Perceptions of the Limitations of Confidentiality Among Chinese Mental Health Practitioners,Adolescents and Their Parents

The present study aims to (a) survey Chinese mental health professionals’ attitudes toward therapeutic confidentiality with adolescent patients in specific clinical situations, and (b) compare Chinese adolescents’ and parents’ beliefs about when most mental health professionals would breach confidentiality. A sample of 36 mental health practitioners, 152 parents, and 164 adolescents completed a survey to assess their opinions about when confidentiality should be breached in 18 specific clinical situations (e.g., an adolescent tells his or her therapist that he or she smoked a cigarette, had unprotected sex, or attempted suicide). Nearly half of the parents (46%) and adolescents (41%) and 78% of the therapists in our sample selected “yes” in response to the question of whether the principle of confidentiality applies to adolescents. However, 49% of parents indicated “no,” and 53% of adolescents indicated “not sure.” Compared to adolescents, parents were significantly more likely to believe that therapists would breach confidentiality for the high-breach-likelihood items. For the low-breach-likelihood items, adolescents and parents were significantly more likely than therapists to believe confidentiality should be breached. Results from this study provide data to inform the development, refinement, practical implementation, and communication of guidelines and recommendations specific to adolescents receiving psychotherapy in China.     

Confidentiality: a survey in a research hospital

Despite the many justifications for protecting patient confidentiality, we recognize that confidentiality cannot be absolute. Our world of automated information and easy access and storage poses many threats to confidentiality. This paper has described a survey conducted at the NIH Clinical Center to assess the knowledge, attitudes, and behaviors of clinical physicians and nurses about confidentiality of patient information. The survey findings demonstrate the need for reminders and increased awareness about confidentiality in our setting. Most of the survey respondents had a good knowledge of what was expected of them, and they believed that confidentiality was important and maintaining it was their responsibility. Of interest was that in several simulated clinical situations, there was a discrepancy between what respondents indicated they should do and what they thought they would do. The biggest discrepancies appeared in situations that involved overhearing a patient conversation on the elevator, approaching an unfamiliar person who is reading a medical record in the nurses' station, and answering a patient's inquiry about the status of another patient. The findings support the speculation that this difference may be attributed to discomfort or decreased awareness, and not necessarily to lack of knowledge. Results indicate that policies and administrative expectations should be frequently communicated and enforced, and that educational programs that address issues of confidentiality should be provided. The results of this survey have been influential in guiding educational strategies and administrative activities at the clinical center. The clinical center initiated a confidentiality awareness campaign, displaying a new poster every three months in strategic locations and distributing other tangible reminders (such as pens, magnets, and buttons) containing the same confidentiality message.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Incorporation of Predictive Genomic Testing into Genetic Counseling Programs

This study explored whether genetic counseling programs are incorporating instruction about the applications and techniques of predictive genomic testing (PGT) based on student recollection, and whether this is perceived as adequate by those students. For the purpose of this study, PGT was defined as the use of genome-based testing to assess a person’s risk, or susceptibility, of developing a disorder with either a known or suspected genetic component. Surveys from 114 graduates were analyzed. The majority of respondents indicated that PGT was covered in their curriculum including methodology, information generated, benefits, risks, limitations, and impact on the field of genetic counseling. A statistically significant increase in incorporating information about PGT as a whole from 2008 to 2011 was also reported. The majority of respondents reported that coverage of PGT prepared them for the American Board of Genetic Counseling (ABGC) board exam (80.6 %), to interpret PGT test results (60.2 %) and to identify clinical situations warranting testing (53.1 %). Although the majority of respondents indicated learning about a wide variety of aspects surrounding PGT, many recent graduates indicated their training was less likely to cover aspects essential for the clinical application of PGT. Therefore, genetic counseling programs should place a greater emphasis on these skills, and the development of continuing education opportunities aimed at increasing genetic counselors abilities to interpret and discuss PGT tests and identify clinical situations warranting such testing may be helpful.     

"Broken covenant": healthcare aides' "experience of the ethical" in caring for dying seniors in a personal care home

Canada's population is aging, and seniors constitute the fastest growing demographic in the nation. The chronic health conditions, limited social support, functional decline, and cognitive impairment experienced by seniors may necessitate admission to a personal care home (PCH) setting up until the time of their death. The ethical problems that arise in the care of dying patients are numerous and complicated. The care of dying seniors in PCHs, however, is largely provided by frontline workers such as healthcare aides (HCAs), who usually have little training in palliative care or ethics. Research examining the identification and resolution of ethical problems in care of the dying has been conducted from the perspectives of nurses and physicians in various clinical settings, but the voice of HCAs in PCHs is virtually absent from clinical ethics. Given that the inability to satisfactorily resolve ethical issues in clinical practice is associated with feelings of guilt, powerlessness, avoiding contact with patients, failing to provide good physical care, and increased staff turnover, an empirical examination of HCAs' experiences of ethically challenging situations is warranted. We conducted a phenomenological study to access the lived experience of HCAs (N = 12) working in proprietary and nonproprietary care homes as they encountered situations they deemed ethically challenging in providing end-of-life care to dying seniors. The findings reported here explicate: (1) the types of situations that are ethically problematic for HCAs; (2) the meanings they assign to these situations, and (3) the impact such situations have on the provision of end-of-life care.     

A Method for Introducing the Concepts of Chaos Theory to Medical Students

Chaos theory is beginning to find applications in the field of medicine. The theory of chaos should be introduced to students to help them as they make the transition from learning the scientific literature to actually applying this newly acquired knowledge in clinical situations. Chaos theory will give the students a powerful conceptual framework from which they can better understand the limits of predictability in clinical situations. Failure to understand the limits of predictability in chaotic natural systems will invariably lead to frustration in both patients and physicians.     

The overjustification effect: A meta-analysis

This article reports the results of a meta-analysis using 50 experimental studies (256 effect sizes) of the overjustification effect. In general, we found support for the effect across age, dependent measure, and design type in specific situations where it is predicted to occur. Findings are less supportive of the theory for situations where there should be no difference between experimental and control groups (e. g. non-contingent or unexpected reward). Suggestions for future research are made.     

Situation-based contingencies underlying trait-content manifestation in behavior

Two studies investigated whether situations are associated with the manifestation of Big Five trait contents in behavior. Several times per day for 2 or 5 weeks, participants reported their current Extraversion, Agreeableness, Conscientiousness, and Emotional Stability states and rated the concurrent situation on several characteristics. Multilevel models tested for the average individual's contingency of each Big Five state on each situation characteristic and for whether individuals differed from each other reliably in those contingencies. Results showed that (1) there are psychologically active characteristics of situations on which trait-manifesting behavior is contingent; (2) contingencies on psychologically active characteristics of varying situations are part of the explanation for the sizeable within-person variability in behavior; (3) individuals differ reliably in their contingencies, and such individual differences may partially explain individual differences in amount of variability; and (4) the situation characteristics that are psychologically active differ by trait. These findings suggest that within-person variability in personality states is meaningful and is related to situations, that personality psychology should characterize situations in terms of their relevance to personality states, and that process and individual-difference structure approaches can be integrated in personality psychology.     

Moral Taint: On the Transfer of the Implications of Moral Culpability

Suppose two people are about to drown. We are in a position to save only one, so the other will have to die. One of the two has just culpably killed an innocent person, but has no intention of killing anybody else and there is no reason to expect that he will. Everything else being equal, should we give them an equal chance of being saved by flipping a coin? In this paper I argue that we should not. I argue that the implications of a person's moral culpability for (recent or prospective) harm to a particular victim should transfer to other conflict situations in which the wrongdoer might find him or herself. This requires establishing the extent to which a person's contributing to harming another person — and his moral culpability for that harm — impinges on our decision making in situations where it is possible only to assist either the wrongdoer or some other person that is not his victim.     

Differentiation is key: should employers offer something unique or the same yet better?

ABSTRACT

Researchers agree that employers should differentiate themselves from their competitors to become the employer of choice. However, from the recruitment literature, it is not clear how employers should differentiate their employment offers. Building upon the structural alignment theory, we investigated in two experimental studies whether offering something unique (i.e., non-alignable attributes; e.g., offer a benefit package when competitors do not) or offering the same yet better (i.e., alignable attributes; e.g., offer a bigger benefit package than competitors) is the most effective differentiation strategy for employment offers and whether this depends on job seekers’ work experience. Offering the same yet better affected job seekers’ preferences more positively than offering something unique in lowly complex judgement and decision-making situations (Study 1) as well as in highly complex judgement and decision-making situations if job seekers had more work experience (Study 2). Hence, our findings suggest that differentiation strategies matter: employers should differentiate by offering the same yet better, particularly when they look for highly experienced job seekers in highly complex judgement and decision-making situations.     

Self-control and cooperation: different concepts, similar decisions? A question of the right perspective

Conflicts between an individual's long-term and short-term goals (i.e., self-control conflicts) and conflicts between individual and collective interests (mixed-motive situations) share some interesting features. In this article both types of conflicts are approached from a perspective hypothesis. The hypothesis holds that a decision maker's perspective on his or her decision determines whether either the long-term goals (the collective interests) or the short-term goals (the individual interests) will guide behavior. The hypothesis also implies that factors known to enhance cooperative choices in mixed-motive situations should also facilitate self-control. Three such factors are evaluated: group identification, self-efficacy, and mutual trust. We conclude that the perspective in which choice is considered part of an identifiable series of behaviors is most likely to result in cooperation or self-control.     

Burning or Building Bridges

SUMMARY

Among the population of physically abused women who present individually in therapy, there is a portion who struggle with their indecisiveness about whether or not they should work toward resolving or terminating their heterosexual relationship. This paper will examine clinical methods that are employed through individually based systemic therapy to assist women who find themselves in such confusing and perilous situations. Due to the complexity of the problem” emphasis is placed on addressing salient issues efficiently and non-judgmentally. Central to treatment is client engagement and the challenging of constraining client beliefs.     

Hot or not: visceral influences on coping planning for weight loss attempts

The current studies aimed to examine how either or not being hungry (hot vs. cold state) affects uninformed (i.e. without specific instructions) coping planning for maintaining goal-directed behaviour in weight loss attempts. We hypothesised that being hungry is beneficial both for (1) increasing awareness of potentially challenging situations and for (2) planning how to cope with these situations. The first hypothesis was supported, whereas the second was not, as it was found that satiated participants constructed better quality coping plans than hungry participants. It appears that awareness of potentially challenging situations when hungry does not necessarily translate into better coping planning. Although coping planning appears to be a promising strategy for maintaining goal-directed behaviour, future research should focus on visceral states to improve its use.     

A note on notes: note taking and containment

In extreme situations of massive projective identification, both the analyst and the patient may come to share a fantasy or belief that his or her own psychic reality will be annihilated if the psychic reality of the other is accepted or adopted (Britton 1998). In the example of' Dr. M and his patient, the paradoxical dilemma around note taking had highly specific transference meanings; it was not simply an instance of the generalized human response of distracted attention that Freud (1912) had spoken of, nor was it the destabilization of analytic functioning that I tried to describe in my work with Mr. L. Whether such meanings will always exist in these situations remains a matter to be determined by further clinical experience. In reopening a dialogue about note taking during sessions, I have attempted to move the discussion away from categorical injunctions about what analysis should or should not do, and instead to foster a more nuanced, dynamic, and pair-specific consideration of the analyst's functioning in the immediate context of the analytic relationship. There is, of course, a wide variety of listening styles among analysts, and each analyst's mental functioning may be affected differently by each patient whom the analyst sees. I have raised many questions in the hopes of stimulating an expanded discussion that will allow us to share our experiences and perhaps reach additional conclusions. Further consideration may lead us to decide whether note taking may have very different meanings for other analysts and analyst-patient pairs, and whether it may serve useful functions in addition to the one that I have described.     

A reconsideration of the achievement-motivation theory

In a reconsideration of the achievement-motivation theory it is assumed that moderate stimulation releases positive affects and very low or high stimulation negative affects. It is further assumed that as far as the achievement-motivation system is concerned the most stimulating situation is that where the probability of success (P_s) is about .50, the least stimulating that where P_s is near 1.00 or .00. The motive to achieve success (M_s) and the motive to avoid failure (M_f) are thought of as moderators of the stimulation provided by a given situation. M_s-dominated individuals should experience positive affects (moderate stimulation) where P_s is about .50 and should therefore engage in such situations. P_s near 1.00 or .00 implies very low stimulation; hence, negative affects should be released, resulting in resistance to such situations. M_f-dominated individuals should experience negative affects (very high stimulation) where P_s is about .50, while they should experience moderate stimulation, and thus positive affects, if at any point, only where P_s is either very high or very low. This implies that the relationship between M_s strength, respectively M_f strength, and degree of engagement should vary from positive to negative, depending on the probability of success in the situation. Results from previous investigations are related to these viewpoints.     

Altered auditory feedback and the treatment of stuttering: a review

Several authors have suggested that devices delivering altered auditory feedback (AAF) may be a viable treatment for adults and children who stutter. This paper reviews published, peer reviewed journal papers from the past 10 years that investigate the effect of AAF during different speaking conditions, tasks and situations. A review of that literature indicates that considerable experimental evidence and limited Phase 1 treatment outcome evidence has been accumulated about the effect of AAF on the speech of people who stutter. However, critical knowledge about the effect of AAF during conversational speech and in everyday speaking situations is missing. Knowledge about how to determine the correct levels of AAF for individuals, and the characteristics of those likely to benefit from AAF, also needs to be established. At present there is no reason to accept a recent suggestion that AAF devices would be a defensible clinical option for children. In general device development and availability has occurred at a faster pace than clinical trials research. EDUCATIONAL OBJECTIVES: After reading this paper readers should be able to: (1) describe what altered auditory feedback is and common ways the speech signal is altered in stuttering; (2) describe the effects of AAF on the speech of adults who stutter; (3) provide a critical analysis of the literature in the area of AAF and stuttering.     

Harassment and bullying at work: A review of the scandinavian approach

A hostile work environment, in which insulting or offensive remarks, persistent criticism, personal abuse, or even physical abuse and threats prevail, is a reality for many employees in both public and private organizations. In Scandinavia, the term “mobbing” is commonly used to describe situations where a worker, supervisor, or manager is systematically and repeatedly mistreated and victimized by fellow workers, subordinates, or superiors. The term is widely used in situations where repeated aggressive and even violent behavior is directed against an individual over some period of time. Although some clinical and anecdotal accounts have been described by American authors, studies of this phenomenon have mainly been restricted to the Northern European countries. The aim of this study is threefold: (1) to present a framework for future research and theory development in this field, (2) to review the Scandinavian research tradition according to this framework, and (3) to provide some suggestions for future research.     

<Emphasis Type="Italic">‘No Time to be Lost!’</Emphasis>

Severe Traumatic Brain Injury (TBI) remains a major cause of death and disability afflicting mostly young adult males and elderly people, resulting in high economic costs to society. Therapeutic approaches focus on reducing the risk on secondary brain injury. Specific ethical issues pertaining in clinical testing of pharmacological neuroprotective agents in TBI include the emergency nature of the research, the incapacity of the patients to informed consent before inclusion, short therapeutic time windows, and a risk-benefit ratio based on concept that in relation to the severity of the trauma, significant adverse side effects may be acceptable for possible beneficial treatments. Randomized controlled phase III trials investigating the safety and efficacy of agents in TBI with promising benefit, conducted in acute emergency situations with short therapeutic time windows, should allow randomization under deferred consent or waiver of consent. Making progress in knowledge of treatment in acute neurological and other intensive care conditions is only possible if national regulations and legislations allow waiver of consent or deferred consent for clinical trials.     

Reinvigorating the concept of situation in social psychology

The concept of situation has a long and venerable history in social psychology. The author argues that recent approaches to the concept of situation have confused certain important elements. Herein, the author proposes that attention to three of these elements will reinvigorate the concept of situation in social psychology: (a) that the analysis of situations should begin with their objective features; (b) that situations should be conceptualized as affordances; and (c) that the interpersonal core of situations, in particular the extent to which they are influenced by relationships, is the proper and most profitable focus for social psychology. These elements are consistent with recent developments in the study of situated social cognition and may help better define social psychology's position within the sciences.     

Contextual information in situations of uncertainty: The value of explicit-information provision depends on expertise level,knowledge acquisition and prior-action congruency

In behavioral control, contextual information is used alongside incoming sensory inputs to reduce uncertainties about the unfolding situation. However, our understanding of this weighting process is limited; particularly regarding the applied question of whether individuals should be provided with information or whether they should rather generate it by themselves. We thus compared the provision of more or less valid (i.e., “true”) contextual information with a self-generation condition by examining the performance of elite and near-elite youth handball players (N = 30 + 27) in a virtual-reality defensive task. We measured response correctness, positioning as a function of the teammates’ defensive behaviors and the degree to which the experimentally induced patterns in the teammates’ strengths were detected. The results show that providing individuals with uncertain information neither enhances nor harms performance decisively. However, valid information enhances performance in congruent situations while degrading performance in incongruent situations, more pronouncedly in elite than in near-elite players. Consequently, individuals should be provided with explicit contextual information only if (i) their expertise level is not adequate enough to rely on self-generation, (ii) the situation-specific knowledge base cannot be sufficiently self-generated, and (iii) the instructor is sufficiently certain that the explicit information actually meets the upcoming situation.     

Diagnosis by Documentary: Professional Responsibilities in Informal Encounters

Most work addressing clinical workers' professional responsibilities concerns the norms of conduct within established professional–patient relationships, but such responsibilities may extend beyond the clinical context. We explore health workers' professional responsibilities in such “informal” encounters through the example of a doctor witnessing the misdiagnosis and mistreatment of a serious long-term condition in a television documentary, arguing that neither internalist approaches to professional responsibility (such as virtue ethics or care ethics) nor externalist ones (such as the “social contract” model) provide sufficiently clear guidance in such situations. We propose that a mix of both approaches, emphasizing the noncomplacency and practical wisdom of virtue ethics, but grounding the normative authority of virtue in an external source, is able to engage with the health worker's responsibilities in such situations to the individual, the health care system, and the population at large.