Understanding “Good Days” and “Bad Days”: Emotional and Physical Reactivity Among Caregivers for Elder Relatives*

Abstract: Using a daily diary design, we examined fluctuations in caregiver well‐being; how day‐to‐day variations in stressors related to the caregiving experience are linked to fluctuations in well‐being; and whether caregivers who are women, or high on certain personality traits (e.g., neuroticism) are more susceptible to emotional/physical health fluctuations in the face of daily stressors. Sixty‐three caregivers reported on eight consecutive days. Multilevel analyses (Hierarchical Linear Modeling) indicated significant within‐person reactivity. On days when caregivers faced more tasks than usual, more care recipient behavior problems, or more family disagreements regarding care, they experienced more depressive symptoms, feelings of burden, and physical symptoms. Some within‐person patterns of reactivity were moderated by gender and personality. Implications for community interventions for caregivers are discussed.     

“Caregiving is a full‐time job” impacting stroke caregivers' health and well‐being: A qualitative meta‐synthesis

Family caregivers contribute to the sustainability of healthcare systems. Stroke is a leading cause of adult disability and many people with stroke rely on caregiver support to return home and remain in the community. Research has demonstrated the importance of caregivers, but suggests that caregiving can have adverse consequences. Despite the body of qualitative stroke literature, there is little clarity about how to incorporate these findings into clinical practice. This review aimed to characterise stroke caregivers' experiences and the impact of these experiences on their health and well‐being. We conducted a qualitative meta‐synthesis. Four electronic databases were searched to identify original qualitative research examining stroke caregivers' experiences. In total, 4,481 citations were found, with 39 studies remaining after removing duplicates and applying inclusion and exclusions criteria. Articles were appraised for quality using the Critical Appraisal Skills Programme (CASP), coded using NVivo software, and analysed through thematic synthesis. One overarching theme, ‘caregiving is a full‐time job’ was identified, encompassing four sub‐themes: (a) restructured life, (b) altered relationships, (c) physical challenges, and (d) psychosocial challenges. Community and institution‐based clinicians should be aware of the physical and psychosocial consequences of caregiving and provide appropriate supports, such as education and respite, to optimise caregiver health and well‐being. Future research may build upon this study to identify caregivers in most need of support and the types of support needed across a broad range of health conditions.     

“I Fell Off [the Mothering] Track”: Barriers to “Effective Mothering” Among Prostituted Women

Ecological theory and basic assumptions for the promotion of effective mothering among low‐income and working‐poor women are applied in relation to a particularly vulnerable population: street‐level prostitution‐involved women. Qualitative data from 38 street‐level prostituted women shows barriers to effective mothering at the individual, community, and societal levels. Suggestions for enhancing the lives and long‐term well‐being of prostituted women with children are included.     

A Couplehood Typology for Spouses of Institutionalized Persons With Alzheimer's Disease: Perceptions of “We”–“I”*

A qualitative analysis of 68 community‐dwelling spouses of institutionalized patients with Alzheimer's disease was conducted. The goal was to ascertain to what degree they perceived themselves as married. Five groups representing different degrees of couplehood emerged. Ranging from strong couplehood to no couplehood, groups were given the following terms: “’Til Death Do Us Parts,”“We, but …,”“Husbandless Wives/Wifeless Husbands,”“Becoming an I,” and “Unmarried Marrieds.” Ways to interpret this typology and implications for both further research and practitioners are described.     

“Best of all I like Choosing Time” Talking with children about play and work

Talking with children is suggested as a useful observational tool for gathering information and evidence on children's understandings. Conversations with children from three different settings are discussed, with reference to their ideas about play, work and learning. Certain common features about children's conceptions emerge: their tendency to see play as a social activity, largely unconnected with learning, and work as related to often seat-based, teacher-initiated tasks. Some differences in attitudes across settings were also apparent, particularly in children's feelings about choice, and their freedom to choose. A model to account for children's conceptions is suggested.     

The case for “structural missingness:” A critical discourse of missed care

Stimulated by our conversations at the 2018 International Philosophy of Nursing Society Conference and our shared interests, the coauthors present an argument for augmenting the broader discussion of “missed care” with our synthesized concept called structural missingness. We take the problem of missed care to be largely grounded on a particular economic construction of the healthcare system within an era of what some are calling the Capitalocene, capturing the pervasive influence of capitalism on nature, humanity and the world order. Our perspective is that of the United States, however, extrapolations can be made to the social and healthcare systems in other countries. We are concerned with the underlying conditions that structurally reify inequality and ultimately undermine nursing practice. To situate the discussion, we briefly review existing literature on the contextualization of missed care. We understand contemporary circumstances of missed care as a function of the neoliberalization of healthcare, including the idea of nursing as a commodity. From this, we discuss the implications of missed care, which forms the basis of our critique. Synthesizing the term “structural missingness, we locate a moral imperative in the professional and disciplinary commitments of nursing to consider who and what have been left out. This moral imperative for the nursing profession, along with other social and health related professions, underscores our obligation to be involved in uncovering inequities and conceptualizing upstream solutions for structural missingness.     

A case study exploring the effectiveness of an innovative “5Q Care Test” to determine whether patients with complex needs require health or social care

A case study was conducted in 2016 to evaluate the effectiveness of an innovation to enable people with “complex” care requirements to be discharged from hospital to an appropriate service for their care, without using the NHS England Continuing Health Care (CHC) assessment. The setting was a rural district general hospital in England, where the quality outcomes and cost‐effectiveness of the CHC assessment being conducted in hospital were giving cause for concern. The NHS CHC Framework advocates conducting these assessments in the community where a more accurate indication of long‐term care can be determined. The “5Q Care Test” was collaboratively developed with health and social care partners, care providers, and CHC interest groups, including users of the services. It was implemented as a tool to support moving the CHC assessment into the community, as it enabled practitioners to swiftly determine patients' appropriate initial care pathway out of hospital. A full economic impact analysis was conducted 7 months after the tool was introduced. The results showed significant improvement in the quality and cost‐effectiveness of the “5Q Care Test,” with a reduction in the hospital length of stay, which is known to be associated with improved outcomes for patients and financial savings.     

Quality children's television: the case of “Lift Off”

“Lift off” is a new, innovative children's television series produced by the Australian Children's Television Foundation. It has been well received by critics, parents, educators and most significantly, by its three-to-eight year old target audience.

The program easily satisfies the five criteria for quality programming formulated by the Children's Program Committee of the Australian Broadcasting Tribunal. The typical half-hour program is dense, requiring close viewer attention but it is claimed that the viewer is rewarded for her viewing investment with an enriching and pleasurable experience. The doubt is raised that the socially disadvantaged segment of the child audience, who use television for diversion rather than enrichment, may not be prepared to make such an investment of viewing attention.

One final concern is voiced. The Foundation's official spokespeople publicly claim that “Lift Off” will enrich the lives of a whole age cohort. It is argued that such claims overemphasise the supposed direct consequences and impact of media messages on individuals.     

The paradox of “wonderful children”: The case of child abuse

In our society young children are generally considered to be “wonderful”. This dominant concept pervades not only parental thinking, but professional thinking as well. In the case of child abuse, however, profound contradictions can arise as a result. Professionals are primarily focused on children's welfare, while parents' views are much more ambiguous.

In our example of a Family Centre these contradictions are clearly illustrated, and we hope to draw conclusions as to what change in theory and practice could result from an analysis of contradictions.     

The “syndrome of the post-premature child”: a study of its significance -- Part I

Prematurity has the greatest influence upon frequency and degree of mechanical disturbances uncovered by the Test of Imitation of Gestures. The authors look for the significance of this syndrome at various levels:

1. Possible organic damage to the central nervous system structures, through the tonic and motor disturbances checked out by the neurological examination.
2. In the disturbances of the early development of posturomotor abilities.
3. Deviant and delayed development of the cognitive factors (spatial and temporal structuring).
4. Emotional and relationship development.

The investigations were carried out on a sample group of prematurely born children and a control group group of children born at term.

After observing certain behavior disorders which occur among normal children -- mild disorders which become less obvious with age -- the authors show that frequent and gross disturbances which appear in the first months of life and persist beyond the age of 6 years distinguish the premature child. In this same group, however, delays in mental development noted early in life often disappear entirely by the age of 4 years, even among children who were born very prematurely.

The authors then isolated the most typical disturbances found among the premature children, with stress on factors of pathology, maturation, adjustment, and environment.

The authors study the relationship between the disturbances described above and the various aspects of the neurological examinations which enable them to objectify the dynamic factors of the body adjustment to the external world and to other people. The hypothesis that a fundamental relationship exists between disturbances of adjustment and the genesis of the “post-premature child syndrome”, develops from the comparison between the psychological and neurological data in their longitudinal evolution.

Commenting on the relevance of these findings for the care of premature children, the authors stress the value of motor training and remedial education for overcoming the disturbances of spatial structuration and body schema.     

Social capital: an investment of “self” in children's learning

The concept, Social Capital, is devoting oneself affectively through implementing the CDA teaching behaviors so as to assure that children learn, like learning, and know how to learn. Since SC was previously verified as embodying five elements, the concept was investigated, using the “Preschool Teachers' Social Capital Questionnaire.” The subjects were 168 ECE teachers in both N.Y. [70] and D.C. [98], and their data were computed for appropriate measures of central tendency, variability, and relationships. The findings were: [1] subjects reported being trained in SC in their degree programs; [2] the five dimensions of SC were related to each other for teaching behaviors; [3] all SC dimensions except persistence#sh continuity over time related significantly to each other on all variables when examined separately; [4] persistence#shcontinuity over time was the one SC dimension that was positive but not significantly related to the others on training and investment of effort. Conclusion: The positive relationships support that teachers should be trained in SC and that SC should be used in teaching young children, although more study is recommended with a larger sample after the two aspects of persistence#shcontinuity over time are separated.