Virtuous Care: The Spatial Organisation of Care in Residential Homes for Older People
University of Bristol, United Kingdom
It has been suggested that the privatisation of residential care for older people has resulted in a dualistic market. Here, residential homes at the lower end of the market drive down costs in order to attract local authority purchasers of care. Residential homes at the higher end of the market, on the other hand, attempt to compete on quality, tailoring their services to meet the needs and demands of older people who purchase their own care. Drawing upon an ethnographic study of two distinctly priced residential homes, this paper examines how divergence in the costing of care has altered the manner in which residential care work is organised. The research found a marked difference in the manner in which space was used in the two homes. In the higher cost home, clear symbolic boundaries concerning the management of personal care activities and their resulting waste products were enforced. In the low-cost residential home, on the other hand, little was done to establish boundaries between different areas, tasks or matter. This paper considers how the preservation of symbolic boundaries in residential homes acts to maintain not only hygiene standards but also more immeasurable qualities - dignity, respect, privacy - which are vital to the care of older people.
The use of Complementary and Alternative medicines (CAM) by Breast Cancer Patients-bridging the gap in communication
1University Hospital Coventry and Warwickshire NHS Trust, Brighton and Sussex Medical School; 2Brighton and Sussex University Hospital NHS Trust; 3University of Bedfordshire,; 4Royal Holloway, University of London; 5Brighton and Sussex Medical School
The study attempts to improve communication between cancer patients and Healthcare professionals (HCPs) in regards to the use of Complementary and Alternative Medicine (CAM) in the UK.
Research has shown a gradual and steady increase in the acceptance of CAM by patients over the years. CAM is popular in patients suffering from life-threatening diseases like cancer; especially in women with breast cancer. Authors in Europe and North America have reported this prevalence rate to be as high as eighty percent, with a majority of participants using CAM concurrently with conventional medicine.
Considering the possibility of harmful interactions, it is important that patients and HCPs share effective communication in regards to CAM use. However research to date suggests that up to 77% of patients do not confide about CAM use to their HCPs. This lack of communication may threaten the fabric of patient-doctor partnership.
In this study, the prevalence of CAM use in U.K breast cancer patients was explored, focusing on the Knowledge, Attitudes and Practices (KAP) of women using CAM. Participants were recruited from two cancer clinics (110 women) to participate in an interview-administered survey. A sub-set of 10 women were also invited to take part in semi structured interviews and a focus group.
The study estimated a prevalence rate of CAM use for the last 12 months at 85% (95% CI: 75-95), with the majority of participants using multiple CAM modalities concurrently with conventional treatment.
This paper presents the survey results and those from the Interviews and focus group. The discussion will include rationales for CAM use and possible ways to enhance communications about CAM use between patients and health care professionals.
Caring For Children During The Cancer Journey: An Analysis Of Cancer Blogs
University of Bologna, Italy
In the process of identity redefinition that a disease like cancer involves (Bury, 1982; Charmaz, 1991), the challenges encountered during the cancer journey force women to, at least partially, rethink their gendered role of caregivers (Devault, 1991; Gerstel and Gallagher, 2001), in order to focus on self-care. Women facing cancer need to renegotiate their gendered identities within the constraints of gendered role expectations and gendered divisions of labour (Sulik, 2007), in a society where they are considered as the main individuals taking care of family and children. Through a thematic analysis of cancer blogs written by women with young children, the purpose of this research is to examine how women with cancer experience the tensions and transitions from care giving to care receiving identities, in relation to their role as mothers. How do they balance expectations, including their own, about putting the needs of their children first, with the heightened need to care for themselves? The research provides a focus on their double vulnerability: as cancer patients and as mothers who may not know how (or even if) to discuss their illness with their young children. These women’s double vulnerability exposes particular features of the constraints of the sex/gender system and how gender inequality is experienced in everyday life. Independently of the coping strategy they adopt, mothers with cancer can feel guilty about taking time for themselves and there is always the risk that they overlook their own needs. Support by other family members and the healthcare/volunteering system is needed.
Buildings, Bodies and Bugs: Constructing Spatio-temporal Boundaries in the Cystic Fibrosis Clinic
1University of York, United Kingdom; 2University of Manchester, United Kingdom
This paper explores the management of cross infection in cystic fibrosis clinics, and how staff and patients construct temporal and spatial boundaries to manage risk (Lowton and Gabe 2006). We also draw attention to the role of the built environment in mediating or constraining these strategies and assess the potential for staff and patients to reconfigure their environment. These issues are explored drawing on data from an ongoing AHRC funded study (PARC) comparing three UK cystic fibrosis clinics using qualitative methods including graphic interviews, walking interviews and ethnography. Findings highlight how staff create a careful choreography or ‘place ballet’ (Seamon and Nordin 1980) to segregate patients, and engage in ‘boundary work’ (Mesman 2009), monitoring and guiding patient pathways. Patients also carefully manage their own pathways, in order to maintain social and spatial distance between themselves and ‘risky’ people, objects and spaces. These strategies involve engagements with the built environment – spacing out chairs, finding a ‘safe’ place to sit, opening windows, wiping down surfaces – ‘reordering’ the environment to manage the threat of contagion, through strategies of ‘separating, tidying, purifying’ (Douglas 1966 p.3). Yet the built environment can also constrain these efforts, illuminating a disconnect between rapidly evolving clinic practice, and the intractability of the built environment. We also explore tensions between a choreography of segregation and a ‘choreography of care’ (Martin 2016).