The Primary Care Health System as a Core Resource in Response to Terrorism

Abstract

Living through a terrorist event or under threat of attack affects both mental and physical health. A nation's primary care system plays a critical role under such circumstances. This article reviews the American experience after September 11, 2001 and advocates for integration of mental and physical health services in primary care settings as a key counter-terrorism strategy. Americans put their trust in primary care providers. The nation's healthcare system must develop and implement a strategy that informs and supports primary care providers in meeting the mental health needs of a nation confronted by terrorism.     

Implicit Mental Processes in Ethical Management Behavior

This article examines the relationship between implicit mental processes and ethical decisions made by managers. Based on the dual-process view in social and cognitive psychology, it is argued that social cognition (e.g., moral judgments) can rely on two different modes of information processing. On one hand, moral judgments reflect explicit, conscious, and extensive cognitive processes, which are attributed to explicit attitude. On the other hand, moral judgments may also be based on implicit, automatic, and effortless processes referring to implicit attitude. To test this thesis, a study involving 182 participants was conducted. The results support the thesis.     

How Psychotherapists Address Hypothetical Multiple Relationships Dilemmas with Asian American Clients: A National Survey

This study examined how psychotherapists address hypothetical nonsexual multiple relationships dilemmas with Asian American clients and identified predictors of conservative decisions and the use of culture-based rationales. This survey of 787 Asian American and non-Asian American psychotherapists revealed that clinicians rely on mostly their personal policies and seldom focus on the clients' cultural backgrounds. Psychotherapists who consider their clients' Asian culture have more cultural knowledge and awareness, have been mental health providers longer, and are Asian American and female. Clinicians who avoid multiple relationships tend to cite formal policies as justification and are less likely to consider clients' cultural worldviews, the therapeutic relationship, or their own values. The results are discussed in terms of specific revisions needed in the American Psychological Association Ethics Code, the benefits of more frequent consultation with colleagues and supervisors about ethical dilemmas, and recommendations for psychotherapists.     

Assessing Needs and Developing Interventions with New Populations

ABSTRACT

The predominance of chronic and lifestyle-induced conditions has emphasized the need for greater access to health care in the community. A corresponding concern is educating practitioners so they are equipped to assume positions in the community at graduation. Lack of preparation to work in the community has led to reluctance on the part of practitioners to pursue positions in the community (Walens et al., 1998). However, the current climate of health care creates many opportunities for practitioners and educators who are willing to make a commitment to work collaboratively with agencies in the community for a common good. The purpose of this paper is to broaden understanding of community built practice by sharing a collaborative process in fieldwork education that was undertaken by faculty at the University of Illinois at Chicago.     

Strategies School Practitioners Report They Would Use to Resist Pressures to Practice Unethically

Abstract

This study focused on strategies school psychologists and special education teachers report they would use to resist administrative pressures to practice unethically. Data came from a national sample of 141 school psychologists and 130 special education teachers who responded to a survey by predicting how they and others would respond to four ethical dilemmas. Qualitative analysis of data revealed four strategies that were generalized across all dilemmas. These general strategies were: preventing dilemmas from occurring; educating and/or threatening others; involving others in solutions; and combining strategies into more comprehensive responses. Qualitative analysis also revealed three strategies that were suggested for only some of the dilemmas (dilemma-specific strategies). Both the general and dilemma-specific strategies appear potentially useful to practitioners seeking ways of resisting pressures to practice unethically.     

年老化对风险决策和模糊决策的影响：来自生理性和病理性老化的证据

随着“全球老龄化”时代的到来, 老年人认知功能的下降引起了研究人员的广泛关注, 其中年老化对决策的影响成为了近年来的一个新关注点。风险决策和模糊决策受生理性老化和病理性老化影响的研究显示, 正常老化个体模糊决策能力受损, 但其风险决策能力受老化影响较小; 而病理性老化个体, 以阿尔兹海默症患者为例, 在两类决策行为上均表现出损伤; 此外, 脑神经机制的研究发现在完成决策任务时正常年老化个体纹状体激活模式与年轻人存在显著差异, 病理性老化个体杏仁核与腹内侧前额叶的功能连接亦存在异常。未来的研究应同时考察并比较两类决策类型, 结合外周和中枢神经证据, 深入探讨老化对决策行为及神经环路造成影响的机制。     

Language and understanding of cardiopulmonary resuscitation amongst an aged inpatient population

Greater patient involvement in health decision-making requires exchange of information between the patient and the healthcare professionals. Decisions regarding healthcare at the end of life include consideration of cardiopulmonary resuscitation (CPR). The stated objectives of this study were to determine how often language around concepts of resuscitation is used in the community by examination of the English language corpora (ELC); to explore the understanding of the same language by a group of older hospital patients; and to determine the patients’ knowledge of the process and success of CPR, as well as the sources of their information. Medical inpatients aged 75 years and older were surveyed to this end in the setting of a tertiary university teaching hospital. Interrogation of the Australian, British and American English Corpora was accomplished by a linguist, and a questionnaire and semi-structured interview were administered to ascertain patient knowledge. We demonstrated that although medical inpatients have some familiarity with terms relating to resuscitation, there is a lack of understanding of the context, process and outcomes of CPR. The predominant sources of information were television and print media. Examination of the ELC revealed a paucity of the use of terms related to resuscitation. This finding indicates that physicians have a duty of care to determine patients’ understanding around resuscitation language, and terms used, in discussions of their preferences before assuming their engagement in shared decision-making. More open public discussion around death and resuscitation would increase the general knowledge of the population and would provide a better foundation for the discussions in times of need.     

The moderating effect of motivation on health-related decision-making

Objective: This study identifies how autonomous and controlled motivation moderates the cognitive process that drives the adoption of personalised nutrition services. The cognitive process comprises perceptions of privacy risk, personalisation benefit, and their determinants.

Design: Depending on their level of autonomous and controlled motivation, participants (N = 3453) were assigned to one of four motivational orientations, which resulted in a 2 (low/high autonomous motivation) × 2 (low/high controlled motivation) quasi-experimental design.

Results: High levels of autonomous motivation strengthened the extent to which: (1) the benefits of engaging with a service determined the outcome of a risk-benefit trade-off; (2) the effectiveness of a service determined benefit perceptions. High levels of controlled motivation influenced the extent to which: (1) the risk of privacy loss determined the outcome of a risk-benefit trade-off; (2) controlling personal information after disclosure and perceiving the disclosed personal information as sensitive determined the risk of potential privacy loss.

Conclusion: To encourage the adoption of personalised dietary recommendations, for individuals with high levels of autonomous motivation emphasis should be on benefits and its determinants. For those with high levels of controlled motivation, it is important to focus on risk-related issues such as information sensitivity.