Complex home care: challenges arising from the blurring of boundaries between family and professional care

Over the last 50 years, increasingly complex care (such as tracheostomy management, dialysis or enteral feeding) has shifted from hospital to home, with a concomitant rise in patient self-management and care given by family members. Recognition of the importance of the contribution of family care to the health system is also growing. This article reports the findings of a New Zealand study which explored the experiences of family carers who manage technical health procedures at home. It then draws attention to some broader issues raised by shifting complex care from professional management in hospital settings to family care at home, namely the ways in which complex home care blurs the boundaries between professional and family care (creating the ambiguous position of the expert carer) and questions of safety and responsibility in family care. We also discuss the implications for policy around family caregiving in New Zealand. Given the potential physical and mental health impacts of caring, it is time for renewed consideration of what family carers should be expected or allowed to manage and how the health system can support them in their important role.     

Mothers and deployment: Understanding the experiences and support needs of deploying mothers of children birth to five

ABSTRACT

Military deployments can demand long separations of service members and their families. The strain of separation is particularly acute for mothers of very young children. This study aimed to better understand the deployment and reintegration experiences of service members who are mothers of young children. Focus groups and interviews were conducted with 12 service member mothers who deployed to Iraq and/or Afghanistan when one or more of their children was younger than age 6. Discussions explored experiences before, during, and after deployment; needs and challenges at each stage; available support resources and gaps in support. Thematic data analysis was conducted, drawing on principles of grounded theory. Disruption and continuity were central themes as participants illuminated the challenges they faced and their profound dedication to sustaining strong family relationships across the deployment cycle. Relinquishing, reassuming, and balancing multiple roles and responsibilities are additional themes that were frequently evoked. Participants noted a lack of formal resources responsive to their needs and circumstances and highlighted a need for services tailored to mothers who are deploying. Military mothers, particularly mothers of young children, face distinct challenges surrounding deployment. Better understanding their experiences and support needs can inform tailored services to meet their needs.     

Family support policies and child outcomes: a realist-scoping review*

Family support policies (FSP) refer to government policies that promote the well-being of families with children (e.g. job-protected paid leave, cash transfers, childcare). We developed an initial conceptual and theoretical framework of FSP and conducted a realist-scoping review to document the state of evidence regarding the influence of FSP on three child outcomes: poverty, development, and health. Based on the contexts and mechanisms through which FSP are hypothesized to affect child outcomes, we constructed a framework to guide a search of five electronic databases (OVID, ProQuest, PubMed, Scopus, and Web of Knowledge). We analysed articles meeting our inclusion criteria (i.e. conceptualized FSP as a function of the welfare state; conceptualized child poverty, development, and health as outcomes; and conducted empirical analyses) in relation to our mechanisms and thematic concerns (context, developmental periods, and differential impacts). A total of 22 studies met our inclusion criteria, which tested 25 independent child outcomes. Our findings identified initial mechanisms that explain the relationship between FSP and child outcomes through (1) increasing parents’ basic capabilities, (2) shaping parents’ childcare options, and (3) influencing parental leave-taking and shifting beliefs about gender relationships in the home and workplace. Future work will be to test these mechanisms and framework through a realist synthesis.     

Sexual and Family Violence: Overcoming Barriers to Service Access for Aboriginal and Torres Strait Islander Clients

ABSTRACT

Despite the fact that Aboriginal and Torres Strait Islander communities typically experience a high prevalence of sexual and family violence, service responses have mostly been culturally inappropriate and ineffective. This article reports on a collaborative, participatory research project aimed at exploring barriers to service access by Aboriginal and Torres Strait Islander clients when they have been affected by sexual and family violence. The findings reveal multiple barriers to service access, including justice system deterrents, social taboo, shame, and a lack of culturally appropriate services. The article highlights the importance of recognising and addressing the complex interplay of historic, social, and cultural factors influencing service access.     

Invisible from View: Leaving and Aftercare Provision in the Republic Of Ireland

Abstract

The adequacy of provisions for young people leaving care and in aftercare in the Republic of Ireland has been the subject of recent policy attention. A landmark report, the Ryan Report (2009), into historic abuse in state institutions recommended strengthening provisions in this area. However, the legislative basis for aftercare remains relatively weak and services for young people leaving care remain ad hoc and regionally variable. This article outlines the current context of leaving and aftercare provision in the Republic of Ireland and traces some of the recent policy debates and recommendations in this area. A genealogical analysis of leaving care and aftercare provision highlights that this issue has historically only emerged as a concern in the context in which young people leaving the care system are perceived as a “threat” to social order. It is argued that the failure to adequately reform leaving and aftercare provision is reflective of wider social inequality and of a context in which young people in care are largely invisible from view.     

生育政策调整及其风险规避

现行生育政策对遏制中国人口过快增长作出了历史性贡献,但是政策本身具有阶段性和局限性,不宜长期实行,否则会因下一代人口的过快衰减而影响家庭、社会甚至国防安全。为了让公民满足在生育上的刚性需求和实现平等的生育权利以及降低政策的负面影响,建议将现行生育政策调整为全国统一的“补偿一孩,允许二孩,控制三孩”,并将这一政策延续到2033年前后。调整生育政策可能会出现生育率波动、推迟和抬高人口峰值、计划生育工作滑坡、独生子女家庭总负担加重、人口与资源生态环境关系更加紧张等风险,需要切实规避。     

家庭保障在我国农村社会保障中的地位和作用研究

家庭是人类自古以来形成的最基本的社会生活单位,在中国的历史长河中始终扮演着十分重要的角色,尤其在保障家庭成员的养老、医疗、生育、精神慰籍等方面以及对于社会的安定和发展方面都发挥了十分重要的作用。在目前社会保障制度化发展过程中,家庭保障也对正式的社会保障制度起到了重要的补充作用,在建立和完善农村社会保障体系过程中,其地位和作用更是值得重视。     

需求取向社区贫困家庭志愿服务的探索

贫困救助是我国社会服务的永恒主题,城市最低生活保障制度和农村五保制度为解决贫困问题提供了制度保障。但是,贫困是一个复杂的持续性的社会问题,社会保障政策的公共性与弹性要求以及社会的不断变迁,使得贫困救助需求的差异性和变化性难以得到有效满足。社区志愿服务以其贴近居民生活的服务特点,可以有效地填补社会救助政策的漏洞。本文描述了社区贫困家庭的现状及其特点,揭示了当前社区服务和社会政策存在的缝隙;立足社区贫困家庭的需要,提出了社区贫困家庭志愿服务应该提供的主要服务内容,寄望建设一个符合中国社会文化情境和具体家庭需求的社区贫困家庭志愿服务。     

语篇衔接与英语习得程度调查分析

通过对大学非英语专业学生的英语议论文写作中使用的语篇连接词进行统计分析,探讨学习者语篇衔接意识和能力与英语习得程度的关系。研究结果发现:1)学习者使用连接词的意识和能力与他们的英语习得程度有关系;2)英语习得程度好的学习者与程度差的学习者所使用的连接词在总数和类别数量上有显著差异;3)在议论文体中所使用的连接词存在单一的特点。     

论语篇连贯的实现机制

连贯是语篇的重要特征,也是篇章分析的关键概念。语篇连贯是显性衔接和隐性衔接交互作用的结果,显性衔接带有明显的语篇标记,而隐性衔接无形式标记,对衔接手段的识别影响到对语篇的理解。在解读语篇时,读者必须充分认识到语篇连贯的显明性与隐含性,善于发现衔接,才能正确理解语篇的连贯意义。