Learning to listen: epistemic injustice and gothic film in dementia care education

Listening is a critical and under-theorized dimension to struggles against injustice and marginalization. In the wake of critiques from the disability movement of the pre-eminence of expert medical voices, educating professionals to listen to health service users has become particularly critical. The utterances of people with dementia have frequently been subject to, in Miranda Fricker’s terms, “testimonial injustice”: that is, seen as irrational, unreliable, and not to be believed. This article will examine the way in which the generic conventions of the gothic, more specifically what Mary Ann Doane has described as “the paranoid women’s film,” are used in a short film, Darkness in the Afternoon, widely screened in dementia care education in the UK and internationally. Drawing on interviews with dementia care trainers, analysis of training materials, and the film itself, this article proposes that gender and genre is used in this film as a strategy to reorient the listening and affective practices and testimonial sensibilities of health and aged care workers.     

The dwelling space of postnatal care

BackgroundThis paper considers the dwelling space of postnatal care, how being-there feels for the woman going through the experience of matrescence. The research takes a hermeneutic approach and draws on philosophical notions from Heidegger. Question: ‘What is the nature of the dwelling space of valued postnatal care?’.MethodsAppropriate ethics approval was gained. Participants were midwives, nurses, women, and other relevant stakeholders. There were 4 focus groups involving 11 participants and 19 individual interviews. Data collection was conducted over a one week period by a team of three researchers. An interview schedule had been organised by the administrator at the Centre. Participants chose whether to come to the centre to be interviewed, or be interviewed in their own homes. Most interviews were an hour. All interviews were tape recorded and transcribed, with the participant's permission. Data was analysed through a hermeneutic process set in the context of related literature.FindingsWhen women are invited into a dwelling space that strengthens them they feel ‘mothered’: being listened to, have their needs anticipated, and are cared for in a loving manner. In such a way they grow confidence. A child health nurse reported the difference such care made to on-going mothering at home.Implications for practiceAll women deserve a dwelling space in their early days of matrescence. Small birthing centres perhaps achieve such care and ambience more easily than large institutional units. Nevertheless, wherever the place, practices need to be enabled that foster the spirit of dwelling.     

Designing an HIV counseling and testing program for bathhouses: the Seattle experience with strategies to improve acceptability

Bathhouses are important venues for providing HIV counseling and testing to high-risk men who have sex with men (MSM), yet relatively few bathhouses routinely provide this service, and few data are available to guide program design. We examine numerous logistic considerations that had been identified in the HIV Alternative Testing Strategies study and that influenced the initiation, effectiveness, and maintenance of HIV testing programs in bathhouses for MSM. Key programmatic considerations in the design of a bathhouse HIV counseling and testing program included building alliances with community agencies, hiring and training staff, developing techniques for offering testing, and providing options for counseling, testing, and disclosure of results. The design included ways to provide client support and follow-up for partner notification and treatment counseling and to maintain relationships with bathhouse management for support of prevention activities. Early detection of HIV infection and HIV prevention can be achieved for some high-risk MSM through an accessible and acceptable HIV counseling and testing program in bathhouses. Keys to success include establishing community prevention collaborations between bathhouse personnel and testing agencies, ensuring that testing staff are supported in their work, and offering anonymous rapid HIV testing. Use of FDA approved, new rapid tests that do not require venipuncture, centrifugation, or laboratory oversight will further decrease barriers to testing and facilitate implementation of bathhouse testing programs in other communities.     

Latin American hospitals improve postabortion care. Maternal health

Approximately 4 million women undergo illegal abortions each year in Latin America and the Caribbean, and hundreds of thousands of women with postabortion medical emergencies or incomplete abortions seek hospital care. Once in an emergency ward, a woman may await treatment for 24 hours, bleeding, frightened, and in pain. A woman in such a situation may also experience nurses who chastise her for becoming pregnant or committing a sin, be examined with several staff members observing, undergo unexplained treatment without anesthesia, and/or leave the service facility without knowing whether she is still fertile or how to avoid pregnancy. INOPAL, Population Council's operations research program on family planning and reproductive health in the region, is working to find the best ways, medically and financially, for hospitals to deliver high-quality, comprehensive services to postabortion patients. Most maternal deaths and injuries could be prevented by access to family planning services and information about contraceptive use. The Population Council and colleagues from hospitals, governments, and nongovernmental organizations are conducting studies in Guatemala, Peru, and Mexico on the emergency treatment of incomplete abortions with the goal of improving and standardizing postabortion services.     

NFP update: researcher cites need to improve instruction

In the Philippines more and more couples are practicing natural family planning (NFP), but there is a need to improve instruction on this method to increase its effectiveness. Calendar rhythm has been the most popular technique of NFP, but failure rates have been high. This could be changed by improved calendar rythm instruction and the introduction of newer, more effective natural techniques like the basal body temperature, cervical mucus, and symptothermal methods. Dr. John E. Laing, in a paper entitled "research on Natural Family Planning in the Philippines," examines the trends in NFP and summarizes major findings of past research related to NFP and the status of current research. It also discusses the implications of such findings for the National Population Program and the needs for current research. Cting World Fertility Survey (WFS) data on 19 developing countries, Laing states that the Philippines is second only to Peru in current and past use of the rhythm method. He also indicates that since the start of the National Population Program in 1971, rhythm has been offered as an official program method. Yet, in the early years of the program rhythm was not promoted as actively as the other family planning methods. In the last few years, program, officials have become more interested in NFP. 1976 National Acceptor Survey (NAS) data showed that rhythm reduced fertility by 78% compared to the condom's 79%, oral contraceptive's 94%, and the IUD's 98%. A comparison of data from the 1972, 1974, and 1976 NAS indicated a decline in continuation rates and an increase in overall pregnancy rates for all methods except rhythm. The overall pregnancy rate of rhythm declined, but there was no significant change in continuation rate. Laing suggests that probably, while the national population program was increasingly recruiting less motivated couples to try other methods, the rhythm acceptors, who were largely self initiated, mantained earlier levels of motivaton. Evidence points to the widespread use of crude formulas that do not take into account individual variations in cycle length. Many users do not even fully understand the mechanism by which rhythm affects fertility. There is also little knowledge among acceptors of the new and more reliable techniques of NFP for identifying the safe and unsafe periods. Despite problems, a considerable number of acceptors still prefer rhythm to other methods. The commission on population has embarked on a solution to some of the problems by committing itself to the training of volunteers of community-based organizations, particlarly lay leaders. 3 large scale projects are planned for this purpose.     

Monitoring postpartum haemorrhage in Australia: Opportunities to improve reporting

Problem

The rate and severity of postpartum haemorrhage (PPH) are increasing, according to research reports and clinical anecdote, causing a significant health burden for Australian women giving birth. However, reporting a national Australian rate is not possible due to inconsistent reporting of PPH.

A qualitative study of innovations implemented to improve transition of care from maternity to child and family health (CFH) services in Australia

BackgroundThe transition of care (ToC) from maternity services, particularly from midwifery care to child and family health (CFH) nursing services, is a critical time in the support of women as they transition into early parenting. However significant issues in service provision exist, particularly meeting the needs of women with social and emotional health risk factors. These include insufficient resources, poor communication and information transfer, limited interface between private and public health systems and tension around role boundaries. In response some services are implementing strategies to improve the transition of care from maternity to CFH services.AimThis paper describes a range of innovations developed to improve transition of care between maternity and child and family health services and identifies the characteristics common to all innovations.MethodsData reported were collected in phase three of a mixed methods study investigating the feasibility of implementing a national approach to child and family health services in Australia (CHoRUS study). Data were collected from 33 professionals including midwives, child and family health nurses, allied health staff and managers, at seven sites across four Australian states. Data were analysed thematically, guided by Braun and Clarke's six-step process of thematic analysis.FindingsThe range of innovations implemented included those which addressed; information sharing, the efficient use of funding and resources, development of new roles to improve co-ordination of care, the co-location of services and working together. Four of the seven sites implemented innovations that specifically targeted families with additional needs. Successful implementation was dependent on the preliminary work undertaken which required professionals and/or organisations to work collaboratively.ConclusionImproving the transition of care requires co-ordination and collaboration to ensure families are adequately supported. Collaboration between professionals and services facilitated innovative practice and was core to successful change.     

Time use in child care and housework and the total cost of children

The use of time for child care and housework among Swedish families is investigated. We allow the effect of children on child care and housework to vary by age of the child and also by whether the child is cared for outside the home or not. Our estimates allow us to compute the total cost of children in the form of the cost of time, and the cost of goods, services and housing.The result shows that time used for child care decreases sharply with the age of the child but this is not the case for time used for other housework. Considerable economies of scale is found to prevail for time used for child care. Child care outside the home reduces time use for other housework but the effect on time used for child care is quite small. For the average family time use cost make up more than half of total child cost. Our estimates indicate that decreased time use cost for children caused by care outside the home are not very different from a typical parental fee for public day care.This research was supported by a grant from the Swedish Council of Social Research (SFR). We thank Lennart Flood for useful comments on an earlier version.     

The Time-Pressure Illusion: Discretionary Time vs. Free Time

People’s welfare is a function of both time and money. People can – and, it is said, increasingly do – suffer time-poverty as well as money-poverty. It is undeniably true that people feel increasingly time pressured, particularly in dual-earner households. But much of the time devoted to paid and unpaid tasks is over and above that which is strictly necessary. In that sense, much of the time pressure that people feel is discretionary and of their own making. Using data from the 1992 Australian Time Use Survey, this paper demonstrates that the magnitude of this ‘time-pressure illusion’ varies across population groups, being least among lone parents and greatest among the childless and two-earner couples.