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Aim: The aim of the present study was to explore the significance of the mealtime experience among residents of nursing homes in Spain. Methods: A qualitative phenomenological approach was followed. An initial purposeful sampling of Spanish residents in for‐profit nursing homes in the southern area of Madrid was carried out. A theoretical sampling was also implemented in order to gain a more in‐depth understanding of dependence. Inclusion criteria for nursing home residents were: age (60 years or older) and lack of any cognitive impairment. Data were collected using unstructured and semistructured interviews. Data collection was concluded once theoretical saturation was reached, and the data were analysed using the Giorgi proposal. Results: A total of 26 residents with a mean age of 83 years were included. Three main themes that describe the significance of meals in nursing homes emerged from the data: (i) timing of the meals – mealtimes serve as a point of reference for organizing activities in the nursing home and orient the residents during the day; (ii) table allocation – table allocation depends on the judgment of the personnel, the behavior of each resident and on the input from the residents that use a table; and (iii) the meals themselves – food is experienced as a privilege, as a sign of autonomy and normality, and as an indicator of personal identity. Conclusion: Understanding the social significance of meals for residents in nursing homes would provide deeper insight into resident expectations. This will in turn help to improve service and quality of life for residents. Geriatr Gerontol Int 2013; 13: 482–489 .  相似文献   
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Background Beliefs about the controllability of behaviour have been consistently shown to be important in understanding the responses of carers to the challenging behaviour of people with intellectual disabilities (IDs). This paper reports the reliability and validity of the Controllability Beliefs Scale (CBS), a 15‐item measure of beliefs regarding the controllability of challenging behaviour when used with carers of people with IDs. Methods Two hundred and sixty‐four carers of people with IDs completed the CBS, 74 people also completed the Modified Attributional Style Questionnaire and the Self‐Injury Behavioural Understanding Questionnaire scale to determine concurrent and convergent validity and 34 people completed the scale twice within a 2‐ to 4‐week period to determine test–retest reliability. Results The scale has a two‐factor structure and has adequate internal reliable. The scale is significantly correlated with the controllability, internality and stability items from the Modified Attributional Style Questionnaire, showed expected associations with behavioural and internal emotional understanding items from the Self‐Injury Behavioural Understanding Questionnaire. The scale has good test–retest reliability. Conclusions The data support use of the CBS in clinical practice and research to assess carers' beliefs regarding challenging behaviour of people with IDs.  相似文献   
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Background Patients with intellectual disabilities (ID) receive health care by proxy. It is family members and/or paid support staff who must recognise health problems, communicate with clinicians, and report the benefits, if any, of a particular treatment. At the same time international and national statutes protect and promote the right of people with disabilities to access the highest attainable standards of health on the basis of free and informed consent. Methods To consider the role of parent‐proxies in the management of epilepsy in adult children with ID who are at risk of lacking capacity to make decisions about their health care we interviewed 21 mothers. Findings These mothers are not pursuing changes in treatment that might improve their son or daughter's epilepsy, nor are they willing to countenance changes in treatment. Clinicians concerned to build and sustain therapeutic alliances with these mothers, our evidence suggests, may well avoid going against their wishes. Discussion Our research highlights the interactional contingencies of a hitherto neglected three‐way clinical relationship comprising parent‐proxy, an adult at risk of lacking decision‐making capacity, and a treating clinician. This is a relationship, our findings suggest, where little importance is attached to either patient consent, or involvement in treatment decisions.  相似文献   
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The emergency department (ED) is a key site in preventing suicide. Yet there has been very little research on ED screening and interventions targeting the suicidal patient. Conducting research on interventions for preventing suicidal behavior in the ED population may evoke the dilemma of how to fulfill ethical obligations to protect research subjects when doing so can impair the validity of the study. In this paper we present a case study of a research protocol on the utility of routine screening with a brief intervention for suicidal ideation that raised issues regarding researchers' obligation to disclose information about subjects' suicidality to ED staff. After exploring the imperfect relationship between suicidal ideation and completed suicide (i.e., many people with ideation never attempt or commit suicide), we present an analysis of the causal relationship between these phenomena. This leads us to suggest that it should not be mandatory for researchers to disclose to ED staff when a subject reveals suicide ideation in a screening questionnaire—although other preventive measures may be called for. In general, the extent of the duty placed on researchers to intervene on behalf of their subjects should be proportional to the likelihood and magnitude of risk presented to subjects by the underlying condition, and should be balanced against the importance of the research question.  相似文献   
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