Transactions between older people and the hospital environment: A social ecological analysis

PurposeTo illuminate how problems arise between older adults and the hospital environment through examination of the transactions between the two rather than a focus on one or the other.Design and methodsA critical ethnographic study that used constant comparative analysis applied to three data sets: hospital observations, interviews with older adults, and hospital employees.FindingsTwo groups of older people are distinguished: those identified as appropriate older patients and those found to be different or less appropriate. Incongruent relationships emerge only when older people who are inappropriate for the hospital's cultural space confront four areas of poor fit: architectural features, bureaucratic conditions, chaotic atmosphere and hospital employee attitude. These environmental features act in independent and interactive ways to produce a disempowering synergy that erodes independence and confidence; produces stress, worry and anxiety; and enhances disabilities when functional impairments exist. Being different is key to a lack of fit in the hospital environment and the construction of problems. Problem construction with older people is less about age and more about the efficiency of a one-size fits all approach to acute care. Ageism emerges as a bi-product of the pressure on hospital employees to keep the system moving.     

Challenging local orthodoxies

Race and State in Capitalist Development: Comparative Perspectives by Stanley B. Greenberg     

Evidence-Based Evaluation of Staircase Architectural Design to Reduce the Risk of Falling for Older Adults

The impact of an increasingly aging population warrants accommodations in home architectural design. Focusing on the staircase design criteria as part of the home environment, this article presents an integrated evidence-based staircase evaluation for home staircase design to reduce the risk of falling for older adults (those 65 years and older). The staircase evaluation has been developed by dividing the staircase into four design elements: handrail design, step design, staircase geometric design, and lighting. Each element is divided into several features that define its architectural design. For example, the step design element is further divided into four features: going depth, riser height, nosing, and step finishing material. A hierarchical list is provided based on an evidence-based comparison of various scenarios for each feature. The hierarchical list presents the comparative effect of each scenario on reducing the risk of falling for older adults.     

Review Essay: The Social Construction of Social Construction

Qualitative Sociology -     

The End of the Welfare State?

This paper critically examines claims of a new consensus on welfare and the end of the welfare state. We first review the concept of welfare consensus, concentrating on the idea of welfare pluralism, in particular the relatively neglected distinction between national minimum (base) and extension ladder (superstructure). We then examine these concepts in the 1990s under Conservative and New Labour governments. Important changes to welfare pluralism are noted. There have been changes in the character of means-tests, with the national minimum replaced by a series of residual minima, which represent fundamental changes to structural incentives governing the social division of welfare and work. The line between state and non-state provision has been blurred and there have been moves to achieve universalism in the private sector. It is possible to tentatively classify Labour's principles and fledgling policies into three categories: essential continuity with the Conservatives, reversing Conservative policies and extending Conservative policies. However, it is difficult to detect the degree of consensus because a new flexible language is beginning to pervade social policy, with the result that the welfare state is being redefined, notably in areas of full employment, citizenship and conditionality. It is possible to detect, in our terms, moves towards turning Beveridge inside out and from the Marshall towards the Beveridge welfare state. It is clear that the welfare state is being redefined, but reports of its death have been much exaggerated.     

Exploratory analysis of verbal aggression in romantic relationships among unmarried men and women: Predictive patterns by gender and race

This is an exploratory study that examined verbal aggression in romantic relationships among unmarried Black and White women and men as a function of gender and race. We employed an ecological approach to examine the receipt of verbal aggression separately for men and women at the levels of individual, relationship, and community. We also explored whether gender-specific correlates of verbal aggression interacted with race. Analyses were based on a sample of 212 women and 133 men in non-marital romantic relationships recruited from 21 U.S. cities for a larger study. Linear mixed-effects models revealed that factors related to experiencing verbal aggression differed substantially for unmarried women and men in romantic relationships. Interesting racial differences also emerged distinctly for women and men.     

Life Course Transitions and Housework: Marriage,Parenthood, and Time on Housework

We examine the effects of transitions in marital and parenthood status on 1,091 men’s and women’s housework hours using two waves of data from an Australian panel survey titled Negotiating the Life Course. We examine transitions between cohabitation and marriage, and from cohabitation or marriage to separation, as well as transitions to first and higher‐order births. We find extraordinary stability in men’s housework time across most transitions but considerable change for women in relation to transitions in parenthood. Our results suggest that the transition to parenthood is a critical moment in the development of an unequal gap in time spent on routine household labor.     

‘I Just Couldn’t Fit It In’: Gender and Unequal Outcomes in Academic Careers

This article reports on the findings of two pieces of research that were designed to test and challenge widely accepted theories about the causes of gender inequity in academic employment at the national level, and subsequently in a more detailed case study of one of Australia's largest and most prestigious universities. Both research projects used large‐scale surveys to capture information about levels of human capital, family responsibilities, career preferences, workloads and objective experiences of appointment and promotion. The case study, conducted in 2002, also utilized focus group discussions with particular groups of women who seemed, from the survey data, to be located just under the glass ceiling. The case study research confirmed the earlier national survey research which concluded that discrimination or bias in appointments, promotions and workloads were not significant in explaining men's domination of the senior levels. It also confirmed the significant gender differences in some kinds of human capital (particularly possession of a Ph.D.). But it also pointed to a quite particular explanation for the failure of women to progress to Level D (associate professor/reader) which involved other more general demographic changes — particularly, high rates of separation and divorce, far higher rates of partnering among men than women and the impact of older children's needs.     

Who Decides? The Social Characteristics of Who Initiates Marital Separation

This study investigates gender differences in the associations between social characteristics and men’s and women’s reports of which spouse initiated marital separation. Using retrospective data on 9,147 first marriages from the Household Income and Labor Dynamics in Australia survey (2001), we find that some social characteristics differentiated between separations initiated by wives compared to husbands, but few differences were statistically significant. The main gender difference is that wives are more inclined than husbands to initiate separation on the basis of their husbands’ as well as their own social characteristics. Our findings indicate that taking account of which spouse initiates separation is important for improving our understanding of gender differences in the processes of marriage breakdown, but more research is required.     

What attributes do Australian midwifery leaders identify as essential to effectively manage a Midwifery Group Practice?

Background

Despite well-known benefits of continuity of midwifery care, less than 10% of women have access to this model of care in Australia. Staff retention and satisfaction are strongly related to the quality of management; however, little is known about the attributes required to effectively manage a midwifery group practice.