Social science & medicine. Part A, Medical sociology最新文献

A formal operational definition of readjustment of disabled persons to the normal social environment after being discharged from a rehabilitation institution has been formulated. A theoretical framework predicting the factors enhancing and impeding a disabled person's readjustment has been suggested and empirically supported. Empirical investigation and application of a multivariate technique of analysis revealed a pattern of the factors predicting readjustment which applies equally to any degree of disability. Data revealed the significance of primary groups and emotional support in predicting success and the limited abilities in achieving such success by formal rehabilitation agencies. It clearly revealed the advantage of ‘resource enhancing support’ in contrast to the impeding effect of direct economic support.

This study investigated the causes and effects of nursing stress in the hospital environment. It was hypothesized that the sources and frequency of stress experienced by nursing staff were functions of the type of unit on which they worked, levels of training, trait anxiety, and sociodemographic characteristics. It was also hypothesized that high levels of stress would result in decreased job satisfaction and increased turnover among the nursing staff. Data were collected from 122 nurses on 5 patient care units of a private, general hospital using a Nursing Stress Scale developed for this study, the IPAT Anxiety Scale, the Job Description Index, and personnel records. Analysis of variance, profile analysis, and path analysis were used to analyze these data. Three major sources of stress were identified : work load, feeling inadequately prepared to meet the emotional demands of patients and their families, and death and dying. The nature of these sources as well as their pervasiveness suggest that factors inherent in the nursing role, particularly that of the registered nurse, are important determinants of stress. Differences in the frequency of stress among the units investigated suggest 2 additional factors that need to be examined in future studies: structural characteristics of units that affect the amount of role conflict and ambiguity staff experience, and personality characteristics that may attract nurses to specific units. As hypothesized, stress was found to have significant effects on job satisfaction and turnover.

Physicians have a variety of opinions about the failures of American health care and who is responsible for those failures. (Failure is defined here as the unexpected illness or death of a patient.) Attribution theory specifies the processes involved social construction of beliefs that attribute responsibility for unexpected events to self and others, and the specification of social situations that are likely to result in different types of attributions. This paper suggests that attribution theory is a useful perspective for understanding the diversity and character of public policy statements made by medical specialists in the years since Medicare.

Using existing literature on the nature of medical practice we infer what types of medical practices are likely to increase a physician's interest in unexpected illness and death and to produce explanations of these events that attribute responsibility for them to self (the physician), to the limits of medical knowledge, to the patient's environment, to misfortune and to the patient. We show evidence that medical specialists make all these types of attributions and that the types they make are associated with the conditions of practice in their fields. We develop hypotheses relating to the nature of the decision-making process resulting in different types of attributions for future research on professional ideology, which we define here as the set of beliefs shared by members of a profession or groups thereof concerning the relative role responsibilities of the profession to its patients and to society.

Methods of investigation have been greatly extended with widespread use of computer and statistical techniques. Nevertheless, field work and environmental knowledge remain essential. Improvement of the availability and of reliability of data would facilitate further research in spatial epidemiology.

Contained in both Parsons' [1, 2] formulation of illness role theory and Scheffs [3, 4] labeling perspective is the assumption that cultural definitions of mental illness are uniform throughout the community. Furthermore, both theorists assert that individuals identified as mentally ill internalize community definitions of their impairment whether positive or negative. Analysis of data of a sample of mental patients and the public lends some support to illness role theory while refuting Scheffs labeling perspective.

There is community wide consensus in the moral (wrongness) evaluation of behaviors and feelings which are indicative of mental illness. Public and patient alike judge their own actions as less wrong than the actions of others. Contrary to Scheff [3, 4] the general public judges the actions, feelings and behaviors of the mentally ill as neither wrong nor right.

With several exceptions, subgroups of the general public held similar definitions of the implications of traits of mental illness for the impairment of role performance. The highly educated, and patients with high symptom levels indicated their role performance was significantly impaired by mental illness. The results of this research call for labeling theorists to distinguish status as a cause from status as a cue for labeling certain types of actions and feelings as indications of mental illness.

The present study explores the relationship between career orientations and assessments of the personal and work environments of a sample of medical interns and residents. Physicians whose career expectations were more “patient-oriented” were found to evaluate their work and social environments differently than physicians who were less patient-oriented. Similar but opposite patterns of associations were found among physicians whose career expectations were more “disease-oriented”. The findings demonstrate the need to take into account how physicians assess their personal and work environments during post-graduate training in order to understand more adequately the process and outcomes of career choice.

The focus of this paper is on physicians as gatekeepers to public access to prescribed drugs. Variations in drug prescription and consumption are examined and the factors associated with varying factors of prescribing are discussed. We look at models of the prescribing process and assess their comparative merits. The paper concludes with a consideration of the priorities that need to be taken into account when planning future research of which nine possible key questions are proposed.