and White women who participated in focus groups conducted in 1996. We reanalyzed transcripts from these discussions, extracting passages in which women talked about the content and quality of their prenatal care experiences. Data were mapped to four domains reflecting patient-centeredness markers identified in the 2005 U.S. National Healthcare Disparities Report (NHDR). These markers include the extent to which the women perceived that their provider listened carefully, explained things, showed respect, and spent enough time with them. The narratives provided by the study participants suggest a critical and intuitive understanding of the NHDR patient-centeredness markers and some shared understanding across cultural groups. Implications for improving quality and its measurement in prenatal care are discussed.