人类学视野中的临终关怀

现代意义上临终关怀的重点是以控制症状为主,护理照料为中心的全方位服务。在以医学为主角的临终关怀服务团队中,渐渐渗透了包括人类学、社会学、心理学、伦理学等社会科学视角。实质上,在临终关怀尚未制度化时,人文社会科学就已切入这一领域的研究,而且并未将问题意识局限在量化的临终阶段①,而是延展至疾病、生死、制度、秩序、习俗、仪式等最重要的社会表象,并探究其背后的社会组织与结构及其相配合的社会人格、族群心理和集体情感等层面。人类学关于这一问题的理论和实践是本文论述的重点。     

Building on the original strengths of direct payments to create a better future for social care

Confidence in the prevailing In Control model of personal budgets in the United Kingdom is beginning to waver. This raises the question of ‘where to next?’ for social care. Will we be returning to the monolithic system that typified services at the turn of the millennium – a system that is deeply oppressive for the great majority who lack the support and confidence to escape it by accessing a direct payment to manage their own support system? The Care Act has made no change to the basic process whereby it is councils that will decide what a person’s needs are, which will be met and with what resource. However, we argue here that the situation is far from hopeless. In Control’s analysis, while attractive to a neo-liberal political ideology, was based on a serious failure to understand the reasons for the success of direct payments. Whilst policy-makers saw it as a triumph for consumerist notions of choice, it is better understood as a triumph for needs-based planning, but carried out in a person-centred way. Learning the right lessons offers a new way forward to deliver a respectful and flexible service within the context of the Care Act.     

Braving Human Suffering: Death Education and its Relationship to Empathy and Mindfulness

Social workers are likely to encounter clients dealing with traumatic grief and death in their practice. Though death education has gained in popularity and acceptance, few social work students receive coursework in this area and many are unprepared to deal with their clients' and their own emotions regarding death and grief. Though death-related content may evoke provider avoidance, mindfulness and empathy may help regulate provider emotions and responses. This United States-based study evaluates the effectiveness of experiential death education on mindfulness and empathy. Measures in three separate cohorts were given at the beginning and end of the course. Results show statistically significant increases on the Five Facet Mindfulness Questionnaire and the Questionnaire of Cognitive and Affective Empathy, indicating that such a course may be effective in increasing both mindfulness and empathy in social work students and those in related fields.     

Enhancing Critical Reflection amongst Social Work Students: The Contribution of an Experiential Learning Group in Care Homes for Older People

As part of a Practice Learning Centre, representing a partnership between an English University social work department and a non-governmental organisation, 12 students were placed in care homes for older people for their first period of assessed practice. The aims of this initiative were to facilitate: development of critical reflection; deployment of social work skills in a care home setting; and opportunities for social work students to work with care home residents. The learning was captured via four Experiential Groups facilitated by the Practice Educator with responsibility for assessing the students' practice. On-site supervisors also participated. Key learning included understanding of: the importance of critical reflection as a key social work skill; the influence of organisational norms and care home culture on the quality of care practice; the complexity and emotion-rich nature of person-centred care; and the pivotal role of relationships in work with people with dementia. Links made in the Groups—between the experiential and theoretical, the emotional and cognitive, and the structural and personal—demonstrate their value as learning platforms. Placements in care homes have considerable potential to enrich practice education; this is especially important in the context of an ageing population.     

An Explorative Study of the Place of the Ethics of Care and Reflective Practice in Social Work Education and Practice

The moral development and identity of social work students have been shown to be enhanced by education in caring. Important aspects of this education are training in reflective practice and learning to have a perspective focused on professional loving care. In this study, we have explored how reflective processes can be implemented in both educational settings and working practice from an ethical point of view. Elaborating upon reflective practice from an ethical perspective focuses on reciprocity in relationships and relational capacity in institutional contexts. The study took the form of interviews with social work teachers and health care professionals. Interview and focus group data were analysed, three main topics were identified and statements were coded with relation to these topics. Use of both educators and practitioners in this study showed the importance of not neglecting the transition from education to practice. Responses also showed the value placed upon continuous education and development over the course of a health care professional's career.     

应对老龄化挑战探索“护理院”发展

上海在20世纪70年代就进入了老龄化社会,这对上海市域社会的发展带来了严峻挑战,大力发展老年护理事业迫在眉睫。对目前上海老年护理院的现状进行调研发现,上海在发展老年护理院方面存在若干瓶颈问题。通过对问题的形成原因加以剖析,并借鉴发达国家的有益经验,提出发展上海老年护理院的具体政策建议。     

Green Care services in the Nordic countries: an integrative literature review

This article reviews Nordic literature on Green Care for people out of work or school, or with mental health- and/or drug-related problems, published from 1995 to April 2014. Green Care is a well-established international concept that uses animals, plants and nature in an active process to offer health-promoting activities for people. Reports, evaluations and scientific articles are included. The main finding was that the Green Care services described in the literature provided positive activities for our target group. Seven main categories emerged during the analysis: mastery and coping, positive effects on mental health, physical activity, structure and meaningfulness, the feeling of dignity produced by performing a decent ordinary job, social gains, animals and nature experienced as being supportive. Essential intervention factors identified can be described as: (i) contact with animals, (ii) supportive natural environments, (iii) the service leader as a significant important other, (iv) social acceptance and fellowship with other participants and (v) meaningful and individually adapted activities in which mastery can be experienced. These five components interact in a holistic way; the synergetic effects extend the sum of the single factors.     

Care managers’ perceptions of eHomecare: a qualitative interview study

To implement information and communication technology (ICT) in elderly care can be a challenge for healthcare organisations. In Sweden, care managers (CMs) are responsible for offering ICT as a new part of homecare, i.e. eHomecare. The aim of this study was to focus on CMs’ perspectives and describe their perceptions of eHomecare. The study has a qualitative approach. Semi-structured interviews based on vignettes were conducted with 12 CMs in a medium-sized municipality in central Sweden. Data were analysed using qualitative analysis. The findings showed that CMs are influenced by surrounding organisations and relatives in their decision to grant eHomecare. There were also difficulties in CMs’ management of eHomecare. Furthermore, eHomecare was perceived to improve the quality of everyday life for older. It is understood that the management of eHomecare is a challenging task for CMs and a complex mission. Interactions among CMs, relatives, care providers, and other factors as for example CMs’ own attitudes have an impact on CMs’ decisions.     

The University of Melbourne Social Studies Department

Abstract

This article seeks to explore, from a social justice perspective, as an issue of concern to social work, the manner in which the National Competition Policy has legitimated economic rationalism and its impact upon the community. It is argued under the influence of classical liberalism and economic rationalism, as reflected in the National Competition Policy, the value of individuals is being determined in terms of their contribution to the economy. In so doing notions of fairness, social justice and achieving community wellbeing through the promotion of equality, freedom and autonomy for individuals has been abandoned as governments increasingly allow market forces to structure social relations. Instrumental to the manner in which social relations are being restructured is the role of language which has enabled social justice concepts to be presented in terms of individualism.