Making bureaucracy work

What gives bureaucracy such a bad name? Is it bureaucracy in itself, or the ghosts in the system who, in a million minor drifts, contribute to turning efficiency into red-tape? Undesirable side-effects need not be confused with necessary first-level effects. There is nothing wrong with the bureaucratic system as such. Ultimately we could not work without it as it is the only known way of co-ordinating vast numbers of people to treat mass problems. However, like any tool, it is only as good as the people who use it, and its results are largely linked to the very agendas of the users. Understanding what makes bureaucracy work requires a good look at the implicit biases in the bureaucratic model, mostly seeded by its various founders and theoreticians, as well as tackling pragmatic issues of creating and applying rules--and where and when to change them.     

The new medical oath in The Netherlands

The Hippocratic oath derives its name from the ancient Greek physician Hippocrates. It has been embraced as a code of conduct by the medical profession throughout the ages, and is used by medical faculties as an explicit moment of reflection during graduation ceremonies. Although this oath is primarily of ceremonial value, it was felt that the text needed revision as it no longer reflected the current ethical norms in the Netherlands. The new Dutch oath drawn up in 2003 has a dual function: it is symbolic in that it represents the end of a doctor's training, but it is also intended to trigger the discussion of moral issues during the medical studies.     

Reflections about death: a challenge for nursing

This reflection proposes a reinsertion on the death theme, in a more present form, in the daily routine of the nurse and its similar, starting with a historic on death, focusing on the transfer of it, that occurred in the bedroom of the moribund, to the hospital bedroom. Soon after, some considerations about the reason to fear death and the need of discussing it, as well as a reflexion on the planning of actions looking as much as to care as to confort the dying patient. With that, it is easy to realize the relevance of the come back of the approach of the subject in the professional daily basis, considering the need to demystify it, to allow that nurses and its similars plan actions of confort to the dying patient.     

The Pan-American Federation of Nursing Professionals: a vision and perspective for the 21st century

This essay concerns the prospective vision of The Pan-American Federation of Nursing Professionals in the scenario of health and education in the new century. It discusses the concepts of association, leadership, and paths the profession has taken as a professional organization. It makes a brief historical study of the construction of nursing as profession and its organization as a corporation. In the second part it places FEPPEN in this context of nursing as corporation, revealing its aims and the specific struggles in which it has played an important role. Finally it discusses the role of associations in building a healthier and fairer society.     

Exercise is medicine: some cautionary remarks in principle as well as in practice

On the basis of extensive research on the relationship between physical activity, exercise and health, as well as strong support from policymakers and practitioners, the “Exercise is Medicine” initiative has become something of a linchpin in the agenda for modern healthcare reform and reflects a broader acceptance that the philosophy of health politics must shift from social engineering to performativity. However, in spite of the avowed commitment to encouraging individuals to take on a more reflexive relation to their health, it remains unclear as to whether an initiative such as this is, unambiguously, a good thing. In this paper, a number of cautionary remarks are made with respect to “Exercise is Medicine” in principle as well as in practice. Firstly, it is argued that equating exercise with medicine is to equate it with a definition of and relation to the body to which it is not entirely akin. And secondly, it is argued that any proposed alignment of the fitness and healthcare industries needs further critical examination, a realigning of interests, and a thorough reconsideration of their suitability of fit.     

Hospital budgeting in Holland: aspects, trends and effects.

Global hospital budgeting was introduced in 1983 in Holland; it was expected to be a much more effective instrument to cost containment than classic retrospective output reimbursement. Several underlying assumptions of hospital budgeting are discussed: it will encourage hospitals to improve efficiency; it will have no negative impact upon the quality of health care; it restores hospital autonomy to some extent; hospital managers are capable to implement more efficiency. Attention is also paid to the design of external budgeting and its implications for the link between planning and budgeting as well as the relationship between hospitals and insurers. The second part deals with several effects of hospital budgeting. There are indications that hospital budgeting is effective from a cost containment perspective; it goes along with a decrease in hospital production; it also affects the organization and policy-making of hospitals as well as the public-private mix in health care. A general conclusion is that the effects of hospital budgeting far exceed the effects for cost containment.     

Qualitative and quantitative gamma-hydroxybutyrate analysis

Gamma-hydroxybutyrate (GHB) is a naturally occurring compound present in the brain and peripheral tissues of mammals. It is a minor metabolite and precursor of gamma-aminobutyric acid (GABA). Just as GABA, GHB is believed to play a role in neurotransmission. GHB was first synthesized in vitro in 1960, when it revealed depressive and hypnotic effects on the central nervous system. In 1960s it was used as an anaesthetic and later as an alternative to anabolic steroids, in order to enhance muscle growth. However, after it was shown that it caused strong physical dependence and severe side effects, GHB was banned. For the last fifteen years, GHB has been abused for its intoxicating effects such as euphoria, reduced inhibitions and sedation. Illicitly it is available as white powder or as clear liquid. Paradoxically GHB can easily be manufactured from its precursor gamma-butyrolactone (GBL), which has not yet been banned. Because of many car accidents and criminal acts in which it is involved, GHB has become an important object of forensic laboratory analysis. This paper describes gas and liquid chromatography, infrared spectroscopy, microscopy, colourimetry and nuclear magnetic resonance as methods for detection and quantification of GHB in urine and illicit products.     

Hypoxyphilia

This is the Advisor's report on Hypoxyphilia, as it is currently called in DSM-IV, submitted at the request of the DSM-5 Paraphilias Subworkgroup of the Sexual and Gender Identity Disorders Workgroup. The background literature is reviewed together with information from the author's recent and as yet unpublished research derived from an internet survey of more than 100 living practitioners of this paraphilic activity. It is recommended that the term “asphyiophilia,” already used in the literature, is preferable as there is little to indicate that the effects of oxygen deprivation per se are the primary motive for the behavior; rather, it is sexual arousal to restriction of breathing. It is properly regarded as a severe and potentially dangerous manifestation of Sexual Masochism which can result in physical harm or death and therefore should be identified as such, perhaps as a specifier. However, there is no good reason to identify it as a separate paraphilia though it should be named in the DSM-5 text as it is a well-recognized and unusual mode of death. Less severe forms of Sexual Masochism which do not threaten life or otherwise cause serious physical harm should not be regarded as mental disorders.     

Abortion in early America.

This piece describes abortion practices in use from the 1600s to the 19th century among the inhabitants of North America. The abortive techniques of women from different ethnic and racial groups as found in historical literature are revealed. Thus, the point is made that abortion is not simply a "now issue" that effects select women. Instead, it is demonstrated that it is a widespread practice as solidly rooted in our past as it is in the present.     

Participative research and health researcher's ethical formation

The present article discusses Ethics concept as dwell and way of dwelling, aiming to articulate it with some elements of participative research from an ethnographic matrix. Mainly, it focuses the idea of the ethical subject's autonomy, associating it with self-reflection and alterity in ethnography. Yet, it approaches the participative research in an ethnographic perspective as a praxis that induces to health researcher's ethical formation.     

On the nature of social stress: production of a modern mythology

In recent decades there has been increasing interest in the subject of stress and a proliferation of research into the contribution of stress as a cause of illness. This association has been widely popularized and now has an established position within the body of popular ideas about health and illness. Nevertheless, very little has been confidently established about the relationship between stress and illness. The precise nature of stress itself eludes definition and there is no consensus as to what it encompasses. There has been a confusion of the models of stress developed in the laboratory and those applied to society. Early laboratory research was modelled on 'mechanical' images of stress taken from contemporary physics and engineering. Since then the stress theory has been heavily psychologised, although it still relies for its validation on the physiological models with which it is fundamentally non-comparable. It is argued that stress is not something naturally occurring in the world, but a manufactured concept which has by now become a 'social fact'. As such it has direct implications for the ways in which people perceive their world and act within it. Stress has increasingly come to be regarded as an integral part of everyday experience. Although much of the attractiveness of the stress theory derives from its seeming to reduce the arbitrariness of suffering, it also carries with it a significant ideological component. This can serve as a means of organising and expressing a variety of ideas about the social order relating, for example, to issues of individual autonomy and responsibility, or to the ways in which society might be perceived as dangerous, repressive or pathogenic.     

DSM diagnosis and beyond: on the need for a hermeneutically-informed biopsychosocial framework

While often dubbed “the bible of contemporary psychiatry” and widely hailed as providing “a benchmark” for the profession, on closer inspection the DSM is seen to be shot through with philosophical assumptions that restrict its theoretical cogency and limit it clinical efficacy. Hence, in the interests of enhanced patient-care it is important to think critically about the DSM, with a view to maximising its diagnostic strengths while minimising its weaknesses. The critical analysis undertaken in the present paper underscores the importance of not construing the DSM as a self-contained diagnostic tool but of viewing it, rather, as an indispensable component in a more comprehensive, multidimensional diagnostic process. More specifically, the contention is that the DSM’s diagnostic limitations evoke a biopsychosocial framework of application as their necessary corrective, notwithstanding the entrenched tendency to construe these approaches as oppositional. Further, it is contended that a hermeneutically informed biopsychosocial template has particular advantages as an integrating framework.     

The Biobank as an Ethical Subject

This paper argues that a certain way of thinking about the function of the biobank—about what it does and is constructed for as a social institution aimed at ‘some good’—can and should play a substantial role in an effective biobanking ethic. It first exemplifies an ‘institution shaped gap’ in the current field of biobanking ethics. Next the biobank is conceptualized as a social institution that is apt for a certain kind of purposive functional definition such that we know it by what it does and what it is designed to do. This purpose is then characterized further as essentially incorporating the human goods the institution is designed to serve, such that it plays a useful and indispensible role in how it should operate, i.e. in the ethics and governance of biobanking. Finally the ethical scope and limitations of such a theory is clarified by a discussion of some theoretical objections and suggested practical examples of its application.     

Significance of teaching the Nursing Process for the faculty

This paper aimed to analyze the significance of teaching the Nursing Process (NP) for faculty, through the Representational Theory of Significance. Ten professors from Guanajuato University participated in the investigation. Data were collected through semi-structured interview and questionnaire. The analysis was done from the perspective of the mentioned theory. All faculty members know, teach and apply the NP. They also refer to the importance of its teaching and practice by professionals. In conclusion, regarding the significance of the nursing process, faculty members tend to recognize it as a scientific method and an important instrument in professional nursing activities; as for the meaning of teaching the nursing process, it is considered as a well-founded, indispensable and modern instruction for the discipline, as long as it covers the five stages it consists of.     

Estimating goodwill: an application of Pine's procedures for hospices

Hospice care is a philosophy as well as a business. As a business, especially in the current healthcare environment, it is subject to many of the same forces that affect other businesses, such as acquisitions, sales, and mergers. Yet, estimating the value of a hospice is problematic, since its most valued asset (the reputation and goodwill that it has generated within the communities it serves) is intangible. This article explores the problem of assessing the value of a hospice, applying Pine's model for estimating goodwill in funeral service as a useful approach for hospices. The article offers assumptions for assessment and examples of suggested approaches.     

The stairway to recovery. An emerging worldview uncovers God's wisdom in nature

What is lacking for the renewal of the earth is not so much ethical consensus as political will. The myth of "man" as the self-sufficient and autonomous master of "inanimate" nature has been ingrained for centuries, and it will take a powerful force to dislodge it. However, we are in a unique period of convergence--a time when we might be transformed by the truth if we only seek it. This new spiritual awakening represents a conscious commitment to a common cause that lies beyond individual self-interest. The commitment has been kindled by a perception that we are creatures intimately connected with the rest of creation and to the power that has called us into being. And it is a commitment carried out in action through a disciplined way of life. If we want to heal the earth, we have to get better ourselves, because it is the way we think and live and act that is harming the earth. We have much to learn from participants in Alcoholics Anonymous, who have learned the secret of proclaiming the good news by doing it, one step at a time, by living it, day by day. The first step is acknowledgment that, as a society--indeed, as the human race-we are at the bottom and cannot get back up. Once we admit we have hit the bottom, there is hope for the environment because we have taken the first step to recovery.     

Dawson Report: sixty years after the high hopes of 1920

Nearly everyone has heard of the Dawson Report although few have read it. Unobtainable for many years, its historical importance was recognised when the King's Fund reprinted it in 1950. It has been described as 'the parent of all regional schemes of health services,' with an influence extending far beyond Britain. Although it was shelved by the government of the day within a few weeks of publication, it can now be seen as a powerful influence on the thinking that went into the creation of the NHS.     

Redesigning health care: new wine from old bottles?

One of the latest remedies for poor quality services is seen as being redesign of the health care system. Redesign is charged with political meaning, representing a radical challenge to practitioners and managers. But is it really a new approach? Although it draws on theories of re-engineering and total quality management, it is a pragmatic blend of components of both. Early findings suggest that quality improvement has been achieved but this has not been as extensive as anticipated. Redesign is in danger of being seen as the new magic bullet and thus may be being set up to fail. It may prove to be one more in a succession of discarded change management fads.     

Documentation and log keeping: ensuring your work does what you intend it to do

Maintaining regular documentation, such as a log-book, can be an organization's most important asset when dealing with radiation protection issues, both normal and abnormal. When an organization is faced with litigation, proper documentation of events can ensure that a record is acceptable and, by extension, that the data itself is acceptable. A record of events will not preclude litigation, nor will it guarantee that an organization will prevail in a court of law, but it will provide evidence and credibility that could favorably affect the outcome of litigation. An organization can ensure that the documents it creates and maintains are as effective as possible by being aware of the legal consequences of documenting events and taking appropriate steps to conform to standards for admission of documentation. Misconceptions about log keeping such as recording only events that are likely to result in litigation, rather than recording all events, can prevent a record from being admissible as evidence. Because of the amount of effort and time put into documentation, and the reliance placed on its contents, it is important for an organization to ensure that a record will do what it is intended to do, namely to accurately record activities. Issues discussed in this article include the legal basis of documentary evidence, what and what not to record, when and how to record it, and how to strengthen the records kept.     

The unsolicited diary as a qualitative research tool for advanced research capacity in the field of health and illness

In this article, the place of diary method is examined in the context of qualitative tools. Although much neglected in qualitative methodology, there is considerable support for its use, and it is argued that unsolicited diary analysis as a qualitative tool has value as a social research method. Although it is commissioned or solicited diaries that are increasingly popular in health research, different kinds of diary usage are examined together with certain possible biases and weaknesses. Although framework analysis was originally developed for analyzing interview data, it is seen as an appropriate qualitative tool for the analysis of unsolicited diaries. The analysis of an unsolicited diary account of a patient suffering from cancer of the larynx is explored as a potential data source.