临床共情的基本路径研究

目的：开展临床共情基本路径研究,调查共情基本路径执行现状,为共情临床实践提供建议。方法：利用自行设计的调查问卷,采用分层随机抽样方法,对江苏省8所公立医院825名临床工作者和在这些医疗机构就诊的807例患者的临床共情基本路径现状进行调查和分析,对医务工作者和患者共情的认知状况进行比较。结果：在临床共情基本路径中的神态、情绪、倾听、微笑环节,医务工作者与患者的认知存在偏差;在耐心、专注、语言、告知、解释环节临床工作者均表现不佳。结论：临床工作者各路径环节表现不佳,需结合临床共情路径的内涵和实施方法,促进临床共情实践的实现和发展。     

精准扶贫与老年贫困消减

精准扶贫是针对以往粗放型扶贫方式提出的扶贫方略。 提高扶贫效率,实现社会公平是精准扶贫的核心要件。 老年贫困人口是贫困群体的主体,要低成本、高效率地消减老年贫困问题,要更多地依靠社会保障制度建设,即更多地依靠制度性力量,更多地依赖市场力量。 只有建立和完善与我国社会发展阶段相契合的“ 普惠+特惠冶 的基本社会保障制度,才能真正实现老年人口精准扶贫的政策初衷,从而提升社会的效率与公平。     

农村老年人日常生活家庭照料与社会照料关系研究——基于多层回归模型的分析

文章利用中国健康与养老追踪调查 2011—2012 年的基线调查数据,运用多层回归模型,通过分析社会照料对农村老年人家庭照料获得的影响,探讨家庭照料与社会照料的关系。 回归估计结果显示,个人层次上的年龄、居住状况、失能情况和社区层次上的老龄补贴、经济状况对农村老年人获得家庭照料有不同程度的影响,而代表社会照料的变量在统计上均不显著。 回归估计结果说明,社会照料并不能对缺位的家庭照料起到补充作用,更不会起到替代作用,两者呈现一种非此即彼的“无关系”。 文章的政策启示是,打破家庭照料与社会照料的壁垒,构建一个“流动”的老年照料体系。     

Nonstandard parental employment schedules and father involvement

This study assesses the impact of nonstandard employment schedules (shift work) on parenting among US fathers of young children in dual-earner couples. The outcomes examined include total caregiving, caregiving without the mother present, and the elements of father involvement proposed by Pleck: positive engagement, warmth, and control. Models with latent variables and with lagged dependent variables are estimated using three waves of nationally representative data from the Early Child Longitudinal Study – Birth Cohort. The results indicate that employment scheduling mainly shapes the context in which involvement takes place. Compared to dual-earner couples who are each employed during the day, fathers in couples in which at least one parent has a nonstandard schedule tend to care for their children more in the mother's absence. To a more limited extent, they also do more caregiving overall. These effects are most conclusively found when the father works during the day and the mother works during the evening, when the mother works during the day but the father works a night, split, rotating, or other shift, and when both parents have nonstandard schedules. Parental work schedules, however, have little impact on father involvement aside from care.     

An Ecological Understanding of Caregiver Experiences in Palliative Care

Palliative care is specialized health care to improve quality of life for patients with serious illness and their families through prevention and relief of suffering. A Palliative Care Institute was held in western Washington to capture community voices about diverse needs, strengths, and opportunities for improvement of palliative care. Researchers employed qualitative methods to obtain thematic data, provide real-time analysis, and engage in a multivoting technique to reflect stakeholder interest in individual themes and prioritize larger group interests. Bronfenbrenner’s ecological systems framework was used to explore caregiver experiences. Within the microsystem, caregivers reported difficulties in interactions with medical providers as a key challenge. Within the mesosysytem, interactions between patients and medical providers and the impact on caregivers were explored. Within the exosystem, caregivers reported lack of control over the schedules of personal care staff. Macrosystem influences included impact of local culture on the development of palliative care services. Chronosystem influences include de-medicalization of childbirth and its impact on perceptions of palliative care. Implications include the need for social workers to be proactive in fostering trust and effective communication between care providers and caregivers, and the demand for health care provider training in communication with patients and families.     

Shit is good: Mental health social work with lives of squalor

This paper investigates the phenomenon of three clients living in squalor, all of whom have severe and enduring mental health problems, and are on the caseload of a mental health social work team. By thinking about the clients both individually and as a group, within a psychoanalytic framework, it attempts to understand their squalor in a new way, with particular regard to the transference and countertransference experienced by the practitioner. By making use of social work literature as well as that concerning organisations and community care, it also discusses the impact these clients make on the wider community around them, and examines some of the dilemmas faced by the practitioner. The implications for social work are serious and far-reaching and these are discussed with regard to long-term intervention as well as professional and personal scrutiny.     

Providing a secure base for LGBTQ young people in foster care: The role of foster carers

The experiences and needs of lesbian, gay, bisexual, trans and queer/questioning (LGBTQ) young people in care have been overlooked in England, in both policy and research. This paper reports on findings from the first study of LGBTQ young people in care in England and focuses on the nature of foster carers' experiences and perspectives on caring for LGBTQ young people. Qualitative interviews regarding the fostering role in caring for LGBTQ young people were conducted with a sample of foster carers (n = 26) and analysed thematically. Foster carers described the importance of offering LGBTQ young people not only the nurturing relationships that all children in care need but also availability, sensitivity and acceptance to help young people manage stigma and other challenges associated with minority sexual orientation and gender identity. The Secure Base caregiving model provided a framework for analysing the different dimensions of these relationships. Understanding caregiving roles and relationships for LGBTQ young people in care has important implications for recruiting, training, matching and supporting foster carers to care for LGBTQ young people effectively.     

Long-term care in Spain: Difficulties in professionalizing services

The aim of this article is to analyze the difficulties in professionalizing the long-term care system in Spain. Since 2006, the new Spanish law has recognized care as a subjective right, and regulations are being designed to create a framework for its professionalization. Nowadays, family remains the most important group of providers who care for their elders, and women remain the main informal caregivers. Why do families resist using public long-term care services and professional carers included in the new law? The hypothesis highlights sociocultural factors as an obstacle to professionalization of long-term care services in addition to political and economic factors. The results show qualitative data about expectations, preferences, and discourses that women caregivers have in relation to their responsibility. The empirical material includes 25 interviews with different profiles of caregivers and six focus groups with family caregivers. The article suggests that the Spanish ideal of care is a problem for the professionalization of services because the family remains as the main provider of care—without specific skills, knowledge, and abilities.     

Whither practice-near research in the modernization programme? Policy blunders in children's services

In this article, we lament the effects of practice-distant research and associated policy initiatives on contemporary children's services in England. In the last decade, as a result of high profile inquiries into non-accidental child deaths, statutory children's social care services in the UK have been subject to a wide-reaching ‘modernization’ programme. We studied decision-making in the high blame environment of local authority children's services. Our research sought to examine the relationship between performance management and the impact of anticipated blame within the decision-making practices of those providing, supervising and managing these services. We show that systems and technologies can be developed which both assist the users in their daily work and achieve desired organizational goals, but without an ethnographically informed, practice-near approach, unsafe work regimes and practices can ensue.