Complex home care: challenges arising from the blurring of boundaries between family and professional care

Over the last 50 years, increasingly complex care (such as tracheostomy management, dialysis or enteral feeding) has shifted from hospital to home, with a concomitant rise in patient self-management and care given by family members. Recognition of the importance of the contribution of family care to the health system is also growing. This article reports the findings of a New Zealand study which explored the experiences of family carers who manage technical health procedures at home. It then draws attention to some broader issues raised by shifting complex care from professional management in hospital settings to family care at home, namely the ways in which complex home care blurs the boundaries between professional and family care (creating the ambiguous position of the expert carer) and questions of safety and responsibility in family care. We also discuss the implications for policy around family caregiving in New Zealand. Given the potential physical and mental health impacts of caring, it is time for renewed consideration of what family carers should be expected or allowed to manage and how the health system can support them in their important role.     

Focus on Home: What Time-Use Data Can Tell About Caregiving to Adults

Care by adults to other adults is being increasingly transferred from formal public institutions to the private home. To learn more about the nature and situation of Canadian adults providing care at home to other adults, we analyzed data from Statistics Canada's 1998 social survey of 10,749 persons. Data included time-use and respondents' sociodemographic, cultural, work, and leisure characteristics, as well as outcome factors. We found 212 respondents (about 2%) providing personal, medical, or other care to other household adults on the day studied. We compared them to those not found to provide these services. The article explores time-use trade-offs, feelings of stress, and the ramifications of gender, age, and paid work in this newly reemerging use of household space.     

Alternatives to Custody in the New Zealand Criminal Justice System: Current Features and Future Prospects

Alternatives to custody in New Zealand have followed a format similar to criminal justice systems in the UK and other European countries but with a stronger emphasis on both punitive, work-based options like periodic detention, and more recently home detention, as well as restorative justice models. Much of current practice relies heavily on the now dated Criminal Justice Act 1985. However, a new sentencing and parole act is proposed for 2002. In this paper the authors review the current alternatives to custody in New Zealand, paying particular attention to issues arising from their recent research on home detention—surveillance, control and impacts on family members—and offering a reflection on the future prospects for alternatives to custody.     

Positive and negative impacts of job loss on family life: the perceptions of Australian car workers

This article contributes to research on the impact of job loss on families. It is based on survey responses from 371 workers and in‐depth interviews with 39 of them about the family impacts of their job loss from the Mitsubishi car factory in Adelaide in 2004–2005. A majority of workers said family life had been affected by their job loss. Quantitative analysis identified four variables significantly associated with family impacts: marital status, children living at home, employment status and financial management. Qualitative responses showed the predominantly negative impacts were financial strain, loss of relationship stability and general stress and worry, although few faced catastrophic impacts from their job loss. However, in contrast to most previous research, the in‐depth interviews also revealed positive impacts from job loss, such as having more time at home and to spend with their family. We conclude that the existence of ongoing income support and public health insurance in Australia were important in avoiding catastrophic financial impacts on these workers and their families.     

The association of work-related worries and anger with home-related worries, and anger at others at home

Studies have found anger at others at home (AOH) to be associated with job-related stress, and work-to-home interference (WHI). These findings suggest that WHI may mediate the translation of stress about work into AOH. This study investigates the associations of work-related worries, and anger about work, with worries about home and AOH. WHI is investigated as a mediator of the translation of job worry into AOH, and spillover of moods between work and home. Gender, age and job control are investigated as moderators of those associations. Data are from a telephone survey of employed residents of Toronto, Canada who are living with others. The results suggest that WHI mediates the spillover of worries between work and home, but not the spillover of anger or the translation of job worries into AOH. The moderation analyses suggest that WHI increases AOH only among people with low job control.     

Does gender ideology explain differences between countries regarding the involvement of women and of men in paid and unpaid work?

Women spend more time doing household work than men, and men spend more time working at paying jobs outside the home than women. But studies also show that there are major differences between countries regarding the degree to which women and men involve themselves in different kinds of labour activity. The main aim of the article is to analyse the significance of gender ideology when studying differences between countries regarding the involvement of women and men in paid and unpaid work. The analysis is based on national random samples from ten OECD countries that were collected within the framework of ISSP 1994. The conclusions are: (a) gender ideology has an impact in all the studied countries on the degree to which women and men involve and engage themselves in labour and (b) gender ideology partially explains the differences between countries regarding women's and men's involvement in paid and unpaid work.     

Effects of minor household interventions to block draughts on social housing temperatures: a before and after study

Half of New Zealand’s renters report damp or mould problems with their homes, which can have negative health implications. Tenants in a newly upgraded social housing complex complained of being cold. Sealing strips around doors and baffles in rangehoods were installed. This exploratory study’s objectives were to determine: (1) whether the interventions influenced indoor temperature, (2) the extent to which indoor temperature changed and (3) benefits to the tenants. The before-and-after rapid response study was conducted in five social housing units. Indoor temperature was subjectively and objectively measured. Using multivariate normal linear regression, units were found to be on average 1.36°C warmer post-intervention after adjusting for outdoor temperature. Tenants’ daily diary entries also claimed units were warmer post-intervention. Simple minor interventions to block draughts made a relatively big difference to indoor temperature and comfort of those living there. Such interventions are worthwhile, especially when housing is tenanted by vulnerable populations.     

Social workers' attitudes towards family group conferences in Sweden and the UK

The New Zealand family group conference (FGC) approach to decision making in child welfare and protection has attracted strong interest among policy makers and professionals all over the world. While New Zealand’s legislation makes use of FGCs more or less mandatory in child protection, other countries permit social workers to refer families to an FGC at their own discretion. Knowledge about social workers’ attitudes towards the model is thus paramount if we want to understand implementation and evaluations of FGCs outside New Zealand. This study looks at attitudes towards and actual referrals to FGCs amongst 219 social workers from 18 local authorities in Sweden and the UK. Results reveal an overwhelmingly positive attitude towards FGCs in both countries. Given these attitudes it was striking that only 42% of the social workers had initiated at least one FGC over an 18‐month period. The number of implemented FGCs was almost exactly the same in Sweden and the UK, after adjusting for time and number of social workers. Possible explanations for this paradox are discussed, using data from the survey and child welfare literature.     

Positive youth development in Māori and New Zealand European adolescents through an adventure education programme

Within Aotearoa New Zealand there is growing interest in positive youth development (PYD). A PYD approach provides balance to narratives surrounding outcomes for youth and broadens our views of what we consider beneficial developmental outcomes. In the current study we used sail training as a method to promote PYD in Māori and New Zealand European adolescents. Specifically, 54 Māori and 37 New Zealand European adolescents completed the 7-day youth-development voyage on-board the gaffed rigged schooner, R. Tucker Thompson. We demonstrate that, for both Māori and New Zealand European adolescents, psychological resilience, self-esteem, and positive outlook on life increased from the first day to the last day of the voyage. In addition, we demonstrate that the increases in psychological resilience were driven by the social/collective identity adolescents formed with their group over the course of the voyage.     

Cultural case workers in child disability services: an evidence-based model of cultural responsiveness for refugee families

The medical/disabled category for quota refugees selected for resettlement in New Zealand allows entry to those who have either a medical condition that can be treated or helped in New Zealand or a disability that requires support. Children from refugee and other culturally and linguistically diverse backgrounds with impairments comprise an increasing proportion of the caseloads of Auckland region child health and disability services. For people from refugee backgrounds, the New Zealand disability system can be complex, difficult to understand and hard to navigate. Disability therapeutic, rehabilitative and support services are often non-existent in countries of origin. The interventions offered in western countries such as physiotherapy, occupational therapy and speech language therapy may be unknown and therefore poorly understood by refugee clients and families. This article presents the findings of an evaluation of the establishment of cultural caseworker positions in the Waitemata District Health Board Child Development Service.     

Houses with elastic walls: negotiating home and homelessness within the policy domain

Efforts to address homelessness in New Zealand are marked by competing discourses that construct it as a housing issue, or more radically, as an issue of social exclusion. This paper presents a case study that illustrates the difficulties of reconciling these discourses when framing homelessness policy. Research was conducted with a national organisation involved in advocating to the New Zealand government on homelessness policy. Members of this group participated in focus groups exploring the meanings of home, homelessness and their advocacy work. The paper traces the challenges presented to the politics of social action by recognising homelessness as an issue of social exclusion, but needing to frame it as an issue of housing to effect policy change. It argues that social activist groups must routinely make pragmatic and strategic compromises that challenge the integrity of their ideological positions and their conceptual understandings, and develop group practices that allow them to resolve the tensions that this can generate.     

Increasing the use of alcohol screening and brief intervention in New Zealand

New Zealand has high rates of acute alcohol-related harm relative to chronic harm, and when compared with other countries. Acute harm is typically caused by binge drinking. New Zealand alcohol use surveys consistently find that about 20–25% of adult drinkers binge drink. There is substantial overseas evidence that alcohol screening and brief intervention (SBI) in primary health care is effective and cost-effective for reducing alcohol harm among binge drinkers. However, while there is also growing evidence that alcohol SBI can successfully be implemented in New Zealand, the approach has been significantly under-utilised. This article provides a brief overview of New Zealand research that supports a case for increasing the use of alcohol SBI in primary health care. It also highlights that when looking to successfully implement alcohol SBI in other settings, it is important to ensure that the intervention is simple and purpose-built for both the setting and recipient.     

Towards a critical discourse analysis of New Zealand security policy in Afghanistan

ABSTRACT

Rather than ask why New Zealand supported the intervention, this paper focuses on how representations of New Zealand and the international terrorist threat resulted in public acquiescence to a pre-emptive strike by the world's sole superpower against one of the poorest, most war-torn countries in the world. The paper concludes that legitimacy was achieved through the blending of themes of terrorism and war, national interest and democracy, rule of law and human rights, to produce an ambiguous ‘international campaign against terrorism’ that allowed for picking and choosing of the most convenient position on different matters. The alternative—to refuse moral and material support for the United States-led ‘war on terror’—was to risk New Zealand's membership of the United States-led international community and a ‘seat at the table’ in future international trade and security negotiations. As such, any campaign benefits appear to have accrued to New Zealand rather than Afghanistan or the Afghan people, especially given the parlous state of that country in 2018. A wide-ranging debate within New Zealand on the purpose of such interventions is needed before similar commitments are made in the future.     

The relationship between ethnicity and fertility in New Zealand

While there is a global shift towards smaller families, some groups maintain relatively high fertility rates. The 2013 New Zealand census data were used to investigate the nature of fertility between ethnicities in New Zealand. The NZ Deprivation Index 2013 was used as a measure of socioeconomic status to determine the relationships with fertility. The results mirror research outside of New Zealand in that socioeconomic status is inversely correlated to fertility. Using crude average fertility rates, sole-ethnicity Pasifika and Māori ethnic groups still have substantially higher fertility than sole-ethnicity Europeans and Asians ethnic groups, even when simultaneously accounting for age, socioeconomic status, education, and religious affiliation. Christians have more children than individuals reportedly without any religion, and fertility rates drop on average for mothers who have higher formal qualifications. Our findings suggest that cultural, or other ethnic-specific factors differentially affect fertility for Māori, Pasifika, New Zealand European, and Asians as aggregated ethnic categories, respectively.     

Camping,climbing trees and marching to Parliament: spatial dimensions of environmental protest in New Zealand

Environmental movements are key actors in challenging social and political constructions of the physical environment. A wide variety of protest campaigns have been undertaken in New Zealand, from local issues of pollution and road building through to national opposition to native forest logging and genetic engineering (GE). The aim of this paper is to examine the scales at which environmental protest in New Zealand have taken place and the impact upon the actions and durability of environmental campaigns. Through an analysis of a catalogue of protest events over the period 1997–2013, this paper describes patterns of actions, before examining the campaigns against GE field trials and mineral extraction in more detail. The findings point to the importance of cross-scale operations in enabling campaigns to capitalise on and respond to changes in the external environment including governance structures, resources and countermovement actors.     

‘Which side of the bridge to safety?’ How young Pacific Islanders in New Zealand view their South Auckland community

The community of South Auckland, an area that is home to the largest population of people with Pacific Island (Pasifika) heritage in New Zealand, has consistently faced scrutiny and criticism from the media, law enforcement, and other sectors of New Zealand for its reportedly increasing levels of violent gang activity and high rate of criminal offences associated with gangs and involving Pasifika youth. Within the community, however, young Pasifika people appear to have a positive opinion of their community and about particular features of gangs in their South Auckland community though they remain highly critical of the presence of gangs. This was revealed in a recent research study for the New Zealand Families Commission (Nakhid et al. 2009), which was carried out with South Auckland youth of Pasifika heritage between the ages of 12 and 28, including those who were involved in gangs and those who had never been involved in gangs.     

The proximity filter: the effect of distance on media coverage of the Christchurch mosque attacks

ABSTRACT

The intense media coverage in New Zealand and Australia of the Christchurch mosque attacks exhibited significant disparity in editorial decision-making between the two countries. This research interrogates the different approaches taken in newsrooms and how these differences were manifested in broadcasts and publications. New Zealand media were focused largely on empathetic coverage of victims and resisted the alleged gunman's attempts to publicise his cause while their Australian counterparts showed no such reluctance and ran extended coverage of the alleged perpetrator, along with material ruled objectionable in New Zealand. It finds the editorial focus in each case exhibits the effect of proximity, identified in literature on empirical ethical decision-making as a factor in applied ethicality. The authors conclude that a proximity filter was used by New Zealand media who identified the victims as part of their own community, but the events of 15 March 2019 were seen as ‘foreign’ by Australian journalists who used perceived distance as justification for extremely graphic content.     

Exploring health-related quality of life determinants of New Zealand sole mothers

International research has repeatedly linked sole motherhood to diminished levels of psychological and physical health. The purpose of the present study was to add to the limited amount of research on the health-related quality of life determinants in sole mothers, particularly in New Zealand. A sample of 263 New Zealand sole mothers recruited through a number of parent or women's networking groups completed a questionnaire on health-related quality of life, perceived stress and social support. Social support was positively associated with health-related quality of life irrespective of level of perceived stress, thus finding no evidence for a stress-buffering effect. The strongest protective factors against lowered health-related quality of life were social support and adult family members living at the same home, highlighting possible strategies to overcome inequalities in health-related quality of life.     

What do social workers and children do when they are together? A typology of direct work

There is renewed interest in the place of direct work and relationship‐based practice in social work. This paper explores the day‐to‐day direct work that happens where children and young people are ‘looked after’ at home, from the perspectives of children, social workers and those supervising practice. It is based on interviews with eight children and 25 professionals about their experiences. In this paper, I highlight that despite barriers, direct work, which is characterized as meaningful by children and professionals, happens and that the relationships formed between children and social workers are an important precursor to and an outcome of direct work. The research was undertaken in Scotland, and although the legislation, policy and guidance differ from other jurisdictions, the messages about direct work are relevant for practice in other countries.     

New Zealanders returning from overseas: how their experiences of xenophobia could help us respond to superdiversity

ABSTRACT

This article draws on qualitative interview data with 42 New Zealanders returning to New Zealand after living overseas, finding they feel more like a ‘migrant’ than someone coming ‘home’. This is in part because New Zealand people and institutions demonstrate an intolerance to difference, theorised here as a form of xenophobia that inhibits the economic, social and political integration of participants. However, the same experiences and ideas that lead many New Zealanders to frame returnees as an ‘out-group’ can be regarded as a national resource. The article concludes that we should embrace – not ignore or disparage – returnees' awareness of integration issues, transnational networks and cross-cultural experiences as we attempt to maintain social cohesion in an increasingly superdiverse world.