Story sharing: restoring the reciprocity of caring in long-term care

Residents in long-term care facilities often experience an interruption in the reciprocity of caring, inadvertently cut off when they enter the unfamiliar surroundings of a residential health care system. This transition from the give and take of caring to being completely cared for often leads to a breakdown of meaning, a loss of identity, and loneliness. This article addresses how an intervention called story sharing can restore the reciprocity of caring. Beginning with a review of the significance and functions of storytelling and listening, a specific story sharing intervention-the mutual sharing of everyday experiences among nurse aides and the nursing home residents for whom they care-is described. The theoretical and practice implications of story sharing are discussed.     

Idealist thought, social policy and the rediscovery of informal care

Recent work in the history of welfare has suggested a need to reconsider the status of some conceptual frameworks within sociology and social policy studies regarding the meaning of 'social welfare' and the 'welfare state'. In this context, the present article argues in particular that the marked upswing of interest in informal care in the UK beginning in the 1970s reflected, at least in part, a reaction, itself not so far adequately understood, to some features of the work of Richard Titmuss and 'traditional social administration', work which, on examination, reveals a distinctive 'idealist' core, unsympathetic to research into familial patterns of caring. Similarities with 'classic' British idealism, broadly defined, at the end of the nineteenth and beginning of the twentieth centuries are reviewed. This idealist thought emerges too as unresponsive to informal care, even though contemporary non-idealist thought had discussed it. The article concludes that the (unacknowledged) persistence and influence of idealist modes of social thought diverted attention away from informal care; informal care was in fact not 'discovered' in the 1970s, it was rediscovered as idealist preconceptions about the nature of 'real' welfare were discarded. The sense of 'discovery' reflected prevailing and dubious historigraphical interpretations of the meaning of 'social welfare' and the status of the ('classic') 'welfare state'.     

Service learning and the practice of social justice and care

The values of a social justice pedagogy in teacher education are assumed to be firmly established in South African higher education. This article discusses how serviced learning (SL) can provide practical experience of caring and serve the promotion of the ideals of social justice in two initial teacher education programmes. However, an analysis of data in this case study shows that, although SL practice has served as a platform for social justice and for care as two basic educational values, participants were not yet able to verbalize and theorize these values. They were also not able to embed these values in their reflection about service as an inherent component of education. With data from different role players in a number of SL projects, we show that the students’ discourse of what it means to be a caring teacher in a just society has not yet been developed despite the successful practical experience. It was found that, although the students had been building a practice ‘platform’ for service, they had not yet been able to articulate the conceptual intersect of care and social justice clearly. With this epistemological notion in mind, two main themes from the data analysis are discussed: 1) How SL shifted student learning from ideas ‘about’ service to implemented service, and 2) how the practical experience promoted reciprocity in inter-institutional and inter-generational communities of practice.     

Care,empowerment and self-determination in the practice of peer support

The concept of ‘care’ has been fraught with negative connotations within the disability movement; the concepts of empowerment, choice and control have been developed as alternatives. The peer-support movement in the mental health sector draws from this tradition, and is uncomfortable with the provision of care. Drawing on the feminist ethic of care, we will argue in this paper that ‘care’ – in the sense of caring about, rather than caring for – should be seen as fundamental within peer support. The practice of peer support evidences a kind of ‘care’ that does involve some interdependence, and taking of ‘responsibility’. The challenge is to make this a ‘responsibility towards’, rather than a ‘responsibility for’. If this is successfully achieved, care can indeed become acknowledged as part of ‘standard peer support’, and the basis for the development of autonomy and self-determination.     

Caring children: exploring care in post-divorce families

This article draws on information from in‐depth interviews in addition to a survey from a Norwegian ‘Families after divorce’ study, in which the perspective of children and younger people are emphasized. We describe the complex relations between care‐giving and care‐receiving among children and adults in post‐divorce families and challenge and nuance the traditional western picture that emphasizes children as the receivers of care and adults as care‐givers. Inspired by the notion of ‘caringscapes’, the article seeks to incorporate the spatial and the temporal into the analysis of care and caring, and three ‘caring routes’ are identified: i) the ‘money squeeze route’, ii) the ‘emotional considerations route’ and iii) the ‘time squeeze’ route. The three routes are verified by the interview data as having both direct and indirect effects on the phenomenon of caring. We argue that children's care‐giving should be further investigated both empirically and theoretically and that a caringscapes approach might provide insight and departure for further research.     

An Explorative Study of the Place of the Ethics of Care and Reflective Practice in Social Work Education and Practice

The moral development and identity of social work students have been shown to be enhanced by education in caring. Important aspects of this education are training in reflective practice and learning to have a perspective focused on professional loving care. In this study, we have explored how reflective processes can be implemented in both educational settings and working practice from an ethical point of view. Elaborating upon reflective practice from an ethical perspective focuses on reciprocity in relationships and relational capacity in institutional contexts. The study took the form of interviews with social work teachers and health care professionals. Interview and focus group data were analysed, three main topics were identified and statements were coded with relation to these topics. Use of both educators and practitioners in this study showed the importance of not neglecting the transition from education to practice. Responses also showed the value placed upon continuous education and development over the course of a health care professional's career.     

Work,parenting and gender: the care–work negotiations of three couple relationships in the UK

Changes globally mean that there are now record numbers of mothers in paid employment and a reported prevalence of involved fathering. This poses challenges to mothers and fathers as they negotiate care–work practices within their relationships. Focusing on interviews with three heterosexual couples (taken from a wider UK qualitative project on working parents), the paper considers care–work negotiations of three couples, against a backdrop of debates about intensive mothering and involved fathering. It aims to consider different configurations of work and care within three different couple relationships. We found that power within the relationships was negotiated along differential axis of gender and working status (full- or part-time paid work). We present qualitatively rich insights into these negotiations. Framed by a critical discursive psychological approach, we call on other researchers to think critically about dominant discourses and practices of working, caring and parenting, pointedly how couples situated around the world operationalise these discourses in talking about themselves as worker and carers.     

The informal rationing of primary medical care

All social services are rationed, yet the effects of such rationing on the client are rarely fully explored. This article reviews the evidence on the existence of informal rationing devices in general practice. It examines the effects on patients of a wide range of informal rationing devices now used by individual general practitioners. Various suggestions for reforming the present rationing of primary medical care are evaluated and the likelihood of any reform being carried out is assessed. Although this article concentrates solely on rationing in the primary care sector of the National Health Service, the issues discussed are relevant to most welfare agencies as they are presently organized.     

From despair to care: A journey of the old and the young at Hope Meadows

Using interpretive ethnographic methods, we examine how living at Hope Meadows benefits both foster children and senior citizens. We (re)tell the stories of some of the residents focusing on the everyday and special signs of care that were given and received. It is these signs of care that serve as the foundation for meaningful relationships between the seniors and the children. We identify social capital and story telling as key elements that contribute to the construction and maintenance of this caring community. Through these mutual caring relationships, the old and the young help each other journey from despair to care.     

The contribution of a cultural perspective in understanding and evaluating client satisfaction

Increasing attention is being given to including measures of client satisfaction as a component in the evaluation of health care services. An understanding of cultural factors that may influence attitudes and behaviors in the health care situation can contribute to the theory and measurement of client satisfaction. Through an examination of some of the cross-cultural literature, this paper delineates dimensions of the health care situation in which clients have been shown to have distinctive preferences, behavioral patterns, attitudes, and treatment expectations. A knowledge of the beliefs and attitudes concerning health and illness that are espoused by a particular cultural group can be a valuable asset in understanding how members of that group will evaluate the delivery of health care services. The examination of how cultural and ethnic differences may affect client satisfaction outcomes points to the necessity of avoiding a global measure of client satisfaction without first examining those particular aspects of health care delivery and of the measurement context that may have a predictable influence on client satisfaction ratings.     

Negotiating a moral identity in the context of later life care

Strategies to maintain independence for older people have received considerable attention as a social policy solution to the financial and social impact of the ageing population. Critical scholars in gerontology have also highlighted the negative consequences of promoting independence in this way. Understandings of independence have profound implications for caring relationships as people age. To investigate the ways that older people talk about caring we interviewed 48 people aged 55-70years. A discourse analysis of these data showed that a dominant discourse of 'independence' was drawn upon to value self-sufficiency and construct dependence on others as burdensome. This construction of care provides a comfortable position for those who can afford to purchase professional care; however, those without resources are unable to accept unpaid help without also accepting a position of dependency. An alternative discourse of 'being there' constructs having others to provide personal care as a virtue and obligations to provide such care as based on family duty and affection. This discourse emphasises connections between people and a moral obligation to care which also creates difficulties for those with fewer material resources. The position for a dependent older subject in these two discourses may seem incompatible but can be reconciled by reframing independence as autonomy. Autonomy for those requiring care alongside a wider recognition of caring as the responsibility of all members of the community rather than with individual family members would support a flexible approach to later life care arrangements.     

National consistency and provincial diversity in delivery of long-term care in Canada

The aim of this article is to demonstrate the diversity in delivery of long-term care at the provincial level, within a national legislative framework that provides universal health insurance and public administration. Not all provinces have legislated provision of long-term care, but mandates for provincial long-term care programs typically address the needs of those with chronic health needs and maintain them in the community for as long as possible. Eligibility is based on common criteria of residency, health need, facility, assessment, and consent. The three common components of the service delivery system are institutional care, community-based services, and home-based services; the kinds of services within each component and the mix among them vary from province to province. There are also five common features in provincial service delivery systems: single point of entry, assessment, client classification, case management, and single administration. Throughout the article, examples from different provinces show the varying ways in which these aspects of service delivery have been addressed, and recent innovations have furthered this diversity. A detailed account of quality management systems also shows that while all provinces have adopted a common set of principles, they use a range of methods to pursue quality of care and to promote good practice.     

Contradictions concerning care: Female surgeons' accounts of the repression and resurfacing of care in their profession

Surgery is a high‐status, distinctly embodied, profession, dominated by men and saturated with masculine ideals of individual heroism, manual skill and detachment. In this study, we focus on exploring how surgery both represses, but also requires, caring work, creating gendered contradictions for the women that enter its ranks. Based on interviews with eighteen female surgeons from Australia and New Zealand, we apply a ‘rationality of caring work’ lens to explore how they experienced these contradictions through training, socialization and in everyday interactions. Our findings show inter‐related mechanisms whereby female surgeons are required to become more independent and self‐reliant than comparable men, but also make up for the systemic lack of care shown to junior staff and students. In particular, their pregnancy and motherhood challenge the ideal of the detached, independent, heroic agent. We conclude by discussing how a ‘rationality of caring’ lens could help unpack the gendered contradictions women experience in other elite professions.     

Natural mentoring among older youth in and aging out of foster care: A systematic review

Due to their histories of caregiver maltreatment, living instability, and potential attachment challenges associated with out-of-home care, older foster youth represent a particularly vulnerable group of adolescents at increased risk for a number of poor well-being outcomes. However, research supports the notion that a relationship with a competent, caring adult, such as a mentor, may serve protectively for vulnerable youth, and a nascent yet growing body of literature suggests that naturally occurring mentoring relationships from within youth's social networks are associated with improved outcomes among young people in foster care during adolescence and the transition to adulthood. This systematic review is the first to comprehensively identify, synthesize, and summarize what we currently know from nearly a decade of theories, concepts, and research findings pertaining to natural mentoring among adolescent youth in foster care. A bibliographic search of seven databases and personal outreach to mentoring researchers and practitioners through a national listserv yielded 38 English-language documents from academic sources and the gray literature pertaining to natural mentoring among older foster youth. We identified quantitative studies that have been conducted to test the theories and hypotheses that have emerged from the qualitative studies of natural mentoring among youth in foster care. Together, this literature suggests that natural mentoring is a promising practice for youth in foster care. Based on our findings from the systematic review, we make practice recommendations to encourage the facilitation of natural mentoring within child welfare contexts and outline an agenda for future research that more rigorously investigates natural mentoring among older youth in foster care.     

Sighs,smiles, and worried glances: How the body reveals women caregivers' lived experiences of care to older adults

This article reports on findings from microethnographic research that examined the lived reality of women caregivers through detailed observation of their everyday, embodied experiences. The research, which was rooted in the trend in social gerontology to emphasize subjective experience, focused on five women who were providing care to an older adult with a chronic illness or impairment. Four of the five women were caring for a spouse; one was caring for a parent. Observing the women's daily realities revealed tensions and contradictions between their subjective lived experiences and the pressures of the system in which they were functioning. The data revealed a caregiver habitus characterized by the performance of emotional labor. Performance was visible through dissonance between the caregivers' verbal and nonverbal expressions, and pointed to a high degree of emotion and body management. The women consistently put aside their own needs, in what can be considered a divestment in health capital. There was also evidence of merging between the caregiver and care receiver, made visible through tandem movements. The findings lead to implications for practice and for future aging research, including the benefits of observation for enhancing understanding of clients' experiences.     

Carer perspectives of factors affecting placement trajectories of children in out-of-home care

Carers are at the frontline working with children in the care of the child protection system. This paper reports carer's views about key factors influencing the placement trajectories of children and young people living in out-of-home care in Queensland, Australia. The study sample included 21 foster and kinship carers with a minimum two-year experience in the carer role. Study data were from semi-structured telephone interviews in which carers shared their experiences of the factors impacting upon placement stability and placement movement. Carers' responses were analysed thematically. Data analysis yielded an overarching theme regarding placement trajectory: Carer engagement, and its three sub-themes; with the child; with the child protection system; and, with the caring role. Findings suggested that carer engagement and ‘fit’ are complex constructs that play critical influential roles in placement outcomes (stability or movement) for individual children in out-of-home care. It is argued that practice needs to be better grounded in these relational dynamics, and better aligned concerning the power differentials that exist.     

‘Care is not a dirty word!’ Enacting an ethic of care in social work practice

While ‘care’ has been positioned as a core value of the social work profession since its inception, the increasing influence of neoliberal rationalities have placed care on the periphery of social work theory and practice. Social work scholars have promoted the incorporation of ethic of care theory into direct social work practice as a means of countering the effects of a context that is antithetical to caring practice. I present findings from my Australian study, providing an original contribution by presenting concrete understandings of how social workers enact care in everyday direct social work practice. The study was guided by a grounded theory approach. Fifteen social workers were interviewed using a semi-structured interview schedule. The interviews were analysed using constructivist grounded theory techniques. ‘Meeting needs’, ‘just being there for clients’, ‘building relationships with clients’, and ‘going the extra mile’ were some of the ways that participants demonstrated care in their practice. Constraints on care were challenged and resisted by ‘taking a stand’, ‘bending the rules’, ‘picking battles’, ‘justifying care’, and ‘taking risks’.     

Person-centred communication in dementia care: a qualitative study of the use of the SPECAL® method by care workers in the UK

Abstract

Communication has featured prominently in person-centred dementia care research, but no consensus has been reached on which communication techniques are most helpful in supporting person-centred care. This qualitative study explored communication techniques used by domiciliary and community care workers of people with dementia in the UK. Care workers trained in the SPECAL® method (Specialised Early Care for Alzheimer’s) were invited to semi-structured interviews. The data were analysed using a constructivist grounded theory approach. Themes from the data were discussed as a potential basis for developing a substantive theory. The care workers contributed to client well-being through modifying their communication techniques, expressing a protective, empathetic and reassuring approach, underpinned by reflection. Clients exhibited greater well-being and less anxious behaviour. The care workers’ use of SPECAL® communication methods, supported by supervision, may provide a unique combination of techniques, contributing to the development of caring relationships, to care worker and client well-being, and to the maintenance of client personhood.     

Does the Person‐of‐the‐Therapist Training (POTT) Promote Self‐Care? Personal Gains of MFT Trainees Following POTT: A Retrospective Thematic Analysis

As we recognize how taxing our profession can be, therapist's self‐care has become a salient topic in mental health. However, we are still discerning how to promote self‐care in our practice and in training. In this paper, we present a study on the personal gains that MFT students experienced after participating in the Person‐of‐the‐Therapist Training (POTT). We propose that the reported changes (better understanding of self, change to self, relational changes, and change as a process) constitute improvements in the trainees’ well‐being, and can therefore be considered self‐caring behaviors and practices. We state that models like POTT, that focus on embracing our vulnerability, can help clinicians be more caring toward ourselves. We conclude this paper by presenting clinical and training recommendations.     

Aggression exhibited by older dementia clients toward staff in Japanese long-term care

This study examined the experiences of staff members from seven Japanese hospitals who had been treated aggressively by older dementia clients. Altogether, 170 questionnaires were analyzed. In the past year, 75.3% and 63.5% of staff members had experienced physical and verbal aggression, respectively. Working numerous night shifts, working shifts other than 3-shifts, and being allotted assignments with clients who had a lower average level of physical capacity were the factors associated with recurrent client aggression. Those staff members who spent adequate time caring for their clients, who gained client consent before providing care, and who tried to build a trusting relationship with their clients were found to have experienced less aggression. Burnout, which is likely to enhance the risk of the staff mistreatment and neglect of older clients, was found to be higher among those who experienced aggression.