The question of work–family practices commonly arises in both theory and daily practice as a matter of responsibility in today’s organisations. More information is needed about them for socially responsible human resource management. In this article our interest is in how work–family practices, serve as an important element of SR-HRM, constructed as helpful for employees’ work–family integration, are realised in organisational life. We investigate the discursive ways in which members of two different organisations working at different (...) organisational levels construct the issue in the Finnish context. Three discourses were interpreted: a discourse of compliance with external pressure, a discourse of negotiation and a discourse of individual flexibility. Discursive constructions of work–family practices make visible the complex interconnectedness of individuals and organisations with the environment in which they operate. Many organisational efforts to create positive work–family practices can, in fact, lead to failure to make these practices either available or usable, and they may result in the unjust treatment of organisation members. Creating sustainable work–family practices is a complex challenge for which SR-HRM must work out a solution. (shrink)

The issue of death due to medical errors is not new. We have all heard horror stories about patients dying in the hospital because of a drug mix-up or a surgery patient having the wrong limb amputated. Most people believed these stories were the exception to the rule until November 1999, when the Institute of Medicine issued a report entitled To Err Is Human: Building A Safer Health System. This report focused on medical errors and patient safety in U.S. hospitals. (...) The report indicated that as many as 44,000 to 98,000 people die each year in hospitals as a result of medical errors. These numbers suggest that more Americans are killed in U.S.hospitals every 6 months than died in the entire Vietnam War, and some have compared the alleged rate to fully loaded jumbo jets crashing every other day. This report was not without its critics. (shrink)

The issue of death due to medical errors is not new. We have all heard horror stories about patients dying in the hospital because of a drug mix-up or a surgery patient having the wrong limb amputated. Most people believed these stories were the exception to the rule until November 1999, when the Institute of Medicine issued a report entitled To Err Is Human: Building A Safer Health System. This report focused on medical errors and patient safety in U.S. hospitals. (...) The report indicated that as many as 44,000 to 98,000 people die each year in hospitals as a result of medical errors. These numbers suggest that more Americans are killed in U.S.hospitals every 6 months than died in the entire Vietnam War, and some have compared the alleged rate to fully loaded jumbo jets crashing every other day. This report was not without its critics. (shrink)

Family medicine has grown as a specialty from its early days of general practice. It was established as a Board Certified specialty in 1969. This growth and maturation can be traced in the philosophy of family medicine as articulated by Edmund D. Pellegrino, M.D. Long before it was popular to do so, Pellegrino supported the development of family medicine. In this essay I examine the development of Pellegrino's philosophical thought about family practice, and contrast (...) it to other thinkers like Ian McWhinney, Kerr White, Walter Spitzer, Donald Ransom, and Hebert Vandervoort. The arguments focus on whether the goals of family medicine and family practice (possibly two distinct entities) can be articulated, especially considering the definitional problems of family and community. I conclude by echoing Pellegrino's hope that family medicine can contribute a fresh alternative to isolated, individualistic and technological thinking in medicine. (shrink)

Medical ethical thought, imbued with the idealism of traditional medicine, has always grappled with the problem of translating abstract principles into actions that do not violate the sensibilities of the patient or the physician. The problem of translation is minimal for the family physician engaged in routine conversations with patients and their family members. This conversation — staying with details, maintaining the union of values and facts, reflecting without detaching or distancing — suggests a model of ethical reasoning (...) and problem-solving that warrants serious attention. (shrink)

Most medical consultations are for self‐limiting conditions. While technical expertise remains necessary, creating therapeutic knowledge in this context is the joint responsibility of physician and patient, and depends upon recognition that the observer, the observation, and the observed form a temporary union.

Despite recognition of the importance of family in health‐care and progress in family theory development, there has been limited transfer of family theory to acute care nursing practice. We argue that this family theory–practice gap results from a persistent lack of conceptual clarity in family nursing and other barriers. Lack of conceptual clarity takes the form of conceptual overlap and semantic inconsistency, as well as the complexity of language found in the family (...) nursing literature. Barriers include practice contexts, relational problems, and knowledge types. Our exploration begins with a brief discussion of the intimate link between nursing theory and practice followed by an overview of some issues associated with the family nursing theory–practice gap. Based on a synthesis of family nursing literature, problems associated with conceptual clarity in family nursing theory are explored. We conclude with recommendations for family nursing research to develop concepts grounded in nursing practice. (shrink)

The paediatric intensive care unit is a high-stress environment for parents, families and health care professionals alike. Family members experiencing stress or grief related to the admission of their sick child may at times exhibit challenging behaviours; these exist on a continuum from those that are anticipated in context, through to unacceptable aggression. Rare, extreme behaviours include threats, verbal or even physical abuse. Both extreme and recurrent ‘subthreshold’ behaviours can cause significant staff distress, impede optimal clinical care and compromise (...) patient outcomes. The unique PICU environment and model of care may magnify stressors for both families and staff and the family-centred approach to care central to paediatric practice, may also contribute to contextual challenges. Pervasive conflict in paediatric healthcare is harmful for patients, families, PICU staff and the institution more broadly. We propose that caring for children and caring for staff are inseparable goals and the latter has been inadvertently but detrimentally deprioritised as FCC has become a primary focus. A transparent and graded hierarchy of responses to variable levels of challenging behaviour is necessary to ensure that families are supported, while HCPs remain protected in the workplace. This requires establishing firm limits supported by all teams and levels of the institution. As such, we aim to identify and clarify the context and impact of challenging parent and family behaviour in the PICU and to offer potential, proactive mitigation strategies, based on reflections and stakeholder discussion following recent clinical challenges and experiences in our unit. (shrink)

Developing a care plan in a critical care context can be challenging when the therapeutic alliance between clinicians and families is compromised by anger. When these cases occur, clinicians often turn to clinical ethics consultants to assist them with repairing this alliance before further damage can occur. This paper describes five different reasons family members may feel and express anger and offers concrete strategies for clinical ethics consultants to use when working with angry families acting as surrogate decision makers (...) for critical care patients. We reviewed records of consults using thematic analysis between January 2015 and June 2016. Each case was coded to identify whether the case involved a negative encounter with an angry family. In our review, we selected 11 cases with at least one of the following concerns or reasons for anger: perceived or actual medical error, concerns about the medical team’s competence, miscommunication, perceived conflict of interest or commitment, or loss of control. To successfully implement these strategies, clinical ethics consultants, members of the medical team, and family members should share responsibility for creating a mutually respectful relationship. (shrink)

If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic genetic testing. Those identified as mutation carriers can undertake strategies to reduce their risk of developing the disease or to facilitate early diagnosis. This procedure of informing relatives through the index patient has been criticised, as it results (...) in relatively few requests for genetic testing, conceivably because a certain number of relatives remain uninformed. This pilot study explored attitudes toward informing family members and relevant practices among clinical geneticists. In general, clinical geneticists consider it to be in the interests of family members to be informed and acknowledge that this goal is not accomplished by current procedures. The reasons given for maintaining present practices despite this include clinical ‘mores’, uncertainty about the legal right of doctors to inform family members themselves, and, importantly, a lack of resources. We discuss these reasons from an ethical point of view and conclude that they are partly uninformed and inconsistent. If informing relatives is considered to be in their best interests, clinical geneticists should consider informing relatives themselves. In the common situation in which index patients do not object to informing relatives, no legal obstacles prevent geneticists from doing so. An evaluation of these findings among professionals may lead to a more active approach in clinical practice. (shrink)

An empirically based family assessment can help family therapists understand how a family functions. In systemic therapy a family is seen as a dynamic system in which the family members form interdependent subsystems. The Social Relations Model is a useful tool to study such interdependence within a family. According to the SRM, each dyadic score is viewed as the sum of an unobserved family effect, an individual actor and partner effect, and a relation-specific (...) effect. If dyadic data are obtained for a specific family using a round robin design, these different SRM effects can be calculated using an ANOVA-approach. To gain insight into the functioning of a particular family, the family-specific SRM effects can be compared to those from a norm sample and it can be deduced whether that family has deviating scores on a particular SRM effect. Currently, such a family assessment relies on the mean and variance of the SRM ANOVA scores in the norm sample. However, family therapists may not always have access to these data, making the current approach of SRM family assessment not as useful in practice. In this article, we introduce a user-friendly web application that uses an alternative method for SRM family assessment. This alternative strategy requires as input the population parameter estimates of SRM means and variances more commonly described in SRM family literature. (shrink)

Family members do not have an official position in the practice of euthanasia and physician assisted suicide in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could (...) serve as a starting point for further empirical and ethical inquiry. A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families’ experiences and grief after EAS. 4) Family and ‘the good euthanasia death’ according to Dutch physicians. Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making. (shrink)

Zhang Zai’s 張載 “Western Inscription ” and Kant’s “Conclusion” of the Critique of Practical Reason are two profound pieces. As of yet, no comparative study has been made of the two. I argue that a comparative and contrasting study provides us a window into the central and powerful ideas within these two pieces. Section 2 of this article contrasts Zhang Zai’s “Heaven-Earth” with Kant’s starry heavens, his external “wonderland.” Section 3 contrasts Zhang Zai’s teaching of morality by personal commitment and (...) exemplars with Kant’s teaching of morality by a theory based on the moral law within, his inner “wonderland.” Section 4 compares and contrasts Zhang Zai’s human self-realization in the one world of Heaven-Earth with Kant’s human realization in the coming-together of the two “wonderlands.” By stressing some significant differences between Zhang Zai and Kant, I conclude that the view that takes Kant’s coming-together of the two “wonderlands” as a version of the union or interpenetration between the cosmos and the human will need important qualifications. (shrink)

Aim: This aim of this study is to describe the development of a program logic model to guide arts-based psychosocial practice delivered in rural South African farming communities affected by transgenerational traumas.Background: The rationale for developing a program logic model for arts-based psychosocial practice in South Africa was based on the lack of evidence for effective community arts-based psychosocial interventions for collective trauma, unknown consensus about best practices and the need for developing cogent collective psychosocial practices. Further to (...) this, the aims and benefits of the practice required clarity given the psychosocial complexity of the environment within which the practices for this population are being offered. The logic model offers a valuable resource for practitioners, participants and funders to understand the problem being addressed, how practice is defined, as well as the impact of practice and on intermediate and longer term goals.Methods: The authors used a systematic iterative approach to describe the operationalization of arts-based psychosocial practice. This resulted in the design of the logic model being informed by data from focus groups, an overview of the literature regarding transgerenational trauma in this population, operational policies and organizational documents. The development of the logic model involved actively investigating with practitioners their work with remote farming communities. We thematised practitioners practice constructs to identify salient practice elements and their relationship to perceived benefits and lastly feedback from practitioners and participants following implementation to make adjustments to the logic model.Results: The results were clearly identified in the form of visual mapping using the design of a program logic model. The logic model was divided into 5 parts and was verified by practitioners following implementation. The parts of the program logic model are main presenting problem, operational processes, practice elements, benefits, and impact and review. (shrink)

Displaying her intellectual and literary abilities from a young age, 'Mrs Taylor of Ongar' enjoyed writing all her life. She had eleven children, of whom six survived to adulthood. Her published works began with advice books for her own daughters, produced when increasing deafness made ordinary conversation difficult for her. Given the difficulty of providing advice equally appropriate to girls at all levels of society, this 1815 work is addressed to 'females in the middle ranks'. It is assumed that a (...) girl's aspiration, as well as her destiny, is to be a wife and mother: conduct towards the husband, and the rearing of children, are of prime importance. But there is also a chapter for the husband, pointing out his reciprocal duties to his wife as an equal partner in their relationship. The book offers fascinating insights into the middle-class ideal of domestic happiness. (shrink)

In 1989 Smart problematised law as a masculinist knowledge which disqualified other forms of knowledge, particularly feminism. Twenty-one years later Smart characterises the relationship between law and feminism quite differently. In this account law responds to feminism and outcomes are progressive. Smart suggests that rather than continuing to focus on law’s disciplinary and normalising role, it is more productive to conceptualise contemporary family law as a creative kinning practice. We argue, however, that we must also bring into this (...) account the changes to the state brought about by neo-liberalism. The paper tests these observations about the trajectories of feminism, law and neo-liberalism by reflecting upon our study of the Albert Kennedy Trust (AKT). AKT was established in 1989, in the wake of gay and lesbian resistance to Clause 28, to provide homes with gay and lesbian adults for homeless gay and lesbian teenagers. We are interested in AKT’s shift in its description of the adults’ relationship with the teenagers in their care from ‘brothers and sisters’ to ‘carers’ as it moved from a marginal force to mainstream partner/provider. In this context we explore the complexity of law’s responsiveness to feminism’s dynamism, its contingent recognition of kinning practices and, in the light of neo-liberalism, its continuing disciplinary role. (shrink)

A significant international development agenda in the practice of nurses supporting families with young children focuses on establishing partnerships between professionals and service users. Qualitative data were generated through interviews and focus groups with 22 nurses from three child and family health service organisations, two in Australia and one in New Zealand. The aim was to explore what is needed in order to sustain partnership in practice, and to investigate how the concept of practice architectures can (...) help understand attempts to enhance partnerships between nurses and families. Implementation of the Family Partnership Model (FPM) is taken as a specific point of reference. Analysis highlights a number of tensions between the goals of FPM and practice architectures relating to opportunities for ongoing learning; the role of individual nurses in shaping the practice; relationships with peers and managers; organisational features; and extra‐organisational factors. The concept of practice architectures shows how changing practice requires more than developing individual knowledge and skills, and avoids treating individuals and context separately. The value of this framework for understanding change with reference to context rather than just individual’s knowledge and skills is demonstrated, particularly with respect to approaches to practice development focused on providing additional training to nurses. (shrink)

Migration is one of the social processes that have influenced and are still deeply influencing current Romanian society, given that millions of Romanian citizens have relatives who had longer or shorter migration projects. Migration leads to socio-economic and cultural changes, which cause temporary or permanent changes in the human reality, the way of life and the personality of those who leave, but also of those who remain at home. Certainly, migration affects, first of all, the family, changing both its (...) structure and functionality. The temporarily disintegrated family has become one of the forms towards which the evolution of the family is moving, raising a multitude of problems aimed at a new lifestyle and interaction, new demands in the line of adjustment and accommodation both within and outside the family. The phenomenon of emigration in order to find a workplace affects both the family, as a social nucleus, and the individual as part of the family structure. Migration has a major impact on the relationship between spouses, on the parent-child relationship, on parental behavior, on destiny, in general. Although the family remains central to the existence of individuals in a transnational situation, its cohesion is not self-evident; it becomes a problem of community integration. Following the way in which the perspective on the family has changed in the context of migration, the study aims to identify and analyze the most important transnational practices through which family cohesion was maintained in the case of Romanian migration. To better understand this process of maintaining transnational family cohesion, we use an analytical model in four dimensions (social, positional, cultural and identity). (shrink)

Many authors have described the ethical issues associated with international adoption for all members of the adoption triad, including adoptive parents, birth parents and the adopted child, and for both sending and receiving countries. This paper explores how political variants of care ethics, combined with a narrative approach to practice, can be used as a conceptual framework for ethically informed practice with families formed via international adoption. Political variants of care ethics foreground the particularized needs of the individual, (...) but also take into account the broader social, political, economic and cultural dynamics in which the experience of individuals occurs. This framework is particularly applicable to collaborative work with individuals or groups, such as families formed via international adoption, whose experience is both highly individualized and shaped by broader contexts and issues of social justice. This paper describes how changes in the social construction of international adoption have meaning for applied ethics and practice. Political variants of care ethics are then explored as a framework for ethical decision making. Finally, the relevance of a narrative, approach to practice is considered. This approach focuses on understanding the needs and experiences of families from their own points of view and within the social, economic, cultural and political contexts in which they have lived; linking a relationship-based, narrative approach to practice to important assumptions in many models of care ethics. (shrink)

Fiester and Yuan discuss important ethical concerns regarding the use of behavior contracts in addressing conflict with patients and families labeled as “difficult” (Fiester and Yuan 2023). We agre...

The aim of this book is to provide an accessible account of ethics in general practice, addressing concerns identified by practitioners. It contains many examples and allows the reader to gain practical insights into how to identify and analyze the ethical issues they encounter in everyday general practice.

Background Obtaining informed consent in the clinical setting is an important yet challenging aspect of providing safe and collaborative care to patients. While the medical profession has defined best practices for obtaining informed consent, it is unclear whether these standards meet the expressed needs of patients, their families as well as healthcare providers. The authors sought to address this gap by comparing the responses of these three groups with a standardised informed consent paradigm. Methods Piloting a web-based ‘reverse’ simulation paradigm, (...) participants viewed a video showing a standardised doctor engaging in an informed consent discussion. The scenario depicted a simulated patient with psychotic symptoms who is prescribed an atypical antipsychotic medication. 107 participants accessed the simulation online and completed a web-based debriefing survey. Results Survey responses from patients, family members and healthcare providers indicated disparities in information retention, perception of the doctor's performance and priorities for required elements of the consent process. Conclusions To enhance existing informed consent best practices, steps should be taken to improve patient retention of critical information. Adverse events should be described in the short-term and long-term along with preventative measures, and alternative psychosocial and pharmacological treatment options should be reviewed. Information about treatment should include when the medication takes therapeutic effect and how to safely maintain the treatment. The reverse simulation design is a model that can discern gaps in clinical practice, which can be used to improve patient care. (shrink)

Drawing on data from a comparative ethnographic study on media usage in transnational families, this paper contributes to a reappraisal of polymedia theory. Two main theoretical assumptions are reconsidered. First, it is demonstrated why the equal availability assumption has to be revised in light of the complex interactions between the corporeal, communicative and social mobilities which together constitute transnational migration. Second, it is argued that the techno-socially accomplished co-presence in transnational families depends more on the creative appropriation and combination of (...) different media channels and communication forms than on the choice between them. In order to empirically investigate the specific needs for, and forms of co-presence in families, the concept of ‘registers of presence’ is proposed. It allows us to understand in detail in what ways and in which constellations transnational families create togetherness with the help of communication technologies. (shrink)

Social anxiety disorders are among the most prevalent mental disorders, with high impact on the life of an affected social system and its individual social system members. We developed a manualized disorder-specific integrative systemic and family therapy for SAD, and evaluated its feasibility in a pilot randomized controlled trial. The ISFT is inspired by Helm Stierlin’s concept of related individuation developed during the early 1980s, which has since continued to be refined. It integrates solution-focused language, social network diagnostics, and (...) genogram work, as well as resource- and problem orientation for both case conceptualization and therapy planning. Post-Milan symptom prescription to fluidize the presented symptoms is one of the core interventions in the ISFT. Theoretically, the IFST is grounded in radical constructivism and “Cybern-Ethics,” multi-directional partiality, and a both/and attitude toward a disorder-specific vs. non-disorder-specific therapy approach. SAD is understood from the viewpoint of social systems theory, especially in adaptation to a socio-psycho-biological explanatory model of social anxiety. In a prospective multicenter, assessor-blind pilot RCT, we included 38 clients with SAD : 18 patients participated in the ISFT, and 20 patients in Cognitive Behavioral Therapy. Within-group, simple-effect intention-to-treat analyses showed significant reduction in social anxiety, while intention-to-treat mixed-design ANOVA demonstrated the advantage of ISFT. Per-protocol analyses supported these results. The remission rate based on blind diagnosticians’ ratings was good to satisfactory ; this has yet to be verified in a subsequent confirmatory RCT. The article will present the ISFT rationale and manual, including a special focus on multi-person settings, and the central findings from our pilot RCT. (shrink)