An Interview-Based Exploration of the Motivations and Occupational Aspirations of Chronic Care workers

A shortage of nurses' aides at a time of dramatically increasing demand for nursing home care makes it imperative to study the occupational motivations and aspirations of those aides who currently work in long-term care. Motivations for choosing this type of work were found to be related to aides' commitment to continue or leave the job at one year, or to combine part-time work and education. Recommendations are made for improved recruitment and retention of workers in long-term care.     

Psychological Adjustment of Elderly Women:

Elderly women are much more likely than elderly men to be admitted to nursing homes. Institutionalization is both a reaction to and a cause of the rupture of women's social support systems. An ecological model of social support is used to explain differences in elderly women's psychological adjustment to communi!' and institutional life. The results of a twelve-month study of 40 el erly women are presented to provide empirical support for this ecological model. It would not be difficult to make institutions more responsive to the psychological and social needs of elderly residents. Several practical suggestions for creating ecologically sound nursing homes are presented.     

Assisted Living and the Aging Trajectory

ABSTRACT

Assisted living (AL) is a caregiving option between independent living and nursing home placement. This study explores women residents' experience of AL in four Midwestern facilities, using interview and field research methods. We found that most residents wanted to stay in AL rather than move to a nursing home; they looked backward nostalgically toward home, and complied with staff rules and directives in order to remain in place. In contrast to nursing homes, AL allows residents to experience continuities with self and home: a private room, some of their own belongings, and access to relationships and activities associated with self and home. Given the expanded lifespan and growing popularity of AL, it is becoming a new stage in the trajectory of women's aging.     

Common Factors That Enhance the Quality of Life for Women Living in Their Own Homes or in Aged Care Facilities

A qualitative study of older women living in their own homes and older women living in aged care facilities found that the concerns of the women living in their own homes were the realities of life for the residents in the aged care facilities. Twenty-five female residents across two facilities and 11 older women living in their own homes were interviewed. The positive outcomes of aging at home are relevant and desirable for residents of aged care facilities. A smooth transition from community living to residential aged care involves retaining some of these positive aspects of their lives.     

Older Women Caring for Older Women: The Rewards and Challenges of the Home Care Aide Job

As our population ages, the need for personal assistance services increases. Paid personal care is predominantly provided by women, often older women, and has been considered low-status, low-wage work. This article reports on a mixed-method, longitudinal study of 261 home care aides; study participants were 46 years old, on average. Predictors of termination included younger age and lack of health insurance. Study participants reported more rewarding than challenging aspects to the job, though low and inconsistent compensation often forced them to leave the work they loved. Implications of the study with regard to older women caring for older women are explored.     

Maternal Work and Child Care in China: A Multi‐Method Analysis

The majority of women in China, including mothers of young children, are in the labor force. This article investigates the relationship between mothers' work and child care and explores how type of work affects level of involvement in children's care. Substantive understandings of the relationship between mothers' work and child care may well depend on the way work is conceptualized and measured, especially nonwage work. Nearly two‐thirds of women in China live in rural areas, where nonwage work predominates. Analysis of data from eight provinces indicates that wage workers spend less time in child care, but so do women with heavy nonwage demands. Women's involvement in multiple economic activities has consequences for both work‐child care compatibility and work intensity, and may be especially important in efforts to categorize women's work in industrializing economies. Because the majority of the world's women do not work in the wage sector, the implications of these findings extend beyond China.     

Assisted living and the aging trajectory

Assisted living (AL) is a caregiving option between independent living and nursing home placement. This study explores women residents' experience of AL in four Midwestern facilities, using interview and field research methods. We found that most residents wanted to stay in AL rather than move to a nursing home; they looked backward nostalgically toward home, and complied with staff rules and directives in order to remain in place. In contrast to nursing homes, AL allows residents to experience continuities with self and home: a private room, some of their own belongings, and access to relationships and activities associated with self and home. Given the expanded lifespan and growing popularity of AL, it is becoming a new stage in the trajectory of women's aging.     

Beliefs and expectations of family and nursing home care among Mexican-origin caregivers

This study examined perceptions of family care, nursing homes, and expectations of future care among 85 Mexican-origin women caregivers, some who lived in Mexico City and some who lived in East Los Angeles, California (East LA). Attitudes of Mexican-born women—living in Mexico City and in East LA—were more similar to each other than those of U.S.-born women. Most caregivers reported a preference for family care and had negative views of institutional care. In addition, despite the negative views about nursing homes, some caregivers expressed a willingness to seek nursing-home care for themselves so as to avoid burdening their children in the future. Findings lend support to the persistence of Mexican cultural values in this sample of Mexican-origin caregiving women, regardless of where they were born.     

The Great Convergence: Gender and Unpaid Work in Europe and the United States

Over the past decades, men's and women's time use in industrialized nations has changed dramatically, suggesting a gender revolution. Women increased their time in paid work and reduced time in unpaid activities, while men increased their time in unpaid work, but not enough to compensate for women's retreat. We investigate developments regarding men's and women's unpaid work across Europe and the United States, using time diary data from the mid‐1980s and onward. We find evidence for gender convergence in unpaid work over time, but different trends for housework and childcare. Gender convergence in housework primarily resulted from women reducing their time, whereas childcare time increased for both sexes, resulting in convergence only where men increased more than did women. Decomposition analyses show that trends in housework and childcare are explained by changes in behavior rather than compositional changes in population characteristics. Though level differences in unpaid work persist, our findings regarding trends support gender convergence in that they are general across country contexts that vary regarding policy and social norms about gender, family, and work.     

Care Arrangement Choices for Older Widows: Decision Participants' Perspectives

SUMMARY

This research examines how a wide range of care arrangement decisions for frail older women are made. Interviews were conducted with 11 older women (ten of whom are widows), nine of their family members, and six professional service providers. Maintaining the older woman's independence was identified as a major theme. While all decision participants identified it as an explicit or implicit decision-making goal, their meanings of independence were different. The older women's meanings were flexible, changing in response to changes in their physical condition and need for assistance. Adult children tended to identify their mothers as independent when they did not actually need assistance, or when they received help from other sources (e.g., home health care). Professional service providers were inclined to define independence narrowly, as avoiding nursing home placement. Minor themes associated with independence include responsibility, reciprocity, and the family's importance in maintaining independence. These themes help to clarify the complex dynamics that take place during care arrangement decisions and explain how care arrangement choices are made.     

Socially disadvantaged women's views of barriers to feeling safe to engage in decision-making in maternity care

BackgroundAlthough midwifery literature suggests that woman-centred care can improve the birthing experiences of women and birth outcomes for women and babies, recent research has identified challenges in supporting socially disadvantaged women to engage in decision-making regarding care options in order to attain a sense of control within their maternity care encounters.ObjectiveThe objective of this paper is to provide an understanding of the issues that affect the socially disadvantaged woman's ability to actively engage in decision-making processes relevant to her care.Research designThe qualitative approach known as Interpretative Phenomenological Analysis was used to gain an understanding of maternity care encounters as experienced by each of the following cohorts: socially disadvantaged women, registered midwives and student midwives. This paper focuses specifically on data from participating socially disadvantaged women that relate to the elements of woman-centred care-choice and control and their understandings of capacity to engage in their maternity care encounters.FindingsSocially disadvantaged women participants did not feel safe to engage in discussions regarding choice or to seek control within their maternity care encounters. Situations such as inadequate contextualised information, perceived risks in not conforming to routine procedures, and the actions and reactions of midwives when these women did seek choice or control resulted in a silent compliance. This response was interpreted as a consequence of women's decisions to accept responsibility for their baby's wellbeing by delegating health care decision-making to the health care professional.ConclusionThis research found that socially disadvantaged women want to engage in their care. However without adequate information and facilitation of choice by midwives, they believe they are outsiders to the maternity care culture and decision-making processes. Consequently, they delegate responsibility for maternity care choices to those who do belong; midwives. These findings suggest that midwives need to better communicate a valuing of the woman's participation in decision-making processes and to work with women so they do have a sense of belonging within the maternity care environment. Midwives need to ensure that socially disadvantaged women do feel safe about having a voice regarding their choices and find ways to give them a sense of control within their maternity care encounters.     

Self-Assessment and Change in One's Profession: Notes on the Phenomenology of Aging Among Mid-Life Women

Using data from a pilot study of mid-life, mid-career women in nursing, this research note suggests further exploration of women's work roles in understanding subjective assessments of self and aging. The analysis shows that among the nurses studied, dynamics of occupational or professional change were related to views of self in the future. These issues of change rather than age graded norms for achievement were paramount in the nurses' self assessment.     

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.     

„Satt und Sauber“

When discussing the care of the elderly in nursing homes, the accusation is frequently made, that care is limited to that of keeping the residents ?clean and well-fed“. A reference to care essentially focused on the physical requirements of the residents, where social and emotional needs are disregarded for the most part. Using Upper Austria as an example, some of the causative factors will be discussed. Personnel decisions within these institutions are dominated by economic considerations. Their employees are, however, faced with the demands of meeting the comprehensive needs of the elderly on a daily basis, while being restricted on the one hand by the institution, and on the other hand by their own emotional limits. The responsibilities of geriatric nurses as such are a constant balancing act between empathic care and professional distance.     

Assessment of neighborhood satisfaction by residents of three housing types

A highly influential but often underemphasized determinant of residential satisfaction is how residents perceive and feel about their neighborhoods. In this study, factors representing different aspects of residents' neighborhoods were identified and examined in relation to their overall assessment of their homes and neighborhoods. Relationships among neighborhood aspects and overall housing and neighborhood assessments were examined separately for residents of conventional homes, mobile homes, and apartments. Results based on all residents indicated that evaluations of neighborhood aspects were unrelated to housing satisfaction, but were moderately related to positive sentiments and satisfaction with the neighborhood. Separate analyses by housing type revealed that neighborhood perceptions of apartment residents were influential in affecting housing satisfaction. For all residents, the neighborhood's attractiveness and pleasant-friendliness were the most important determinants of neighborhood acceptance and satisfaction. The results also indicated that despite sharing similar determinant patterns of neighborhood acceptance with the other two housing type groups, the basis for mobile home residents' evaluations was considerably less related to the factors identified as influential. The findings indicated that different neighborhood factors formed the basis for differences in overall housing and neighborhood satisfaction among residents living in the three housing types. However, since the type of housing does not by itself define a neighborhood, the differences that were found need to be considered in the larger context of other components of a neighborhood like economic and community characteristics typically associated with a specific structure type.     

Relationships Among Older Women Living in a Nursing Home

SUMMARY

Literature suggests that women's skills in establishing close ties with other women help sustain them in old age by giving them a sense of control over their lives. This paper questions how such a notion may apply to women in a nursing home setting and contrasts women's experiences with those of men. It is a reanalysis of data from a previously reported study of institutionalized elders' social networks, this time with a specific focus on women residents' relationships with one another. Here, I consider the role of negative interaction in personal relationships, the meaning of intimacy and reciprocity in the nursing home context, and issues of age and gender. The final section, implications for practice and future research, includes a discussion of the opportunities for and constraints on relationship formation.     

Women's Employment History and Their Post-Retirement Health and Resources

The purpose of this study is to assess the degree to which the advantages apparently accruing to employed women are maintained into the post-retirement years. That is, do women who were employed cany with them into the retirement years more social and fmancial resources and do they maintain better health than women who remained largely outside the work force? The importance of this issue increases as greater numbers of women enter and remain in the work force and as our population ages. The study uses a longitudinal cohort design and employs the data from the National Center for Health Statistics' Longitudinal Study on Aging. This analysis uses the core questions from the 1984 National Health Interview Survey, the Supplement on Aging questions from 1984 and the follow-up data on mortality from the National Death lndex from 1984-1990. The data include the 4667 female respondents who were 70 years or older in 1984. Overall, the results suggest that women who have more recent paid employment have better health in their later years than women with no employment or no recent employment. However, for social and fmancial resources the direction of the relationships vary. For example, women with more recent employment have less social resources in the form of spouse and living children; however, they have more social resources in the form of social contacts with both family and friends. Having no history of paid employment increases women's risk of living in poverty and lacking private health insurance, but increases the chances that they own their own home. Interpretations and implications are discussed.     

Antenatal group care in a Midwifery Group Practice—A midwife’ perspective

The following article describes a midwife's experience in the adaption of the CenteringPregnancy model into her own group practice to provide education and support to the women in her care. Using personal experience and feedback from women and midwifery students the author describes not only the process of group care in her work context but the apparent benefits to women, families’, midwifery students and herself. Antenatal group care was so successful for the author that it extended to postnatal group care and student group care, all well attended and sought after groups. This is an exciting and innovative way to provide care for women and families and the author encourages other midwives and group practices to consider how they can adapt and progress similar group care into their own practice.     

Maternity waiting homes in times of crisis: Can current models meet women’s needs?

BackgroundMaternity waiting homes (MWHs) located close to birthing facilities are a conditional recommendation by the World Health Organisation, based on very low-quality evidence that they contribute to improvements in maternal or perinatal health outcomes. In addition, several studies suggest that more vulnerable women are less likely to use them. Yet significant investments continue to be made in building and running MWHs within conflict-affected and under-resourced health systems.AimsWe critically examine the literature to shed light on the challenges and opportunities provided by MWHs during health emergencies and in conflict situations.Findings and discussionMWHs are difficult to utilise during crises because they require women to be away from home, are often designed as dormitories, can lack security and be over-crowded. Some MWHs have been adapted during situations of political conflict to incorporate birthing and broader reproductive health care, thereby improving the availability of care away from over-burdened health facilities. How MWHs are adapted during times of crisis may provide insights into what systems of care are more appropriate in meeting women’s needs more broadly.ConclusionThe current global pandemic is an important time to reflect on whether MWHs are meeting the needs of a diverse range of women, in times of stability and during emergencies, and engage in genuine dialogue with women about the kinds of maternity care they want. We need to co-create those systems now so that they are more resilient during the inevitable crises we will face in the future.     

The future in their hands: Graduating student midwives’ plans,job satisfaction and the desire to work in midwifery continuity of care

BackgroundMidwife-led continuity of care models benefit women and the midwives who work in them. Australian graduate midwives are familiar with, and educated to provide, continuity of care to women although the opportunity to work exclusively in positions providing continuity of care on graduation is uncommon.AimTo explore the immediate and aspirational employment plans and workforce choices, reasons for staying in midwifery and perceptions around factors likely to influence job satisfaction of midwives about to graduate from one Australian university during the years 2012–2016.MethodsThis longitudinal study draws on survey responses from five cohorts of midwifery students in their final year of study.FindingsNinety five out of 137 midwifery students responded to the survey. Almost nine out of ten respondents either aspired to work in a continuity of care model or recognised that they would gain job satisfaction by providing continuity of care to women. Factors leading to job satisfaction identified included making a difference to the women for whom they care, working in models of care which enabled them to provide women with ‘the care I want to give’, and having the ability to make autonomous midwifery decisions.ConclusionAligning early graduate work experiences with continuity of care models may have a positive impact on the confidence and professional development of graduate midwives, which in turn may lead to greater satisfaction and retention among a workforce already committed to supporting the maternity healthcare reform agenda.