In 1920, in America, psychology was dominated by two main currents. The first was a tendency to reduce life to habit, and the second was to establish differences between humans by test. The second tendency, toward testing, had burst suddenly on the scene with the coming of the Binet tests to America in 1905. The idea of contextualized relationships determined by perceptual interpretation challenged the notions that had sprung up around behaviorism that the brain was empty, functioning only as a router between environmental stimulus and motor response. The idea, still vivid in American psychology during the 1920s, that psychology was “the science of mental life” was reinforced and extended by the diffusion of Gestalt psychology through American psychology over the coming decades, as the rest of these reviews of theory and practice will show.
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Gordon Allport, addressing the American Psychological Association (APA) as its president in September 1939, observed that psychology, over the preceding 50 years, had divided into its pure and applied aspects. Troland was a socialist, and proposed that a “technology of behavior” be devised to maximize human happiness. In his comprehensive psychological system, Troland proposed a hedonic theory of motivation: Behavior depends on the quantity of pleasure to which it is related. Taken together, Troland and Miles represent the flowering, during this decade, of two persisting areas of psychological applications: consultation on the design of technologies in which human sensory and perceptual characteristics interact with equipment and devices, and the study of the effects of drugs of various kinds on human performance. Within psychiatry, psychology had long had allies, and during the 1930s some powerful ones became associated with psychology and supported its aims to develop a parallel nonmedical psychotherapy system.
The year 1945 saw the culmination of many developments in psychology since the 1920s, which led to two major coalitions being formed. The first of these was represented in the reorganization of the American Psychological Association (APA). The most important aspect of this reorganization was the consensus that theory, applications, and clinical activities, formerly represented by separate organizations and carrying on their affairs at a distance from each other, were indeed all parts of a unitary entity, psychology. Psychologists advanced their own comprehensive views of behavioral science as a complex system. The perception that psychology was a united front continued to be a successful strategy, which further confirmed its presence within the spectrum of physical and social sciences. Social psychology, which in previous decades was a melange of crowd psychology and anthropological ideas, acquired a perceptual and cognitive focus.
The 1950s, in American society as well as psychology, were characterized by two pairs of opposites: liberty versus repression and conformity versus creativity. Repression of suspected Communists and other left-leaning individuals was in full swing at the beginning of the decade, driven by long-standing partisan enmity as well as fresh anger over the loss of atomic superiority to Soviet Russia. Many of those who had been instrumental in the creation of the bonds between them had died or retired to other interests, and a new generation of psychiatrists emerged to question the qualifications of what they saw as psychiatrists practicing without medical licenses. Cognition and internal states also emerged in the 1950s versions of theories of motivation. Applied cognitive psychology, in its 1950s incarnation, interested Eddie, Helen’s husband, and he occasionally read articles by aviation psychologists working on contract for the Office of Naval Research.
The 1960s were brought to the United States on television. In ensuing decades, psychologists would engage in inconclusive debates about whether violence on TV had social effects. Ultimately, psychologists’ isolation in the academy, their cultural backgrounds, and their focus on integrating individuals by adjustment and assimilation rather than on managing immediate mass social change pushed psychology, as a field, to the periphery of civil rights, at least as they pertained to color. The pages of psychology’s journal of record, the American Psychologist, recorded few traces of the Vietnam conflict, a central feature of American life in the second half of the 1960s. Counseling psychologists concentrated on civilian problems. Hospital clinicians worked to develop ways to implement the new community mental health system. The combined effect of the Community Mental Health Act and the Great Society’s medical programs was a further infusion of energy and resources into rapidly developing clinical psychology.
By any measure, the 1970s and 1980s were marked, for psychology, by a continual upward change in professional self-designations as indicated by membership in the American Psychological Association (APA), a marker of the increase in the number of practicing psychologists now well distributed in all areas of U.S. culture. Psychology entered the 1970s as a well-established, lucrative coalition of professions. While some of its activity over the rest of the decade could be understood as directed toward meeting the challenge of selfless public service, for the most part psychologists were interested in career advancement. The response of officially organized psychology in the 1970s to these political and social events was the same as it had been during the preceding two decades the creation of further interest groups reflected as new divisions in the APA. Clinical psychology continued to contend with medical psychiatry for authority in treating mental illness.
One of the reflections of the rise of postmodernism in the American Psychological Association (APA) was the inclusion, for the first time, of psychoanalysts as official members of its coalition in Division 39 (a reflection of the gradual decoupling of psychoanalysis from medicine). The APA added a division of clinical neuropsychology, another specialty area where the advances in both cognitive and brain studies translated into an acceptable medical support occupation for psychologists. Psychologists increasingly found employment, during the ‘80s, advising clients, for a fee, of the best way to present themselves to juries, recommending with indifferent success changes in legal language in the direction of more accessibility and understandability, and offering expert testimony on clients’ mental states, as psychiatrists had been doing for at least a century. The theoretical models of health psychology that began to emerge about this time share characteristics with both Bandura and Cialdini.
In psychology, it was a prosperous year. It was 6 years since President George H. W. Bush signed a proclamation designating the 1990s as “The Decade of the Brain”, and 4 years before the American Psychological Association (APA) would pronounce the succeeding decade “The Decade of Behavior”. Since 1990, Peace Psychology, Group Psychology and Group Psychotherapy, and Society of Addiction Psychology had also been added. The Human Genome Project was about halfway through the process of mapping the entire human genome. For years, the sentiment in much of psychology, especially among the more senior members of the profession, was that as Howard Kendler put it in a 1999 article psychology could not scientifically prescribe correct moral behavior, and that psychologists should separate their scientific activity and their roles as private citizens, speaking out for social causes only outside of the official structure of the psychological coalition.
In recent years, the rural hospital closure crisis has escalated with 2015 closure rates six times higher than in 2010. The National Rural Health Association (2020) reported that currently one in three rural hospitals may be at risk of closure. Much of the blame for closures has long been attributed to factors external to rural communities, such as reduced Medicare reimbursement, a declining rural economy, provider shortages, and being located in states that did not expand Medicaid under the Affordable Care Act. Improving equity in access to care has been an ongoing concern throughout most of the past half century, and rural access to care has been a particularly persistent problem. Improving equity in access to care has been an ongoing concern throughout most of the past half century, and rural access to care has been a particularly persistent problem. This chapter focuses on the Acceptability Scale.
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Achieving the Quadruple Aim in Healthcare With Evidence-Based Practice: A Necessary Leadership Strategy for Improving Quality, Safety, Patient Outcomes, and Cost Reductions
Evidence-based practice (
EBP) is a seven-step problem-solving approach to the delivery of healthcare that integrates the best evidence from well-designed studies with a clinician’s expertise and the values/preferences of the patient/family. This chapter discusses the importance of EBPin achieving the quadruple aim in healthcare, describes the current state of EBPin healthcare, including EBPcompetencies, identifies the barriers and facilitators of EBP, and discusses the key leadership strategies to ignite and sustain EBPin healthcare. It briefly describes EBPcompetencies for practicing registered nurses and advanced practice nurses in real-world clinical settings. Leaders must first understand that EBPis the direct pathway to achieve the quadruple aim in healthcare and be willing to invest in it knowing that healthcare quality and safety will be enhanced, population health outcomes will improve, healthcare costs will diminish, and clinician job satisfaction will increase as EBPdiffuses throughout the organization.