Introduction 1. Woman's Place in Man's Life Cycle 2. Images of Relationship 3. Concepts of Self and Morality 4. Crisis and Transition 5. Women's Rights and Women's Judgment 6. Visions of Maturity References Index of Study Participants General Index

In a Different Voice. Psychological Theory and Women’s Development. Cambridge, MA (Harvard University Press) 1982.

http://science.sciencemag.org/content/sci/201/4359/899.2.full.pdf

Phenomenology of perception.

Individualism and collectivism

Symposium Review: 25th Anniversary of Moral Boundaries by Joan Tronto

ContextHealth literacy is a measure of patients' ability to read, comprehend,
and act on medical instructions. Poor health literacy is common among racial
and ethnic minorities, elderly persons, and patients with chronic conditions,
particularly in public-sector settings. Little is known about the extent to
which health literacy affects clinical health outcomes.ObjectivesTo examine the association between health literacy and diabetes outcomes
among patients with type 2 diabetes.Design, Setting, and ParticipantsCross-sectional observational study of 408 English- and Spanish-speaking
patients who were older than 30 years and had type 2 diabetes identified from
the clinical database of 2 primary care clinics of a university-affiliated
public hospital in San Francisco, Calif. Participants were enrolled and completed
questionnaires between June and December 2000. We assessed patients' health
literacy by using the short-form Test of Functional Health Literacy in Adults
(s-TOFHLA) in English or Spanish.Main Outcome MeasuresMost recent hemoglobin A1c (HbA1c) level. Patients
were classified as having tight glycemic control if their HbA1c
was in the lowest quartile and poor control if it was in the highest quartile.
We also measured the presence of self-reported diabetes complications.ResultsAfter adjusting for patients' sociodemographic characteristics, depressive
symptoms, social support, treatment regimen, and years with diabetes, for
each 1-point decrement in s-TOFHLA score, the HbA1c value increased
by 0.02 (P = .02). Patients with inadequate health
literacy were less likely than patients with adequate health literacy to achieve
tight glycemic control (HbA1c ≤7.2%; adjusted odds ratio [OR],
0.57; 95% confidence interval [CI], 0.32-1.00; P
= .05) and were more likely to have poor glycemic control (HbA1c ≥9.5%;
adjusted OR, 2.03; 95% CI, 1.11-3.73; P = .02) and
to report having retinopathy (adjusted OR, 2.33; 95% CI, 1.19-4.57; P = .01).ConclusionsAmong primary care patients with type 2 diabetes, inadequate health
literacy is independently associated with worse glycemic control and higher
rates of retinopathy. Inadequate health literacy may contribute to the disproportionate
burden of diabetes-related problems among disadvantaged populations. Efforts
should focus on developing and evaluating interventions to improve diabetes
outcomes among patients with inadequate health literacy.

https://jamanetwork.com/journals/jama/articlepdf/195143/JOC12049.pdf

Association of health literacy with diabetes outcomes.

This book examines the nature of clinical knowledge and judgment. The authors present a report of a six-year study of over 1,300 hospital nurses, primarily in critical care. The contributors document and analyze their clinical narratives for stages of clinical skill acquisition and the components of expert practice. Ultimately, this work examines the meaning of expertise in nursing practice through the nurse's use of scientific knowledge, professional experience, and careful attention to each patient's changing condition.

Expertise in Nursing Practice: Caring, Clinical Judgment and Ethics

Barriers to diabetes management: patient and provider factors.

The purpose of this study was to further explicate the Dreyfus Model of Skill Acquisition in the practice of critical care nursing. For this analysis data were used from a sample of 105 nurses practicing in the adult, pediatric, and newborn intensive care units of eight hospitals in three metropolitan areas. The data were composed of group interviews in which nurses gave narrative accounts of exemplars from their practice and close observations and intensive personal history interviews of a subsample of nurses. Two interrelated aspects were found to distinguish four levels of practice, from advanced beginner through expert. First, practitioners at different levels of skill literally live in different clinical worlds, noticing and responding to different directives for action. Second, a sense of agency is determined by one's clinical world and shows up as an expression of responsibility for what happens with the patient.

From beginner to expert: gaining a differentiated clinical world in critical care nursing.

Nurses' discourse about knowing the patient emerged as a recurring theme in an interpretive phenomenological study of the development of expertise in critical care nursing. The purpose of this article is to present analyses related to the meaning of knowing the patient, and its role in everyday nursing practice. Informants in the study were 130 nurses who practiced in adult, pediatric and newborn intensive care units of eight hospitals in three metropolitan areas. The data were group interviews in which nurses gave narrative accounts of exemplars from their practice; in addition, a sub-sample of 48 nurses were observed in their practice and participated in intensive personal history interviews. Knowing the patient means both knowing the patient's typical pattern of responses and knowing the patient as a person. Knowing the patient is central to skilled clinical judgment, requires involvement, and sets up the possibility for patient advocacy and for learning about patient populations.

Catherine A. Chesla

Papers

Expertise in Nursing Practice: Caring, Clinical Judgment and Ethics

Barriers to diabetes management: patient and provider factors.

From beginner to expert: gaining a differentiated clinical world in critical care nursing.

The Phenomenology of Knowing the Patient

Expertise in Nursing Practice