The rationing of health care: A doctor's dilemma

Physicians are currently presented with very difficult ethical issues regarding who receives what level of medical care and for how long. A meaningful response to these perplexing issues necessitates a collaboration of doctors with others steeped in religious and ethical traditions. This paper addresses the complicated issue of the rationing of health care, and this issue is then addressed by responses from representatives of the religious community. This symposium took place at the New York Hospital—Cornell Medical Center in March 1991.The Rev. Curtis W. Hart, M.Div. is Director of Pastoral Care and Education at the New York Hospital—Cornell Medical Center.The Rev. Paul Conner, O.P., is Associate Professor and Director of the Master's Program in Public Health Care Ethics at New York Medical College. Larry Rasmussen, Th.D., is Reinhold Niebuhr Professor of Social Ethics at Union Theological Seminary in New York. Dr. Harlan J. Wechsler is Rabbi of Congregation Or Zarua and Visiting Professor of Philosophy at Jewish Theological Seminary in New York.     

Profile of Rural College Reach-Out Students

This study focuses on the personality profile and career aspirations of rural, underachieving seventh-grade students from low socioeconomic families who were selected to participate in a college reach-out program. Implications for career counseling and educational planning are discussed.     

A Career Counseling Diagnostic Model: How to Assess and Counsel Career-Concerned Clients

This article provides a practical and proven diagnostic system that can be used by career counselors to assess and counsel their clients.     

New Careers Model Revisited: The Importance of Mentoring

The authors report a study that suggests the career paths of workers on short-term federal projects may be enhanced as a result of developing a relationship with a mentor through such projects.     

Morale and Job Satisfaction Among Nurses: What Can Hospitals Do?

In an attempt to account for morale and job satisfaction among 314 nurses, this study investigated the influence of work-related and interpersonal variables. Morale on the unit was directly related to supervisor support, co-worker relationships, and work recognition. Personal morale was accounted for by recognition, physical environment, the job itself, and pay. Job satisfaction was predicted by personal morale, work commitment, job clarity, work pressure, and innovation. Suggestions for improving nurse morale and job satisfaction are made.     

Small Wins: Perceptual Focus,Efficacy, and Cooperation in a Stage-Conjunctive Social Dilemma1

A multi-stage social dilemma was used to explore the notion that focusing on part rather than all of a complex problem would affect self-efficacy and action. In two experiments subjects considered a multi-stage game asking them to invest an initial sum of money in hopes of earning a larger bonus to be paid if provision points were met at all stages (a “stage-conjunctive” task). Results indicated that under most conditions considered, presentation of the whole problem encouraged cooperation. The opposite pattern occurred when group members were asked to complete very demanding stages first. We suggest that these results depend strongly on the stage-conjunctive nature of our task.     

THE DECISION TO IMPLEMENT GAINSHARING: THE ROLE OF WORK CLIMATE, EXPECTED OUTCOMES, AND UNION STATUS

This study empirically examines several factors that may predict management decisions to implement high-involvement gainsharing plans, interventions that pay company-wide bonuses for performance improvements and encourage employee involvement in work decisions. It addresses the question: why does one facility that considers implementing a gainsharing plan decide to do so, while another facility does not? In 59 facilities (32 nonunion and 27 union) considering the implementation of a gainsharing plan, 485 upper-level managers evaluated the work climate in their facilities (participation, identity, cooperation, and expected plan support) and rated the anticipated outcomes of the intervention. Union status had no direct relationship with the implementation decision. A significant interaction showed that implementation was positively related to participation and expected outcomes in the nonunion facilities, but was unrelated to these variables in the unionized facilities. The results provided little support for a “transformation” model of plan implementation and moderate support for a "compatibility" model.     

The differential validity of hyperactivity/attention deficits and conduct problems among mentally retarded children

The independence of hyperactivity, attention deficits, and conduct problems among mentally retarded children was addressed using factors of the Conners' Teacher Rating Scale-39 (CTRS-39) and the more recently developed IOWA Conners' inattention/overactivity (IO) and aggression (A) subscales. CTRS-39 ratings were obtained for children of normal intelligence and for mentally retarded children. Differences between the groups were examined as were intercorrelations of the Conners' factors and IOWA subscales. Conduct problems proved to be less strongly associated with hyperactivity and attention deficits among mentally retarded children compared to children of normal intelligence. However, attention problems and conduct problems may be associated with mental retardation in general. Implications of these data and CTRS scoring system recommendations for mentally retarded children are discussed.