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.     

Giving Victims of Bullying a Voice: A Qualitative Study of Post Bullying Reactions and Coping Strategies

Current research on how adolescents cope with bullying is primarily quantitative, examines youth in Grades 1 through 6, and neglects to specifically assess how victims of bullying cope with being bullied. The current qualitative study explored the coping strategies of 22 rural middle- and high-school youth victimized by bullying. Results indicated that youth report using an array of emotion focused coping strategies (an internal coping strategy that focuses on emotion regulation) and problem focused coping strategies (active behaviors that are aimed to decrease or eradicate the stressor). These coping strategies included help seeking, physical and verbal aggression, standing up for themselves, and prosocial bystander behavior. While the majority of coping strategies were similar between middle- and high-school participants, these groups reported utilizing verbal and physical aggression in different ways. Further, certain coping strategies, such as help seeking and lashing out with physical and verbal aggression, were utilized as both emotion- and problem-focused coping strategies. Implications are discussed.     

Predictors of Problem Gambling in the U.S.

In this article we examine data from a national U.S. adult survey of gambling to determine correlates of problem gambling and discuss them in light of theories of the etiology of problem gambling. These include theories that focus on personality traits, irrational beliefs, anti-social tendencies, neighborhood influences and availability of gambling. Results show that males, persons in the 31–40 age range, blacks, and the least educated had the highest average problem gambling symptoms. Adults who lived in disadvantaged neighborhoods also had the most problem gambling symptoms. Those who attended religious services most often had the fewest problem gambling symptoms, regardless of religious denomination. Respondents who reported that it was most convenient for them to gamble had the highest average problem gambling symptoms, compared to those for whom gambling was less convenient. Likewise, adults with the personality traits of impulsiveness and depression had more problem gambling symptoms than those less impulsive or depressed. Respondents who had friends who approve of gambling had more problem gambling symptoms than those whose friends did not approve of gambling. The results for the demographic variables as well as for impulsiveness and religious attendance are consistent with an anti-social/impulsivist pathway to problem gambling. The results for depression are consistent with an emotionally vulnerable pathway to problem gambling.     

Changes in the gender structure: Inequality at the individual,interactional, and macro dimensions

As a society, we've made tremendous progress toward gender equality over the past several decades. Yet there remains significant inequality between women and men. Furthermore, when we look closely at some of the progress made toward gender equality, we find it considerably less impressive than surface appearances. In this article, we review the updated framework of Risman's (2017) gender structure theory and argue that it can help us make sense of the progress we've made as well as analyzing inequality as it persists between women and men. Using gender structure theory, we then show how gender is simultaneously reproduced and contested across the individual, interactional, and macro levels of society within 3 major social domains: work, family, and gender identity.     

The ‘digital glimpse’ as imagining home

This paper proposes the concept of the ‘digital glimpse’, which develops the existing framing of imaginative travel. Here it articulates the experiences of mobile workers digitally connecting into family life and everyday rituals when physically absent with work. The recent embedding of digital communication technologies into personal relationships and family life is reconfiguring how absence is experienced and practiced by workers on the move, and through this, new digital paradigms for life on-the-move are emerging. This paper explores how such social relationships are maintained at-a-distance through digital technology – using evidence from qualitative interviews with mobile workers and their families. Digital technology now enables expressive forms of ‘virtual travel’, including video calling, picture sharing, and instant messaging. This has implications for the ways in which families can manage the social and relational pressures of being apart. Experiences of imaginative travel created through novel media can enrich the experience and give a greater sense of connection for both those who are at home and those who are away. While technology is limited in its ability to replicate a sense of co-presence, ‘digital glimpses’ are an emergent set of sociotechnical practices that can reduce the negative impact of absence on family relationships.     

‘Street-level bureaucracy,management and the corrupted world of service’

Lipsky's analysis of the implementation gap in welfare policy in ‘Street-level Bureaucracy’ focuses on the problem of front-line discretion but ‘brackets off’ the discretion of senior managers. In this paper I draw on a qualitative study to argue that senior managers can also exercise significant discretion and that their discretion can contribute to the conditions of policy confusion and contradiction, and resource inadequacy that characterise ‘the corrupted world of service’ of front-line discretion. In this context front-line discretion may be used by front-line staff to bridge the policy implementation gap created by senior managers.     

Development and Evaluation of a Web-Based Clinician Training Program for a Family-Focused Depression Preventive Intervention

This study evaluated the acceptability, feasibility, and satisfaction associated with a newly developed online clinician training program for the Family Talk preventive intervention, both alone and together with a redesigned, shortened, face-to-face component. Fifty-eight predominately in-home therapy clinicians participated in the study. Results indicated that clinician participants found the online training to be enjoyable and comprehensive, and they reported that the most beneficial training package involved the combination of web-based and in-person training. This combined training could efficiently cover necessary didactic material online while also delivering important clinical skill practice and in-person discussion. Exceptions, limitations, and important future research questions are discussed.     

The Self-Employment of Men and Women: What are their Motivations?

Do men and women carry different motivations for entering self-employment? Earlier researchers have suggested that, as primary care givers for children and families, women face a more stringent time constraint relative to men. Thus, where men see self-employment as a chance for greater financial opportunity, women see a chance to take work that allows more time at home. This paper investigates this hypothesis using unique data that allow analysis of individual self-employment as a function of traditional economic and demographic variables as well as variables that partially capture individuals’ opinions and perceptions of pecuniary and nonpecuniary aspects of entrepreneurism. Results suggest that men who choose self-employment are influenced principally by pecuniary concerns, while women are influenced principally by family concerns and by the opinions of their family, friends, and peers.