"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.     

Subtypes of obsessive-compulsive disorder: Implications for specialized cognitive behavior therapy

Although obsessive-compulsive disorder (OCD) is a heterogeneous condition, OCD subtypes have received limited attention in trials of cognitive behavior therapy (CBT). Because many patients with OCD do not respond optimally to CBT, it is important for clinicians to consider whether variability in treatment response is related to symptom presentation. Treatment modifications for patients without overt compulsions or with hoarding symptoms show promise. In this article we discuss the available research addressing the treatment of OCD subtypes, review the clinical characteristics and treatment recommendations for prominent OCD subtypes, raise the prospect of using dysfunctional beliefs as a potentially helpful conceptual approach to subtyping OCD and matching treatment to subtypes, and consider future directions in the treatment of OCD subtypes.     

Wittgenstein on Scepticism and Nonsense

In the Tractatus Wittgenstein wrote: “Skepticism is not irrefutable, but obviously nonsensical when it tries to raise doubts where no questions can be asked.” In this paper I show how Wittgenstein developed this insight in On Certainty. My principal aim is to show that this is a logical insight, that it is bound up with the distinction between saying and showing, and that one misses the point of On Certainty if one reads it, as some commentators have, in epistemological terms. Throughout all of this I pay special attention to why Wittgenstein thought that skepticism is nonsensical, and what it might mean to say that philosophy is a logical investigation.     

Leisure counselling, coping skills and therapeutic applications

Leisure counselling is defined as the systematic exploitation of a client's past, existing or prospective hobbies, activities and interests for broad psychotherapeutic purposes. It functions as a powerful agent in the invigoration of a range of existing but inadequate coping skills, and can also act in an innovatory style when such key skills are absent. The effective functioning of leisure counselling, as this paper argues, requires a methodology of application, and the author's main contribution has been to identify a triad of approach techniques open to the leisure counsellor, namely, distraction, anticipation and confrontation, and to outline appropriate settings in which they may be fruitfully implemented. Effective leisure counselling requires a new mode of thinking, wherein leisure becomes instrumental and hobbies, activities and interests, its tools. So as to sharpen awareness of the full possible range of leisure counselling's application, this paper outlines how it may be applied across a wide span of coping needs and covers three broad domains: the need to ease phobias, panics, stress and tension states, and the aftermath of traumatic episodes; the need to create and sustain positive moods; and the need to contain and limit the destructive demands of habits and impulses as well as address the very sharp therapeutic challenge of obsessions and compulsions.     

Presidential IQ, Openness, Intellectual Brilliance, and Leadership: Estimates and Correlations for 42 U.S. Chief Executives

Individual differences in intelligence are consistently associated with leader performance, including the assessed performance of presidents of the United States. Given this empirical significance, IQ scores were estimated for all 42 chief executives from George Washington to G. W. Bush. The scores were obtained by applying missing-values estimation methods (expectation-maximization) to published assessments of (a) IQ (Cox, 1926; n =  8), (b) Intellectual Brilliance (Simonton, 1986c; n =  39), and (c) Openness to Experience (Rubenzer & Faschingbauer, 2004; n =  32). The resulting scores were then shown to correlate with evaluations of presidential leadership performance. The implications for George W. Bush and his presidency were then discussed.     

Right-Wing Authoritarianism, Attitude Salience, and Beliefs about Matters of Fact

Previous investigations have demonstrated a relationship between endorsement of right-wing authoritarian (RWA) ideology and attitudes toward social and societal issues (e.g., abortion, drug use, affirmative action, and homosexuality). By contrast, the present studies examined the relationship between RWA and beliefs about matters of fact bearing on such issues (e.g., estimates of the prevalence of third trimester abortions, AIDS, concealed weapons). Studies 1 and 2 supported the propositions that high-RWA and low-RWA participants would show differences in their informational beliefs about sociopolitical matters consistent with differences in their respective ideologies and consistent with their putative differential cynicism about human nature. Study 3 demonstrated that the relationship between RWA and informational beliefs is amplified by the heightened salience of attitudes toward the targets of those beliefs.     

Sexual Passion in Committed Relationships: Measurement and Conceptual Issues

The purpose of this study is to discuss the need for a new triadic model of sexual passion in relationships and to present the preliminary psychometric properties of a scale designed to measure these three approaches to passion (harmonious, obsessive, and inhibited) for use in clinical and scholarly work. Existing theory and measures of general passion are based on a dualistic model of passion that includes the harmonious and obsessive approaches to passion. We added the inhibited approach to passion from the sexuality research and develop measures for assessing sexual passion in relationships. We utilized an Amazon Mechanical Turk sample of 1,421 individuals in committed relationships to test this measure. Reliability analyses and confirmatory factory analyses evinced that these three approaches to sexual passion were unique constructs and distinct from sexual satisfaction. Sexual passion showed predictive validity above and beyond relationship length, sexual desire toward a partner, and a broader variable of sexual drive. Harmonious sexual passion robustly predicted higher sexual satisfaction and relationship satisfaction, and inhibited sexual passion moderately predicted lower sexual satisfaction and relationship satisfaction. Obsessive sexual passion had minimal associations with either outcome. These new constructs, especially harmonious and inhibited sexual passion, may help scholars and practitioners improve their understanding of sexual satisfaction and overall relationship satisfaction.     

How do I Analyze Thee? Let Me Count the Ways: Considering Empathy in Couple Relationships using Self and Partner Ratings

In this article we describe some of the benefits and challenges of using self ratings and ratings of the partner to measure empathy and similar terms in couple research. If both members of the dyad are assessed, there will be four measures of the same variable. How to use these 4 measures in research and clinical work is a central question in this paper. We demonstrate 3 different latent models that can be used to analyze these ratings based on different theoretical premises. Using empathy as the independent variable with a longitudinal sample of 275 couples, structural equation models are used to evaluate the strength of these models in predicting relationship satisfaction. The findings indicate that the model that is consistent with the social constructionist perspective that focuses on the perceptions within the same person is a good fit to the data. Other models that compare ratings between members of the dyad do not fit the data well. The results demonstrate that perceptions of empathy do have a significant influence on relationship satisfaction across time, especially for females. However, it is largely males' perceptions of empathy of the self and the partner that influence relationship satisfaction for females.