“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.     

Engaging on the ‘front line’: exploring how family support teams construct meaning in their work with young mothers

This paper explores the provision of family support services for young mothers within a Sure Start Children's Centre, drawing on data collected within a larger study. It identifies how the family support team attempted to build supportive relationships with young mothers between the ages of 16 and 19 years. The findings presented here draw on narrative interviews (n = 10) and focus group interviews (n = 2) with the family support team that included early years workers, family support workers and their managers. The findings captured how the participants actively resisted the stigma (Goffman 1963) of teenage motherhood in order to support young mothers in gaining the necessary skills and knowledge to care for their child. Drawing on the findings, this paper argues that the building of a supportive relationship enables a young mother to construct positive counter‐narratives about her parenting experience. This suggests that the family \to offer informal early support to young mothers who are at risk of more formal intervention. However, the complexity of this task should not be underestimated because in doing this, the family support team must at all times ensure the well‐being and safety of the child.     

Staying safe: strategies for qualitative child abuse researchers

Undertaking interview‐based research with victim/survivors of child abuse can be difficult and challenging for researchers. Much has been written about the impact of research on participants, but researcher effects are less explored. This paper reviews the literature on sensitive interview‐based research and child abuse research. The theoretical underpinnings of researcher trauma are outlined and challenges identified and related to child abuse research using researcher reflections from the authors' interview‐based research with children who have been abused and young mothers who were sexually abused in childhood. Strategies and recommendations are developed to minimise child abuse researcher trauma. Copyright © 2009 John Wiley & Sons, Ltd.     

Lesbians Leaping Out of the Intergenerational Contract:

Changing demographics and economic models in modern industrial countries have led to changes in the nature of the intergenerational contract, repositioning of the family as the site for care, and increasing privatization of welfare, housing and health services for the aged. These shifts have important implications for access to services for lesbians and gays as they age and enter their third age, often in the absence of traditional family support. The needs and desires of some older lesbians in Australia in relation to housing and health care were explored via focus group interviews. The results are discussed in relation to the intergenerational contract, policy shifts and the social organization of aged care in Australia.     

Caregiver Burden: A Comparison Between Elderly Women as Primary and Secondary Caregivers for Their Spouses

The overall purpose of this research was to examine the burdens of caregiving on elderly women who serve as primary and secondary caregivers for their impaired spouses. Fifty women 60 years and older identified as spousal caregivers participated in an in-person structured interview. Data were analyzed to compare primary caregivers (caregivers living with their spouses) and secondary caregivers (caregivers of institutionalized spouses) on the following factors: loneliness, depression, time constraints, perceived health status, financial status and perceived life satisfaction. Findings suggest that both groups of women are equally susceptible to the burdens inherent in caregiving. Time constraints were identified as the one major difference between caregiving groups. In addition, the results indicate that spousal caregivers, both primary and secondary, are an at-risk population and are especially vulnerable to loneliness, mild depression, financial worries and low life satisfaction.     

The Status of Psychiatric Inpatient Group Therapy: Past,Present, and Future

This article examines the history, current conditions, and future possibilities of psychiatric inpatient group psychotherapy. Attention is directed toward exploring the purpose, structure, theoretical perspectives, and empirical research of inpatient group therapy. Trends in inpatient care are contextualized within a historical perspective and current politics of care. Future challenges to the viability of inpatient groups, including fiscal pressures, high patient acuity, shorter stays, and pressures for evidence-based practices, are considered.     

Factors in Differential Utilization of Services by Urban Elderly

This paper examines the extent to which people aged 60 years and over living in the inner city of New York utilize community services. It was found that agencies providing income maintenance were utilized by the highest percentage of fhe respondents, followed, in order, by the police, religious organizations, and the housing authority. Among the lowest in reported utilization were voluntary social agencies such as settlement houses and family service agencies. There was also a low level of utilization of visiting nurse and homemaker services. Differences in utilization were found among ethnic groups represented in the population. Reasons for the low level of service utilization are discussed.     

Staff-Family Relations and Institutional Care Policies

As institutional care providers increasingly recognize the importance of the family, the quality of staff-family relations has become a concern. This study investigated the relationship between selected facility care policies and staff-family relationships. Data secured from staff members and family members in rural nursing homes revealed a relationship between the family role that the care policy prescribed and the degree of staff-family integration. The study concluded that care policies viewing family members as clients will have positive consequences for staff and families and ultimately the residents.     

Which Champions,Which People? Public and User Involvement in Health Care as a Technology of Legitimation

This paper concerns two practices, public consultation and user involvement, whose adoption has been urged upon the UK National Health Service in recent years. Public consultation is a local attempt to seek the views of a broad constituency of persons. User involvement is a local attempt to include organized groups of service users in the planning, and occasionally the management, of such services. The paper has four objectives. First, it locates the topic in the context of several related current debates. Second, it outlines the main findings of a recent empirical study of public consultation as they relate to the above debates. Third, it summarizes the relevant findings of an empirical study of user involvement. Finally, it examines these two practices as "technologies of legitimation" which can be seen as a means by which managerial legitimacy is maintained in the context of an increasingly pluralistic policy arena.