This multidisciplinary study, which includes Practical Theology and also insights from Psychology and Sociology, investigates experiences of abuse in social structures such as the church. My epistemological approach is social constructionist. Psychological theories employed are the social constructivist personal construct theory of George Kelly and Gergen's social constructionist theorization. Kelly's theory posits that people construct their own realities in social settings, such as family, culture and everyday social structures. This takes place on a cognitive level through the nervous system. By means of Gergen’s social constructionist theorization the role that social constructions (beliefs and practices) play in (often unintentional) abusive practices in social structures as well as the experiences of victims, is explained. Sociological theories included are Berger and Luckmann’s theory of the social construction of reality as well as Anthony Giddens’ structuration theory, which emphasizes agency (human action) and structure tensions in social structures. I argue that processes such as typification, reification and structuration, as explained by these theorists can result in abusive actions and behaviours (often unintentional) and experiences of abuse by people in groups. In addition, the lives and teachings of Jesus and Paul are examined from a social constructionist perspective. A qualitative investigation was conducted with participants who claim to have experienced abuse in groups. Their stories are used as case studies. A narrative thematic analysis reveals that dominant discourses, for example patriarchal worldviews and belief systems which go unexamined, are often imposed on others which results in experiences of abuse. The study is therefore embedded in a postmodern, social constructionist narrative framework constructed from all three disciplines. Traditions, belief systems and practices should be reflected upon, carefully examined and revisited, and not simply accepted as "reality". Reality is constructed in social interaction and relationship and should be open to review and change should the need arise, prompted by, for example, unacceptable phenomena, such as experiences of abuse in the church. The findings of this study are that the church and pastoral care ministry are often experienced as uncaring and abusive. Underlying dominant discourses should be exposed, since they contribute to practices that cause psychological, social and physical traumatisation and consequences for people. Pastoral care is often neglected because these actions and behaviours are regarded as "normal" and even "biblical". People are labelled and blamed. Male domination, objectification, humiliation, abuse of power and control, misuse of knowledge and truth claims are the consequence. The study revealed a strong correlation between participants’ experiences of abuse and the social constructionist constructs. Therefore social constructionist theory offers an adequate explanation for experiences and actions of abuse in the church. / Thesis (PhD)--University of Pretoria, 2012. / Practical Theology / unrestricted

Excerpt: Last fall, I sat through an uncomfortable board meeting. I was charged to work with a Clinical Social Worker, Licensed Practicing Counselor, a Counseling Psychologist, and a Licensed Nurse Practitioner to develop an integrated care training program as part of a rural workforce development project.

The Effect of a Quality Improvement Initiative on Reducing Hospital Transfers of Nursing Home Residents by Denise Eileen Jarboe MSN, Walden University, 2010 BS, University of Maryland, 1981 Project Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2015 Nursing homes (NH) in the 21st century provide skilled healthcare services for resident populations who are older, frailer, and often suffering from multiple incurable chronic medical conditions. Nurses practicing in this setting must be keen observers and effective communicators with the ability to recognize and report subtle changes in health status that may lead to an avoidable or unnecessary hospital transfer. The purpose of this DNP project was to evaluate the impact of a quality assurance performance improvement (QAPI) initiative implementing the INTERACTTM (interventions to reduce acute care transfers) SBAR (situation, background, assessment/appearance, recommendation) communication tool in a skilled NH setting. The Synergy Model, which posits that optimal patient outcomes are possible when nurse competency is matched or synergized with patient care needs, provided the conceptual framework for this project. To evaluate the effect of the program, resident hospital transfer events groups before and after SBAR utilization (n = 295) were analyzed using a dependent t test to determine if significant differences existed in the groups in overall number of transfers, clinical condition categories, and those leading to an inpatient hospitalization. Although analysis of the data did not demonstrate significant decreases in resident transfer events, the results did provide valuable baseline information for future studies. This project contributed to social change by evaluating communication among care providers in a skilled NH setting, establishing baseline information and identifying the need for future projects. This information is vital for determining which resident transfers to the hospital are avoidable and for developing future programs addressing this practice issue.