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 fear potentiated startle effect

A differential conditioning study examined whether an acoustic startle probe, presented during extinction of an aversively conditioned visual stimulus, potentiated the reflex eyeblink response in humans and whether this potentiation varied with the change in affective valence of the conditioned stimulus. Sixty college students were randomly assigned to view a series of two slides, depicting either unpleasant/highly arousing, unpleasant/moderate arousing, neutral/calm, pleasant/moderate arousing or pleasant/highly arousing scenes and objects (duration: 8 sec). During preconditioning (8 trials) and extinction (24 trials) acoustic startle probes (white noise bursts [50 ms; 95 dBA] were administered during and between slide presentation). During acquisition (16 trials) CS+ was reinforced by an electric shock. Startle response magnitudes significantly increased from preconditioning to extinction and were substantially larger to CS+. Conditioned startle reflex augmentation linearly increased with the pleasantness of the slides. Furthermore, subjects showed a greater post-conditioning increase of judged aversiveness to slides that they had previously reported to be more pleasant, exactly paralleling the startle reflex results.

     

Undermining the Zeigarnik effect: Another hidden cost of reward

Forty college students participated in a study ostensibly designed to obtain measures of the hemispheric activity while they worked on a spatial reasoning task. In fact, our true interest was in determining whether subjects would return to the spatial reasoning task once the hemispheric recordings were completed. Subjects would normally be expected to return to the task by virtue of the Zeigarnik effect because no subject completed the task during the “hemispheric recording” phase. The manipulation involved telling one group of subjects that they would be paid $1.50 for participating in the study (expected reward group). The remainder of the subjects were not led to expect the reward (unexpected reward group). The result was that 86% of the unexpected reward subjects but only 58% of the expected reward subjects (p < .05) manifested the Zeigarnik effect. This differential tendency to return to the task was further reflected in time differences. The average unexpected reward subject spent 3 min 48 sec of a five-minute free-choice period at the task, whereas the average expected reward subject spent only 2 min 20 sec (p < .05). Reward expectancy, therefore, led to an undermining of the Zeigarnik effect. This observation supports Condry's prediction that rewarding performance at a task can lead to premature task disengagement.     

The use of structured learning therapy and transfer programming with disruptive adolescents in a school setting

In behavior change literature, little attention has been paid to the systematic study of variables affecting transfer of training. The present study employed a skill-training method known as Structured Learning Therapy (SLT) for the dual purpose of testing the effectiveness of this method and to identify variables that will promote transfer of training. Forty-three disruptive male adolescents were assigned to three experimental and two control conditions. One experimental group received SLT plus an additional transfer-enhancing procedure referred to as Transfer Programming (TP) which consisted of in vivo practice of treatment gains and peer reinforcement. Another group received only SLT, and a third group received only TP. One control group received only brief instructions pertaining to the nature of the skill, while the second group served as an attention control. Consistent with predictions, the results were that the two groups receiving the SLT performed significantly better than the three groups not receiving SLT on all dependent measures at posttest. These differences generally maintained at follow-up. Contrary to expectations, the implementation of TP did not prove to promote transfer of training beyond that found with SLT alone.     

Response competition effects insame-different judgments

An account ofsame-different discriminations that is based upon a continuous-flow model of visual information processing (C. W. Eriksen & Schultz, 1979) and response competition and inhibition between the responses by which the subject signifies his judgment is presented. We show that a response signifyingsame will on the average be executed faster due to less priming or incipient activation of the competing response,different. In the experiment, the subjects matched letters on the basis of physical identity. The degree of priming ofdifferent responses on same trials and ofsame responses ondifferent trials was manipulated by an extraneous noise letter placed in the display. Latency for judgments onsame trials increased as the feature overlap of noise and target letters decreased. Latencies were shorter ondifferent trials when the noise letter was dissimilar to either target letter than when the noise letter was the same as one of the targets. These results were consistent with the response-competition interpretation.     

A constructivist analysis of the Rotter I-E scale1

A conception of locus of control attribution was advanced as an alternative to the generalized expectancy view presented by Rotter. That alternative stems from regarding the individual as actively constructing a pattern of specific choice consequence relations out of his/her ongoing experience. An integration of structural and factor approaches was used to analyze the Rotter I-E scale. The structural analysis categorized items on four dimensions (focus, area, self-attribution and world attribution) and indicated that the I-E scale unevenly represents the domain it encompasses. Nevertheless, specification of that structural matrix helps to provide a more comprehensive framework for interpreting I-E response patterns of 216 high school juniors and seniors. For example, male responses cohered around asserting active control over tasks hut attributing control to external sources with regard both to personal issues and to more abstract systems-related issues. Females organized their senses of self-efficacy with a central theme being that of a passive agent stance, plus an expectation that circumstances would provide equality of opportunities to which they could respond. Thus the present approach has demonstrated its utility in interpreting I-E findings and its conceptual advantage for personality research on locus of control and on similiar attributional characteristics.     

Serial learning in the pigeon.

Three pigeons learned to peck four colors in a particular sequence, regardless of how these colors were positioned on four response keys and without feedback following each response. This demonstrates that serial learning is possible in subprimate animals.