Forever Changing Research Articles

The evolving role of case management in consumer-centric health plans

As with many disciplines in the health care industry, the roles and responsibilities for case managers have changed during the past decade. Work settings have shifted from independent firms or individual practices to insurance health plans and hospitals. During this time, the American system of health care has witnessed the popularity of various types of managed care plans rise and threaten to forever change the health care reimbursement system.

Wildfires in Amazonia: A pilot study examining the role of farming systems, social capital, and fire contagion

Environmental destruction caused by fires threatens to forever change the ecological composition of tropical rainforests. Researchers have addressed the role of drought and logging on fire propagation and the ecological consequences of fires. Nevertheless, little is known about its human dimensions. This lack of information is of concern because it represents a real and important gap in our own understanding about a major global change factor. This paper attempts to partly redress this shortcoming by presenting a pilot study that considers the importance of farming systems and social capital to the mitigation or exacerbation of fire in Amazonia. The paper explores the theoretical connection between social capital and fire contagion, and presents results from a pilot study examining such links. This study combines satellite data analysis and data on community organization derived from household surveys in the municipio of Uruara in the State of Para, Brazil.

Reframing nursing education to renew the profession. The keynote address from the NLN Education Summit 2002.

Welcome TO THE NLN EDUCATIONAL SUMMIT AND TO MAKING HISTORY, It all started in 1873 with the graduation of the first nursing student, Linda Richards. Twenty years later, a group of educators, meeting at the 1893 Chicago World's Fair, formed the first nursing organization in the United States, the American Society of Superintendents of Training Schools for Nurses. This organization led to the formation of the National League of Nursing Education and, eventually, to the National League for Nursing. Today, we stand on the shoulders of nurse educators from the 1890s on, who came together to discuss problems, propose solutions, and share best practices. * Looking far outside of nursing, two models set the stage for a discussion of how we must reframe nursing education to renew the profession. The second model comes from business, and I will allude to it later. The first model is inspired by the location of this Summit. We are in California, in a nation that was built on the notion of "going west" to find new opportunities and new ideas. Nurse educators are in the right place at the right time to solve our problems. In the Land of Disney This Education Summit takes place in Anaheim, in the land of Disney, where children believe that dreams come true. Walt Disney and the company he founded provide an interesting backdrop for a discussion of nursing's renewal. While Disney's life was directed toward making children happy, his own childhood was not a happy one. He left home at age 16 to join an ambulance corps in World War I and, following the war, made his way to Hollywood to produce animated films (1). After he lost the rights to one of his first films, Oswald Rabbit, the critics predicted that his second film, and first full-length feature, would fail. Its unprecedented success--Snow White and the Seven Dwarfs grossed $8 million in its first year, 1937--provided Disney with the incentive to believe in what he did (2). The story behind Disneyland is relevant to us today. While taking his daughters to an amusement park, Disney noticed that although the carousel was beautiful, the paint was chipped and the horses on the inside were nailed to the floor. Noting that parts of the park were not very nice, Disney determined to build Disneyland, where everything would be perfect. What is written about nursing and nurses today would lead one to believe that the profession is in trouble--the paint is chipped and the horses are nailed down. The success of the Disney Corporation (3,4) has been attributed to its ability to retain Disney's core values while continuing to innovate. Nursing has retained its core values for clinical competence and caring while innovating a wide array of new roles over time. To reframe nursing education, we must, like the young Walt Disney, recognize that unprecedented opportunities lie before us. Refraining Nursing Since the first chapter of Exodus, the role of nursing has been, and continues to be, to create a different world from the one we find. Nurses care for the sick and the well during the best and the worst moments of their lives. A small part of what is considered nursing practice is what nurses refer to as caregiver burden. In a clinical situation, nurses instantly enter into the most intimate areas of peoples' lives, at the most important times of their lives. As we talk, thousands of nurses will save, touch, and forever change thousands of lives across the United States. What is even more incredible is that you, someone you know, or someone who once taught in your school educated all of those nurses. Whatever we are doing, however we are doing it, we have done it well. Nursing is the profession that has never been drafted in wartime because nurses have always volunteered. Our military history is fascinating. In World War I, more than 10,000 of the 22,000 nurses who served went to Europe. In World War II, 70,000 nurses served with commissions, many without any benefits. …

Film Review

Pamela Beere Briggs and William McDonald Women of Mystery: Three Writers Who Forever Changed Detective Fiction.

Stalin's Reluctant Soldiers: A Social History of the Red Army, 1925-1941

Under Joseph Stalin's iron-fisted rule, the Soviet state tried to forge an army that would be both a shining example of proletarian power and an indomitable deterrent against fascist aggression. In reality, Roger Reese reveals, Stalin's grand military experiment failed miserably on both counts before it was finally rescued within the crucible of war. Reese greatly expands our understanding of the Red Army's evolution during the 1930s and its near decimation at the beginning of World War II. Counter to conventional views, he argues that the Stalinist state largely failed in its attempt to use military service as a means to indoctrinate its citizens, especially the peasantry. After 1928, the regime's recruits became increasingly disenchanted with Stalin's socialist enterprise primarily due to the disheartening changes brought on by collectivization and dekulakization. In effect, these reluctant soldiers turned their backs on both the army and Communist Party leadership, neither of which regained credibility until after World War II. The soldiers' alienation and hostility, Reese demonstrates, was most clearly manifested in the highly volatile tensions between officers and peasant recruits following the military's chaotic expansion during the 1930s. Those tensions and numerous internal conflicts greatly undermined the regime's effort to create a well-trained, cohesive, and politically indoctrinated army. In place of this ideal, the regime stumbled along with a disunited and ineffective fighting force guided by outdated doctrines and led by an undeveloped officer corps. All of those elements made the Soviet Union particularly vulnerable to the devastating military disasters of 1941. Along the way, Reese persuasively dispels a number of myths. He shows, for example, that the Red Army's humiliating defeats at the start of the war were not, as many still believe, due to Stalin's bloody purges of the officer corps during the 1930s nor to overwhelming German military and economic superiority. Stalin, Reese argues, was only one of many key influences on the Soviet's disorganized effort to field an effective fighting force. And, while the Red Army was actually technologically superior to the Wehrmacht, the Germans made far better strategic and tactical use of their forces to overwhelm the poorly led Soviets. A fascinating portrait of an army at war with itself, Reese's study illuminates the daily lives of soldiers, officers, and civilians and forever changes the way we look at the relation between political motives and military needs in the early Soviet state.

Whither the Genome Project?

The Human Genome Project represents the convergence of three billion years of biological evolution and ten thousand or more years of cultural evolution-and their interaction is bound to change both, profoundly. From now on, their futures will be indissolubly linked. Actually, these streams, coursing through time, have already unwittingly made contact. With the invention of sanitation and the introduction of modem medicine, the role of natural selection in the perpetuation of the species was markedly reduced, with inevitable influence on the human gene pool. Now we foresee a more conscious interaction. Those who fear, even dread, its uncertain consequences, argue that we should prevent or abort this meeting. To do so would, of course, consign humanity forever to the cruelties and opportunities of the genetic lottery-statistical cruelties that mean blighted lives for those afflicted; statistical opportunities that provide the rare genius who, appearing at the right time, forever changes our civilization. Must we accept the former to have the latter? And though rarely noted, to do so implies that our present genetic endowment-with all of its admixed ancient baggage and recent innovation-is beyond human grasp and appreciation, much less improvement, an acme, or the expression of a divine will. To some, even increased knowledge of the genetic basis of human characteristics is an assault upon human dignity. But is human dignity best affirmed by willful ignorance, or by increasing human self-knowledge? Some, seeking an intermediate course, argue that biology and culture should meet at arms length. They fear the consequence of unrestrained interaction. They seek a decorous relationship in which the culture may pick and choose from the biological knowledge acquired to alleviate a few grievous genetic ailments, but avoid large-scale biological, and inevitably cultural, change. Others would set no a priori limits to this interaction, but would advocate great caution. We know so little about the complexity and tolerances of either our biological or cultural organization, they argue, that either or both could easily be destabilized with catastrophic consequence. In their view any experiments should be of small scale and slow pace. Still others, no doubt, full of confidence, would simply permit free enterprise to reign. The human genome project per se is intended solely to acquire knowledge. Yet in the ethos of modem society, it is feckless to suppose that knowledge, once available, will not be used. While ethicists may properly debate the morality of experimentation with sentient beings-in either the biological or cultural mode-heuristically, in a secular age dominated by the twin pillars of power-commerce and politics-what in fact is likely to happen? …

Mind Over Mead: Collins' Theory of Thought

In his Neo-Meadian article, Collins has offered a number of highly tenable and even testable notions that extend central Meadian concepts. He proposes, for instance, that in theorizing thought we should “take seriously the conception of internalized conversation’’ and, further, that “what we think about is a reflection of what we talk about with other people (or what we communicate with them on paper).” I should basically like to applaud such a stance and offer two simple extensions, both intended to elaborate the main discussion on the microsociology of language and cognition. One proposal is to suggest that if we think about what we talk about, the reverse may well also be true; namely that talk can reasonably be assumed to give some direct handle on the hidden process of thought itself. That is to say that while we may not say aLl we think nor even have consciously thought out all we say, what we say and, more specifically, how the micromoments of talk’s production unfold in interaction may, in distinctly observable ways, locate certain thought processes in action. My second proposal is more speculative. It will be best explored later in this short article but, briefly, I shall want to suggest that thought processes are themselves part of interactive and real-time realization. Whether in external or internal dialogue, my thoughts on a particular subject, person, decision, or even fantasy are not now what they were a day or week or year ago. Fundamental aspects of sociation have changed them and continue to do so. My thoughts, in Meadian terms, are social. I may hold the same opinion, plan the same activity, or wish certain events might or might not happen, but my views on themin Garfinkel’s world of indexicality and reflexivity-are forever changing relative to each other along a distinctly forward-moving trajectory. Moreover, my internal sense of what I believe, plan, or wish has emerged in just that Meadian process of internal conversation and rehearsal that Collins has highlighted. Let me return to these points shortly. First, it will be useful to examine and critique a set of issues basic both to Collins’ discussion and to the traditions on which he has chosen to build. My focus here will be on what I see as the perils of ritual or, more precisely, the analytic if convenient cul de sac that overdependence on ritual or routine behavior can create.