A loss of will: Arminianism, nonsectarianism, and the erosion of American psychology\u27s moral project, 1636--1890

The concept of the will dominated American moral psychology for nearly three centuries. To possess a will was, among other things, to be made in the image of God and to have moral responsibility. College textbooks, as tools of moral inculcation, conveyed this moral psychology from the seventeenth to the early twentieth century. A significant shift occurred in college psychology textbooks during the 1930s: the topic of will was being removed as a chapter heading---never to return. By the end of the decade, American psychology had lost its will. What explains this loss of will in American psychology? From a perspective internal to the discipline of psychology, one might argue that the shifting emphasis toward non-mentalistic, behavioral explanation (i.e., behaviorism ) may have been to blame (or credit). Yet, a broader historical case can be made that long-standing intellectual trends or impulses in American colleges may have also played a significant role. This dissertation examines these trends as manifested in four leading textbooks, each arguably the best representative of its era: William Ames\u27s (1629) Marrow of Theology, Jonathan Edwards\u27 (1754) Freedom of the Will, Thomas C. Upham\u27s (1869) Mental Philosophy , and William James\u27s (1890) Principles of Psychology. This analysis suggests that the concept of will was already in serious trouble well before the twentieth century. One of the trends that may have eventuated in the loss of will was the nonsectarian impulse that came to characterize American higher education beginning in the eighteenth century. Put baldly, sectarian formulations of the Christian story supported a robust psychology of will while nonsectarian formulations appear to have undergirded less robust moral psychologies. Another factor is what I call the Arminian impulse in American moral psychology. A radical shift took place in this textbook discourse during the eighteenth and nineteenth centuries, a shift from a Calvinistic psychology of will which embraced universal causation to an Arminian psychology of will which rejected it. This process of Arminianization was intended to strengthen and elevate the concept of will. Ironically, however, the effect was to fatally weaken the concept, at least in mainstream American psychology

Imre József a magyar nyelőcsősebészet megalapitója = Josef Imre founder of Hungarian esophageal surgery

Petri Gábor a szegedi Sebészeti Klinika különös intellektuális képességekkel felruházott vezetője tudta, hogy klinikáját csak úgy tudja európai rangra emelni, ha legtehetségesebb sebészeit nyugati tanulmányútra küldi

How much time do nurses have for patients? a longitudinal study quantifying hospital nurses' patterns of task time distribution and interactions with health professionals

<p>Abstract</p> <p>Background</p> <p>Time nurses spend with patients is associated with improved patient outcomes, reduced errors, and patient and nurse satisfaction. Few studies have measured how nurses distribute their time across tasks. We aimed to quantify how nurses distribute their time across tasks, with patients, in individual tasks, and engagement with other health care providers; and how work patterns changed over a two year period.</p> <p>Methods</p> <p>Prospective observational study of 57 nurses for 191.3 hours (109.8 hours in 2005/2006 and 81.5 in 2008), on two wards in a teaching hospital in Australia. The validated Work Observation Method by Activity Timing (WOMBAT) method was applied. Proportions of time in 10 categories of work, average time per task, time with patients and others, information tools used, and rates of interruptions and multi-tasking were calculated.</p> <p>Results</p> <p>Nurses spent 37.0%[95%CI: 34.5, 39.3] of their time with patients, which did not change in year 3 [35.7%; 95%CI: 33.3, 38.0]. Direct care, indirect care, medication tasks and professional communication together consumed 76.4% of nurses' time in year 1 and 81.0% in year 3. Time on direct and indirect care increased significantly (respectively 20.4% to 24.8%, P < 0.01;13.0% to 16.1%, P < 0.01). Proportion of time on medication tasks (19.0%) did not change. Time in professional communication declined (24.0% to 19.2%, P < 0.05). Nurses completed an average of 72.3 tasks per hour, with a mean task length of 55 seconds. Interruptions arose at an average rate of two per hour, but medication tasks incurred 27% of all interruptions. In 25% of medication tasks nurses multi-tasked. Between years 1 and 3 nurses spent more time alone, from 27.5%[95%CI 24.5, 30.6] to 39.4%[34.9, 43.9]. Time with health professionals other than nurses was low and did not change.</p> <p>Conclusions</p> <p>Nurses spent around 37% of their time with patients which did not change. Work patterns were increasingly fragmented with rapid changes between tasks of short length. Interruptions were modest but their substantial over-representation among medication tasks raises potential safety concerns. There was no evidence of an increase in team-based, multi-disciplinary care. Over time nurses spent significantly less time talking with colleagues and more time alone.</p

Traditions of research into interruptions in healthcare: A conceptual review

Background Researchers from diverse theoretical backgrounds have studied workplace interruptions in healthcare, leading to a complex and conflicting body of literature. Understanding pre-existing viewpoints may advance the field more effectively than attempts to remove bias from investigations. Objective To identify research traditions that have motivated and guided interruptions research, and to note research questions posed, gaps in approach, and possible avenues for future research. Methods A critical review was conducted of research on interruptions in healthcare. Two researchers identified core research communities based on the community’s motivations, philosophical outlook, and methods. Among the characteristics used to categorise papers into research communities were the predominant motivation for studying interruptions, the research questions posed, and key contributions to the body of knowledge on interruptions in healthcare. In cases where a paper approached an equal number of characteristics from two traditions, it was placed in a blended research community. Results A total of 141 papers were identified and categorised; all papers identified were published from 1994 onwards. Four principal research communities emerged: epidemiology, quality improvement, cognitive systems engineering (CSE), and applied cognitive psychology. Blends and areas of mutual influence between the research communities were identified that combine the benefits of individual traditions, but there was a notable lack of blends incorporating quality improvement initiatives. The question most commonly posed by researchers across multiple communities was: what is the impact of interruptions? Impact was measured as a function of task time or risk in the epidemiology tradition, situation awareness in the CSE tradition, or resumption lag (time to resume an interrupted task) in the applied cognitive psychology tradition. No single question about interruptions in healthcare was shared by all four of the core communities. Conclusions Much research on workplace interruptions in healthcare can be described in terms of fundamental values of four distinct research traditions and the communities that bring the values and methods: of those research traditions to their investigations. Blends between communities indicate that mutual influence has occurred as interruptions research has progressed. It is clear from this review that there is no single or privileged perspective to study interruptions. Instead, these findings suggest that researchers investigating interruptions in healthcare would benefit from being more aware of different perspectives from their own, especially when they consider workplace interventions to reduce interruptions