Interpersonal skills. What they are, how to improve them, and how to apply them

Interpersonal skills are those essential skills involved in dealing with and relating to other people largely on a one-on-one basis. The interpersonal communication behavior of many people suggests they assume to have the ability to communicate effectively, which they do not possess and which they take for granted. One must work conscientiously to develop interpersonal competence by doing the right things at all times and doing them repeatedly until they become ingrained. As with any human skills, interpersonal skills can be improved through conscious effort. Successful interpersonal communication involves shaping the behavior of others, often while countering their shaping behavior. To have a chance of being successful, every interpersonal contact must have an objective and every effort must be made to avoid creating win-lose transactions whenever possible.     

Linguistic factors in critical thinking

Critical thinking is often taken as the demonstration of the learner to think critically and originally. Often, it is overlooked that the object of examination is the 'surface structure' of the spoken or printed sentences, but the 'deep structure' is not consideration. The probability of misjudgement is rather high because of varying degrees of access to different 'registers' of the language and expressive power into the prescribed language form of people from different classes of the society. This probability is higher when the language in question is a foreign language which is not available to all in the same proportion. This paper examines the process of 'sign' creation and the hurdles in the reading and responding to the non-native 'signs'. The paper later highlights the role a language can play in being judged as a critical thinker.     

Risky business: setting public health policy for HIV-infected health care professionals.

An analysis of the restrictive proposals provoked by the case of Kimberly Bergalis and four other patients apparently infected with HIV during the course of dental treatment reveals that they resulted from an inability to evaluate appropriately the infinitesimal risk of HIV transmission from practitioner to patient. The proposals also resulted from an effort to create risk prevention policy without appreciating the distinction between regulating things or procedures, which have no human rights, and regulating people, who have rights that should not be infringed without serious justification. This analysis demonstrates that the proposed restrictive policies are not justified because they do nothing to prevent the spread of HIV, and they cause unnecessary and substantial harm to health care practitioners.     

The intention to switch health insurer and actual switching behaviour: are there differences between groups of people?

Background Several western countries have introduced managed competition in their health care system. In the Netherlands, a new health insurance law was introduced in January 2006 making it easier to switch health insurer each year. Objective The objective was to measure people’s intention to switch health insurer and actual switching behaviour. We also examined whether some groups were less inclined to switch health insurer and/or had more difficulty to exert their intention to switch. Design In October 2006, members of three Dutch panels indicated whether they intended to switch health insurer during that year’s open enrolment period. In the beginning of 2007, the same people were asked whether they indeed switched health insurer. Results Only 1% intended to switch health insurer. Women, older people, lower educated people, people who were insured for a longer period and people who reported a bad or moderate health were less inclined to switch health insurer. The amount of switching was higher among individuals who intended to switch (31%) than among individuals who did not know whether they would switch (7%) and individuals with no intention to switch (2%). Among those who intended to switch health insurer, women and people who reported a good health switched health insurer more often. The years of enrolment were also associated with actual switching behaviour. Discussion and Conclusions We might have to temper the optimistic expectations on enhanced choice. Future research should determine why people do not switch health insurer when they intend to and which barriers they experience.     

Peer Reviewed: Eating as an Automatic Behavior

The continued growth of the obesity epidemic at a time when obesity is highly stigmatizing should make us question the assumption that, given the right information and motivation, people can successfully reduce their food intake over the long term. An alternative view is that eating is an automatic behavior over which the environment has more control than do individuals. Automatic behaviors are those that occur without awareness, are initiated without intention, tend to continue without control, and operate efficiently or with little effort. 

The concept that eating is an automatic behavior is supported by studies that demonstrate the impact of the environmental context and food presentation on eating. The amount of food eaten is strongly influenced by factors such as portion size, food visibility and salience, and the ease of obtaining food. Moreover, people are often unaware of the amount of food they have eaten or of the environmental influences on their eating. A revised view of eating as an automatic behavior, as opposed to one that humans can self-regulate, has profound implications for our response to the obesity epidemic, suggesting that the focus should be less on nutrition education and more on shaping the food environment.

     

Eating as an automatic behavior

The continued growth of the obesity epidemic at a time when obesity is highly stigmatizing should make us question the assumption that, given the right information and motivation, people can successfully reduce their food intake over the long term. An alternative view is that eating is an automatic behavior over which the environment has more control than do individuals. Automatic behaviors are those that occur without awareness, are initiated without intention, tend to continue without control, and operate efficiently or with little effort. The concept that eating is an automatic behavior is supported by studies that demonstrate the impact of the environmental context and food presentation on eating. The amount of food eaten is strongly influenced by factors such as portion size, food visibility and salience, and the ease of obtaining food. Moreover, people are often unaware of the amount of food they have eaten or of the environmental influences on their eating. A revised view of eating as an automatic behavior, as opposed to one that humans can self-regulate, has profound implications for our response to the obesity epidemic, suggesting that the focus should be less on nutrition education and more on shaping the food environment.     

Improving the bottom line through a better understanding of rules and statutes

In an effort to improve their incomes, providers are often deterred from undertaking certain initiatives that they have heard to be illegal under various statutes or contracts. Though the statutes do limit joint ventures, certain referrals, and other practices, some of these beliefs are based on misinterpretations or "myths. " In reality, practitioners may have more flexibility than they assume. This article discusses some of the matters that confront practitioners in regard to Stark laws, anti-kickback regulations, and other statutes when they consider contractual arrangements with various sources of services for their patients. The authors explain why clinicians may have more recourse than they estimate in appealing Medicare reimbursement rulings.     

How can Rorty help nursing science in the development of a philosophical ‘foundation’?

What can nurse scientists learn from Rorty in the development of a philosophical foundation? Indeed, Rorty in his 1989 text entitled Contingency, Irony, and Solidarity tantalizes the reader with debates of reason ‘against’ philosophizing. Forget truth seeking; move on to what matters. Rorty would rather the ‘high brow’ thinking go to those that do the work in order to make the effort useful. Nursing as an applied science, has something real that is worth looking at, and that nurse researchers need to think about. And as a profession built upon relationships, we should be thinking of the exchanges we have with those around us, of the contrasts in vocabularies used and of the contingencies involved, letting this launch us into our imaginings and areas of enquiry. The business of nurse researchers is to study what nurses do – how we care; Rorty would have us care. But, not to dismiss the reflective thinker as Rorty advocates for the self‐doubting ironist to continue to seek the final vocabulary, the ideal of what ‘this’ means, accepting this as the best to be offered at the time. As a science struggling to find foundation, we need only to look at what we do and value – as antifoundational as Rorty portrays himself, Rorty ‘ironically’ may have revealed a foundation for nursing science that is consistent with its path.     

Plaintiff's attorneys share perspectives on patient communication

This article reports that malpractice attorneys representing plaintiffs accept a small percentage of the clients who request legal representation for medical liability claims. Of those cases they do not accept, these attorneys report that a significant motivator for patients seeking legal counsel is poor clinician‐patient communication. They cite poor listening skills; delegation of critical consent communication; failure to share timely information with colleagues and nursing personnel; failure to have meaningful, empathetic conversations when adverse outcomes occur; and defensive behavior when patients seek to learn more by questioning diagnoses and treatment options.     

Critical thinking experiences for students of child development: outcomes in values and attitudes

Early childhood professionals are likely to benefit from critical thinking skills as they explore problems facing children and evaluate policy issues related to those problems. To facilitate their critical thinking, students in child development classes were assigned two types of learning activities: general exploration of problems that involved critical thinking only implicitly and specific activities that guided students explicitly through steps of critical thinking in the context of exploring problems facing children. Regardless of the type of assignment, students increased their self-ratings of personal attributes related to public policy and helping others, understanding other cultures, and developing methods for human services. Also, students increased their value of both breadth and depth of postsecondary education. Nevertheless, the type of assignment appeared to have differential effects, with general experiences providing more changes in educational values and self-confidence and specific experiences providing more change in knowledge and self-awareness.     

Mitigating the Health Risks of Dining Out: The Need for Standardized Portion Sizes in Restaurants

Because restaurants routinely serve food with more calories than people need, dining out represents a risk factor for overweight, obesity, and other diet-related chronic diseases.Most people lack the capacity to judge the caloric content of food and there is limited evidence that people make use of calorie-labeling information when it is available. Standardized portion sizes would not preclude people from eating as much as they want, but would make the amount they are getting fully transparent.We describe the potential benefits and means of implementing a system of standardized portion sizes that might facilitate a healthier diet among the US population.A robust finding in multiple experiments, in both natural and laboratory settings, is that when people are served more food than they need, they eat more than they should.1 Furthermore, there is considerable evidence that many people cannot recognize when portions are increased and cannot rely on internal satiety signals to indicate when they have eaten enough.2Substantial increases in energy consumption over the past four decades have occurred in both children and adults without compensatory increases in the level of energy expenditures.3 Food away from home is a major contributor to excess calories consumed, contributing more than one third of all calories, while constituting fewer than one third of all eating occasions.4,5 Data from the 1999–2000 National Health and Nutrition Examination Survey indicate that the average person eats commercially prepared food 2.8 times per week, and since then the frequency of dining out has continued to grow.6 Because the calories in the portions of food prepared away from home are substantially higher than what is generally prepared at home, dining out has become a major risk factor for obesity.7One public health effort to reduce the risk of consuming too much food away from home has been to mandate menu calorie labeling. Although menu labeling was intended to help people assess their caloric intake, a review indicated that calorie labels do not consistently influence the choices of most people, in part because people do not notice them, but also because many do not understand their significance.8To mitigate the risk that dining out contributes to chronic diseases, a more effective approach should make serving size a matter that cannot be ignored. One solution is to create and implement a system of standardized portions for people who are eating out, so that all foods are served in quantities that are appropriate for consumption by one person at a single sitting. In this article, we describe the potential benefits and means of implementing a system of standardized portion sizes that might assist the US population in obtaining a healthier diet.     

Tutorial: planning for data collection. Part I: Asking the right question

While data collection is fundamental to any scientifically based effort, health care improvement teams often report that it is one of the most frustrating aspects of their work. Groups that do succeed in gathering some data can also sometimes find that the data they have worked so hard to obtain does not really help them or deepen their understanding of the process. The root of many of these problems can be traced to insufficient planning for data collection and to fundamental misunderstandings about the eventual goals of such studies. In this tutorial, we will explore a systematic way of thinking through the planning for data collection that will result in a higher probability of generating useful information.     

待孕人群对优生知识的知晓、态度和需求情况调查

目的 了解中山市待孕人群对优生知识的知晓、态度和需求情况,为探索出生缺陷一级干预中宣传教育的服务方式和内容提供科学依据.方法 选择2011年至2013年中山市户籍人口符合政策生育的待孕人群作为调查对象,随机抽取了1 025个调查对象进行调查.结果 出生缺陷预防的基本知识知晓率较高,如“女性最佳生育年龄”、“第1胎孩子有出生缺陷,第2胎是否有必要做产前诊断”等.但是对一些较为专业的优生知识知晓率较低,如“正确补充叶酸”等.绝大多数待孕者希望得到优生知识,获取途径以通过医生获取比率最高,不同文化程度者所需求的优生知识内容随文化程度的上升而增加.结论 待孕人群对优生知识有一定的了解,但不全面,达不到中山市制定的干预目标（待孕夫妇优生知识知晓率要达到90％以上）,有少数人存在迷信思想.针对不同优生知识内容、不同对象,开展多元化的优生教育,使人们知道出生缺陷的危害,从而主动参与出生缺陷干预工程,对降低出生缺陷率,提高出生人口素质具有重要作用.     

Nutritional status of the elderly. IV. Nutritional knowledge, food preferences and life styles connected with the nutritional process

On 106 women and 101 men aged 65 and over, elderly pensioners of the city of Perugia (Italy), a survey was carried out to identify their nutritional knowledge, their food preferences and some life styles connected with the nutritional process. The group of elderly people demonstrates a low level of nutritional knowledge. Meat, pasta and soup are the most suitable foods, with no great difference between males and females. Vegetables, fruit, milk and cheese are indicated as important only by low percentages of both sexes, fish, eggs, offal and rice are practically ignored. From the analysis of the sequency with which the various foods are indicated, it appears that a greater importance is attributed to pasta and soup. A higher percentage of women think that meat is a more suitable food for elderly people, and in respect to the men, they have a greater preference for this food. The harmfulness of foods is concentrated in the fatty foods by both sexes, but in particular by the women. Foods which are given up with the greatest sacrifice are mainly cakes, meat and pasta. Women and men show similar percentages of energy expenditure both in time and in frequency in relation to sleep and sedentary activities. For the activities that require a greater energy expenditure, the values are relatively low. This group of elderly people is well integrated into family life. They usually eat their meals with their families. There are frequent occasions when they are at home alone for periods of time that vary from two to four hours of more a day. The percentage of people living alone is small.     

Theorising Inequalities in Health: The Place of Lay Knowledge

This paper contributes to the development of theory and research on inequalities in health. Our central premise is that these are currently limited because they fail adequately to address the relationship between agency and structure, and that lay knowledge in the form of narrative has a significant contribution to make to this endeavour. The paper is divided into three sections. In the first section we briefly review the existing, largely quantitative research on inequalities in health. We then move on to consider some of the most significant critiques of this body of work highlighting three issues: the pursuit of overly simple unidimensional explanations within ‘risk factor’ epidemiology and the (probably inevitable) inability of this research tradition to encompass the full complexity of social processes; the failure to consider the social context of individual behaviour and, in particular, the possibility for, and determinants of, creative human agency; and, thirdly, the need for ‘place’ and ‘time’ (both historical and biographical) to be given greater theoretical prominence. In the final section of the paper the potential theoretical significance of ‘place’ and ‘lay knowledge’, and the relationship between these concepts, in inequalities research is explored. Here we suggest three developments as a necessary condition for a more adequate theoretical framework in this field. We consider first the need for the conceptualisation and measurement of ‘place’ within a historical context, as the location in which macro social structures impact on people’s lives. Second, we argue for a re-conceptualisation of lay knowledge about everyday life in general and the nature and causes of health and illness in particular, as narratives which have embedded within them explanations for what people do and why – and which, in turn, shape social action. Finally, we suggest that this narrative knowledge is also the medium through which people locate themselves within the places they inhabit and determine how to act within and upon them. Lay knowledge therefore offers a vitally important but neglected perspective on the relationship between social context and the experience of health and illness at the individual and population level.     

How to break down tasks so they don't break you: coping with overwhelming demands on your time

Everyone, in every profession, seems to have too much to do and too little time to do it all. This seems to be even more true in the health care setting, where change is constant. Health care supervisors can become so overwhelmed with tasks that are expected of them that they have no idea of where to even begin. Rather than thinking about everything that must be done, the one single task strategy describes how you can break down your overwhelming tasks into manageable steps.     

医护人员突发公共卫生事件知识调查分析

目的：考察突发公共卫生事件下,医护人员对事件相关知识和信息的了解状况,及其对情绪的影响。方法：采用自编调查问卷,调查一所综合性医院中各类医护人员。结果：突发公共卫生事件下,各类医护人员对与突发事件相关的知识和信息的了解以及信息来源,均无显著差异。较之本院工作人员,外院进修人员对信息透明和知情的要求最低。在知情的情况下治疗和护理SARS病人,医护人员更多体验正性情绪;而不知情的情况下的情绪反应更多是负性的。结论：在突发公共卫生事件下,应让医护人员及时充分地享有和运用各类信启、资源,增强心理储备和情绪调节,避免因信息缺失带来过多负性情绪反应。     

Antiretroviral interventions to reduce mother-to-child transmission of human immunodeficiency virus: challenges for health systems, communities and society

This paper examines the ethical, economic and social issues that should be considered when antiretroviral interventions are being planned to reduce mother-to-child transmission of the human immunodeficiency virus. Interventions aiming to reduce mother-to-child transmission should be concerned with the rights of both the child and the mother. Women should not be seen as vectors of transmission but as people entitled to adequate health care and social services in their own right. For women accepting mother-to-child transmission interventions it is important to consider their medical and emotional needs and to ensure that they are not stigmatized or subjected to abuse or abandonment following voluntary counselling and testing. Seropositive women who do not wish to continue with pregnancy should have access to facilities for safe termination if this is legal in the country concerned. Problems arise in relation to the basic requirements for introducing such interventions via the health services in developing countries. A framework is given for making decisions about implementation of interventions in health care systems with limited resources where there is a relatively high prevalence of human immunodeficiency virus infection among pregnant women.     

Why does the burden of disease persist? Relating the burden of anxiety and depression to effectiveness of treatment.

Why does the burden of mental disorders persist in established market economies? There are four possibilities: the burden estimates are wrong; there are no effective treatments; people do not receive treatment; or people do not receive effective treatments. Data from the Australian National Survey of Mental Health and Wellbeing about the two commonest mental disorders, generalized anxiety disorder and depression, have been used in examining these issues. The burden of mental disorders in Australia is third in importance after heart disease and cancer, and anxiety and depressive disorders account for more than half of that burden. The efficacy of treatments for both disorders has been established. However, of those surveyed, 40% with current disorders did not seek treatment in the previous year and only 45% were offered a treatment that could have been beneficial. Treatment was not predictive of disorders that remitted during the year. The burden therefore persists for two reasons: too many people do not seek treatment and, when they do, efficacious treatments are not always used effectively.     

What lies behind the subjective evaluation of health status?

The evaluation of health or subjective health (SH) is considered a legitimate indicator of overall health status, providing a valid, reliable and cost-effective means of health assessment. This study looks at factors reported by respondents as influencing their SH, it analyzes to which extent people compare themselves with others when evaluating their health, and examines the difference between people with optimal or sub-optimal SH. Face-to-face interviews were conducted with 383 Israeli residents. Three models for judging health status were identified: the biomedical or disease oriented, the emotional or "general feeling", and the functional-related model. The reported influence of some factors for the evaluation of health changed by age and by level of subjective health. Respondents with sub-optimal health reported tiredness and pain as more influential. Most interviewees spontaneously reported comparing their health to reference groups. Age and level of subjective health were associated with the way people compare their health to others. The young reporting sub-optimal health did not compare themselves to people their age, but a high percentage of the old did so. Among those with excellent health, the young rather than the old were more likely to compare themselves to people their age. These findings imply that each individual tries to find ways to evaluate his/her health in a more positive light. When old and not healthy they tend to compare themselves to friends or people their age, but if young and not healthy they do not perform the comparison so as not to feel worse. Understanding how people evaluate their health can contribute to the conceptual development of subjective health.