The Role of Empowerment in Home Care Work

ABSTRACT

The home care industry experiences similar problems with the recruitment and retention of direct care workers (DCWs) as those faced by institutions, and it is important to identify strategies to help retain and grow this important workforce. The empowerment of DCWs has been shown to be an effective strategy for increasing job satisfaction and decreasing turnover in nursing homes but has not been studied in home care. Using Kanter’s organizational theory of empowerment, including structural empowerment (structure of opportunity, access to resources, access to information, and access to support) and psychological empowerment (meaning, competence, self-determination or autonomy, and impact) this study examined whether home care workers (HCWs) feel empowered in carrying out their jobs. An exploratory, qualitative study of 12 HCWs, recruited from two states in the United States, found high levels of both structural and psychological empowerment among research participants, as well as a number of disempowering aspects of their job. Findings suggest ways to support elements of the work that HCWs find empowering and decrease elements that contribute to job dissatisfaction and turnover.     

Contested attachments: rethinking adoptive kinship in the era of open adoption

Since its legal inception in 1926, adoption work has been centrally concerned with the matter of the adopted child's ‘first’ or prior life, whilst also focussed on achieving a new and secure substitute family for that child. Adoptive kinship has been formed through this dual and contradictory concern, a concern that has produced diverse policies and practices over the last 90 years. Drawing on Foucault's concept of technologies of the subject, this paper is an exploration of adoptive kinship within the new context of open adoption, a set of practices that more actively promotes the involvements of the adopted child's former family. These practices both promote a radical reworking of adoptive kinship, as well as confirming its more orthodox moorings. Drawing on an adoption archive study, the paper concludes with an analysis of letterbox contact to explore how far this form of open practice transforms adoptive kinship in the contemporary era.     

Two's Company,Three's a Crowd: Revisiting Triangles in Family Therapy

In this article I would like to investigate the place of the couple in family therapy intervention. Within this I will look at the usefulness of the concepts of triangulation and triangles in families and as to whether it is a theory that translates to be useful in practice and in technique. Attention will be paid to both the experience of this phenomena and emerging theories of the mind which casts new light on the concept of the emotional triangle.     

Social Inclusion or Market Competitiveness? A Comparison of Rural Development Policies in the European Union and the United States

The language of EU rural development policy appears more interested in social inclusion and that of US policy more interested in market competitiveness. We seek to determine why policies directed at rural development in the EU and the USA differ. In both contexts new rural development policies emphasize partnership and participation but we find local participation is used to promote social inclusion in the EU and market competitiveness in the USA. An examination of these dimensions illustrates important transcontinental differences and similarities in rural development policies. We explore the socio‐historical reasons for differences in the commitment to social inclusion, while also noting similarities in the priority of market competitiveness.     

Social Work Student Views on Palliative Care Learning Resources

Abstract

Many social workers are expected to work with individuals and families who are dealing with life-limiting illnesses, yet during their university education they may not have been exposed to materials that address issues related to death and dying. The Social Work Department of University of New England in Armidale, Australia designed and delivered a palliative care teaching and learning session using publicly funded online materials. Themes emerging from questionnaire and focus group data analysis included appreciation for the importance and emotional demands of the materials, sensitivity and flexibility among educators who ideally have work experience in the field, expanding presence of social work philosophy in curriculum materials and exploring spirituality, and examining culture-informed practice in greater depth. Among the implications is the need for concerted efforts to teach about death and dying using high quality accessible materials, while ensuring social work values and approaches are reflected in the content.     

Auditing Nonphysician Providers' Visits through a Computer-Assisted System

Abstract

The Medical Department is using a computer-assisted system for auditing care provided by mid-level practitioners. Standards of care and corresponding checklist forms have been developed for six common ambulatory problem areas. These include: Respiratory complaints, headache, gastrointestinal disorders, urinary tract infections, male genitourinary problems, and minor trauma. The standards for the diagnostic process and treatment of each complaint were developed by a working group of physicians and mid-level practitioners. Providers complete a checklist form for each patient presenting with problems covered by the protocol. The checklist serves as the medical record for the visit. Checklist data is entered into a computer which audits the visit record against protocol standards. The computer identifies records containing discrepancies in the appropriateness of diagnosis, treatment plan, and physician consultation. The computer output is not the end of the audit process. It identifies encounter records which need further review. Because a discrepancy from the programmed standards does not necessarily reflect faulty medical judgement or care, these records are referred weekly to a physician-nurse audit team. The computerized system allows the auditors to focus their efforts on problems which may make a significant difference in patient care.

As a result, the Medical Department's audit process is both more comprehensive and more thorough than it was prior to the inception of this program. Since April 1, 1977, more than 15,000 encounters have been audited through this system.     

Brief Screening and Intervention for Alcohol and Drug Use in a College Student Health Clinic: Feasibility,Implementation, and Outcomes

Abstract

Objective: Evaluation of the Brief Alcohol Screen and Intervention in College Students (BASICS) in a university primary care setting. Participants/Methods: Undergraduates (N = 449) participated in BASICS and electronic surveys assessing frequency/quantity of alcohol and drug use, psychosocial and mental health outcomes, and demographic information. Data were collected at baseline and 6-month follow-up between August 2006 and August 2008. Results: Drinking and drug use decreased between baseline and 6 months. Participants reported an increase in protective factors and in readiness to change alcohol-related behaviors, and a decrease in alcohol-related consequences and in distress symptoms. Heavy episodic drinking at baseline significantly moderated the changes in number of drinks in a typical week and in a typical weekend, and number of drinks on the occasion drank most on a weekend. Conclusions: BASICS can be implemented in a primary health care setting and university students may reduce their alcohol and/or drug use.     

Physical Activity,Exercise, and Sedentary Behavior in College Students

Abstract

Objective: This article examines students’ perceptions of individual and institutional responsibility for sexual health so that institutions can better provide for the needs of their students to increase academic success and healthy relationship outcomes. Participants: Students from 2- and 4-year colleges in 1 state (N = 78). Methods: From May through November 2010, the authors used go-along interviews to examine students’ perceptions of resources for sexual health on their campuses. Results: Participants believed that it is the college's responsibility to provide resources and the responsibility of students to access resources. Participants at 2-year schools wanted referrals to resources, whereas participants at 4-year schools expected resources to be available and emphasized the importance of a supportive community. Conclusions: Students at 2- and 4-year colleges have different expectations of their institutions; by making resources and referrals for sexual health available, colleges can better serve their students, which will result in improved health outcomes.