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.     

Extraversion: A “Hidden” Personality Factor in Coping?

Recent evidence suggests a larger role for personality determinants of the coping response than has been traditionally held. In the two studies presented here, we examined the influence of personality on the use of social support and other coping strategies in samples of undergraduate students. The first study surveyed a range of coping responses to naturally occurring stressors and found that Extraversion was related to social support seeking, optimism (identified as germane to coping in prior research) was related to problem solving, and both dispositions were negatively related to avoidance. The second study used an experimental approach and multiple personality measures to correct for possible methodological problems in the first. Extraversion again proved to be associated with help seeking; moreover, this relationship accounted for that of another disposition, self-esteem—a construct considered crucial in the literature. The utility of personality variables, particularly Extraversion, in predicting and explaining the choice of a coping strategy is discussed.     

Are All Hostility Scales Alike? Factor Structure and Covariation Among Measures of Hostility1

Few studies have examined the correlational and structural relationships between measures of hostility that may predict coronary heart disease. Using data from a population-based study (N= 2,682), we examined the factor structure among the five subscales from Siegel's (1986) Multi-dimensional Anger Inventory, the three subscales from Spielberger et al.'s (1985) anger expression scales, a Cook-Medley (Cook & Madley, 1954) hostility subscale that measures cynicism, and items measuring hostility from four scales that assess Type A behavior. Eight separate factors were identified: hostile anger expression, perceived control over the expression of one's anger, frequency of anger, ease of anger provocation, brooding, hostile outlook, cynicism, and sullenness. These results suggest that the structure of hostility measures is more complex than previous factor analyses have suggested. Our findings point to the dangers in assuming that a factor structure can be generalized beyond the data on which it is based to provide theoretical statements about psychological structure. The new scales appear to be valid because they correlate with demographic variables and indicators of social support in the expected directions.     

The importance of stories in the act of caring

This article focuses on the essential role and function of story in the care of young children with emotional and behavioral disorders in an institutional setting. Highlighted in this article is the importance of story in the therapeutic relationship, its educational implications, and in theological reflection. A narrative approach of care becomes a way of healing both heart and mind, and is ultimately an act of love.     

On the Relation between Representational and Processing Models of Asyntactic Comprehension

Most accounts of asyntactic comprehension fall along a spectrum from pure representational accounts to pure processing accounts. The double dependency hypothesis of Mauner, Fromkin, and Cornell (1993) is an example of the former, while the SYNCHRON model of Haarman and Kolk (1991; see also Kolk, this volume) is an example of the latter. This paper attempts to demonstrate some of the ways that these two approaches interact. We introduce GENCHRON, a computer model based on Haarman and Kolk′s SYNCHRON. GENCHRON is a parser subject to the kinds of processing deficits examined in Haarman and Kolk (1991). We present a simple grammar which leads GENCHRON to produce the kinds of semantic representations which Mauner, Fromkin, and Cornell (1993) propose for asyntactic comprehenders.     

Gender differences in coping: A further test of socialization and role constraint theories

To further test role constraint and socialization theories of gender differences in coping, two studies were conducted to examine coping strategies in individuals occupying similar roles. The relations between coping strategy frequency and effectiveness and between coping strategy use and psychological functioning also were examined. Predominantly Caucasian female and male college students participated in the studies. Results indicated support for both socialization and role constraint theories. Effectiveness and frequency of coping strategy use were moderately correlated. Gender differences in cognitive appraisal varied with dispositional vs. situational assessment. The need for a more integrated model to explain gender differences in coping and implications for existing theories are discussed.     

Training Soviet immigrant therapists in the field of group psychotherapy

Between 1970 and 1990 about one-half million Jews immigrated to Israel, most of them from the former Soviet Union, including many mental health therapists who had trained and worked in the Soviet Union. This article addresses the special characteristics of this population, in general, and of the mental health therapists, in particular. It relates these characteristics to training for group psychotherapy. Key issues include their unique experience of the inner world as a source of danger, the specific defensive modes connected with this experience, their perception of authority as an agent of ideology, and their representation of the group as a persecutory entity and as a vehicle of indoctrination.     

Telling stories: metaphors of the Human Genome Project

Scientists of the Human Genome Project tend to rely on three metaphors to describe their work, each of which implicitly tells much the same story. Whether they claim to interpret the ultimate “book,” to fix a flawed “machine,” or to map a mysterious “wilderness,” they invariably cast the researcher as one who dominates and exploits the Other. This essay, which explores the ways such a story conflicts with feminist values, proposes an alternative.