Autonomy for nursing home residents: the role of regulations

The importance of autonomy and choice to nursing home residents' well-being has been well established. This paper examines the complex role of regulation as it affects the autonomy of nursing home residents. Nonstandardized interviews with residents, family members, nursing staff members, and administrators were conducted at three nursing homes in suburban Maryland. These anecdotal interviews identified the most problematic areas where regulations enforce barriers to autonomy and control. These areas include: scheduling of activities of daily living, food portions, physical environment, and documentation. Suggestions for possible improvements are discussed.     

Qualitative research in multicultural psychology: philosophical underpinnings, popular approaches, and ethical considerations

This article reviews the current and emerging status of qualitative research in psychology. The particular value of diverse philosophical paradigms and varied inquiry approaches to the advancement of psychology generally, and multicultural psychology specifically, is emphasized. Three specific qualitative inquiry approaches anchored in diverse philosophical research paradigms are highlighted: consensual qualitative research, grounded theory, and participatory action research. The article concludes by highlighting important ethical considerations in multicultural qualitative research.     

Measuring the person-centeredness of caregivers working with nursing home residents with dementia

There is increasing interest in promoting person-centered caregiving within gerontology. However, few observational instruments have been developed to measure person-centered caregiving behaviors. In the present study, two innovative coding instruments—the Person-Centered Behavior Inventory (PCBI) and the Global Behavior Scale (GBS)—were used to test the hypothesis that caregivers’ person-centeredness would be negatively correlated with residents’ resistiveness to care. The study hypothesis was based on the need-driven dementia-compromised theory of behavior. It was expected that person-centered caregiving would better meet residents’ needs and be associated with less resistiveness to care. This hypothesis was tested by coding 70 videotaped interactions between 54 caregivers and 20 residents diagnosed with dementia. Resistiveness to care was measured by behaviorally coding residents’ resistive behaviors based on the Resistiveness to Care scale. The study hypothesis was supported when the GBS was used to measure person-centeredness, but not when the PCBI was used. The findings provide preliminary support for the predictive and construct validity of the GBS and the PCBI.     

Making ethical choices: a comprehensive decision-making model for Canadian psychologists.

This paper proposes a theoretical augmentation of the seven-step decision-making model outlined in the Canadian Code of Ethics for Psychologists. We propose that teleological, deontological, and existential ethical perspectives should be taken into account in the decision-making process. We also consider the influence of individual, issue-specific, significant-other, situational, and external factors on ethical decision-making. This theoretical analysis demonstrates the richness and complexity of ethical decision-making.     

Temporal patterns of negative and positive behavior among nursing home residents with Alzheimer's disease

Although clinical observations suggest a late-day peak in disruptive behavior in persons with dementia, results from studies of temporal patterns of behavior are equivocal. This study used direct observation methods and systematic time sampling to examine temporal patterns of negative and positive behavior in 177 residents of 2 long-term care facilities with clinically diagnosed Alzheimer's disease (AD). The authors found small statistically significant diurnal variation in both negative and positive behavior, characterized by a curvilinear pattern with a single peak. This pattern was unaffected by seasonal differences in length of day, severity of cognitive impairment, level of behavior, or sleep disturbances. Time when behavior peaked differed by type of behavior and by facility, and there was substantial heterogeneity in behavior patterns.     

A neurocognitive model of the ethical decision-making process: implications for study and practice

The field of business ethics is entrenched in a cognitive approach that portrays the ethical decision-making process as a completely deliberate and reasoned exercise. In light of growing concerns about the veracity of this approach, I build upon current knowledge of how the brain functions to present a neurocognitive model of ethical decision making. The model suggests that ethical decision making involves 2 interrelated yet functionally distinct cycles, a reflexive pattern matching cycle and a higher order conscious reasoning cycle, and thereby describes not only reasoned analysis, but also the intuitive and retrospective aspects of ethical decision making. The model sparks research in new areas, holds significant implications for the study of ethical decision making, and provides suggestions for improving ethical behavior in organizations.     

Parental consent for psychological evaluations: Legal,ethical and practical considerations

This article explores the legal, ethical, and practical considerations underlying the requirement for acquiring parental consent prior to a psychological assessment of children in school settings. Publ. L. 94-142 now mandates that parents for all children potentially labeled as handicapped give permission for a preplacement evaluation. This article reviews in detail specific aspects of that mandate, argues that this procedure be generalized to all situations where psychologists propose to evaluate children by reviewing both current ethical codes and standards for practice and public policy which favors such an undertaking. Finally, the authors indicate methods for implementing the mandate by discussing such issues as who should obtain consent and what information parents should receive prior to giving consent.     

Effects of a forced institutional relocation on the mortality and morbidity of nursing home residents

Residents of a county nursing home underwent a forced, mass relocation. Gerontologists advised on preparation of staff and residents. No increase in residents' mortality or morbidity was found after the relocation. The highest death rate was in the anticipatory period, the year prior to the move.     

Termination: Legal and Ethical Considerations for Marriage and Family Therapists

Every Marriage and Family Therapist (MFT) must carefully plan how to initiate, convene, and terminate therapy. Determining how to ethically terminate therapy in a variety of therapeutic contexts can be challenging. Though termination is a common aspect of all therapeutic relationships, a lack of empirically based information on how to terminate therapy leaves practitioners alone in determining how best to end the treatment relationship. Furthermore, the subject of termination is discussed so scarcely in MFT literature that few authors have attempted to establish a standard for ethical termination. In the current climate of evidence-based services, predetermined session limits, and increased litigation for malpractice, MFTs must examine their termination procedures. This paper identifies the current available literature on termination and discusses the ethical and legal considerations for practicing MFTs as outlined by the AAMFT Code of Ethics (2004) American Psychological Association. 2004. Code of ethics., Washington, DC: Author.  [Google Scholar]. Directions and suggested methods for future research are set forth.     

Doing as they would do: How the perceived ethical preferences of third-party beneficiaries impact ethical decision-making

Although unethical behavior often benefits third-parties not directly complicit in the misconduct, not all beneficiaries welcome these ill-gotten benefits. We investigate whether actors consider the ethical preferences of potential beneficiaries or rely solely on their own ethical predispositions when making decisions that affect others. Three studies demonstrate that the perceived ethical preferences of these beneficiaries can substantially influence the likelihood that actors behave unethically on their behalves. These studies show that actors consider the ethical preferences of beneficiaries only when their own ethical disposition is outcome-based.     

Decision-making incapacity among nursing home residents: results from the 1987 NMES survey. National Medical Expenditure Survey

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.     

Linking level of care to level of need. Assessing the need for mental health care for nursing home residents

What are the mental health status and active treatment needs of nursing home residents? A stratified random sample of 828 residents in 25 facilities serving Medicaid recipients was assessed for levels of physical and psychosocial functioning. Although 91.2% had sufficiently high levels of medical and physical care needs to justify nursing home placement, 79.6% also had moderate to intense needs for mental health care. Older residents, relative to their younger counterparts, had more intense medical and mental health care needs. It was also found that psychiatric diagnosis was a poor indicator of mental health service needs, particularly among elderly individuals.     

The neural mechanisms of inter-temporal decision-making: understanding variability

Humans and animals prefer immediate over delayed rewards (delay discounting). This preference for smaller-but-sooner over larger-but-later rewards shows substantial interindividual variability in healthy subjects. Moreover, a strong bias towards immediate reinforcement characterizes many psychiatric conditions such as addiction and attention-deficit hyperactivity disorder. We discuss the neural mechanisms underlying delay discounting and describe how interindividual variability (trait effects) in the neural instantiation of subprocesses of delay discounting (such as reward valuation, cognitive control and prospection) contributes to differences in behaviour. We next discuss different interventions that can partially remedy impulsive decision-making (state effects). Although the precise neural mechanisms underlying many of these modulating influences are only beginning to be unravelled, they point towards novel treatment approaches for disorders of impulse control.     

中国情境下团队伦理决策的过程机制及影响因素

尽管绝大多数商业伦理决策都是由团队而非个人所做出的,但目前对团队伦理决策的研究还很少,尤其缺乏基于理论的深入研究。在前人研究的基础上,借鉴个体伦理决策和团队决策方面的研究成果,结合中国文化强调反省、中庸、威权领导等特点,我们对团队伦理决策的过程机制及影响因素的作用模式展开理论驱动的深入研究。具体来讲,将综合利用多种方法来进行两个方面的4项子研究。在团队伦理决策的过程机制方面,拟开展团队伦理决策的过程机制模型构建研究,然后聚焦于团队伦理决策和个体伦理决策的核心区别,展开基于社会决策图式理论的团队伦理决策观点整合机制研究;在团队伦理决策的影响因素作用模式方面,拟从成员和领导两个方面来进行:基于信息加工和团队冲突的成员多样性对团队伦理决策的影响机制研究,基于信息取样模型的领导特征对团队伦理决策的影响机制研究。     

Longitudinal reliability of the Life Satisfaction Index (Short Form) with nursing home residents: a cautionary note.

We administered the Life Satisfaction Index (Short Form) 18 times over a 39-wk. period to an initial sample of 76 old, frail, multiply impaired, and depressed nursing home residents participating in a longitudinal quasi-experimental study of the effects of cognitive group interventions on cognition and depression. As no changes over time were observed on the outcome variable of life satisfaction, the stability of the instrument's internal consistency could be examined. Kuder-Richardson KR-20 coefficients ranged from .11 to .60, with a mean of .42 (SD = .11). We conclude that caution should be used when applying this instrument to measure life satisfaction in frail nursing home residents.