Emotional Labor and Health Care

We examine the literature on emotional labor and health care to demonstrate the potential for emotional labor research to inform how social and medical scientists think about health care and how examining healthcare contexts has contributed to the scientific understanding of emotional labor processes. In doing so, we first review the key terms and definitions that are used within the emotion management perspective and evaluate the ways in which power differences have remained largely implicit features of research on emotional labor in healthcare settings. Finally, we explore how the increasing economic rationalization of health care may be influencing the emotional experiences of today's healthcare professionals and the implications of this trend for future research on emotional labor and the health and well-being of care providers and their patients.     

Questioning the professionalization of recovery: a collaborative exploration of a recovery process

While the recovery concept strongly resonates in clinical mental health care today, it first arose in service user-led contexts. A major risk of this professionalization shift is that recovery primarily becomes defined by treatment providers. This study aims to keep the debate on recovery alive through a collaborative exploration of Pete’s recovery process by means of a bricolage approach. This resulted in an idiographic portrait of Pete’s experiences of recovery and treatment, clustered around four themes: life rebuilding, identity, continuity of care and the role of drugs. His experiences illustrate a number of contradictions in the operationalization of the recovery ethos in today’s mental health care; whilst recovery appears as a hopeful vision of empowerment, it also risks being reduced to a tokenistic model that fails to address the social realities of people in recovery and in which the assumption that mental illness is chronic is still latently present.     

Discourse,affect and affliction

While much recent theorizing into affect has challenged the primacy of discourse in understanding social life, this paper is premised on the intertwining of affective experience with discursive meaning. Furthermore, appreciating the entwining of affect and discourse facilitates broader understanding into the illness experience, medical decision‐making and experiences of healing. Today, the biomedical discourse carries particular affective weight that can saturate experiences of affliction. Cultural understandings of disease similarly shape affect that may emerge in affliction. Social meaning, more specifically stereotypes pertaining to identities, interweave with emotion also in the context of medical practice. The doctor‐patient relationship is an affect‐laden encounter where the entwining of affect with social assumptions carries important, yet poorly understood, repercussions for treatment decisions and for the furthering of health inequalities. Both the elusiveness and the power of affect that unfolds in relation to discursive meaning rest on the way in which affect dwells in and resounds through the body.     

The Lived Experiences of Transgender Persons: A Meta-Synthesis

This article synthesises findings from qualitative studies which have explored the lived experiences of transgender persons, using Noblit and Hare's (1998) meta-ethnography method. Thirty-one qualitative studies related to the lived experiences of transgender individuals, published between 1998 and 2013, met the inclusion criteria. A literature search was conducted between November 2012 and September 2013 using computerized searches from nine databases as well as online manual searches of key journals. Results from these individual studies revealed five major themes: (a) crossing gender and physical problems in life, (b) experiencing psychological distress, (c) encountering discrimination and social exclusion, (d) having relationships does matter, and (e) dealing with difficulties in life. Yet, despite these negative experiences, transgender people have tried to find ways to help them deal with their difficulties. We conclude that there is a need for health care providers, social workers, and health promoters to support transgender individuals, for their health and well-being. This meta-synthesis provides a clear account of what transgender individuals experience in their lives, to support the development of sympathetic health and social care services to assist them with their difficulties, and enhance their health and well-being.     

Healthcare Use in the Heartland: How Health Care Selection Varies Between Rural,Retirement‐Age Migrants and Long‐Term Residents

One increasingly important problem affecting rural health care selection is the tendency of older residents to bypass local health care providers. This research investigates how the effects of community characteristics and attachment on health care bypass behavior vary between rural retirement‐age migrants and retirement‐age long‐term residents. Non‐health‐related behaviors, such as purchasing goods and services outside one's community during a health care trip, that is, “outshopping,” could influence bypass if individuals combine trips for their medical care with other consumer needs. Basing our work on the outshopping theory, we argue that bypass behavior is one facet of consumer consumption patterns for both rural retirement‐age migrants and long‐term residents. In addition, dissatisfaction with local health care and services like shopping can “push” rural residents to bypass local health care and travel greater distances for primary health care. We further contend that strong community attachment has an opposite “pull” effect that can help to negate the push of outshopping and reduce the likelihood of bypass. Our results reveal retirement‐age migrants are significantly more likely to bypass local primary health care providers than retirement‐age long‐term residents. Furthermore, our analysis bridges the rural health care and retirement community development literature to suggest that outshopping theory can now be applied to rural primary health care bypass behavior.     

Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.     

Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Diaspora and Health? Traditional Medicine and Culture in a Mexican Migrant Community

As members of the Mexican diaspora acculturate/assimilate to life in the United States they gain skills that help them improve their socioeconomic status and overcome barriers to the mainstream American healthcare system. Thus, we might expect better health among more acculturated Mexicans. However, most of the research conducted during the past 20 years shows that the health of Mexicans living in the United States deteriorates as acculturation increases. This suggests that certain health promoting aspects of Mexican culture are lost as migrants adapt to and adopt American ways of life. This paper is the first step in testing the hypothesis that declining health among acculturated people of Mexican descent is related to a loss of traditional medical knowledge. During an ethnographic study of women’s medical knowledge in an unacculturated Mexican migrant community in Athens, Georgia, I observed many ways low‐income, undocumented migrants maintain good health. Migrant women encourage health‐promoting behaviors and treat sick family members with a variety of home remedies that appear to be effective according to chemical and pharmacological analyses. Additionally, migrant women in Athens learn how to navigate the American medical and social service systems and overcome barriers to professional healthcare services using information provided through social networks. Nevertheless, migrant women often prefer to treat sick family at home and indicated a preference for Mexican folk medicines over professional medical care in most situations. This case study suggests that migration and diaspora need not always lead to disease. The maintenance of a Mexican culture that is distinct from the rest of American society helps ensure that traditional medical knowledge is not lost, while the social networks that link Mexicans to each other and to their homeland help minimize threats to health, which are usually associated with migration. Thus, increased access to professional medical care may not improve the health of migrants if it comes with the loss of traditional medical knowledge.     

Individualization and Prevention

SUMMARY

In 1905, Massachusetts General Hospital initiated the first medical social work program in the United States. Based on the writings of its leaders, this paper presents the early history of medical social work in the United States. Inspired by developments in European health care that emphasized the community context of disease, medical social work pioneers saw a need to individualize the patient while also promoting public health measures in the community, improving the patient's environment to eliminate the causes of disease. In addition, since they served patients because of their diseases rather than their poverty, medical social workers were among the first to provide social work services to the non-poor. In spite of their emphasis on environmental change, many of early medical social work leaders had an anti-institutional bias; they were suspicious of large-scale solutions for what they saw as fundamentally individual problems. Consequently, methods for promoting individual adaptation developed more rapidly than methods for promoting environmental change. Ironically, the medicalization of social problems in contemporary times has resulted in a focus on individual pathology rather than social and lifestyle causation in health, even as the rising cost and complexity of the system challenges health care consumers in the United States. Reaffirming the environmental emphasis of medical social work pioneers provides a way for today's health care social workers to incorporate environmental modification into their practice and promote the health of all citizens.     

Professionals' and parents' perceptions of A&E use in a children's hospital

Helpful keywords in accessing literature on the use made of hospital accident and emergency (A&E) departments are ‘misuse’ ‘abuse’ and ‘inappropriate’. While the medical literature is inclined to present patients (and, in the case of children, their parents) as irresponsible, or misguided, social scientists looking at similar data have tended to act as apologists for patients, explaining A&E attendance in terms of poor access to GPs, mistaken beliefs about the relative skills of hospital-based doctors and GPs and ‘lay’ health beliefs. Both of these approaches see the patient (or parent) as passive recipients of health care, rather than active caretakers of their own or their children's health. On the basis of a study of minor ailments presenting at a children's A&E department, this paper explores the differing views of health workers and parents. It suggests that a view of patients (parents) as largely passive custodians of their own or their children's health is inadequate. Patients (parents) can and do play an active part as providers of primary health care and their decisions to use A&E are not as irrational as health providers sometimes suppose. In this light, attempts to ‘re-educate’ parents to use A&E in a way which would be more acceptable to health providers is unlikely to succeed.     

Practice Wisdom on Custodial Parenting with Mental Illness: A Strengths View

ABSTRACT

Social work principles of strengths, empowerment, and consumer-centered care for persons with mental illness are currently being adapted to broader contexts. This article presents study findings on practice wisdom about custodial parents with mental illness, a potentially increasing group of consumers in light of mental health reform. The research team organized thirty-six professionals with practice experience into five focus groups. Findings reflect strengths perspective categories of resilience, social support, family functioning, self-care, and parents' positive experience of their symptoms. Implications discuss how providers who work with custodial parents and their children can apply these findings in assessments and interventions.     

Variations in provider capacity to offer accessible health care for people with disabilities

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

A Hitchhiker's Guide to caring for an older person before and during coronavirus‐19

Coronavirus‐19 (COVID‐19) has reconfigured working lives with astonishing velocity. Older people have suffered the worst effects of the pandemic, with governments marginalizing or overlooking their needs. Women perform the majority of care for older people, often compromising their working lives and health. Yet in academic articles their voices are often filtered or aggregated in quantitative studies. Based on a weave of personal experiences and secondary research, the article traces a path through UK forms of care and shows how the inadequate response to COVID‐19 stemmed from existing policies embedded in health and social care. COVID‐19 has severed important informal care work, rendering the vulnerable yet more exposed and carers anxious and bereft. Longitudinal research capturing the trajectory of care from the perspective of older people and their carers would lead to improved support hence gender equality.     

Military spouses speak up: A qualitative study of military and Veteran spouses’ perspectives

ABSTRACT

The purpose of this qualitative study was to examine military family life through the lens of military and Veteran spouses. Twenty-two female, active-duty military and Veteran spouses provided extensive written responses to essay questions as part of an online survey that were analyzed with qualitative data analysis methods. Findings revealed seven main themes: how military life has influenced health care access, spouses’ identities as caregivers, marital relationships, health outcomes, social support, spouses’ educational and career opportunities, as well as their personal growth. In summary, their experiences indicate that military service affects all aspects of their lives. Spouses gave numerous suggestions as to how service providers can address their unique experiences to improve the supports they offer military families, including ensuring the spouse is involved in health care, and providing support programs that focus on the entire family.     

Caregiving, ethical and informal: emerging challenges in the sociology of health and illness

The concept of care, integral to medical sociology and to the sociology of health and illness, suggests new challenges in two key areas of this field: 1) within professional socialization, an examination of socialization to ethical thinking, behavior, and identity among professional caregivers, building on the substantial literature already accumulated; 2) in the arena of hidden or informal care providers, an analysis of male and female informal providers and the productive work, other than care, done by these individuals. In both analyses, as well as in all medical sociology and sociology of health and illness, gender, race, and class require more attention. Both analytic endeavors influence the substance and the contours of the field.     

Changing Fatherhood: An Exploratory Qualitative Study with African and African Caribbean Men in England

This paper presents findings from a qualitative study undertaken with 46 African and African Caribbean men exploring their experiences of fatherhood. Data analysis was informed by Connell’s theoretical work on changing gender relations. Findings indicate that fathers’ lives were mediated by masculinities, racism, gender, migration and generational changes in parenting. Fathers advocated a style of parenting centred on good communication with children. The implications of findings for theory, future research and health and social care policy regarding both children’s well‐being and the inclusion of fathers by health and social care practitioners are discussed.     

Driving to Work: The Front Seat Work of Paramedics to and from the Scene

The work paramedics do in the front of the ambulance on their way to and from the scene is central to the safety and well‐being of both paramedics and patients. However, most research on paramedics and emergency medical services assumes rather than empirically explores the actual happenings of what paramedics do in the front of their ambulance. In this article, I move beyond this taken‐for‐granted understanding of front‐seat work by taking readers in the front of the ambulance and exploring the hidden work paramedics do on their way to and from the scene. I draw on data from an institutional ethnography into the socially organized work and work settings of paramedics, which included over 200 hours of observations and over 100 interviews with paramedics. This article adds to research on the sociology of work and health and illness by focusing explicitly on how paramedics give meaning to their work setting, the social conditions and relations central to their work practices, and how their work knowledge is actually put into practice. In doing so, I shed light on an ever‐important occupational group in health care that has garnered little sociological attention to date.     

Experiencing parenthood,care and spaces of hospitality

Drawing on research conducted in Australia and the United Kingdom, this paper explores how parenting and care provision is entangled with, and thus produced through, consumption in hospitality venues. We examine how the socio‐material practices of hospitality provision shape the enactment of parenting, alongside the way child‐parent/consumer‐provider interactions impact upon experiences of hospitality spaces. We argue that venues provide contexts for care provision, acting as spaces of sociality, informing children's socialization and offering temporary relief from the work of parenting. However, the data also highlight various practices of exclusion and multiple forms of emotional and physical labour required from care‐providers. The data illustrate children's ability to exercise power and the ways in which parents’/carers’ experiences of hospitality spaces are shaped by their enactment of discourses of ‘good parenting’. Finally, we consider parents’/carers’ coping behaviours as they manage social and psychological risks associated with consumption in such public spaces of leisure.     

Job matching and return to work: Occupational rehabilitation as the link

Return to work after injury or illness is important for the worker and the employer. Medical providers manage and treat the worker with the illness or injury. Except in cases of focused specialists, the medical professional's role is to take care of a patient, rather than empower a worker. As much as there is promotion of the workers compensation health care system to be similar to sports medicine, there are significant dissimilarities. One major barrier is that the medical caregivers do not know the demands of jobs as they would know the details of sports. Thus, there is a gap in returning a worker to function as the medical professional cannot accurately match the worker to specific jobs. A new model of job function matching, based on research and skills of occupational rehabilitation professionals, is proposed to bridge the gap between the medical community, the employers and the workers.     

Children and Young People Living Through a Serious Family Illness: Structural,Interpersonal and Personal Perspectives

This study explores the experiences of children and young people in Britain living through a serious family illness. The study considers the interplay between social structures, social relationships and individual agency. We draw on data from the Millennium Cohort Study to estimate the number of children and young people affected nationally and on seven in‐depth interviews to understand young people’s experiences and the effects on their daily lives. Living through a serious family illness impacts on young people’s educational achievements, mental health and social relationships over long periods. Policy and service responses are suggested.