Training clinical psychologists for rural and northern practice: Transforming challenge into opportunity

Abstract: The Rural and Northern Program (R&NP) of the University of Manitoba's Department of Clinical Health Psychology (DCHP) is a unique training and service delivery platform that was developed in response to the scarcity of psychological services in rural and northern areas of the province of Manitoba, Canada. Since 1996 rural and northern‐based psychologists, in conjunction with the faculty based in Winnipeg (Manitoba's largest city) have offered training to two interns and one postdoctoral resident (resident) yearly. The current article discusses the nature of the program, the regions of Manitoba that the program services, and recruitment and retention data. The authors conclude by offering suggestions for creating sustainable rural/northern psychological practice.     

Living up to high standards and psychological distress

We argue and demonstrate that setting high standards, an essential aspect of perfectionism, is not associated with maladaptive responses in and of itself. Rather, our findings suggest that people's responses to their perceptions that they consistently fail to meet their own standards are maladaptive. More importantly, in the present survey study (n = 293), we extend previous research by showing that low personal standards and the perception that others are imposing high standards on the self operate in concert to strengthen the link between perceived discrepancy and psychological distress. Furthermore, in support of our moderation‐mediation model, regression analyses provided evidence for the mediating role of generalised self‐efficacy beliefs. Copyright © 2008 John Wiley & Sons, Ltd.     

Practical Reasons, Practical Rationality, Practical Wisdom

There are a number of proposals as to exactly how reasons, ends and rationality are related. It is often thought that practical reasons can be analyzed in terms of practical rationality, which, in turn, has something to do with the pursuit of ends. I want to argue against the conceptual priority of rationality and the pursuit of ends, and in favor of the conceptual priority of reasons. This case comes in two parts. I first argue for a new conception of ends by which all ends are had under the guise of reasons. I then articulate a sense of rationality, procedural rationality, that is connected with the pursuit of ends so conceived, where one is rational to the extent that one is motivated to act in accordance with reasons as they appear to be. Unfortunately, these conceptions of ends and procedural rationality are inadequate for building an account of practical reasons, though I try to explain why it is that the rational pursuit of ends generates intuitive but misleading accounts of genuine normative reasons. The crux of the problem is an insensitivity to an is-seems distinction, where procedural rationality concerns reasons as they appear, and what we are after is a substantive sense of rationality that concerns reasons as they are. Based on these distinct senses of rationality, and some disambiguation of what it is to have a reason, I offer a critique of internalist analyses of one’s reasons in terms of the motivational states of one’s ideal, procedurally rational self, and I offer an alternative analysis of one’s practical reasons in terms of practical wisdom that overcomes objections to related reasons externalist views. The resulting theory is roughly Humean about procedural rationality and roughly Aristotelian about reasons, capturing the core truths of both camps.

Principles versus procedures in making health care coverage decisions: addressing inevitable conflicts

It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is “accountability for reasonableness.” We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients’ rights law in Norway, health technologies coverage recommendations in the UK, and care withheld by HMOs in the US. In each case a process is at the center of controversy, illustrating the difficulties in establishing procedures that are widely accepted as legitimate. Further work must be done in developing procedural frameworks. The opinions expressed are the authors’ own. They do not reflect any position or policy of the National Institutes of Health, US Public Health Service, or Department of Health and Human Services. This research was supported by the Intramural Research Program of the NIH Clinical Center.     

新型农村合作医疗制度创新测度指标体系研究

为了对新型农村合作医疗制度创新状况进行客观、准确的测度,在汲取有关公共服务创新理论的基础上,结合新型农村合作医疗制度创新状况,探索构建新型农村合作医疗制度创新测度指标体系,以促进新型农村合作医疗绩效的提高。     

新型农村合作医疗中的道德风险及防范

以“新乡模式”为例对商业保险公司参与承办新型农村合作医疗进行了有益的探索。对商业保险公司利益激励不足致使其参与新农舍的积极性不高,而激励不足主要是源于制度不足导致对新农合中的道德风险约束无力。探讨了对道德风险的防范措施。     

Context dependency of conditioned aversions to familiar and novel fluids

Using a context discrimination procedure and rats as the subjects, the formation of context-dependent aversions to novel and familiar fluids was investigated. Experiment 1 revealed that context dependency could be established to a novel fluid (saccharin) after three cycles of context discrimination training and that the acquired context dependency was revealed also to a second familiar fluid (water) presented in the following test. Experiment 2 showed that the formation of the context-dependent aversion and its transfer to a second fluid was not affected by whether fluid presented during discrimination was novel (saccharin) or familiar (water). Experiment 3 demonstrated that when the same water was given both in the two training contexts and in the home cages of the subjects during discrimination, the context-dependent aversion formed was specific to it. These findings can be explained in terms of a simple summation effect of fluid-nausea and context-nausea associations.     

New Directions in Goal-Setting Theory

ABSTRACT— Goal-setting theory is summarized regarding the effectiveness of specific, difficult goals; the relationship of goals to affect; the mediators of goal effects; the relation of goals to self-efficacy; the moderators of goal effects; and the generality of goal effects across people, tasks, countries, time spans, experimental designs, goal sources (i.e., self-set, set jointly with others, or assigned), and dependent variables. Recent studies concerned with goal choice and the factors that influence it, the function of learning goals, the effect of goal framing, goals and affect (well-being), group goal setting, goals and traits, macro-level goal setting, and conscious versus subconscious goals are described. Suggestions are given for future research.     

Using goal setting, task clarification, and feedback to increase the use of the hands-free technique by hospital operating room staff

We evaluated the effects of a behavioral treatment on the safe passing of sharp instruments using the hands-free technique among hospital operating room personnel during surgical procedures. Treatment consisted of participative goal setting, task clarification, and feedback. The average percentage of sharp instruments passed safely increased from 32% to 64% and 31% to 70% between baseline and treatment phases in the inpatient and outpatient surgery units, respectively. Five-month follow-up data suggested maintenance of treatment effects. These findings suggest the utility of organizational behavior management strategies in reducing risky behavior in hospital settings.