Race and Healthcare Disparities: Overcoming Vulnerability

The paper summarizes recently published dataand recommendations about healthcaredisparities experienced by African Americanswho have Medicare or other healthcare coverage.Against this background the paper addresses theethics of such disparities and howdisadvantages of vulnerable populations likeAfrican Americans are typically maintained indecision making about how to respond to suchdisparities. Considering how to respond todisparities reveals much that vulnerablepopulations would bring to the policy-makingtable, if they can also be heard when they getthere. The paper argues that vulnerablepopulations like African Americans need fairrepresentation in bodies deciding what to doabout such disparities and that fairnessrequires proportional representation at alllevels of decisions that affect healthcare – aradical change. In this decision setting, howto provide adequate protection of minoritiesneeds much further attention. The mostattractive decision-making model isdeliberative democracy. The paper shows thatin deliberation, fair representation requiresnot only having a voice in decisions, but afair hearing of those voices. Achieving a fairhearing requires changes in norms ofcommunication and training of all to giveimportance to greetings and other measures ofcivility and trust building, and to be open todiverse forms of expression. Decisions abouthow to respond to healthcare disparities wouldinclude what programs to initiate for whom, howto evaluate the programs, and what to do inresponse to such evaluations. Conclusions arethat achieving such goals will take a seachange in how healthcare institutions andproviders do their business, and that socialactivism at every level will be needed toeffect these changes. The discussionhighlights many ethical issues that need muchgreater attention.     

Battling Discrimination and Social Isolation: Psychological Distress Among Latino Day Laborers

Day labor is comprised of predominately male and recent Latino immigrants, mainly from Mexico and Central America who work in an unregulated and informal market. Three-quarters of the day labor force is undocumented and live under the federal poverty threshold as work is seasonal and highly contingent on the weather and the local economy. However, in spite of their exposure to significant health risks, little is known about the impact of Latino day laborers’ (LDLs) work and life conditions on their mental health. This mixed methods study extends the literature by using the minority stress theoretical model to examine the relationship between discrimination and social isolation as well as participant identified protective factors such as religiosity and sending remittances with psychological distress. A quantitative survey with 150 LDLs was conducted and was followed by a qualitative member checking focus group to extend upon the quantitative results as well as the minority stress model with the lived experiences of these immigrant workers. Results reveal implications for prevention efforts with this hard-to-reach and marginalized population.     

Gender Mainstreaming and Healthcare Policy

This review addresses how The Palgrave Handbook of Gender and Healthcare structures and analyzes the themes that emerge from its own interrogation of the complex concepts of gender, equality, health and policy. Overall the review takes a complimentary tone towards the handbook's arguments and premises and the unique research that sets it apart from other more scientifically or development based gender health texts. It points out, however, that the book maintains its focus on the global north and the efficacy of state policy as the primary tool for gender equality, however defined. The author suggests that in future discussions, the alternative routes and different countries that are only just touched on in the text should be more thoroughly explored.     

Risk,Uncertainty, and Gender Stereotypes in Healthcare Decisions

Disparities in healthcare access, treatment, and outcomes are widely prevalent for women and minorities. At the same time, healthcare choices have become increasingly intricate and correspondingly uncertain. We review contemporary issues in healthcare for women, with emphasis on access to care and on healthcare disparities. In the belief that forewarned is forearmed, we review the role of sexism and the psychology of decision making in producing health disparities. In the face of this complexity, therapists can help women seek sound healthcare and make informed choices. Implications for feminist therapy are suggested that emphasize client empowerment and agency.     

Occupational demands,psychological burnout and anxiety among hospital personnel in norway

The present study reports the results of a questionnaire survey among 212 health care workers at a hospital in Northern Norway. Measures included burnout, trait anxiety, various job demands and supports, and work attitudes (job satisfaction and organizational commitment). Results provided support for Maslach's conceptualization of the burnout syndrome cross-culturally. Correlations among the three burnout subscales, as well as organizational correlates of burnout were generally consistent with earlier findings. The burnout scores of hospital workers were higher than North American norms, and some occupational differencs among subscales were found. A model of individual characteristics, job demands, burnout, and work attitudes was tested through a series of multiple regressions. Trait anxiety as well as job demands contributed to burnout. The influence of trait anxiety on work attitudes was mediated through emotional exhaustion. However, in addition to emotional exhaustion, both job demands and organizational supports had direct effects on work attitudes. Thus, burnout does not fully operate as a mediating variable between demands and attitudes such as commitment. The study also addressed the issue of individual differences in the burnout response and focused on the need to systematically investigate the relaive importance of situational versus personality variables in future burnout research.     

Suffering–At the Bedside of the Dying

SUMMARY

Care of people at the end of life is a challenge for the person with a life-limiting illness, their family and friends, and their professional carers. Clinicians, including pastoral care workers, nurses, doctors, and allied health professionals, find themselves at the bedside of the dying. At times, the professional's sense of self is challenged both by the suffering that they witness (physical, emotional, existential, social, sexual, or financial) and a sense of helplessness to relieve not only the patient's suffering but also that of the people to whom the dying person is close. What framework can help us to deal with the suffering that we cannot help but encounter? Ultimately people connecting in a real and meaningful way with other people is probably the only way that each of us can confront suffering and not have it destroy us. Creating an environment where people can begin to, or continue to connect with others at a level that is meaningful for all concerned is a pivotal starting point in dealing with suffering in any encounter with people at the bedside.     

Perceived Change of Values and Intention to Return Among Kibbutz People Who Emigrated From Israel

We examined perceived changes of values and intentions to return to Israel among 149 Kibbutz people who had lived for 3 or more years in New York, Los Angeles, and San Francisco. In answering standardized attitude questionnaires, participants reported significantly less general agreement today with Kibbutz values, but more support for the idea that Israel should compromise on occupied territories and more support for the idea that people should live where they choose. Political opinions also moved toward more liberal attitudes. Most participants intended to return to Israel without specifying a clear time frame. Values were significantly associated with behavioral intentions, with those endorsing Zionist values the most likely to report that they would return to Israel in times of war or peace. Results suggested acculturation to American society and political opinions.     

Consequences of Violence Exposures by Emergency Nurses

Emergency nurses are among the most likely groups of health care professionals to be exposed to violence. Violence exposure is the witnessing or receiving of a violent act with or without the intention to cause physical or psychological harm. The purpose of this paper is to evaluate the literature in relation to emergency nurses' exposure to violence and discuss the implications for emergency nursing practice. A review of the literature was conducted using the keywords violence, emergency nursing, health care workers, and productivity. Emergency nurses exhibited anxiety, vulnerability, guilt, anger, sadness, and peer blaming following violence exposures. Violence exposures affect emergency nurses both physically and psychologically. Interventions should be developed to reduce the negative consequences of violence exposures.     

Factors Associated With Adverse Mental Health Outcomes in Locally Recruited Aid Workers Assisting Iraqi Refugees in Jordan

Nongovernmental organizations (NGOs) serve Iraqis living in Jordan as “guests.” In 2008, 258 Jordanian humanitarian staff and Iraqi volunteers working for NGOs completed a needs assessment survey. Work characteristics, stressors, and support variables were evaluated regarding their influence on depression, anxiety, post-traumatic stress disorder (PTSD), and burnout through multivariate logistic regressions. There was a significant difference in depression, anxiety, and burnout across nationality. Traumatic exposure increased the risk for anxiety, depression, and PTSD. Working longer in the humanitarian sector was associated with less risk of anxiety and depression, and lower social support was a risk for anxiety. Managers were at higher risk for burnout, and low team cohesion was a risk for burnout. Implications for aid organizations are discussed.     

The Scope of Client Aggression Toward Social Workers in Israel

The phenomenon of client violence toward social workers has been documented in various parts of the world. The goal of this study is to describe the phenomenon and explore the relationship pattern between contextual variables and clients’ aggression. The study encompassed a sample of 645 workers in 34 municipal social service agencies. Of the entire sample, 80% reported being exposed to some form of aggression at least once over the last 3 months. The findings highlight 2 broad axes related to client aggressiveness: frequency and level of aggression. With respect to frequency, we can discern a continuum running from common types of aggressive behaviors to rare ones. The other axis focuses on the level of aggressiveness used, from minor types of client aggression, such as verbal assaults and threats, increasing to more severe ones, such as property damage, and, finally, to physical injury. The routineness of aggression in the work environment lends it the appearance of being normal, and functioning in such an environment desensitizes social workers to clients’ aggressiveness. Also examined and discussed are organizational and personal factors that contribute to the aggressive behavior of clients, including seniority, gender, workload, inadequate service conditions, and coworkers’ aggressive behavior.