Discrepant Views Research Articles

Consultation with children in hospital: children, parents’ and nurses’ perspectives

To explore children's, parents' and nurses' views on participation in care in the healthcare setting. Children have a right to be consulted and involved in their care. The grounded theory method was used and data were collected through in-depth interviews, questionnaires and observation. Sample consisted of 11 children, 10 parents and 12 nurses from four paediatric wards in two hospitals in England. Parents felt that children should be involved in the decision-making process thereby enhancing and promoting children's self-esteem and positive self-regard, which would consequently enhance their overall welfare. Likewise, children expressed the need for consultation and information so that they could understand their illness; be involved in their care, and prepare themselves for procedures. However, children's own opinions and views were underused and they had varying experiences of being consulted about their care and treatment. Nurses appeared to hold varying and discrepant views on the involvement of children in decisions and for some nurses, the child's involvement seemed to be dependent on the child's cognitive maturity and being defined as a rational subject. Health professionals' communication behaviour may reflect recognition of children's cognitive abilities rather than their competence to understand. The fact that children's nurses appeared to make decisions about involving children in decision making in the absence of a reliable framework was a significant finding and highlights a real problem in the current climate. Nurses faced with workforce pressures may encounter considerable challenges to facilitating children's involvement in decisions about their care. Hence it is imperative that nurses' examine the basis of their decisions and use more explicit criteria for determining children's involvement.

Mothers Re-Partnering After Divorce

Using a “divergent realities” approach, the present study compared mothers' and adolescents' perceptions of the mothers' postdivorce re-partnering (i.e., remarriage, cohabitation, or dating) as it relates to the adolescents' lives (N = 83 dyads). Mothers' and adolescents' perceptions were elicited via open-ended questionnaire items. Qualitative content analysis of the written responses revealed discrepant views for 47 dyads and agreement for 36 dyads. The discrepant codes (themes) fell into three broad topical categories: (a) the quality of the adolescent-new partner relationship; (b) the level or nature of impact of the new partner on the family's life; and (c) the impact of having a partner on the mother-adolescent relationship. Possible reasons for divergent perceptions include inadequate communication, attempts to protect self or relationship, and personal stake.

Discrepant Parent-Adolescent Views on Family Functioning: Predictors of Poorer Self-Esteem and Problems of Emotion and Behaviour in British and Canadian Adolescents

Conflict between a parent and an adolescent may be indicative of problems of family cohesion, and may predict poorer self-esteem and problems of emotion and behavior. This idea is explored in high school and junior college populations in Alberta, Canada, and in Britain. In all, 1,796 12 to 19-year-olds completed the summary scale of the McMaster Family Assessment Device (FAD), which was also completed by a parent. Results were generally similar in both cultures, with many more similarities than differences. On all scale items, adolescents were significantly more critical of their family life than were their parents. The degree of difference between parent and child desc riptions o f family functioning was significantly correlated with the adolescents’ Rosenberg Self-Esteem Scale scores, as well as self-completed, standardized measures of problems of emotion and behaviour. Differences between parent and child’s responses to the FAD were better predictors than FAD scores alone.

Discrepancy between Mother and Child Perceptions of Their Relationship: I. Consequences for Adolescents Considered within the Context of Parental Divorce

Previous research has shown that parent-adolescent conflict is associated with adolescent adjustment. One possible source of conflict between parents and adolescents is the discrepant ways in which they perceive their relationship, which may contribute to adolescent adjustment difficulties. The present study examined the association between mother-adolescent discrepant views in their relationship and adolescent adjustment difficulties concurrently and longitudinally. In addition, the role of a family stressor, in this case parental divorce, in enhancing the discrepant views and moderating the relationship between discrepancy in perceptions and adolescent adjustment was examined. Results indicated that discrepancies in mother perception and adolescent perception of their relationship were associated with mother report of internalizing and externalizing behavior problems concurrently and longitudinally. Furthermore, discrepancies were significantly higher in divorced families than intact families, but divorce did not moderate the relationship between discrepancies and adolescent adjustment. Clinical implications and directions for future research are discussed.

Discrepancy between mother and child perceptions of their relationship : II. Consequences for children considered within the context of maternal physical illness

Discrepancies between parent and child perceptions of parenting have been well established. The current study addressed whether discrepancies in one dimension of parenting, the parent-child relationship, are associated with child adjustment difficulties concurrently and longitudinally. In particular, it was hypothesized that greater discrepancies in mother and child perceptions of parenting would be associated with child adjustment difficulties. Furthermore, it was hypothesized that families experiencing a stressor—in this case, maternal infection with the human immunodeficiency virus (HIV)—would experience larger discrepancies than families in which the mother is noninfected and that maternal HIV infection would moderate the association between discrepant views and child adjustment. Participants were 183 African-American women (61 HIV infected; 122 noninfected) and one of their noninfected children. All participants were from the inner-city area of New Orleans. Results indicated that discrepancies in mother and child perceptions of their relationship was associated with mother and child reports of externalizing behavior problems concurrently and longitudinally. In addition, discrepancies were significantly higher in families experiencing maternal HIV infection than in the noninfected group. However, with one exception, maternal HIV status failed to moderate the relationship between discrepancies in perception and child adjustment, indicating that discrepancies play a similar role in both types of families. Clinical implications of the present results are discussed.

Childhood Chronic Illness: A Comparison of Mothers’ and Fathers’ Experiences

Despite a growing emphasis on gender differences in parental response to childhood illness and disability, relatively few studies have compared how mothers and fathers adapt to having an ill child. This article explores how mothers and fathers of a child with a chronic illness viewed their experience and its impact on family life. Within families, parents typically had a shared view of the experience and its impact on their life as reflected in both the qualitative interview data and quantitative measures of family and individual functioning. In the minority of cases where parents held discrepant views, it was the mother who emphasized the negative aspects of the chronic illness situation. The results of this analysis support the growing emphasis among family researchers on exploring family strengths in the face of illness challenges and collecting data from multiple family members.

An Analysis of Factors That Contribute to Parent—School Conflict in Special Education

Understanding factors that escalate conflict, and understanding how conflicts are perceived, particularly by parents, is necessary in developing appropriate response strategies. The purpose of this study was to identify factors that escalate and deescalate parent-school conflict from the perspectives of parents of children with disabilities, school administrators, and mediators. Data from 44 telephone interviews were transcribed and then analyzed. A grounded theory approach was used to analyze data. Eight categories of factors that escalate parent-school conflict in special education were identified: discrepant views of a child or a child's needs, knowledge, service delivery, reciprocal power, constraints, valuation, communication, and trust. Implications for preventing and handling conflict are discussed.

Does It Matter What Your Client Thinks? The Role of Theory in Intervention: Response to Kamhi.

Kamhi (2000) presents a case study of a child with a phonological impairment whose view of the intervention process led her to refuse to work on her goals with anyone other than her clinician. In this response, the potential clinical impact of discrepant views among the participants in a clinical intervention is discussed. In particular, it is argued that subjectivity is inherent in all interactions, but that different theories place differing emphasis on the importance of the subjective states of interactional participants. Three prominent theories of intervention are discussed: social interactionist, behaviorist, and information processing. It is argued that discrepancies between a clinician's and a client's view of what is happening during clinical interactions may complicate intervention. It is further argued that theoretical eclecticism may have a particularly negative impact, as it will increase the likelihood of misunderstandings. A conclusion is that, when clashes in perspectives arise, they force the clinician to make explicit what he or she believes-what causes disorders, what processes work to remediate them, and why.

Standardizing “Expectedness” and “Seriousness” for Adverse Experience Case Reporting

Recent harmonization initiatives have led to the idea of a core safety data sheet. Even with a single company statement, however, there can well be debate and sometimes discrepant views between personnel within an organization as to what the safety data mean. Such a nonstandardized company view can lead to the same adverse event (AE) case history being reported to some authorities and not to others, even when assessed against the same source reference document, or similar regulations.The opportunity was, therefore, taken to informally survey views on some selected borderline AE cases from attendees at Drug Information Association (DIA) Safety Monitoring Workshops held in Europe and the United States. In addition, 22 physician monitors employed by either Glaxo or SmithKline Beecham Pharmaceuticals completed the exercise.The results of the survey are analyzed and guidelines proposed. Whether or not the reader agrees with all of these suggestions, the authors recommend an agreed company position with regard ...

The Future of Evaluation: a retrospective

Abstract This article gives an account of the 5th International Conference on Educational Evaluation. It represents discrepant views of contemporary evaluative research, ranging from the ‘disinterested’ approach of Stake, through the pragmatic interventions of Stem, to the ‘committed’ standpoint of Troyna‐‐ the ‘hands‐off’, ‘hands‐on’ and the ‘hands‐up’ schools of evaluation. The authors offer a deconstruction of the conference debates and explore the reconceptualisation of evaluation roles and practices. They conclude (somewhat playfully) that the range of emotional and intellectual responses may be characterised by ‘post‐modern grief’.

Concordant and discrepant views of patients' physical functioning.

Although considerable research has been done on patient-physician interaction, few studies have examined discrepancies between patients and physicians in their assessments of the patient's physical functioning. One recent study reports such discrepancies between rheumatologists and 41% of their rheumatoid arthritis patients. This article reports data replicating that study and examining the relationships between such discrepancies and a number of other variables. This is a longitudinal study of 158 patients with rheumatoid arthritis who were interviewed 4 times over a 2-year period and who reported their levels of physical functioning on the Arthritis Impact Measurement Scales. At the time of the fourth interview, the rheumatologists rated each patient's physical functioning on the revised criteria published by the American College of Rheumatology. Rheumatologists' assessments of their patients' physical functioning were discrepant with the patient's assessment for 35% of these patients. Twenty-seven patients were rated as worse than they rated themselves and 28 were rated as better. There were no differences between the concordant and the two discrepant groups in demographic or health status characteristics.

Use of mental health and support services among families of children with disabilities: discrepant views of parents and paediatricians

ABSTRACTViewing families of children with disabilities in terms of normative coping responses to stress is a relatively recent trend. This investigation examined differences between parents of children with spina bifida and paediatricians in their views of families' mental health support service needs. The study involved 21 parents and 23 paediatricians who completed a needs assessment instrument.Although the views of the two groups were similar in regard to a perceived need for services, discrepancies were evident in the type of mental health support service providers thought to be most appropriate, and the perceived severity of families' psychosocial problems. Results are discussed in relation to family compliance in paediatric health care settings, and the need to consider parental attitudes when family mental health support service issues are raised.

Towards a Systemic Model of Health Care Compliance: Rationale and Interview Protocol

Health care professionals and patients often hold highly discrepant views about medical problems and their treatment. This discrepancy plays a significant role in patient compliance. The existence of these two distinct belief systems is related to the fundamentally different ways in which lay-persons and medical professionals acquire health care information. Patients' health beliefs are described from three interacting perspectives: socio-cultural, familial, and intrapsychic. Patient compliance is likely to be enhanced if the health care professional elicits the patients' health beliefs and presents appropriate medical information within this familiar context. A clinical interview protocol is provided as a guide for eliciting patients' health beliefs. This protocol has been found to be useful in facilitating communication and enhancing compliance. A case example illustrates the protocol's application.

A multiple paradigm approach to the sociology of medicine, health and illness

Sociologists may look at the social world from a variety of perspectives. Depending on their point of view, they will focus on some of the puzzles of social life and ignore others. Different questions will be asked. Alternative means of answering questions will be considered. There have recently been several attempts to classify the theoretical approaches adopted by sociologists (see for example, Sherman, 1974; Ritzer, 1975; Boughey, 1978; Turner, 1978; Eckberg and Hill, 1979; Poloma, 1979; Wallace and Wolf, 1980). All of these authors have grouped discrete sociological theories into a few categories. They have discovered commonalities among theoretical approaches previously considered widely divergent. In so doing, they have clearly articulated that sociologists qua sociologists approach the diverse social world from several distinct vantage points. The discrepant sociological views are evident in the substantive subdiscipline of the sociology of medicine. Medical sociologists have begun with contrasting and contradictory, or merely divergent assumptions about the social world and about ways of understanding this world. At times they have described or analysed an aspect of medical sociology from such widely differing points of view as to appear to be discussing a different phenomenon. But, the fact that sociologists of medicine take many approaches is an advantage not a disadvantage. Attempts at understanding and explaining the complex, diverse social world must in turn be multi-faceted . There is some agreement that sociology may be categorized as entailing three distinct perspectives. Boughey (1978) states these involve three fundamental choices in 'doing sociology.' One aims to discover universal, causal law of the if x . . . theny variety, another to empathetically understand the symbolic meaning or the interpretation of the social world, and the final one to diagnose and ameliorate injustice of the world.

Fictions, factions, and functions of behavior therapy

Behavior therapy is extraordinarily diverse in its theoretical approaches, research methods, and therapeutic techniques. The diversity has raised problems in generating a uniform definition of behavior therapy that adequately reflects the multifaceted nature of the field and at the same time accurately portrays the many different approaches. The present paper examines the nature of contemporary behavior therapy by presenting many misconceptions about its distinguishing features (fictions), discrepant views, approaches, and theoretical orientations within the field (factions), and some of the important contributions that behavior therapy has made to psychology in general (functions). Elaborating the fictions, factions, and functions of behavior therapy not only conveys the diversity within the field but also the evolution of what behavior therapy is as an area of research and practice.

In every marriage there are two marriages.

While investigators often have commented about discrepancies in the way a husband and a wife view the same marriage, little attention has been devoted to the implications such discrepancies have for marital and family therapy. As part of a continuing study of the differences between couples who seek marital therapy and those who seek sexual dysfunction therapy, this report examines these two clinical populations on the dimension of discrepant views of the marriage. Our results suggest that overall discrepancy scores may be an important indicator of stress between partners. In particular areas, however, such as rating the quality of the marriage, specific complaints about the marriage, and concerns about male sexual difficulties, marital therapy patients obtained significantly higher discrepancy scores than sexual therapy patients.

Reducing Discrepancies in Professional and Custodial Perspectives

Conflict between custodial and professional treatment person nel has been a persistent problem in correctional institutions. It has been suggested that a possible solution of this problem lies in reducing the discrepant views of custodians and professionals by providing some overlap in their respective roles. The question investigated in the present study was whether such overlap would reduce this discrepancy. Prison custodial officers who volunteered to counsel inmate groups were found to have attitudes toward inmates significantly more congruent with those of professionals than those of custodians who were not counselors; in addition, they were slightly more positive toward treatment personnel. The results suggest that overlap in custodial and treatment roles may be a viable device for more congruent perspectives and expectations among those carrying out these roles.

Statement of agreement regarding the ring-current effect

In an earlier communication [Hines and Parker, 1958], we recorded discrepant views regarding the possible magnetic effects at the ground caused by a hypothetical ring current in the earth's exosphere. This followed upon earlier statements by Parker [1956, 1958a and b] to the effect that only an increase of geomagnetic field could be produced in a reasonably short time by such a current, as a consequence of exospheric shielding, and conflicting statements by Hines [1957] and Hines and Storey [1958] to the effect that geomagnetic field changes of either sense could be propagated rapidly through the exosphere by hydromagnetic waves. In view of the interest that this controversy appears to have raised, and because of the basic importance of the consequences in geomagnetic storm theory, we wish now to record a reconciliation of views, to the effect that circulating charge high in the exosphere can indeed be associated with a decrease of geomagnetic field at ground level in a reasonably short time and, therefore, may indeed be responsible for the main phase of a geomagnetic storm. In order to clarify the basic features of the controversy most readily, the original discrepant views will be restated briefly in application to very extreme models where each in turn undoubtedly applies. It should be noted, however, that each view can in turn be justified for other models which bear a much closer resemblance to the circumstances of nature, and the separate conclusions were originally formulated with these other models in mind.

TREATMENT OF CHRONIC OTORRHEA.

The subject of chronic tympanic suppuration is an important topic of aural surgery. The purpose of this paper, however, is not to introduce novel procedures for its relief, but rather to summarize our knowledge and endeavor to ascertain the crystallized sentiment of otological experience. For, be it remembered, unanimity by no means exists concerning relief measures for this troublesome and dangerous pathological condition, its treatment ranging all the way from the time-honored syringe to the radical mastoid operation. If concrete opinions concerning curative measures prevailed, no excuse would exist for this paper, but the discrepant views entertained by eminent authorities on both sides of the Atlantic furnish ample provocation for an endeavor to produce order from apparently chaotic conditions. A professional classification according to expressed views might be designated as follows: The ultraconservatives, conservatives and radicals. 1. The ultraconservatives are those still possessing an abiding faith in the syringe. cleanliness,