Unreasonable Requests Research Articles

Exploring the protective capabilities developed by hospital nurses to deflect workplace violence: a qualitative study in Taiwan

BackgroundWorkplace violence is a serious safety hazard in the healthcare sector and has attracted much attention worldwide, especially for nursing staff. Equipping nursing personnel with protective capabilities for workplace violence can reduce the risk they face in work settings. This study explored scenarios of common violent patient–nurse conflicts in the workplace of hospital nursing staff and their capabilities for de-escalating such conflicts.MethodsWe used a qualitative content analysis for this study. Qualitative interviews were conducted with 21 nurses in two teaching hospitals in New Taipei City, Taiwan, until data saturation was reached. The data were transcribed, encoded, and analyzed and similar concepts were grouped under the same category.ResultsFour categories of workplace violence scenarios common to hospital nursing staff were identified: unreasonable requests, caring for high-risk patients, long waiting times for medical consultation, and close contact when caring for patients. Two protective capabilities were recognized: communication and interpersonal capabilities and problem-solving skills. Each scenario may require a different combination of abilities.ConclusionOur findings suggest that a violence-prevention training program could be designed for various workplace violence scenarios to enhance nurses’ abilities to de-escalate workplace violence in hospitals.

Association of organizational and patient behaviors with physician well-being: A national survey in China

This study aims to investigate the association of organizational and patient behaviors (reflecting the internal and external environment of hospital, respectively) with physician well-being. A national cross-sectional survey was conducted in 77 hospitals across seven provinces in China between July 2014 and April 2015. Physician well-being was assessed with job satisfaction, career regret and happiness. Organizational behaviors were assessed with organizational fairness, leadership attention and team interaction; patient behaviors were assessed with patient trust and unreasonable requests from patients. Of a study sample of 3,159 physicians, 1,788 were men (56.6%) and 1,371 were women (43.4%). Overall, positive organizational and patient behaviors reported by physicians were relatively low. Negative organizational behaviors and patient behaviors including lower organizational fairness, lower leadership attention, lower team interaction and lower patient trust were associated with lower job satisfaction and lower life satisfaction, and higher career regret. The association between organizational behaviors and physician well-being exhibited some gender differences, while no clear gender difference was found for the relationship between patient behaviors and physician well-being. Given the importance of physician well-being for the healthcare system, interventions for improving internal and external hospital environments (e.g., organizational fairness, leadership attention, team interaction and patient trust) may benefit physician well-being.

"This Was Just How This Friendship Worked": Experiences of Interpersonal Victimization Among Autistic Adults.

The victimization of autistic people by familiar others (interpersonal victimization) is an understudied phenomenon despite suggestions that prevalence rates may be disproportionately high. We know very little about the way autistic people perceive these experiences, and how to support them. The aim of the current study was to explore experiences of interpersonal victimization among autistic adults from their own perspective. We recruited 43 autistic adults to take part in a qualitative online study, and asked about their experiences of being victimized or taken advantage of by people they know in the past. We analyzed their comments at the semantic level using inductive thematic analysis, from a critical realist perspective. We identified two key themes in the data. The first theme, "cycles of victimization" highlighted the occurrence of polyvictimization in the sample. The second ("perceptions of victimization") focused on how these experiences were related to difficulties with trust (of both self and others), the recognition of victimization, and heightened compliance. The participants expressed difficulty with saying no to people, and found it difficult to identify when someone had negative or manipulative intentions. Our findings suggest that autistic adults experience victimization from a range of close others, and may find it difficult to recognize when someone is acting in an abusive manner. Many participants had experienced heightened compliance in response to unreasonable requests from others, however, reasons for this were varied (e.g., fear and desire to avoid confrontation) and require further investigation. These findings have implications for developing supports that enable autistic adults to recognize their own boundaries and advocate for themselves, in addition to helping them to recognize what a healthy relationship looks like.

Conditions for gatekeeping when GPs consider patient requests unreasonable: a focus group study.

BackgroundRequests from patients that are regarded by GPs as unreasonable are a source of conflict between GPs and patients. This makes gatekeeping challenging, as GPs negotiate a struggle between maintaining the doctor–patient relationship, protecting patients from the harms of medical overuse and acting as stewards of limited health care resources. More knowledge of how GPs can succeed in these difficult consultations is needed.ObjectiveTo explore Norwegian GPs’ perceptions of conditions that can promote their ability to act as gatekeepers when facing patient requests which they consider ‘unreasonable’.MethodsA qualitative study based on three focus groups with Norwegian GPs conducted in 2019, exploring consultations in which the patient made a seemingly unreasonable request, but the GP was able to navigate the consultation in a clinically appropriate manner. Thematic cross-case analysis of verbatim transcripts from the focus groups was carried out using Systematic Text Condensation.ResultsThe analysis revealed three major themes among the conditions that the GPs considered helpful when faced with an ‘unreasonable’ patient request: (i) professional communication skills; (ii) a long-term perspective; (iii) acknowledgement and support of GPs’ gatekeeping role among peers and from authorities.ConclusionProfessional communication skills and relational continuity need to be prioritized for GPs to maintain their role as gatekeepers. However, support for the gatekeeping role within the profession as well as from society is also required.

«Технологии себя» в условиях самоизоляции

Introduction. In the context of the COVID-19 pandemic, which spread around the world in early 2020, special attention is paid to external transformations in human life: forced staying at home, using personal protective equipment in public places, social distance, etc. Nevetheless, the inner world of a man is susceptible to serious transformations. Another necessary element that structures the world of self (J. Deleuze’s point of view) is turning into a potential carrier of the virus. Therefore, the problem of human reflection with the goal of taking care of oneself in a crisis situation is of particular relevance. The aim of the study is to substantiate the effectiveness of spiritual practices of the period of Antiquity and the early Middle Ages as forms of caring of the internal in a person in the pandemic. Methods. The author uses general scientific methods: analysis and synthesis, induction, deduction, abstraction. In addition, a comparative historical method, an interpretation method and a systematic approach are applied. With the help of the dialectical approach, the connection between the external and the internal in a person was designated. Scientific novelty of the study. Three scenarios of human responses to self-isolation in the context of an event (external) – meaning (internal) are outlined: orientation to an external event; creating an external event; appeal to the self. Results. In the context of self-isolation, staying alone with himself, a person faced a problem, a crisis of identity (empirical evidence for this problem was provided by psychologists and psychotherapists in Chelyabinsk and the Chelyabinsk region). This problem is due to the fact that the pandemic has reduced many of the person’s connections with the outside world (work, study, relationships with friends and relatives) and / or transferred them to a remote format. Therefore, consciously or optionally, at the level of an unreasonable request, a person has a need to rethink his self. Rethinking is a reflexive procedure when a person re-learns to communicate with his self. M. Foucault analyzed and systematized examples of spiritual work with I, looking into the practices of care of the self in ancient thinkers’ and early Christians’ studies. Conclusion. The COVID-19 virus has made significant adjustments to human life. No less adjustments were made to the events (F. Girenok) that fill the life of a person. A man’s replies to changes in his being can be laid between two poles: event and meaning. Even while at home, many continue to focus on the external, creating something of their own (for example, audiovisual production) or consuming the results of others. At the same time, orientation to meaning involves focusing on oneself. Philosophers and theologians who practiced self-care about two millennia ago, proposed different forms of reflection, pursuing one goal, to learn to talk with oneself.

Transcranial Direct Current Stimulation Modulates the Effect of Unreasonable Request in the Context of Peer Punishment.

Making a request is a common occurrence during social interactions. In most social contexts, requesters may impose punishments and many behavioral studies have focused on the differential effects of reasonable and unreasonable requests during such interactions. However, few studies have explored whether reasonable or unreasonable requests involve differential neurocognitive mechanisms. In this study, we used transcranial direct current stimulation (tDCS) to investigate the mechanistic effects of request within the context of peer punishment. We used a modified ultimatum game (UG) task as well as a modified dictator game (DG) task. Both unreasonable and reasonable requests induced the proposer to increase their monetary offer for both tasks. Moreover, in the modified UG task, cathodal tDCS over the right dorsolateral prefrontal cortex (rDLPFC) significantly decreased the effect of an unreasonable request when compared to sham stimulation. Cathodal stimulation did not impact the effect of a reasonable request on the modified UG task. For the modified DG task, no tDCS effect for either an unreasonable or reasonable request was observed. These findings suggest that rDLPFC was only involved in decision-making processes during unreasonable requests when there was an opportunity for peer punishment. Moreover, our results indicate that reasonable and unreasonable requests involve differential neurocognitive mechanisms in the context of possible peer punishment.

American Red Cross and the World Trade Center

Dr. Bernadine Healy was the president of the American Red Cross when the terrorist attacks took place on September 11, 2001. In the aftermath, the American Red Cross implored the American public for donations of money to help those affected by these attacks. This is not an unusual or unreasonable request from this charitable organization, which provides assistance and relief to victims of disasters. The difference in this case study rests within the management of the $564 million collected. Rather than distributing all the donated money to victims of the attacks, Healy created the Liberty Disaster Relief Fund to create a blood reserve/storage system and saved $200 million of the donations for future disasters. Healy would be forced to resign by her board. This case study looks at both sides of this debate: Was Healy being a responsible steward of the money, or did she mislead the American public? Subscribe to JNEL

Court: Unreasonable request dooms former student's accommodation suit

Case name: Profita v. The Regents of the University of Colorado, et al., No. 16‐cv‐03032 (D. Colo. 03/15/17).

Unreasonable accommodation request vindicates university

Case name: Sessoms v. The Trustees of the University of Pennsylvania, No. 16‐2954 (E.D. Pa. 05/24/17).

A review of this month's lawsuits and rulings

Termination: Generous New York statute language gives former employee's suit a boost Dismissal: Unreasonable accommodation request vindicates university Accommodation: Granting of generous medical leave exonerates college district Retaliation: Failure to allege major life activity limitations dooms former student's suit Adult learner: University properly accommodated disabled student

Due process paranoia and the procedural judgment rule: a safe harbor for procedural management decisions by international arbitrators

Faced with a party’s procedural request, international arbitrators sometimes need to decide a delicate question: is this a legitimate exercise of the party’s procedural rights, or an unreasonable move, leading to an unnecessary delay of the proceedings? When answering this question, the fear that the eventual award might be challenged due to a violation of the parties’ due process rights lingers as the proverbial Sword of Damocles. Often, such “due process paranoia” will lead the arbitrator to grant unreasonable procedural requests, thus prolonging the proceedings unnecessarily. This neither benefits the parties nor the attractiveness of international arbitration as a dispute resolution mechanism. The present contribution attempts to ameliorate this situation. It reviews the state courts’ approach to dealing with arbitrators’ exercise of their procedural management discretion to reveal that “due process paranoia” is unfounded. Rather, the review brings to light what may be termed the “Procedural Judgment Rule”, a safe harbor for arbitrators’ exercise of their procedural discretion. The contribution encourages international arbitrators to embrace this discretion by conducting proactive proceedings. It offers methods to efficiently deal with delicate procedural management situations in order to avoid “due process paranoia” altogether.

A review of this month's lawsuits and rulings

Intentional infliction of emotional distress: Instructor's conduct not outrageous enough to justify suit Sexual misconduct: Failure to ask for accommodation sinks former student's suit Adult learner: Unreasonable request undermines former student's accommodation suit Athletics: Failure to allege outrageous conduct kills former coach's suit Accommodation: Lack of physical limitations defeats epileptic's disability suit

Lawsuits & Rulings

Dismissal: Disability may have factored into readmission denial Cheating: Failing to produce evidence sinks student's suit Disability: Unreasonable request undermines former student's accommodation suit

A review of this month's lawsuits and rulings

Adult learner: Judicial deference to academics dooms former student's suit Dismissal: Bad grades justify denial of former student's readmission Accommodations: Alleged request for accommodations keeps student's suit alive Campus security: Unreasonable request sinks employee's suit

Unreasonable accommodations requests don't have to be granted

Case name: Snowden v. The Trustees of Columbia University, No. 14‐1362‐cv (2d Cir. 04/16/15).

Due process paranoia and the procedural judgment rule: a safe harbour for procedural management decisions by international arbitrators

Faced with a party’s procedural request, international arbitrators sometimes need to decide a delicate question: is this a legitimate exercise of the party’s procedural rights, or an unreasonable move, leading to an unnecessary delay of the proceedings? When answering this question, the fear that the eventual award might be challenged due to a violation of the parties’ due process rights lingers as the proverbial Sword of Damocles. Often, such ‘due process paranoia’ will lead the arbitrator to grant unreasonable procedural requests, thus prolonging the proceedings unnecessarily. This neither benefits the parties nor the attractiveness of international arbitration as a dispute resolution mechanism. The present contribution attempts to ameliorate this situation. It reviews the state courts’ approach to dealing with arbitrators’ exercise of their procedural management discretion to reveal that ‘due process paranoia’ is unfounded. Rather, the review brings to light what may be termed the ‘Procedural Judgment Rule’, a safe harbour for arbitrators’ exercise of their procedural discretion. The contribution encourages international arbitrators to embrace this discretion by conducting proactive proceedings. It offers methods to efficiently deal with delicate procedural management situations in order to avoid ‘due process paranoia’ altogether. UNCITRAL Model Law on International Commercial Arbitration

Exercise for surgery: Acceptable pre-med or unreasonable request?

Exercise for surgery: Acceptable pre-med or unreasonable request?

AME survey-003 A1-part 2: the motivation factors of medical doctors in China.

The professional moral and job satisfaction of medical profession remain highly disputed in media in China. On the other hand, there is wide disaffection of patients toward doctors in China. This survey aims to obtain a better understanding of the motivation of Chinese medical professionals. An anonymous online cross-sectional survey, AME survey III, was conducted using the platform provided by DXY (www.dxy.cn) during the period of September 10-23, 2015. In total 2,356 DXY users completed the survey, including 1,740 males and 617 females, with a mean age of 31.96±7.03 yrs. The reasons (multiple choices) for career disaffection included poor patient/doctor relationship (88.6%), imbalance between workload and pay (79.5%), could not enter the preferred specialty (14.14%), and working in small clinics with no career progress (11.17%). If given the choice to enter the specialty as well as the hospital grade of their choice, 73.8% dissatisfied respondents replied they would like to be a doctor. For the dis-satisfied respondents, university teacher appeared to be the most popular career choice. The cited high workload was considered to be due to (I) imbalance in geographical allocation of doctors and insufficient training of doctors; (II) many red-tapism formalities; (III) Chinese patients often have unreasonable requests; (IV) over-examination and over-treatment; (V) high pressure to publish papers. One hundred and twelve respondents have their child/children attending university or graduated from university, 25.0% of them are pursuing a career in medicine. Nine hundred and ninety respondents have child/children while did not reach university age yet, among them 23.62% would like their child/children to study medicine. 64.87% of the 2,356 participants favor China to open up medical market to qualified foreign medical organizations to take part in fair competition, and 57.91% favor the government supporting regulated private hospitals. The moral and motivation of medical doctors in China are likely to be similar to other continuously evolving societies. Cost-effective use of existing resources should be explored as the first priority.

Food Allergy Knowledge and Attitudes among School Nurses in an Urban Public School District.

Since food allergy knowledge and perceptions may influence prevention and management of school-based reactions, we evaluated them among nurses in an urban school district. All District of Columbia public school nurses were asked to anonymously complete a food allergy knowledge and attitude questionnaire. Knowledge scores were calculated as percentage of correct responses. Attitude responses were tabulated across five-point Likert scales, ranging from strongly disagree to strongly agree. The knowledge questionnaire was completed by 87% of eligible nurses and the attitude questionnaire by 83%. The mean total knowledge score was 76 ± 13 with domain score highest for symptom recognition and lowest for treatment. Regarding attitudes, most (94%) felt food allergy is a serious health problem, for which schools should have guidelines (94%). Fewer believed that nut-free schools (82%) and allergen-free tables (44%) should be implemented. Negative perceptions of parents were identified as: parents of food-allergic children are overprotective (55%) and make unreasonable requests of schools (15%). Food allergy knowledge deficits and mixed attitudes exist among this sample of urban school nurses, particularly related to management of reactions and perceptions of parents. Food allergy education of school nurses should be targeted to improve their knowledge and attitudes.

‘Buy your own drugs’: an unreasonable request or sensible policy?

‘Buy your own drugs’: an unreasonable request or sensible policy?