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The study aimed to extend the existing discussion on assessment literacy by focusing on English teachers’ ability to implement it in South Korea where a new assessment policy was implemented as part of educational reform. Scholars have pointed out a lack of teachers’ assessment knowledge and gaps in their ability to conduct the appropriate assessment for effective instruction. Thus, the scope of teacher assessment literacy needs to include teachers’ ability to implement it appropriately in given contexts. Grounding our study in the notion of teacher-based assessment as a guiding framework and using a mixed-methods design, we examined how Korean teachers perceived performance assessment emphasized in the reform and how they put it into practice. One hundred and twenty-seven teachers participated in survey questionnaires and 15 teachers were interviewed as a follow-up. The findings of the study showed that there were discrepancies between the teachers’ perceptions of assessment and their assessment practice and that the teachers showed diverse reactions toward teacher-based assessment from being capable to feeling powerless depending on their assessment knowledge and contextual constraints. The study suggests the importance of teachers’ agency in assessment literacy as a prerequisite for teacher-based assessment.

Despite the widespread use of celebrity endorsers to stimulate word of mouth in marketing practice, surprisingly little academic research investigates factors that influence consumers to spread word of mouth about celebrity-endorsed brands. In accord with compensatory consumer behavior research on consumer power states, we find that consumers in low-power states report stronger intentions to spread word of mouth about a brand that is celebrity-, compared to model-, endorsed, and that consumers in low-power states report stronger intentions to spread word of mouth about celebrity-endorsed brands than consumers in high-power states. However, consumers in high-power states can be encouraged to spread word of mouth about celebrity-endorsed brands when the endorsement message communicates high-power expectations, because such messages are easier to process. Consumers in high-power states seek to conform to expectations of how powerful people behave, and spread word of mouth in order to self-verify their power state. Consumers in low-power states are attuned to status cues that facilitate perceptions of the brand as possessing referent power, and spread word of mouth in order to remedy the aversive nature of feeling powerless.

This research sought to address a gap in the literature about women’s lived experience of pelvic surgical mesh complications, conducted by an insider researcher. An increasing number of women who have pelvic mesh surgeries with a view to improving their lives are experiencing life-altering complications. Without knowledge of these experiences we cannot know how best to care for affected women and prevent harm to further women. Van Manen’s hermeneutic phenomenological method was used. Seven women with pelvic mesh complications aged 43–69 years were enrolled using criterion sampling. Four of the seven women had surgical mesh for both pelvic organ prolapse (POP) and stress urinary incontinence (SUI), one for POP only, and two for SUI only. The women completed a modified ICIQ-LUTSqol questionnaire pre-interview and answered a separate global spiritual question adapted from the HOPE tool, a framework for spiritual assessment. Women were interviewed once using a semi-structured approach. Data were analysed using Van Manen’s selective reading technique and organized according to Lifeworld Existentials. Modified ICIQ-LUTSqol scores ranged between 43 and 76 (range 19–76), with a mean of 62.2 (SD + 10.011) demonstrating significant impact on quality of life. Themes emerging from the analysis were: (1) lived space: 1(a) feeling powerless in the medical space, 1(b) living in a shrinking world; (2) lived body: 2(a) living with unrelenting pain, 2(b) inhabiting a body that can no longer be relied on; (3) lived time: 3(a) living in the gap between what was and what could have been; (4) lived other: 4(a) suffering in silence, 4(b) finding absolute Other and others as a source of strength. Pelvic surgical mesh complications have an extensive adverse impact on the lifeworld of women experiencing complications. Failure to acknowledge mesh complications as treatment injury stalls the development of safer alternatives and changes needed to industry practices, regulation, clinical practice, and monitoring to keep women undergoing innovative urogynaecological procedures safe.

Moral distress is prevalent in many areas of medicine, including the NICU.1 Defined as “knowing the right thing do to, but feeling powerless to do it,” moral distress was initially thought to be experienced primarily by bedside nurses related to constraint from the medical team’s hierarchy.1 However, we now recognize that all health care team members experience moral distress, and the increasing complexity of health care delivery has increased the prevalence of moral distress.2,3 In this issue of Pediatrics, Prentice et al use a mixed-method study to assess moral distress in 525 neonatologists, trainees, and nurses in relation to 99 patients

Background Continuous Positive Airway Pressure (CPAP) is a form of non-invasive ventilatory support which is increasingly used in low- and middle-income countries to treat neonates with acute respiratory distress. However, it may be harmful if used incorrectly. We aimed to explore the experiences of doctors and nurses using CPAP in neonatal units in India and their views on enablers and barriers to implementation of CPAP. Methods Participants from 15 neonatal units across Andhra Pradesh were identified through purposive sampling. Eighteen in-depth interviews (IDI) with doctors and eight focus group discussions (FGD) with 51 nurses were conducted. Data were analysed thematically using the framework approach. Results Common structural factors that limit the use of CPAP include shortages of staff, consumables and equipment, and problems with regard to the organisation of neonatal units in both district hospitals and medical colleges. This meant that CPAP was often not available for babies who were identified to need CPAP, or that CPAP use was not perceived to be of the highest quality. Providing care under constrained circumstances left staff feeling powerless to provide good quality care for neonates with acute respiratory distress. Despite this, staff were enthusiastic about the use of CPAP and its potential to save lives. CPAP use was mostly perceived as technically easier to provide than ventilation and allowed nurses to provide advanced neonatal care, independently of doctors. Conclusions Doctors and nurses embraced CPAP use but identified barriers to implementation which will need to be addressed in order not to impact on safety and quality of care. Ensuring a supportive and enabling environment is in place will be crucial if CPAP is to be scaled-up more widely. Electronic supplementary material The online version of this article (10.1186/s12887-018-1311-8) contains supplementary material, which is available to authorized users.

Stillbirth is a tragedy that can leave parents feeling powerless and vulnerable. Respectful and supportive bereavement care is essential to reducing adverse psychosocial impact. Initiatives of the Australian Centre of Research Excellence in Stillbirth are designed to improve care after stillbirth. At their heart are the voices of perinatally bereaved parents and support organisations and shared decision making between parents and health care providers. Priorities in future perinatal bereavement care research include ensuring appropriate care for population groups who experience higher rates of stillbirth and addressing implementation challenges to best practice in respectful and supportive bereavement care within our health systems.

In Ruth Ozeki’s 2013 novel A Tale for the Time Being, sixteen-year-old Nao faces severe bullying and sexual violence at her new school in Japan. Seeking escape, she experiments with different identities, turning first to the Internet and then later to Zen Buddhist practices. These approaches appeal to her because they allow her to transcend the bounds of her physical body, but she soon finds these experiences limiting in other ways. Intervening in discourses about the liberating potentials of cyber- and Buddhist feminisms, Ozeki’s novel explores how experiences of disembodiment are empowering in some ways and inhibiting in others. This article argues that A Tale for the Time Being critiques philosophies that strive for social liberation by denying physicality and introduces a model of feminism that balances material and bodily experiences with ideas of equality that emerge from cyber-, Buddhist, and transnational feminist projects. Nao Yasutani is not sure if she wants to live. The sixteen-year-old Japanese girl, who takes center stage in Ruth Ozeki’ s2 013 novel AT ale for the Time Being, confides her troubles in her diary. Forced to leave her California home and relocate with her family to Japan, she faces severe bullying at school and is unable to rely on her suicidal father and absent mother. Feeling powerless and alone, “ al ittle wave person,floating around

Incarcerated youth have numerous healthcare needs, yet access to healthcare following community reentry is limited. Healthcare and juvenile justice providers, along with parents, strongly influence access to care for youth undergoing reentry. However, their perspectives are often missing from the literature. We examined parent and provider perspectives on youths' access to healthcare during community reentry. We conducted 72 longitudinal interviews with parents of youth undergoing reentry (n= 34 parents) and cross-sectional interviews with health and juvenile justice providers (n=20 providers). We performed inductive analysis of interview transcripts to identify the major themes related to access to healthcare during reentry. Respondents identified key leverage points that influence access to healthcare along the spectrum of individual, community, and policy-level factors. Parent and provider perspectives demonstrated substantial overlap, strongly concurring on the essential role of parents in linking youth to care and the external factors that limit parents' ability to connect youth to care. However, providers discussed parents not buying-in to treatment plans as a barrier to care, and parents uniquely described feeling powerless when their children were not motivated to receive care. Parents and providers agreed on priority solutions for improving care access during reentry. Immediate solutions centered on: 1) increasing reliability and continuity of providers, 2) providing free or low-cost transportation to healthcare visits, and 3) eliminating gaps in Medicaid coverage post-incarceration. Findings also signal the broader need to pursue strategies that increase family engagement in healthcare during reentry. In doing so, health and juvenile justice providers can partner with parents to overcome barriers to healthcare for youth during reentry.

© 2018 Informa UK Limited, trading as Taylor & Francis Group. Aim: To explore the experience of readmissions to hospital from the perspective of older adults. Methods: A systematic review with an interpretative approach was conducted. CINAHL, Embase, and Medline were consulted in October 2016. Results: Six studies with data collection between 2004 and 2013 fit the relevant criteria and included a total of 68 older adults. Two overarching themes were developed with relevant subthemes: Experience during initial hospital stay distinguished by exclusion (Feeling powerless; Feeling disregarded; Perception of readiness for discharge); Patients experience uncertainty following discharge (Perception that community-based services are not available or adequate; Perception that hospital is the only safe place; Difficulty in adapting to a “new normal”). Conclusions: A cycle of exclusion exists during the initial hospital stay and beyond. The experience of being readmitted to hospital is challenging, mostly perceived as negative, and, existential, emotional and psychological well-being is not satisfactorily addressed by healthcare professionals.

Two experiments examined the role of perpetrator power in witnesses’ decision to confront a prejudicial remark. In Experiment 1, participants who witnessed a sexist remark by a higher-power (vs. an equal-power) perpetrator were significantly less likely to express confrontation intentions, despite finding the remark highly biased and inappropriate. In Experiment 2, participants read scenarios involving a sexist versus racist remark perpetrated by someone higher vs. lower vs. equal in power, and they reported their confrontation intentions. Perpetrator power again inhibited direct confrontation intentions, and this effect was mediated by perceptions of responsibility for intervening, perceived ability to decide how to respond, and perceived costs versus benefits of confronting. Findings were not qualified by discrimination type (racism vs. sexism) or by individual differences in participant prejudice. Consistent with power-as-approach theory, feeling powerless increased sensitivity to confrontation obstacles and thereby inhibited confrontation intentions.

Spirituality and religion are acknowledged as playing a vital role in psychological coping within monotheistic (especially Christian) and American populations. Other traditions, however, remain largely absent from the coping literature. In addition, the bulk of the work consists of quantitative methods, so the examination of the constructs remains limited. In the present study, a 49-year old Caucasian woman living in northern Indiana in the U.S. is interviewed about her use of shamanistic beliefs and rituals to cope with bulimia. Content analyses reveal that over the course of the interview, she identifies shamanic rituals as facilitating a change from feeling powerless to feeling empowered to alter the bulimic behaviors. Related themes concerning energy and strength also emerge and stand in relation to an expression of the importance of an internalized system of beliefs. These observations align with the predominately monotheistic American literature, suggesting that principles of religious and spiritual coping may be meaningful in the context of other traditions.

BACKGROUND AND OBJECTIVES: Medical errors are a leading cause of death in the United States. Effective communication and speaking up are crucial factors in patient safety initiatives. We examined the reasons reported by pediatric residents for not speaking up about safety events when they are observed in practice. We also tested a priori hypotheses of associations between categories of barriers to speaking up with perceptions of safety and teamwork culture. METHODS: Pediatric residents completed an anonymous electronic survey measuring safety and teamwork culture along with an open-ended question asking them to list the top 3 barriers to speaking up about patient safety concerns. Researchers independently coded the open-ended responses to identify themes, which were then categorized into a published framework. Data were collected in 2013 (response rate = 46%) and 2014 (response rate = 62%). RESULTS: The most common reported barriers to speaking up were as follows: perceived personal safety of speaking up (consequences, intimidation, and hierarchy concerns), individual barriers (communication skills and confidence), perceived efficacy of speaking up (feeling powerless), and contextual factors (high workload). Residents who reported barriers relating to efficacy of speaking up reported lower safety culture scores in 2013 and 2014. Residents who reported barriers related to safety reported lower teamwork culture scores in 2013. CONCLUSIONS: Pediatric residents reported individual barriers, personal safety concerns, lack of efficacy, and contextual factors as reasons to not speak up about patient safety. Concerns about the safety of speaking up and the efficacy of speaking up were correlated with teamwork and safety culture, respectively.

The loss of autonomy associated with dementia affects the people with dementia themselves as well as their caregivers who are often left feeling powerless and incompetent in their caregiving role. Most of the programs developed to support caregivers focus on burden and do not consider the positive aspects of caregiving. Leisure represents a way to enhance the presence of positive aspects in the caring experience. Moreover, leisure might contribute to the maintenance of satisfactory relationships between the caregivers and the person with dementia. An adapted leisure education program was developed as a means of support to caregiver involvement. This study (n=49) aims to evaluate the impact of this program on caregivers' well-being, self-efficacy towards adapted leisure, and quality of the relationship with the care receiver. Mixed methods were used. Pretest-posttest with a follow-up design made up the quantitative part. In addition, open-end interviews (n=10) were conducted. The quantitative results showed few impacts of the program on caregivers. However, the qualitative analysis revealed that the intervention had positive impacts for the caregivers, care receivers and other family members. This study introduces caregiver support in a new, positive perspective by focusing on the positive aspects of caregiving rather than the burden.

Narrative letter writing is used in therapy as a powerful therapeutic tool. Letters written to the client can help rewrite his or her story, as well as help clients realize that they are their own agent of change. Women, feeling powerless in a male dominant society, may need to feel that they have the strength within to change. Providing the client a nickname can help maintain confidentiality, and can also strengthen his or her drive. Mythology can serve as a tool for therapists in selecting a nickname for the client. Matching a God or Goddess to a client can be a therapeutic tool.

PurposeThis study investigated the experiences of Japanese women who underwent emergency cesarean sections (c-sections), including their experiences during labor before to the decision for surgery, during surgery, and during the first postnatal week.MethodsEleven Japanese women who delivered live babies by emergency c-section at a private maternity hospital were interviewed in a semi-structured manner on the second and seventh postpartum days. Interviews were tape-recorded, and transcripts and participant observation in the postnatal ward assisted the interpretation. Data were analyzed qualitatively and inductively.ResultsEleven women (seven primiparas, four multiparas) participated in the study. The main reasons for surgery were fetal distress (n=9) and arrest of labor (n=2). The time between making the decision to perform surgery and birth ranged from 15 to 69 minutes. Six themes were evident from the women's experiences: shock of disappointed expectations, unavoidable fear and responsibility, release from pressure, re-experience of fear and pain, being "saved" by the baby, and getting out of a vicious cycle. Trying labor pain, shock, fear of their babies' or their own deaths, and feeling powerless and guilty contributed to the women's negative feelings about their birth experiences by emergency c-section. After surgery, however, women felt loving toward their babies, who had been born safely as a result of the surgery, and eagerly breast-fed or took care of the infants with midwifery/nursing support.ConclusionsThe findings suggest that prenatal childbirth classes need to include information on and discussion of possible emergency c-section and that emotional support from midwives and nursing staff in the operating room/postpartum unit helps to decrease a woman's negative feelings about birth experiences by emergency c-section and enhance her experiences as a mother. In addition, medical staff should be more aware of the birth trauma felt by the expectant mother surrounding emergency c-section.

Victims of violent crime often complain of feeling powerless. In some respects this represents a psychological aftereffect of the crime — an experience in which something was done to them against their will that they were powerless either to prevent or to stop. However, focusing attention on the psychological aftereffects of such experiences often overshadows other important considerations. For example, there is the possibility that an accumulation of subsequent social and institutional interactions may serve to minimize their ability actively to cope with their experiences. This paper seeks to address these issues head on by reframing victimization in terms of the interplay between victims' social and institutional interactions, on the one hand, and their agency to cope on the other.1 Following a brief review of the critical literature on victims' problematic institutional positions and a discussion of agency, data will be presented from a qualitative study of individuals who have suffered the murder of a loved one.2 As will be seen, the differing experiences of these individuals in a variety of social contexts have much to teach us about institutional influences, therapeutic ideologies, and human agency.

Simple Summary In rental housing policy, pets are rarely considered as valued household members. Instead, landlords and property managers are often permitted to ban pets outright, or to advertise them as merely negotiable in their listings for rental housing. In fact, previous research has shown that moving and renting are key reasons for animal relinquishment. To reduce the number of animals that are given up each year due to housing issues, we surveyed landlords and property managers about their perspectives towards pets. Also, because younger adults are disproportionately tenants and because dogs are often banned from rental housing, we interviewed younger tenants with dogs about their recent experiences in the rental market. Our results confirm that dog owners face difficulties in finding rental housing. To keep their pets, tenants made compromises on where and how they lived, which held consequences for their health and that of their pets. Suggestions for improvement are provided, as are implications for research, policy, and practice. Abstract Previous research has shown that housing insecurity contributes to animal relinquishment and that tenants with dogs face disadvantages in the rental market. Still, little is known about how dog owners navigate rental markets, nor how landlords and property managers perceive dogs and other pets. This case study reports on in-depth interviews with younger tenants with dogs and on open-ended survey responses from landlords and property managers. In their housing searches, tenants with dogs reported feeling powerless in negotiations and feeling discriminated against. They described settling for substandard properties, often located in less desirable neighborhoods. Also, some said they felt obliged to stay put in these rentals, given how difficult it had been to find a place that would accommodate their dogs. Meanwhile, landlords and property managers indicated that listings advertised as “pet-friendly” tend to receive more applicants than listings in which pets are prohibited. Suggestions for improvement included meeting pets prior to signing the lease; getting everything in writing; steering clear from furnished units; charging utilities to tenants; and speeding up the pet approval process when dealing with condominium boards. These suggestions offer implications for future research, partnerships, and policy options to improve the prospects of pets and their people in rental housing.

Cure sometimes, treat often and comfort always – Hippocrates As clinicians, we are in a uniquely privileged position; we have passive admittance to the most private aspects of human life and often find ourselves silent observers of death. Sometimes we may be left feeling powerless and that maybe we have failed, given the expectations of modern medicine. In this issue of the Future Healthcare Journal we explore the complexities of creating sustainably resourced end-of-life and palliative care services. These require a foundation of specialist education and skills to empower clinicians, not …

This chapter will explore and analyse the perceptions of the young people and professionals of how certain aspects of the overall policy framework and practices of the care system relate to and influence offending behaviour. It will begin by exploring the impact of placement movement upon already vulnerable young people and go on to discuss how placement size, homogeneity and location have the potential to engender negative reactions. Certainly, the ideals of corporate parenting seem to be something which the care system all too often fails to uphold with young people often feeling powerless to influence their experiences.

One of the recurring problems reported by supported employment participants has been an overall lack of involvement in the process. People with disabilities have reported feeling powerless within programs which offer no opportunity for choice and control. This creates a need to provide opportunities within supported employment to maximize consumer participation. The Consumer Initiated Approach to Supported Employment demonstrates how to promote full consumer inclusion. The authors provide an overview of this approach. Key model components include: customer lead assessment, customer driven job selection, individualized vocational supports and customized job retention services. The outcome data from this federally funded demonstration project are also provided.

Fred Cummings is an ABD working on his dissertation at a land grant institution in the Midwest. Unfortunately, four of the five members on his dissertation committee are making it difficult for him to complete it. Feeling powerless and vengeful, he plots four distinct plans to get back at each one of his faculty tormentors. His schemes have some unexpected results.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:03:56Z No. of bitstreams: 1 S1413-81232011000400026.pdf: 40418 bytes, checksum: 25eaccffc7d26fc4fb2ffd08b7236d01 (MD5) Made available in DSpace on 2013-08-22T19:03:56Z (GMT). No. of bitstreams: 1 S1413-81232011000400026.pdf: 40418 bytes, checksum: 25eaccffc7d26fc4fb2ffd08b7236d01 (MD5) Previous issue date: 2011-04-01 Made available in DSpace on 2013-09-30T20:06:24Z (GMT). No. of bitstreams: 2 S1413-81232011000400026.pdf: 40418 bytes, checksum: 25eaccffc7d26fc4fb2ffd08b7236d01 (MD5) S1413-81232011000400026.pdf.txt: 33496 bytes, checksum: 7340f84d8787cf7592ae218ae56afda6 (MD5) Previous issue date: 2011-04-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:34:50Z No. of bitstreams: 2 S1413-81232011000400026.pdf: 40418 bytes, checksum: 25eaccffc7d26fc4fb2ffd08b7236d01 (MD5) S1413-81232011000400026.pdf.txt: 33496 bytes, checksum: 7340f84d8787cf7592ae218ae56afda6 (MD5) Made available in DSpace on 2014-05-20T13:34:50Z (GMT). No. of bitstreams: 2 S1413-81232011000400026.pdf: 40418 bytes, checksum: 25eaccffc7d26fc4fb2ffd08b7236d01 (MD5) S1413-81232011000400026.pdf.txt: 33496 bytes, checksum: 7340f84d8787cf7592ae218ae56afda6 (MD5) Previous issue date: 2011-04-01 A busca por espaços comunicativos para reflexão sobre o exercício e a prática da enfermagem, usando referenciais bioéticos, teve o objetivo de apreender como os enfermeiros participantes do estudo interpretam a realidade da sua prática perante a observância da justiça. Utilizou-se a técnica de grupo focal para coleta de dados e, para análise, a Grounded Theory. Foram identificados três fenômenos: conceituando senso de justiça; sentindo-se impotente em conviver com iniquidades/injustiças; movendo-se em direção às lutas por justiça. da inter-relação deles, emergiu a categoria central: construindo mecanismos de superação de injustiças e iniquidades que minam a qualidade da assistência de enfermagem: a experiência de enfermeiros recém-formados em um hospital estadual do interior paulista. A estratégia de grupo focal mostrou-se muito adequada à consecução dos objetivos propostos, e a Grounded Theory permitiu a compreensão do movimento empreendido pelos enfermeiros nessa experiência. The search for communicative settings for reflection concerning the exercise and practice of nursing based on bioethical frameworks sought to comprehend how participant nurses interpret the reality of their praxis vis-à-vis the observance of justice. The focal group technique was used for data collection and the latter was analyzed using Grounded Theory. Three phenomena were identified: conceptualizing a sense of justice; feeling powerless in living with inequities/injustice; and moving towards the fight for justice. From the inter-relation of such phenomena, the core categories emerged, namely constructing mechanisms to overcome injustice and inequities which undermine quality in nursing care, and the experience of recently-graduated nurses in a public hospital in the interior of São Paulo State. Focal group strategy proved to be highly adequate for achieving the proposed objectives, and Grounded Theory made it possible to assess the movement undertaken by the nurses in this experience. Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Enfermagem Universidade Estadual Paulista Júlio de Mesquita Filho Faculdade de Medicina de Botucatu Departamento de Enfermagem

In May 2008, townships around South Africa exploded in what has been called xenophobic violence. Barbaric images of foreigners being burned alive and assaulted by xenophobic mobs were splashed across most international newspapers and TV. Scores of people were killed and thousands displaced as internal refugees. It was sobering, leaving me feeling powerless, distraught and deeply ashamed. I imagine most South Africans felt the same way. Xenophobic violence in South Africa is a stark reminder of how easily violence can still erupt despite all the efforts that have been put into building a new human rights culture in the country. Issues raised by the xenophobic violence seen in South Africa in 2008 lie at the heart of this chapter.

Interacting with people who suffer from dementia poses a challenge for care providers, and the presence of behavioral disturbances adds a further complication. Our article is based on the assumption that behavioral disturbances are meaningful expressions of experiences. Six narrative interviews were conducted with care providers with the aim of illuminating the meaning of interaction with people suffering from dementia and behavioral disturbances. The interviews were tape-recorded, transcribed into text, and interpreted using a phenomenological hermeneutic methodology. The findings indicate that interacting with people with dementia and behavioral disturbances, as narrated by care providers, means balancing between contradictions concerning meeting the person in my versus her/his world, feeling powerless versus capable, and feeling rejected versus accepted. Interaction involves being at various positions along these continua at different points in time. Furthermore, it means facing ethical dilemmas concerning doing good for the individual or the collective. This is interpreted as a dialectic process and is reflected on in light of Hegel's reasoning about the struggle between the master and the slave.

Although the BMJ briefly and objectively mentioned the ombudsman’s report,1 2 the medical profession is all too muted. Geriatric nurses seem afraid to support the critics, and some doctors report feeling powerless to change things. I would have expected far more anger and outrage. But the truth is unpalatable and people recoil …

Relationships between health status and behavioral factors were studied in 211 insulin-dependent diabetic children, ages 5-19 years, at a camp for diabetic children. In general, diabetic control, as measured by counselor-monitored urine tests made across a 2-week period, improved across age. Diabetic control was negatively related to knowledge of diabetes; that is, the worse the diabetic control, the higher the degree of knowledge. Acquisition of a high level of knowledge was viewed as a coping effort in response to the stress of poor diabetic control. Also, boys in poor diabetic control tended to be more internal in locus of control (ready to take action to confront their difficulties), and girls in poor diabetic control tended to be more external (feeling powerless and acting compliant). This sex difference in the relationship between diabetic control and locus of control was interpreted as reflecting sex differences in responses to stress. Findings involving other health status, behavioral, and demographic variables are presented and discussed.

Feeling powerless is a major cause of tension in organizations. This paper looks at five techniques that facilitate the effective use of power — in both managers and subordinates.