Advance Care Planning in Skilled Nursing Facilities: A Multisite Examination of Professional Judgments
Advance directives; African Americans; CONFIDENCE intervals; Gerontology And Geriatrics; Judgments; Nurses; Nursing; Quality of care; Quality of life; Race; Racism; Research design; Residential segregation; Rural areas; Rural education; Rural urban differences; Segregation; Social science research; Social workers; Urban education
Background and Objectives Lack of advance care planning (ACP) may increase hospitalizations and impact the quality of life for skilled nursing facility (SNF) residents, especially African American residents who may be less likely to receive ACP discussions. We examined the professional judgments of SNF providers to see if race of SNF residents and providers, and risk for hospitalization for residents influenced professional judgments as to when ACP was needed and feelings of responsibility for ensuring ACP discussions Research Design and Methods Nurses and social workers (n = 350) within 29 urban SNFs completed surveys and rated vignettes describing eight typical SNF residents. Linear mixed modeling was used to examine factors that impacted ratings of need for ACP and responsibility for ensuring ACP. Results Neither the race of the provider, resident, nor the interaction of the two were associated with either outcome variable. In contrast, providers rated (on a 9-point scale) residents at high risk for hospitalization as more in need of ACP (estimate = 0.86, confidence interval [CI] 0.65, 1.07) and felt more responsible for ensuring ACP (estimate = 0.60, CI 0.42, 0.78) Discussion and Implications Research on ACP is continuing to evolve and these results show the primacy of disease trajectory variables on providers' judgments about ACP. Differences between providers indicate a need for stronger policies and education. Further, research comparing rural, suburban, and urban SNFs is needed to explore possible forms of structural racism such as residential and SNF segregation.
Baughman Kristin R; Ludwick PhD R N-B C C N S F A A N Ruth; Jarjoura PhD David; Kropp BS Denise; Shenoy BS Vimal
The Gerontologist
2019
2019-04
<a href="http://doi.org/10.1093/geront/gnx129" target="_blank" rel="noreferrer noopener">10.1093/geront/gnx129</a>
The limits of narrative: medical student resistance to confronting inequality and oppression in literature and beyond.
Sexism; Students; Empathy; Human; Student Attitudes; Exploratory Research; Racism; Cultural Values; Medical – Psychosocial Factors; Teaching Methods – Evaluation; Social Values – Education
INTRODUCTION: Upon designing and implementing a literature course on family values for Year 4 medical students, we found that while the supposed benefits of literary inquiry were to lead students to a deeper understanding of difficult issues such as illness and violence in the family, many of our students were unable to engage critically with the course material. This, we believe, was a result of their resistance to confronting issues such as inequality and oppression. This paper is an attempt to theorise student resistance to difficult, unruly subjects they encounter in a literature class, particularly those surrounding race, gender, social class and sexual identity. METHODS: We modify some of the expansive claims made by narrative medicine and put forth a new pedagogical and curricular approach to the uses of literature in medical education. RESULTS: We found that many students resisted course material and corresponding discussions, especially those related to sexual identity and non-traditional family values, male-female relationships and white racism. DISCUSSION: To reduce student resistance, we pose a more critical approach to narrative inquiry in medical settings that may deepen students' willingness to imagine what it is like to be someone who is suffering, and to work against oppressive social structures that sustain such suffering. Thus, we recommend moving narrative inquiry beyond a focus on the self and the patient in that individualised, circumscribed relationship and into a collective process involving the social, political, cultural and economic conditions that affect health and well-being.
Wear D; Aultman JM
Medical education
2005
2005-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1365-2929.2005.02270.x" target="_blank" rel="noreferrer noopener">10.1111/j.1365-2929.2005.02270.x</a>
Review of jonathan metzl, the protest psychosis: how schizophrenia became a black disease.
Blacks; Books; Racism; Schizophrenia – Ethnology
Aultman JM
American Journal of Bioethics
2010
2010-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/15265161.2010.520600" target="_blank" rel="noreferrer noopener">10.1080/15265161.2010.520600</a>
The limits of narrative: medical student resistance to confronting inequality and oppression in literature and beyond.
*Literature; *Narration; Curriculum; Education; Female; GENDER identity; Humans; Interpersonal Relations; Male; Medical; MEDICAL education; MEDICAL students; Medical/*psychology; NARRATIVE medicine; RACISM; Social Values; Students; Undergraduate/*methods
INTRODUCTION: Upon designing and implementing a literature course on family values for Year 4 medical students, we found that while the supposed benefits of literary inquiry were to lead students to a deeper understanding of difficult issues such as illness and violence in the family, many of our students were unable to engage critically with the course material. This, we believe, was a result of their resistance to confronting issues such as inequality and oppression. This paper is an attempt to theorise student resistance to difficult, unruly subjects they encounter in a literature class, particularly those surrounding race, gender, social class and sexual identity. METHODS: We modify some of the expansive claims made by narrative medicine and put forth a new pedagogical and curricular approach to the uses of literature in medical education. RESULTS: We found that many students resisted course material and corresponding discussions, especially those related to sexual identity and non-traditional family values, male-female relationships and white racism. DISCUSSION: To reduce student resistance, we pose a more critical approach to narrative inquiry in medical settings that may deepen students' willingness to imagine what it is like to be someone who is suffering, and to work against oppressive social structures that sustain such suffering. Thus, we recommend moving narrative inquiry beyond a focus on the self and the patient in that individualised, circumscribed relationship and into a collective process involving the social, political, cultural and economic conditions that affect health and well-being.
Wear Delese; Aultman Julie M
Medical education
2005
2005-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1365-2929.2005.02270.x" target="_blank" rel="noreferrer noopener">10.1111/j.1365-2929.2005.02270.x</a>