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Executive Summary Risk and Quality Managment in Healthcare

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As mentioned in Chapter 1, Urie Bronfenbrenner (1917–2005), proposes an ecological theory that centers on the relationship between the developing individual and the changing environmental systems. These interactions cannot be captured entirely in the laboratory, for, as Bronfenbrenner
(1979, p. 27) points out, “Development never takes place in a vacuum; it is always embedded and expressed through behavior in a particular environment.” One cannot grasp human development by simply observing and measuring individuals’ behavior in clinical settings that are divorced from their relevant social, physical, and cultural environments. Of course, change must occur over time, and so Bronfenbrenner added the concept of the chronosystem to capture the dynamics of development with and across other systems. The chronosystem refers to changes within the individual and changes in the environment across time, as well as the relationship between the two processes. For example, if a divorce occurs in a child’s family during the preschool period, it will have a different impact than if the child is an adolescent or young adult. Bronfenbrenner’s ideas have been influenced by Freud, Piaget, Vygotsky, and, most importantly, Kurt Lewin. According to Lewin’s field theory, the “dialogue” between the person and the environment can be expressed in the formula B=f(PE): Behavior is determined by the interaction between the Person and the Environment. Bronfenbrenner modifi ed the formula to refl ect the distinction between behavior and development so that his formula reads D=f(PE): Development is the result of the interaction between the Person and the Environment. By substituting development for behavior in the equation, he highlights the importance of time and, with that, change and the significance of the longitudinal study as essential to understanding the human condition. In proposing the ecological model as a research tool, Bronfenbrenner wants to move away from the traditional focus that sees either the environment (E) or the person (P)—instead of the relationship between them—as the most important aspect of development.

Furthermore, he wants to focus on the process of development rather than concentrate on isolated variables at a single point in time. Think of someone you know who either dropped out of school or considered dropping out. Bronfenbrenner suggests that an approach focusing solely on factors such as the yearly income of the family, intellectual ability, or ethnicity to explain the student’s disengagement from school will miss most of the information relevant to this particular student’s situation. Instead of trying to match categories or labels with certain outcomes, researchers must look at the relationships among variables in different environments. If you were to read an article in a research journal that sought to explain your friend’s “dropping out” primarily in terms of distinct categories to which she or he belonged, you would probably be dissatisfi ed with the explanation, knowing that the reasons were much more complex or historical than those offered by the researcher. Finally, Bronfenbrenner’s theory is important as a way of capturing how people make sense of their circumstances and how their understanding, in turn, influences their behavior. You have probably been in a situation where a number of people reacted differently to the same experience. How each person defined that situation—based on his or her personal history, expectations, feelings, and so forth—determined how he or she behaved. It is important to keep in mind while studying development not only that different people see things differently, but that the same person—as she or he develops cognitively, physically, and psychosocially—will see the same phenomenon differently throughout the life span. For example, a person will probably have very different reactions to a film about war if the same film is seen both before and after the person has fought in a real war.

Preview: ... s a point of explaining that individual internal psychology, while important, is not the whole story of individual growth and development; the external environment and the many experiences that flow from it to the individual are also involved. A core principle he uses in this regard is "developmental influences" (1979, p. 4), and he connects it to individual psychology by saying that these influences are important not because of their objective reality but because of how the individual perceives or interprets them (Bronfenbrenner, 1979, p. 22). The combination of the wash of experience on an individual and that person's response to it constitutes a system on which features of life events can be hung and evaluated. Graphical representation of Bronfenbrenner's ecological system in which a child functions is in the form of a cross section of a layered sphere. A name is given to each layer of the system, and each layer represents a kind of relationship between the child as self and the content of that layer as the other. As the layers move outward from the center, the child's relationship becomes progressively more impersonal influences. The content of the relationship at each level seems to be the ecological health of the child's environment. At the core of this sphere is of course the child himself, who is not categorized by Bronfenbrenner but who can be thought of as the organism system.
Encircling the organism is the first layer, the microsystem, the name given to the "immediate environment," or network of intimate relationships; examples given are family, school, doctors, peers, neighborhood, church group (Bronfenbrenner, p. 643). The divorce of my parents upset the microsystem stability of my life, and it changed my relationships at school and church when I had to get work to help my mother financially. The relevance of the personal transition that I made is best expressed in connection with the fact that because there was no longer any father-breadwinner in the house, I eventually had to step into that role, although of course it was in a small way. In that regard, Bronfenbrenner (1979, p. 6) refers to ecological transition as "shifts in role or setting, which occur throughout the life span." Before the divorce, my personal microsystem was a very typical American “nuclear” family, with me as a child who was the center of parents' attention. Afterward, that role had disappeared forever. The transition in my life started out as a diminishing of the child role but was gradually transformed into a transition to the role of ...

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