An Ecological Understanding of Caregiver Experiences in Palliative Care

Palliative care is specialized health care to improve quality of life for patients with serious illness and their families through prevention and relief of suffering. A Palliative Care Institute was held in western Washington to capture community voices about diverse needs, strengths, and opportunities for improvement of palliative care. Researchers employed qualitative methods to obtain thematic data, provide real-time analysis, and engage in a multivoting technique to reflect stakeholder interest in individual themes and prioritize larger group interests. Bronfenbrenner’s ecological systems framework was used to explore caregiver experiences. Within the microsystem, caregivers reported difficulties in interactions with medical providers as a key challenge. Within the mesosysytem, interactions between patients and medical providers and the impact on caregivers were explored. Within the exosystem, caregivers reported lack of control over the schedules of personal care staff. Macrosystem influences included impact of local culture on the development of palliative care services. Chronosystem influences include de-medicalization of childbirth and its impact on perceptions of palliative care. Implications include the need for social workers to be proactive in fostering trust and effective communication between care providers and caregivers, and the demand for health care provider training in communication with patients and families.     

Shit is good: Mental health social work with lives of squalor

This paper investigates the phenomenon of three clients living in squalor, all of whom have severe and enduring mental health problems, and are on the caseload of a mental health social work team. By thinking about the clients both individually and as a group, within a psychoanalytic framework, it attempts to understand their squalor in a new way, with particular regard to the transference and countertransference experienced by the practitioner. By making use of social work literature as well as that concerning organisations and community care, it also discusses the impact these clients make on the wider community around them, and examines some of the dilemmas faced by the practitioner. The implications for social work are serious and far-reaching and these are discussed with regard to long-term intervention as well as professional and personal scrutiny.     

Providing a secure base for LGBTQ young people in foster care: The role of foster carers

The experiences and needs of lesbian, gay, bisexual, trans and queer/questioning (LGBTQ) young people in care have been overlooked in England, in both policy and research. This paper reports on findings from the first study of LGBTQ young people in care in England and focuses on the nature of foster carers' experiences and perspectives on caring for LGBTQ young people. Qualitative interviews regarding the fostering role in caring for LGBTQ young people were conducted with a sample of foster carers (n = 26) and analysed thematically. Foster carers described the importance of offering LGBTQ young people not only the nurturing relationships that all children in care need but also availability, sensitivity and acceptance to help young people manage stigma and other challenges associated with minority sexual orientation and gender identity. The Secure Base caregiving model provided a framework for analysing the different dimensions of these relationships. Understanding caregiving roles and relationships for LGBTQ young people in care has important implications for recruiting, training, matching and supporting foster carers to care for LGBTQ young people effectively.     

Long-term care in Spain: Difficulties in professionalizing services

The aim of this article is to analyze the difficulties in professionalizing the long-term care system in Spain. Since 2006, the new Spanish law has recognized care as a subjective right, and regulations are being designed to create a framework for its professionalization. Nowadays, family remains the most important group of providers who care for their elders, and women remain the main informal caregivers. Why do families resist using public long-term care services and professional carers included in the new law? The hypothesis highlights sociocultural factors as an obstacle to professionalization of long-term care services in addition to political and economic factors. The results show qualitative data about expectations, preferences, and discourses that women caregivers have in relation to their responsibility. The empirical material includes 25 interviews with different profiles of caregivers and six focus groups with family caregivers. The article suggests that the Spanish ideal of care is a problem for the professionalization of services because the family remains as the main provider of care—without specific skills, knowledge, and abilities.     

Humanitarian response and stress in Kenya: gendered problems and their implications

ABSTRACT

Stress-related conditions such as burnout and post-traumatic stress disorder are a growing concern in the humanitarian sector. Aid workers themselves report not only that mental health problems are common, but that the support they receive from their employers is insufficient. Problematically, the experience of the international aid worker – particularly those who are white and from the global North – is often foregrounded in explaining what constitutes stress and related mental health problems. This indicates a wider problem of what is required of ‘the perfect humanitarian’ – a personality that is gendered and racialised – and how this influences the different experiences and treatment of national and international staff from aid agencies. This article explores the organisational culture and working conditions of humanitarian settings and their impact on the mental health and well-being of staff. It argues that there is a structural dimension to stress that is less to do with external security threats and more to do with the specific infrastructure, policies, and practices of humanitarian operations, with implications for aid workers which cut across dimensions of race, gender, and nationality.     

Whither practice-near research in the modernization programme? Policy blunders in children's services

In this article, we lament the effects of practice-distant research and associated policy initiatives on contemporary children's services in England. In the last decade, as a result of high profile inquiries into non-accidental child deaths, statutory children's social care services in the UK have been subject to a wide-reaching ‘modernization’ programme. We studied decision-making in the high blame environment of local authority children's services. Our research sought to examine the relationship between performance management and the impact of anticipated blame within the decision-making practices of those providing, supervising and managing these services. We show that systems and technologies can be developed which both assist the users in their daily work and achieve desired organizational goals, but without an ethnographically informed, practice-near approach, unsafe work regimes and practices can ensue.     

Consultancy to a Care Home: The Influences of Family and Gender Roles,and of Race and Colonialism

This paper is an account and critical analysis of the psychodynamic and systemic consultancy that the author provided to a care home (and the voluntary organisation running it) over a period of about 16 months. In addition two emergent, linked themes are identified and discussed: family and gender roles in care homes, and racism and colonialism. Care homes are of course part of the society in which they exist and of which they are a product. This means that all the overt and covert psychological and social pressures, defences and trends that occur in the wider society, for individuals, families, groups and communities are also to be found in care homes and in the organisations that run them. They are not isolated from these forces, indeed, it is argued in this paper, the forces are intensified in the ‘hot house’ environment of a care home and, if ignored, avoided and denied, result in the exploitation, abuse and neglect of both staff and residents.     

赋权与增能：农民工弱势地位改变的根本途径

农民工①作为一个特殊的群体，为国家和社会的经济发展做出了巨大的贡献，可是他们处于社会的弱势和边缘状态，无法分享经济和社会发展的成果。对此，文章分析了农民工弱势地位的基本表现，农民工弱势地位的产生原因，提出改变农民工弱势地位的途径：赋权和增能。     

Student and faculty perceptions about mandatory influenza vaccinations on a health sciences campus

Objective: To examine the perceptions among faculty and health professional students regarding mandatory vaccination policies on a health sciences campus. Participants: A total of 296 faculty and 244 students completed surveys during Fall 2015. Methods: The online survey administered to individuals who received the influenza vaccine during the fall 2015 influenza vaccination clinic season included five items evaluating perceptions of employer mandatory vaccination requirements. Results: Chi-square analysis indicated that although faculty and students agree mandatory vaccinations in a health care environment are appropriate, faculty are more likely than students to get vaccinated in the absence of a mandate. Additionally, a small fraction of faculty would consider employment elsewhere when facing this mandate. Conclusions: Overall, faculty and students had favorable perceptions about mandatory influenza vaccine policies. Since students were less likely to be vaccinated in the absence of a mandate, education of students should be improved to support the importance of vaccinations in a health care environment.