Search

BackgroundFamily involvement in decision making for hospitalised patients is associated with improved end-of-life care. Yet, these discussions can be challenging for physicians and families and associated with distress, confusion and conflict. There is a need to understand how best to support families involved in decisions regarding the transition from active to palliative treatment in hospital settings.AimTo explore bereaved families’ experiences of end-of-life decision making for general medicine patients.DesignA qualitative exploratory study framed by social constructionism using semistructured interviews and thematic analysis.Setting and participantsThe general medicine units of one large public hospital in Melbourne, Australia. We recruited 28 bereaved family members of patients who had received end-of-life care.FindingsPatients and families depended on physicians to explain clinical complexity and treatment beneficence; however, trust in medical judgement was mediated by participant’s own interpretations of clinical progress. Families sought to be respected as advocates and experienced distress if physicians disregarded their perspectives and insight concerning patient preferences. Ideally, families supported patients to express their preferences to physicians. Otherwise, families contextualised treatment decisions through their knowledge of patient’s values and quality of life. Families often felt burdened by or excluded from medical decision making and experienced distress and confusion regarding their rights to request or refuse treatment.ConclusionOur study highlights how families contribute to decision making to ensure end-of-life care treatments reflect patient preferences. Physicians can ease families’ distress around treatment withdrawal by providing a meaningful explanation of complex clinical issues, clarifying decision-making roles and acknowledge families’ desire to protect and advocate for their loved one.

There are barriers to implementing person-and family-centred end-of-life care for people with dementia in hospitals. Nursing care for people with dementia is enhanced through family involvement. However, families report unmet needs during admissions contributing to distress and dissatisfaction. Furthermore, little is known about families’ needs during end-of-life care for people with dementia in hospital.

The growing incidence of obesity among children can be linked to our increasingly sedentary lifestyles and lack of physical activity from a young age. Nurses and health visitors have an important role to play in tackling the current obesity epidemic, by adopting innovative strategies to facilitating children's physical activity and making activity-promoting changes in the environment, whether this is the home or the school. One such approach – a floor-based game called Connexercize – aims to encourage physical activity among young children. This article highlights the need for such innovative approaches and discusses the process of planning, developing and piloting this particular game.

Objective:To describe some clinical issues encountered in individual and group therapy with women with metastatic breast cancer.Conclusions:The pressure to ‘‘keep positive’’ poses dilemmas for patients and therapists alike, whether in individual or group therapy. The basis of skilled supportive care rests on the ability of therapists to assist patients and their families to face death rather than avoid it. Paradoxically, facing issues of death and dying leads to a greater sense of control, and empowers patients to reorder life's priorities, thus improving quality of life and relationships. In addition to the obvious need to detect and treat illness such as depression, working with women with metastatic breast cancer requires flexibility on the part of the therapist to adapt to her physical state of health, to include partners and family members where possible, and to liaise with colleagues in the treating team to facilitate communication and understanding of specific difficulties that may be encountered.

Focuses on the effectiveness of the Metta scheme, an innovative psychotherapy program aimed at marginalized young people who are often traumatized, abused and homeless. Background on the history and structure of Metta; Importance of understanding trauma and attachment issues on determining the responses of marginalized young people to psychotherapy programs; Evaluation of Metta scheme.

In this paper the authors discuss recent research in Victoria exploring the dimensions of co-occurring serious I psychiatric disorder and problematic drug or alcohol use. A mutt-method approach was adopted in the light of I the absence of any previous local studies. The findings highlighted the critical lack of service and care for this most severely disadvantaged group. Of particular importance is the evidence of conflicting conceptualisations of the problem amongst service providers in different health and welfare sectors and the impact of administrative divisions which serve to exacerbate the difficulties of people with these dual problems. The evidence from the research points to a need to develop a common philosophical outlook amongst service providers. It is argued that the social policy of “harm minimisation” may, if developed within the mental heafth domain, provide a crucial first step in addressing the urgent and critical needs for services and management strategies for people with these dual problems.

In this paper we note some of the problems surrounding the conflicted issue of social work student placements. We argue that, although on an espoused level fieldwork is considered to be at the 'core' of social work education, there appears to be increasing difficulty in acquiring suitable and sufficient fieldwork placements. The extent of this difficulty suggests the existence of a contradiction between espoused views about social work education and the reality. We suggest that this contradiction cannot simply be explained in terms of the pressures on individual agencies or fieldwork teachers, but rather symbolises an ongoing power struggle (at a covert level) over who, or which interest groups, are to control the practice of social work. We conclude by advocating the need to debate the issues raised in our paper in open forum.

In this article those characteristics of research which make the research distinctively 'social work research' are discussed. In distinguishing social work research from sociological, psychological or anthropological research the question is also raised concerning what might be social work's particular contribution to research in the human sciences. In so doing, I discuss those aspects of the social work endeavour which constitute its particular orientation, namely, a focus on the individual in relation to the social, a commitment to social change, and a concern with the poor and the oppressed. I argue that these three foci express particular values and must remain at the centre of social work research epistemology and methodology. In the second half of the article six factors which might act as guidelines to the framing of social work research practices are discussed.

This article is drawn from a minor thesis presented for the Master of Urban Planning in 1982.It commences with comments upon the gap between theory and practice which is perceived to exist by many social work practitioners. It then goes on to examine how this gap was explored in recent research using four social planners as subjects.The research revealed that the subjects had constructed individual theories based upon values, beliefs and assumptions about their role and which were reflected in the practice models they adopted. The article concludes with a discussion about the implications of the findings and their relevance to social work education.

This article, which draws upon material from a minor thesis completed for the degree of Master of Urban Planning, looks at the use of cognitive mapping as a research tool. Cognitive mapping has recently been developed in the field of Operations Research, management and amongst policy makers. This paper attempts to show how it may be applied effectively to social science research, particularly if used in combination with other more usual data gathering techniques such as questionnaires and diary recording. The article commences with a discussion of Personal Construct Theory which provides the conceptual basis for cognitive mapping. The middle section demonstrates the mapping process, and the article concludes with some comments concerning its limitations as well as its advantages over other techniques. The utilisation of cognitive mapping in settings other than research is also raised.

The constructivist research paradigm informed a research investigation on the relevance of music therapy in a cancer hospital that is, what did the music therapy do and did it help? Over 3 months, criterion sampling was used to elicit interpretations in 5 studies from 5 sources: 128 patients who participated, 27 patients who overheard or witnessed music therapy, 41 visitors, 61 staff, and the music therapist-researcher. Fifty-seven percent of the patients who participated had advanced or end stage cancer. The music therapist's interpretations were recorded in a reflexive clinical journal and the respondents' interpretations were written on anonymous open-ended questionnaires. Thematic and content analyses were performed on the 5 groups of data with the support of qualitative data management software. Findings from the 5 data groups were contrasted and compared. Many patients', visitors' and staff members' affective, contemplative, and imagined moments in music therapy affirmed their “aliveness,” resonating with an expanded consciousness, in a context where life's vulnerability is constantly apparent. Philosophical depictions about the relevance of music in human life, including theories by Addis and Winnicott, substantiated the therapeutic reactions.