Critical thinking, charity and care: reason and goodness both

Care reasoning is valuable not because its nicer or kinder. Rather, it is the most reasonable way to come to terms with moral phenomena. Interpreting arguments requires making sense of the relationship between statements. Making sense of moral pheno mena requires making sense of relationships between (inherently indeterminate) moral subjects. Thus, the best reconstructions of moral problems will be realized in a medium (such as narrative) where meaningfulness is not undermined by indeterminacy. Fur ther, the rationality of care reasoning, which Gilligan calls narrative, can be appreciated by analogy with the rationale for the principle of charity in the interpretation of arguments

Review of factors which contribute to graduate employees' intention to stay in South Africa

In the past decade, human resource practitioners have focused their attention on employee retention. They have tried various practices in order to keep their employees in the organisation for longer. The research gap identified is in the graduate employees' intention to stay context. There has been even less research in this field within South Africa. This study aims to examine the extent to which career advancement opportunities and supervisor involvement contribute to graduate employees' intention to stay. In addition, this study focused on four factors namely, career progression, continuous learning, performance management and recognition in analysing the extent to which these four factors have contributed to graduate employees' intention to stay. Job satisfaction and affective commitment were also examined for their mediational effects on the relationship between career advancement opportunities, supervisor involvement and graduate employees' intention to stay. Graduate employees working in South African organisations participated in a self-report, quantitative survey (N = 357). Whilst the exploratory factor analysis of the intention to stay revealed a unidimensional factor, it was interesting to note that career progression and continuous learning loaded onto one distinct factor, labelled as career advancement opportunities. The multiple regression analysis indicated that career advancement opportunities and supervisor involvement were statistically significant predictors of intention to stay. Process mediation was used to test whether job satisfaction and affective commitment were mediators between career advancement opportunities, supervisor involvement and intention to stay. It was found that both job satisfaction and affective commitment were significant partial mediators in the abovementioned relationship. The study discusses suggestions for future research and the implications, both theoretical and practical, associated with the study

The problems of offenders with mental disorders: A plurality of perspectives within a single mental health care organisation

Managers, doctors, nurses, occupational therapists, social workers, psychologists, unqualified staff and service users were interviewed for a qualitative study of risk management and rehabilitation in an inner city medium secure forensic mental health care unit. Different professional orientations to service user problems were identified. Doctors focused primarily on the diagnosis of mental disorder, which they managed mainly through pharmaceutical interventions. Psychologists were principally concerned with personal factors, for example service user insight into their biographical history. Occupational therapists concentrated mainly on daily living skills, and social workers on post-discharge living arrangements. Some front line nurses, held accountable for security lapses, adopted a criminogenic approach. Service users were more likely than professionals to understand their needs in terms of their wider life circumstances. These differences are explored qualitatively in relation to four models of crossdisciplinary relationships: monoprofessional self-organisation combined with restricted communication; hermeneutic reaching out to other perspectives; the establishment of interdisciplinary sub-systems; and transdisciplinary merger. Relationships between professions working in this unit, as portrayed in qualitative interviews, corresponded mainly to the first model of monoprofessional self-organisation. Reasons for restricted crossdisciplinary understanding, particularly the wide power/status differences between the medical and other professions, and between staff and patients, are discussed

Assessing the probability of patients reoffending after discharge from low to medium secure forensic mental health services: An inductive prevention paradox

Citizens of developed societies are troubled by those who commit ‘irrational' crimes against the person. Reoffending by ex-patients following their release from secure mental health services triggers particularly intense angst when amplified by media and political scrutiny. Forensic mental health service providers are expected to minimise the occurrence of such transgressions by releasing only those patients who are judged acceptably unlikely to reoffend. However, reoffending probabilities can only be estimated by observing behaviour in secure institutional settings designed specifically to prevent patients from transgressing. The article explores this ‘inductive prevention paradox' which arises when the implementation of measures designed to avoid an adverse event obscures direct observation of what might have happened if prophylaxis had not been attempted. The analysis presented draws on data obtained in 1999–2003 from two qualitative studies in medium to low secure UK institutions, one providing forensic mental health services and the other forensic learning disability services. We explored the views of 56 staff members and 21 patients about risk management in forensic services and undertook additional 25 staff interviews for case studies of the 21 patients. The wider applicability of the inductive prevention paradox will be considered in the Discussion. We argue that the prognostic limitations arising from prevention have been underestimated by policy makers and in official inquiries; and that the prevailing personal risk assessment framework needs to be complemented by greater attention to the environments which patients will be discharged into

Streaming primary urgent care: a prospective approach

Aim: To identify the appropriate service provider attendees of emergency departments (EDs) and walk-in centres (WiCs) in North East London and to match this to local service provision and patient choice. Design: An anonymous patient survey and a retrospective analysis of a random sample of patient records were performed. A nurse consultant, general practitioner (GP) and pharmacist used the presenting complaints in the patients’ records to independently stream the patient to primary care services, non-National Health Services or ED. Statistical analysis of level of agreement was undertaken. A stakeholder focus group reviewed the results. Subjects and setting Adult health consumers attending ED and urgent care services in North East London. Results The health user survey identified younger rather than older users (mean age of 35.6 years – SD 15.5), where 50% had not seen a health professional about their concern, with over 40% unable to obtain a convenient or emergency appointment with their GP. Over a third of the attendees were already receiving treatment and over 40% of these saw their complaint as an emergency. Over half of respondents expected to see a doctor, one-quarter expected to see a nurse and only 1% expected to see a pharmacist across both services, although WiCs are nurse-led services. More respondents expected a prescription from a visit to a WiC, whereas in the ED a third of respondents sought health advice or reassurance. Conclusion: A number of unscheduled care strategies are, or have just been, developed with the emphasis on moving demand into community-based services. Plurality of services provides service users with a range of alternative access points but can cause duplication of services and repeat attendance. Managing continued increase in emergency and unscheduled care is a challenge. The uncertainties in prospective decision making could be used to inform service development and delivery