“Unexpected and Distressing”: Understanding and Improving the Experience of Transferring Palliative Care Inpatients to Residential Care

The survival of patients with advanced cancer, coupled with the increased presence of end-stage chronic illnesses in an aging population, is leading to a demand in palliative care. Due to the ongoing need for acute-pain and symptom control in hospice/palliative care units, few are able to offer long-stay admission for those whose symptoms have stabilized. When a patient no longer requires specialist palliative care services, transfer from an inpatient palliative care facility may then be necessary. A core component of the role of palliative-care social workers involves working with patients and their families/carers when the care pathway shifts and the option of residential aged care facility (RACF) needs to be considered. This research explored several issues, including the impact of this transition on the patient and their families and on the interdisciplinary health care team treating the patient. An investigation was undertaken to identify concerns and barriers regarding the transition from hospice care to RACF and opportunities were highlighted to improve clinical practice in this area. A tripartite approach was adopted conducting face-to-face interviews with patients, their families/carers, and health care professionals. Members of the interdisciplinary team were interviewed and social workers working in similar inpatient palliative-care facilities undertook telephone interviews to gauge their experiences. A thematic analysis discerned a number of themes highlighting the impact of this transition on key stakeholders and incorporated recommendations to improve or best manage this process. The research has highlighted the difficulties that patients/families encounter in this transition, as well as the emphases of protecting the integrity of the patient and family. This is achieved by holding open and ongoing dialogue, particularly through family meetings and working in collaboration with the patient, the family, and the team. Understanding the experience and impact of this transition on key stakeholders is helpful in building up a knowledge base and to ensure a more effective relationship occurs. This research incorporated the voices of terminally ill patients, families, and members of the health care team in order to understand their views and recommendations for best managing the transition from a hospice/inpatient palliative-care facility to a RACF. This enables their input to have some real impetus in clinical practice and service delivery.     

State Responses to Alcohol Use and Pregnancy: Findings From the Alcohol Policy Information System

This article describes U.S. state policies related to alcohol use during pregnancy, using data from the National Institute on Alcohol Abuse and Alcoholism Alcohol Policy Information System. Specifically, this study examines trends in policies enacted by states over time and types of policies enacted across states in the United States, with a focus on whether laws were supportive or punitive toward women. Findings revealed substantial variability in characteristics of policies (19 primarily supportive, 12 primarily punitive, 12 with a mixed approach, and 8 with no policies). Findings underscore the need to examine possible consequences of policies, especially of punitive policies and “mixed” approaches.     

Uncertainty and Incest—Beyond True and False Commentary on Janice Haaken's Pillar of Salt

In this discussion of Pillar of Salt, I address the ambiguous location of truth within the false-memory controversy. Proposing a vision of traumatic history and knowledge as inherently confusional with regard to truth, I share with the author a repudiation of simple true-false dichotomies. Arguing for a new epistemological paradigm, I examine the nature of traumatic truth (and falsehood) and the way confusional history is manifest in this controversy.     

Protecting Children and Young People from Tobacco‐Related Harm: A Review

Tobacco use continues to be a serious public health issue. Although declining in middle‐ to high‐income countries, smoking rates are often higher in disadvantaged communities and vulnerable groups. Knowledge about tobacco‐related harm also tends to be incomplete. To date, legislation has focused on public domains, but the pressure to protect children in the home and other private spaces is fast becoming a focal point for potential legislation and intervention. Negotiating the boundary between privacy and protection is likely to become a matter of professional concern.     

Remote access and care: A comparison of Queensland women's maternity care experience according to area of residence

BackgroundThis study fills a gap in the literature with a quantitative comparison of the maternity care experiences of women in different geographic locations in Queensland, Australia.MethodData from a large-scale survey were used to compare women's care experiences according to Australian Standard Geographical Classification (major city, inner regional, outer regional, remote and very remote).ResultsCompared to the other groups, women from remote or very remote areas were more likely to be younger, live in an area with poorer economic resources, identify as Aboriginal and/or Torres Strait Islander and give birth in a public facility. They were more likely to travel to another city, town or community for birth. In adjusted analyses women from remote areas were less likely to have interventions such as electronic fetal monitoring, but were more likely to give birth in an upright position and be able to move around during labour. Women from remote areas did not differ significantly from women from major cities in their satisfaction with interpersonal care. Antenatal and postpartum care was lacking for rural women. In adjusted analyses they were much less likely to have booked for maternity care by 18 weeks gestation, to be telephoned or visited by a care provider in the first 10 days after birth. Despite these differences, women from remote areas were more likely to be breastfeeding at 13 weeks and confident in caring for their baby at home.ConclusionsFindings support qualitative assertions that remote and rural women are disadvantaged in their access to antenatal and postnatal care by the need to travel for birth, however, other factors such as age were more likely to be significant barriers to high quality interpersonal care. Improvements to maternity services are needed in order to address inequalities in maternity care particularly in the postnatal period.     

Slippery discrimination: a review of the drivers of migrant and minority housing disadvantage

ABSTRACT

This paper aims to identify housing disadvantages faced by migrants and ethnic minorities; the legal, policy and market forces that shape them; how they have developed over time; how they are manifest nationally and locally; and how they are being responded to locally by those concerned with mitigating them. The paper thereby intends to provide a foundation to inform future research and policy and to engage with local actors to develop ways of overcoming migrant housing disadvantage and challenging discrimination. The paper finds that the interplay of legal changes, which have increasingly differentiated migrants since the 1940s, and shifting housing markets, has driven exclusion of migrants and minorities such that considerable disadvantage is revealed by analysis of census data. However, attention to local specificity provides evidence of positive responses. Examples are presented in relation to access to affordable housing, enactment of homelessness duties and community actions. Methodologically, this paper highlights the importance of simultaneous consideration of migration and ethnicity as markers of difference and exclusion, and the potential of co-production approaches for socially meaningful research concerned with inequalities.