‘I'm beyond caring’, a response to the Francis Report: the failure of social systems in health care to adequately support nurses and nursing in the clinical care of their patients

Lord Francis was commissioned to look at why the serious problems (between January 2005 and March 2009) at Mid Staffs Foundation Trust were not identified sooner and the appropriate action taken. Lord Francis was also asked to outline what lessons could be learned to enhance patient care. The report was delivered on 5 February 2013 and contained 290 recommendations. The key message was that the National Health Service needed to put the patient first and everything else should flow from that principle. Poor standards of care should not be tolerated and staff would be expected to speak out when they felt patient care was being compromised. Lord Francis also recommended that there should be one regulatory body and that the role of the Care Quality Commission was to be reviewed.     

The effects of applied tension on symptoms in French-speaking blood donors: a randomized trial.

Blood-donation-related symptoms such as dizziness and weakness discourage people from participating in this important health-related activity. Four hundred sixty-seven young adult, French-speaking blood donors were randomly assigned to (a) a condition in which they learned a possible preventive technique called applied tension and were asked to practice it from the time they got on the donation chair until they were just about to get up, (b) a placebo condition in which they learned applied tension and were asked to practice it from the time they got on the chair until the insertion of the donation needle, or (c) a no-treatment control condition. Donors assigned to the treatment condition reported significantly fewer blood-donation-related symptoms than did donors assigned to the other conditions and rated their likelihood of returning to give blood again as greater than did those in the no treatment condition. Among donors whose chairs were not reclined, participants in the treatment condition had significantly smaller heart rate reactions to blood donation than did those in the other conditions.     

更优更耐心：质量结果对跨期选择的影响

跨期选择以往的研究集中于金钱数量结果。基于维度加工的模型,本文探究了在跨期选择中,人们面对质量差异的结果(如,今天的低配版手机还是六个月后的高配版手机)vs.相对应的金钱结果(如,今天的5000元还是六个月后的6000元)的选择偏好差异。3个实验结果表明：人们面对质量结果(相比于金钱结果)的跨期选择表现得更耐心,而这种现象是由于人们面对选择时在结果维度差异感知不同所致。与金钱结果跨期选择相同,质量结果跨期选择的心理加工过程同样遵循维度间差异比较。本研究为基于维度的跨期选择模型提供了新的证据。     

Electrophysiological Evidence of Different Interpretative Strategies in Irony Comprehension

We explore the hypothesis that induction of holistic or analytic strategies influences comprehension and processing of highly contextualized expressions of ordinary language, such as irony. Twenty undergraduate students were asked to categorize as coherent or incoherent a group of sentences. Each sentence completed a previous story, so that they could be ironical, literal or nonsensical endings. Participants were asked to evaluate whether each sentence was coherent or incoherent. Half of them were initially instructed to consider whether the sentences made sense (holistic condition); the other half were instructed to consider whether the sentences were congruent or incongruent (analytic condition). Behavioral responses and Event Related Potentials were registered during the experiment. Both behavioral and electrophysiological results allow clearly distinguishing between the holistic and the analytic strategies. The fact that the same set of stimuli elicits different ERP waveforms, depending on the strategy with which they are analyzed, suggests that different cognitive processes and different areas of the brain are operating in each case.     

The effects of accountability on bias in physician decision making: Going from bad to worse

Members of the Iowa Academy of Family Physicians participated in a survey study in which they were asked to make hypothetical decisions in either high- or low-conflict treatment conditions. In the low-conflict treatment condition the options were a common medication with a referral or a referral only. In the high-conflict treatment condition the same two options were given plus another attractive medication. In addition, we manipulated accountability by asking half of the participants to provide a written defense of their treatment options, which they would then agree to discuss at a later time. The results showed that physicians in the high-conflict condition chose the referral-only option significantly more than the physicians in the low-conflict condition, thus violating the normative rule of regularity. Moreover, that pattern was significantly amplified for physicians who were held accountable for their treatment decisions. These findings replicate and extend previous research and are discussed within the framework of reason-based choice.     

The Effect of the Physical Attractiveness and Role of the Helper on Help Seeking

The effects of a helper's physical attractiveness and role on help-seeking behavior were investigated here. Eighty randomly selected Smith College students were the subjects; the helpers were two confederates selected on the basis of a separately conducted photograph evaluation. The confederate was designated either as an experimenter (Role condition) or as a fellow subject (Nonrole condition). Subjects were reluctant to ask the attractive confederate for help when she was in the Nonrole condition; rather, most in this condition asked for information instead of assistance. When the confederate was unattractive, more subjects asked for help when she was in role than when she was not. Although there was a significant main effect, most of this effect appears to be accounted for by the low rate of seeking help in the Attractive, nonrole condition. Subjects took longer to communicate with the attractive confederate than with the unattractive one; further, they reported feeling more uncomfortable in the presence of the attractive helper regardless of role.     

Children's reports of emotionally laden events: adapting the interview to the child

This study examined the influence of expressive vocabulary and temperament on children's verbal reports about emotionally laden events in different interview conditions. In one of three conditions, 58 children aged between 5 and 7 years were interviewed about a time they had felt happy and a time they had felt scared. The interview conditions were: drawing, in which they were asked to draw and tell; re‐enactment, in which they were asked to re‐enact and tell; and verbal, in which they were simply asked to tell. The principal finding was that, whereas for children in the verbal interview condition expressive vocabulary was associated with the amount of information reported and for children in the re‐enactment condition, temperament had a moderate association with the amount reported, for children in the drawing interview condition, neither temperament nor expressive language was associated with the amount of information reported. Children in the drawing condition reported more information than those in the other two interview conditions. The possible mechanisms underlying these findings and their implications for interviewing children in clinical contexts are discussed. Copyright © 2002 John Wiley & Sons, Ltd.     

Evidence that process simulations reduce anxiety in patients receiving dental treatment: randomized exploratory trial

Process simulations--mental simulations that ask people to imagine the process of completing a task--have been shown to decrease anxiety in students facing hypothetical or psychological threats in the short term. The aim of the present study was to see whether process simulations could reduce anxiety in a sample of the general population attending a dental practice, and whether these effects could be sustained throughout treatment. Participants (N=75) were randomized to an experimental condition where they were asked to simulate mentally the process of seeing the dentist, or to a control condition where they were asked to simulate mentally the outcome of seeing the dentist. Findings showed that participants in the experimental condition were significantly less anxious both before and after their consultations. Self-efficacy and self-esteem remained unchanged. This study suggests that process simulation is one active ingredient in anxiety treatment programs and further research is required to enhance its effects.     

Similarity and social interaction: when similarity fosters implicit behavior toward a stranger

People interact more readily with someone whom they think they have something in common with. At a pedestrian crossing, confederates asked participants for the time and, in one condition, said she/he had the same watch as the participant. The amount of time that participants lingered near a confederate was used as the dependent variable. Participants in the similarity condition spent significantly more time near the confederate than when no similarity was manipulated. The results showed that similarity fosters implicit behavior, adding to the growing body of data on the positive effects of similarity and its role in social interaction.     

Food and violence: Childhood violence and emotional abuse as complicating factors in the inpatient treatment of eating disorders

SUMMARY

This paper considers the treatment, on an inpatient eating disorders ward, of patients who have suffered violence and emotional abuse during childhood. The complex web of relationships surrounding these patients is discussed, and it is suggested that there are multiple transferences — to the institution, to various members of staff, and to other patients — and that splitting of these transferences is inevitable. Staff experience powerful countertransference feelings, related to the patient's violent history. A central task for the staff team as a whole is to understand and contain the patient's disturbance — taking on, tolerating, and processing the projections. This demands the close working-together of the members of the multidisciplinary team, so that staff can together openly examine the patient's interaction with them and their own emotional responses to the patient and to other members of staff. If these responses are not understood by the ward staff, they can lead to conflict and inappropriate decisions. On the other hand, if the staff team together can build up a picture of the patient's relationships on the ward, and their meaning for the patient, this picture, like a particular projection of the world in an atlas, provides a ‘map’ of the patient's inner world. This ‘map’ can be used by the staff team in navigating their interactions with the patient. It can also assist the psychotherapist in her work to help the patient recognise and, eventually, own the split-off parts of herself.     

Do Health Care Workplaces Affect Treatment Environments?

Previous research has demonstrated that characteristics of the health care workplace influence staff outcomes such as morale and burnout, but the potential effect of health care workplaces on the treatment environment has been little studied. Building on a model proposed by Schaefer and Moos (1993), we propose that the workplace factors of supervisory work environment (e.g. support from supervisors, managerial control) and programme philosophical orientation (e.g. disease model of addiction, psychosocial learning model of addiction) predict four treatment environment elements: patient autonomy, staff control, staff sensitivity, and patient alienation. Multiple regression analysis of data drawn from a survey (response rate = 86%) of 327 staff members at 15 Veterans Affairs (VA) inpatient substance abuse treatment programmes revealed that greater managerial control over staff predicted greater patient alienation, lower staff sensitivity towards patients, and greater staff control over patients. Stronger disease model programme orientations predicted less patient alienation and greater staff sensitivity, whereas stronger psychosocial model programme orientations predicted less staff control. These results suggest that health care workplaces may influence treatment environments. Implications for further research and practice are discussed. © 1997 John Wiley & Sons, Ltd.     

Promoting response variability and stimulus generalization in martial arts training

The effects of reinforcement and extinction on response variability and stimulus generalization in the punching and kicking techniques of 2 martial arts students were evaluated across drill and sparring conditions. During both conditions, the students were asked to demonstrate different techniques in response to an instructor's punching attack. During baseline, the students received no feedback on their responses in either condition. During the intervention phase, the students received differential reinforcement in the form of instructor feedback for each different punching or kicking technique they performed during a session of the drill condition, but no reinforcement was provided for techniques in the sparring condition. Results showed that both students increased the number of different techniques they performed when reinforcement and extinction procedures were conducted during the drill condition, and that this increase in response variability generalized to the sparring condition.     

Relationships between patients' perceived improvement and their evaluations of treatment components in a behaviorally-oriented psychiatric inpatient unit

Patients on a behaviorally-oriented inpatient psychiatric unit were asked to rate their perceptions of treatment outcome and the value of 16 program components in producing that outcome. Significant correlations were found between perceived outcome and positive evaluations of the overall behavioral treatment plan, individual meetings with nursing staff, individual meetings with team psychologists, assertion group training, and daily group therapy. Patients perceived individual meetings with the nursing staff to be the single most valuable program component among those related to favorable outcome. Implications for the increased utilization of nursing staff during a time of dwindling resources for mental health are discussed.     

Thanks for asking: Self-affirming questions reduce backlash when stigmatized targets confront prejudice

Two experiments tested the prediction that stigmatized individuals can avoid backlash when they confront others about bias if they first ask questions designed to activate self-affirmation processes. Experiment 1 showed that compared to a no-strategy control condition, highly prejudiced perceivers tended to express less desire to meet an Arab-American when he asked them to take his perspective on prejudice, but they expressed more desire to meet him when he asked self-affirming questions prior to making the perspective-taking request. Experiment 2 replicated this effect with a different affirmation and revealed that asking self-affirming questions reduced perceptions that the target was being confrontational when asking others to take his perspective. Together, these studies show that stigmatized targets can effectively challenge prejudiced individuals to reduce their biases if they first use a subtle strategy that reduces defensiveness.     

Staff members' feelings toward psychiatric patients related to their own and the patient's self-image and gender

The relation between staff members' feelings toward a patient and their own and the patient's self-image in different gender combination groups was studied. Staff at 16 psychiatric treatment homes for patients with severe psychopathology reported their feelings toward their patients on a number of occasions. At the start of treatment, both staff members and patients rated their self-images using the Structural Analysis of Social Behavior (SASB). Male staff seemed less influenced by the patient, with their feelings relating mainly to aspects of their own self-image, while the feelings of the female staff were more related to the patient's self-image. The patient's diagnosis was less important for a staff member's feelings than that member's self-image. Generally, the relation between feelings and self-image was stronger for negative feelings. The results point to the importance of understanding more about the influence of staff members' self-structure on their negative feelings toward their patients and how this relates to both the staff member's and patient's gender.     

The acceptability and preference for the psychological treatment of PTSD

The acceptability and preference of psychological treatments is important in understanding patient treatment seeking, choice, engagement and attrition and possibly treatment response in health care. The acceptability of, and preference for, 14 different types of psychological treatment for posttraumatic stress disorder (PTSD) were investigated in a student population through invitation to participate in a web-based survey. Respondents were asked to rate each treatment on 10 scales and to rank the treatments in order of preference. Respondents were also asked whether they would seek treatment themselves, recommend treatment to friends and family, feel stigmatised by suffering from PTSD, had any prior knowledge of the treatments and if this had been positive or negative and whether they had a history of psychological problems or treatment. A total of 330 respondents completed the survey. A past or current history of psychological problems and treatment was surprisingly high. Almost all respondents indicated that they would seek or recommend treatment in spite of high levels of stigmatisation. Factor analysis of the 10 scales indicated two factors: Endorsement and Discomfort. Rank ordering on preference and Endorsement scores was highly consistent. The highly preferred and endorsed treatments involved cognitive therapy, exposure or psycho-education in spite of high levels of discomfort anticipated with exposure. Treatments involving new technologies, EMDR and psychodynamic psychotherapy received the lowest Endorsement and preference. There was a modest influence of prior knowledge of a treatment.     

Similarity and Social Interaction: When Similarity Fosters Implicit Behavior Toward a Stranger

ABSTRACT

People interact more readily with someone whom they think they have something in common with. At a pedestrian crossing, confederates asked participants for the time and, in one condition, said she/he had the same watch as the participant. The amount of time that participants lingered near a confederate was used as the dependent variable. Participants in the similarity condition spent significantly more time near the confederate than when no similarity was manipulated. The results showed that similarity fosters implicit behavior, adding to the growing body of data on the positive effects of similarity and its role in social interaction.     

Development of the ability to judge relative areas: Role of the procedure of placing one object on another

This study examined the role of the cognitive procedure of superimposition in the development of an area concept. Forty-five children from age 4 to 6 were presented with target squares or rectangles and asked to choose one that was equal to two standard rectangles in area. In the perceptual judgment condition, children compared these figures just by looking; whereas, in the manipulative judgment condition, they placed the standard figures on the targets. Children were also asked to compare the sizes of geometric figures, and their spontaneous strategies were observed. The children performed better under the manipulative judgment condition than under the perceptual judgment condition, and their performance was facilitated when one target could be overlapped completely with the standard figures. Each of these facilitating effects was found independently of the other only in children who used the strategy of superimposition spontaneously for comparing sizes.     

Sex differences in conformity: Instrumental or communal response?

Male and female introductory psychology students (N=88) were asked to read a clinical case history and the opinion consensus of either (a) their peers, (b) advanced psychology students, or (c) Ph.D. clinical psychologists that the patient should be hospitalized for at least 90 days (an extreme treatment). Subjects then indicated on a scale of 10 to 90 days, the length of hospitalization they thought best. In a significant interaction effect (sex of subject × expertise of source) males were least influenced by the opinions of their peers and increasingly influenced as the source became more expert. Females, however, seemed most influenced by their peer group, recommending longest hospitalization terms in that condition. Results are interpreted in terms of sex-role identification and the emergence of an instrumental (task) or communal set.     

Moral bias toward different social classes

The influence of social class on prosocial behaviour has long been a focus of intense research interest. The present research involved four studies that covered four moral exemplars (villains, victims, heroes, and beneficiaries) to test whether people of different social classes are treated equally in moral judgements. We described moral events experienced by different agents of varying social classes and asked participants to rate the morality of the events and their emotional responses. The results revealed that compared with the low-class condition, high-class individuals had an overall moral disadvantage when they were regarded as villains, victims, and beneficiaries. For the exemplar of hero, the high-class condition was no different from the low-class condition except that high-class heroes evoked less elevation than low-class heroes. The results reveal that people hold a biased moral attitude toward individuals in different social classes.