William James greatly influenced the fields of psychology, philosophy, and religion during the late 19 and early 20 centuries. This was the era of Modernism, a time when many writers rejected the certainty of Enlightenment ideals. Positivism, which rose to prominence in the early 19th century, had emphasized physical phenomena, empirical evidence, and the scientific method. Darwin's On the Origin of Species, with its theory of natural selection, provided an explanation for the evolution of species apart from a divine Creator. (...) Within this context, William James served as a "mediator between scientific agnosticism and the religious view of the world." James' own experience inhaling nitrous oxide played an important role in shaping his views. For James, the use of nitrous oxide served a key role in elucidating some of his most central ideas: 1) the value of religion, and the emphasis on mysticism and revelation as religion's foundation; 2) the universe as pluralistic, driven by chance, experience, and change. (shrink)

Historically, research-focused doctoral programs in nursing have used the apprenticeship model to educate and prepare nurse scientists for research careers. The assumption is that students learn best when paired with a faculty member who is working on the same topic. This model works well when there is a stable workforce, adequate funding streams and sufficient faculty with diverse expertise to capture the enthusiasm and varied topics of incoming doctoral students. However, we believe there are alternative approaches that are worth exploring. (...) We propose an alternative way of preparing students for entry into nursing science. The purpose of this paper is to describe one PhD program's new approach, based on the philosophical premises of Bernard Lonergan, to create a generation of creative, insightful thinkers who expand the horizons of the nursing discipline. (shrink)

Cardiovascular disease is the number one cause of death for women in the United States. Acute myocardial infarction carries a more negative prognosis for women than men. Women with AMI have both increased mortality and disability. All researchers who have documented a difference in delay times between men and women note that women delay longer in seeking treatment. In the case of an evolving AMI, women who delay in seeking medical attention will often place themselves outside the limits of reperfusion (...) therapies such as angioplasty and thrombolysis, thereby increasing their risk of an out-of-hospital sudden cardiac death. Several investigators have reported that reasons for delay to treatment may include the presence or absence of “somatic awareness”, that is, how a woman perceives body activity and physiological functioning. The inability of women to disregard social roles and place primacy of caring over their own health issues may limit them from seeking formal care. Social roles and obligations in a women’s life are often influenced by everyday, ordinary happenings which may have a negative impact on decision making. These everyday, ordinary happenings have been defined as “daily hassles”. The Leventhal self-regulatory model of illness behavior, which has been used to study treatment seeking behavior in response to symptoms, provides a coherent framework for interpreting the problem of delayed treatment of myocardial infarction. The Leventhal model proposes that the patients’ belief about their health is structured in a hierarchical fashion and that these structures are based on previous illness experiences and information presented in the social environment. Utilizing a descriptive design, this study examined the relationship between somatic awareness and daily hassles and how these variables influenced a women’s treatment seeking behavior in AMI. The Modified Somatic Perception Questionnaire was used to measure somatic awareness; and daily hassles were measured through the Daily Hassles and Uplift Scale. The questionnaires were administered at least 24 hours post admission to women with AMI. Though there were no significant relationships found between somatic awareness, daily hassles and time to treatment for AMI, the study revealed other pertinent findings. A significant relationship was found between daily hassles and age; revealing that younger participants revealed a higher daily hassle score. Also, a significant relationship was found between total MSPQ and prior cardiac events; indicating infrequent occurrence of intense symptoms experienced by women with a positive cardiac history. Though it is unknown what impact this new knowledge will have on treatment of women with AMI, these findings hold promise for clarifying these areas of research. Keywords: somatic awareness, daily hassles, treatment seeking behavior, women with acute myocardial infarction. (shrink)

CONTEXT: The phrase "Science of Improvement" or "Improvement Science" is commonly used today by a range of people and professions to mean different things, creating confusion to those trying to learn about improvement. In this article, we briefly define the concepts of improvement and science, and review the history of the consideration of "improvement" as a science. METHODS: We trace key concepts and ideas in improvement to their philosophical and theoretical foundation with a focus on Deming's System of Profound Knowledge. (...) We suggest that Deming's system has a firm association with many contemporary and historic philosophic and scientific debates and concepts. With reference to these debates and concepts, we identify 7 propositions that provide the scientific and philosophical foundation for the science of improvement. FINDINGS: A standard view of the science of improvement does not presently exist that is grounded in the philosophical and theoretical basis of the field. The 7 propositions outlined here demonstrate the value of examining the underpinnings of improvement. This is needed to both advance the field and minimize confusion about what the phrase "science of improvement" represents. We argue that advanced scientists of improvement are those who like Deming and Shewhart can integrate ideas, concepts, and models between scientific disciplines for the purpose of developing more robust improvement models, tools, and techniques with a focus on application and problem solving in real world contexts. CONCLUSIONS: The epistemological foundations and theoretical basis of the science of improvement and its reasoning methods need to be critically examined to ensure its continued development and relevance. If improvement efforts and projects in health care are to be characterized under the canon of science, then health care professionals engaged in quality improvement work would benefit from a standard set of core principles, a standard lexicon, and an understanding of the evolution of the science of improvement. (shrink)

In the last several years, state mental health authorities throughout the United States have assigned a high priority to the funding, development, and operation of case management programs. Although the concept of case management has been in existence for over a decade, there is still confusion regarding the definition of case management and the identification of alternative case management approaches. Recognizing this confusion, the Center for Psychiatric Rehabilitation undertook a comprehensive study to determine the state of case management practice today. (...) This article reports on the results of a national survey of case management programs and describes the characteristics of the programs themselves, the case managers, the clients they serve, and the systems within which they operate. Implications of these findings for a definition of case management are discussed. (shrink)