Neoliberalism has ushered in a rise in managerialism, technocracy and bureaucratisation in residential child care where economy, efficiency, and effectiveness have been prioritised over the moral imperative to care. One implication has been the commodification of children who are traded in a culture of procurement and commissioning compounded by a climate of austerity, and where moral regulation has been replaced by contractual regulation. The impact of this upon the care that children receive has raised concern. (...) The impact upon frontline carers of intractable moral challenges which this climate presents in their role of caring each day is less well understood. The naming of an experience can provide an important starting place to understanding and challenging it. This article draws upon the phenomenon of ‘moral distress’, which is well documented in the medical field, and considers the transferability of this phenomenon from nursing to residential child care. It proposes that moral distress discourse may provide a language to residential child care workers through which their experience of the betrayal of the moral fabric of their work may be articulated. (shrink)

Despite the centrality of the term within the title, the meaning of ?care? in residential child care remains largely unexplored. Shifting discourses of residential child care have taken it from the private into the public domain. Using a care ethics perspective, we argue that public care needs to move beyond its current instrumental focus to articulate a broader ontological purpose, informed by what is required to promote children's growth and flourishing. This (...) depends upon the establishment of caring relationships enacted within the lifespaces shared by children and those caring for them. We explore some of the central features of caring in the lifespace and conclude that residential child care is best considered to be a practical/moral endeavour rather than the technical/rational one it has become. It requires morally active, reflexive practitioners and containing environments. (shrink)

Recording is a task often perceived by residential child care workers as boring or taking time away from the ‘real work’, direct engagement with young people. It is required by legislation and policy but has been undertheorized and treated as a technical/rational task. In this essay, Foucauldian and feminist perspectives are applied to shift recording, a routine aspect of residential practice, in order to problematize the positivist approach assumed in legislation and policy. The analysis suggests that (...) this approach represses emotional aspects of care and subjugates particular forms of knowledge, such as young people’s experiences. Recording inevitably involves ethical choices and treating it as technical/rational task obscures its ethical implications. This essay concludes that greater attention needs to be given to the ethical aspects of shift recording in order to challenge practice that oppresses young people by failing to recognize their individuality and silencing their voices. (shrink)

In this paper, we are going to address job satisfaction and perceived self-efficacy within the context of residential child-care. A joint report from the European Foundation for the Improvement on Living and Working Conditions and the European Agency for Safety and Health at Work revealed that managers in the field of health and education were the most concerned about the psychosocial risk of their employees, although concern is not automatically translated into tools to face the risk and (...) to manage it. So, measuring and improving employees’ job satisfaction and self-efficacy can be an important means for organizations to prevent the outcomes of psychosocial risk, and supporting high quality performance of workers. But profound changes are affecting the nature of work at large, and specifically social educator’s in the field of residential care with minors. Globalization, radical technological and communication developments, as well as the pressure to frame care as a commodity, are quickly changing procedures and praxis at work, and even the meaning of job itself. All these changes are highly demanding for this category of professionals, as much as the fact that the organizational setting is vanishing as a resource to sustain their professional attitudes and behaviours. Under these circumstances, job satisfaction and self-efficacy can be hard to experience, and isolating their precursors is essential to develop healthy and effective work environments. This paper means to highlight the process of supporting self-efficacy and job satisfaction in the educational work in residential youth care that is still underrepresented in research. It presents data emerging from two studies, study 1 involving 268 educators and study 2 involving 472 educators belonging to different Italian residential child-care services. Study 1 consists of a quantitative study including the following measures: attachment style, job satisfaction, work-related self-efficacy, and length of service. Study 2 consist of a qualitative exploration deepening the sources of educators’ work-satisfaction. Quantitative data support the identification of attachment style and length of service as antecedents of work-related self-efficacy. Qualitative data show the importance of relational issues in shaping the educators’ satisfaction at work. (shrink)

Christians care for orphans and children without parental care in different forms. However, in the Global South, care is primarily provided in orphanages or large residential settings. Despite good intentions, there are limitations to provide a nurturing family environment for the children in such care environment. With current knowledge of alternative child care and in light of the holistic ministry, this article suggests an approach for the church to care for orphans and (...) children at risk by focusing on the family and the local community. Additionally, simple steps to transition to holistic orphan care are offered. (shrink)

This article explores staff work patterns in an Australian residential aged care facility and the implications for high‐quality care. Rarely available minute by minute, time and motion, and ethnographic data demonstrate that nurses and care staff engage in high degrees of multitasking and mental switching between residents. Mental switching occurs up to 18 times per hour (every 3 min); multitasking occurs on average for 37 min/h. Labor process theory is used to examine these outcomes and to (...) explore the concepts of high demand and high commitment as core components of work intensification. These conditions of work result in high levels of cognitive burden and stress on staff in managing the multitasking and mental switching, exacerbated by lack of knowledge about residents associated with labor force casualization. These new interpretations of data in relation to mental and manual labor can contribute to understanding, and, therefore, problem solving, in the aged care sector. (shrink)

Intimacy contributes to our well-being and extends into older age, despite cognitive or physical impairment. However, the ability to enjoy intimacy and express sexuality is often compromised—or even controlled—when one moves into residential aged care. The aim of this study was to identify what factors influence senior residential aged care staff when they make decisions regarding resident intimate relationships and sexual expression. The study used vignette methodology and a postal survey to explore reactions to a fictionalised (...) case study of a couple—Norm and Carol—who develop a close, mutually satisfying relationship. Staff were first asked whether they would intervene in the relationship. Using an innovative approach, several variations to the case study were then presented to explore whether views about intervening changed according to varying contextual factors. Findings indicated that over 90% of respondents initially agreed that the relationship should continue, and only 10% indicated they would intervene. However, when the case study was varied, respondents indicated they were more likely to intervene, particularly if Norm was exhibiting distress in Carol’s presence (89%), but also if Norm was married and his wife was living in the community (40%). Other factors including level of cognitive impairment and family disapproval were also found to influence staff views. This study provides insight into how residential aged care staff make decisions regarding the intimacy and sexuality of older people living in residential aged care and how personal views and values likely guide practice in the absence of formal policies. (shrink)

People with dementia at times exhibit threatening and physically aggressive behavior toward care staff in residential aged care facilities (RACFs). Current clinical guidelines recommend judicious use of antipsychotic (AP) medications when there is an immediate risk of harm to care staff in RACFs and non-pharmacological interventions have failed to avert the threats. This article examines an account of how this recommendation can be ethically defensible: caregivers in RACFs may have a prima facie ethical justification, in certain (...) cases, to use APs as an act of self-defense. The author examines whether such uses of APs meet the three commonly invoked conditions of ethically permissible acts of self-defense—namely, the conditions of liability, proportionality, and necessity—and argues that such conditions obtain only in a restricted range of cases. The liability constraint can be satisfied if residents are the only ones who are causally responsible for the threats they pose. Further, the condition of proportionality obtains if there is sufficient objective ground to demonstrate that the harm of using the medications does not outweigh the good to be secured. Lastly, the necessity condition obtains when the medications are used at their lowest effective dosage and caregivers in RACFs can reasonably assume that, for the purpose of averting threats posed by residents, the use of APs is the only available course of action. Not meeting any of these fairly stringent conditions renders uses of APs as acts of self-defense in RACFs morally impermissible actions. -/- . (shrink)

Sexual self-determination is considered a fundamental human right by most of us living in Western societies. While we must abide by laws regarding consent and coercion, in general we expect to be able to engage in sexual behaviour whenever, and with whomever, we choose. For older people with dementia living in residential aged care facilities (RACFs), however, the issue becomes more complex. Staff often struggle to balance residents' rights with their duty of care, and negative attitudes towards (...) older people's sexuality can lead to residents' sexual expression being overlooked, ignored, or even discouraged. In particular, questions as to whether residents with dementia are able to consent to sexual activity or physically intimate relationships pose a challenge to RACF staff, and current legislation does little to assist them. This paper will address these issues, and will argue that, while every effort should be made to ensure that no resident comes to harm, RACFs must respect the rights of residents with dementia to make decisions about their sexuality, intimacy and physical relationships. (shrink)

The practical and ethical issues associated with obtaining informed consent from children and young people living in residential state care for their participation in a research study are explored in this paper. Research involving the participation of these young people has received comparatively limited attention in the social sciences: this is due to several reasons including the challenging methodological and ethical issues associated with undertaking such research. These can be categorized as the practical issues of gaining direct contact (...) with these young people through gaining the consent of relevant gatekeepers and the process of gaining a favourable opinion from a research ethics committee. Whilst the principles of clarity and consistency of practice are key elements in the process of accessing consent to participate in research, flexibility and imagination are also important skills for the researcher when developing the appropriate protocols for research in an area of social policy which can be methodologically and ethically complex. (shrink)

We argue that Aged Residential Care (ARC) facilities should be allowed to create and adopt an informed “No Chest Compression” (NCC) policy. Potential residents are informed before admission that staff will not provide chest compressions to a pulseless resident. All residents would receive standard choking care, and a fully discussed advance directive would be utilized to determine if the resident wanted a one-minute trial of rescue breaths (to clear their airway) or utilization of the automatic defibrillator in (...) case of arrest. The benefits of chest compressions for residents in ARC are dubious, and the burdens are high. For frail elderly people without a pulse, chest compressions are arguably unethical because the chance of benefit is minuscule, the procedure is violent, painful, and challenging to perform correctly, and procedures detract from a peaceful end of life. These burdens fall on residents, their families, ARC facilities providers, and society. We further argue that limitations on universal invasive resuscitation, such as advance directives, need to be more consistently sought and applied. The goals of an informed NCC policy are twofold: removing added suffering from a person’s end-of-life experience and increasing ARC residents’ understanding of the burdens of ineffective treatments for pulselessness. (shrink)

Background This article explores the Story Stem Assessment Profile (SSAP), a narrative-based measure, for the assessment of internal representations in children between the ages of 4 and 11 years old. Methods The findings draw upon two samples of children comprising of a sample of looked-after children at Five Rivers Child Care (FR) ( n = 42) and a community-based population ( n = 42). The FR group identified were suggested to have a higher level of need, as defined (...) by scores obtained from the Strengths and Difficulties Questionnaire (SDQ) and Relationship Problems Questionnaire (RPQ). Results Using the SSAP, the findings indicate the instrument’s discriminant validity with strong differences being displayed between the two populations. Consistently children in the FR sample displayed more disorganized, avoidant and negative representations, whilst at the same time having significantly fewer representations characteristic of ‘secure’ attachment. Conclusion The SSAP is successful in differentiating between ‘low’ and ‘high’ cohorts of children aged 4–11 years. The study provides strong support for the measure as a way of capturing internal and attachment representations, with further research to explore possible changes in these representations at follow-up being promising and intriguing. Continued research efforts at FR will allow for improved clinical formulations, increased understanding and therefore positive outcomes relating to the children in their care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Resilience and the Narratives of Parents of Adults with Autism Spectrum DisordersNabil Hassan El-GhorouryThe prevalence of autism spectrum disorders (ASDs) is on the rise; the most recent report from the Autism and Developmental Disabilities Monitoring Network (2012) indicated a prevalence of ASDs of one in 88 children. This was a 78% increase from reported prevalence rates in 2002, when the rate was one in 150. Major health organizations have (...) been emphasizing the importance of early identification (Johnson, Myers, & Council on Children with Disabilities, 2007) to increase access to early intervention services, which are most effective when implemented before age three (Rogers & Vismara, 2008).The bulk of autism research has been focused on children, particularly young children. Given the growing identification and prevalence of ASDs, there will be more and more adolescents and adults with ASDs in the near and long term future. This issue of Narrative Inquiries in Bioethics is important because of its focus on an underrepresented area in the literature. The constraints of current health care delivery systems do not allow for providers to spend significant amounts of time with their patients. Furthermore, hearing first person narratives can be valuable by informing health care professionals about the experiences that parents (and by extension, the individual with an ASD) have experienced.As a licensed clinical psychologist with over two decades of experience with children, adolescents, and adults with ASDs in a variety of settings, I have a professional perspective on autism. As the older brother of Omar, a 38–year–old adult male with autistic disorder, I also have a lifetime of personal experiences of autism. As long as I can remember, I have had a brother with autism. I hope this unique perspective as both a behavioral health care provider and a family member of an adult with an ASD allows me to comment on these narratives in a thoughtful manner.Seeing Beyond Autism: Multiple IdentitiesMany parents commented on how their child was more than just autism or Asperger’s; they reflected on the strengths, unique experiences, and perspectives of their child. The narratives are rich in their desire to see the whole being of their children. Anonymous One writes:Another thing, and I think every parent will agree with this—teachers, school staff, health care industry staff, doctors and every one that comes into contact with an ASD individual—take the time to get to know them. It may be difficult and some may appear non–caring and rude. You must overlook this and look to the person underneath. They are great people. They have been through stuff and it means so much to them. Like I said—parents, you know this. Please remember it when times get tough. [End Page 189]Mark Osteen wrote about his son Cameron as they were making the decision to place their son in a residential placement: “I felt proud. It was like he was being recruited for college. And I am just as proud of him, and love him just as much, as if he were. What I hate is talking only about his ‘disability.’ I hope they see his good qualities. How smart he is. How funny he is. How charming he is. How strong he is.”Understanding the multiple identities of individuals with ASDs is important for parents so that they are not solely focused on the autism diagnosis. The talents and skills of the young adults described are remarkable. Anonymous One’s son David became a computer engineer at 13, reportedly “he was the youngest person in the United States to do so at such a young age.” Lori Centineo’s son Nathaniel is a poet, a rock climber, and skilled at sailing. Virginia Clapp’s son Nathaniel is a “chess genius”, a talented juggler “with the ability to juggle seven balls, which he told me is ‘insanity in a nutshell’,” and an origami expert. David McDonald’s nephew grew from a teenager who spoke only 30 words to speaking thousands of words and ultimately becoming a world traveler. Anonymous Four’s son Sam is “practically an expert” in earth sciences.Seeing beyond the autism is not always easy. Given the serious challenges... (shrink)

In this paper, we argue that ‘good care’ in residential nursing homes is enacted through different care practices that are either inspired by a ‘professional logic of care’ that aims for justice and non-maleficence in the professional treatment of residents, or by a ‘relational logic of care’, which attends to the relational quality and the meaning of interpersonal connectedness in people’s lives. Rather than favoring one care logic over the other, this paper indicates how (...) important aspects of care are constantly negotiated between different care practices. Based on the intricate everyday negotiations observed during an ethnographic field study at an elderly nursing home in Germany, the paper puts forth the argument that care is always a matter of tinkering with different, sometimes competing ‘goods’. This tinkering process, which unfolds through ‘intuitive deliberation’, ‘situated assessment’ and ‘affective juggling’ is then theorized along the conceptualization of a ‘practical ethics of care’: an ethics which makes no a priori judgments of what may be considered as good or bad care, but instead calls for momentary judgments that are pliable across changing situations. (shrink)

In this study, family- and center-based child care providers participated in day-long research workshops in which they first identified dimensions of an “ideal” caregiving situation and then, using a critical incident technique, explored the meaning and experience of “power” as caregivers. This article is devoted to examining the ways in which child care workers understand the notion of “powerfulness” and “powerlessness” in their work. Themes emerging from critical incidents are considered in light of feminist and caregiving (...) literatures. The article concludes by drawing implications from the project's findings for policy, advocacy, and conceptual development. (shrink)

This article examines baby farming as an urban neighborhood-based system of group child care in Philadelphia in the late nineteenth century and considers the dangers and abuses the practice of baby farming posed for parents, children, and baby farmers. It explores reformers' early efforts to regulate the city's baby farms. Finally, the essay also investigates the ways in which the residents of Philadelphia's poor neighborhoods monitored the child-care establishments in their communities that catered to working mothers.

Large differences in scientific productivity between male and female researchers have not yet been explained satisfactorily. This study finds that child care and lack of research collaboration are the two factors that cause significant gender differences in scientific publishing. Women with young children and women who do not collaborate in research with other scientists are clearly less productive than both their male and female colleagues.

_What place do Anna Freud’s ideas have in the history of psychoanalysis? What can her writings teach us today about how to work therapeutically with children? Are her psychoanalytic ideas still relevant to those entrusted with the welfare of infants and young people? _ _Reading Anna Freud_ provides an accessible introduction to the writings of one of the most significant figures in the history of psychoanalysis. Each chapter introduces a number of her key papers, with clear summaries of the main (...) ideas, historical background, a discussion of the influence and contemporary relevance of her thinking, and recommendations for further reading. Areas covered include Anna Freud’s writings on: • The theory and practice of child analysis and 'developmental therapy' • The application of psychoanalytic thinking to education, paediatrics and the law • The assessment and diagnosis of childhood disorders • Psychoanalytic research and developmental psychopathology Nick Midgley draws on his extensive experience as a child psychotherapist and a teacher to bring Anna Freud's ideas to life. He illustrates the remarkable originality of her thinking, and shows how analytic ideas can be used not only in child psychotherapy, but also to inform the care of children in families, hospitals, classrooms, residential care and the court-room. __Reading Anna Freud__ will be of interest to child therapists, child analysts and psychoanalysts, as well as others working in the field of child and adolescent mental health, such as clinical psychologists, child psychiatrists and educational psychologists. It also has much to offer to those entrusted with the care of children in a wide range of settings - including teachers, nurses and social workers - for whom Anna Freud was always keen to demonstrate the value of a psychoanalytic approach. _Nick Midgley_ trained as a child and adolescent psychotherapist at the Anna Freud Centre, where he now works as a clinician and as Programme Director for the MSc in Developmental Psychology and Clinical Practice. Nick has written articles on a wide range of topics and is joint editor of _Minding the Child: Mentalization-based Interventions with Children, Young People and their Families_ and _Child Psychotherapy and Research: New Directions, Emerging Findings_. (shrink)

Background Person-centred care is based on ethical principles, and it is regarded as high-quality care. Care of older persons should embrace person-centredness. During the pandemic, older persons were highlighted as a vulnerable group at risk of developing serious illness and/or suffering death from COVID-19. Several pandemic-related measures were introduced in residential care facilities (RCFs) to reduce this risk, which influenced the possibilities to lead and provide a person-centred care. Aim This study’s aim was to (...) explore ethical challenges in relation to person-centredness during the COVID-19 pandemic, from the perspective of leaders in RCFs. Research design The study had a qualitative descriptive design. Participants and research context Semi-structured interviews were conducted with 26 leaders working in RCFs in Sweden. Data were analysed using conventional content analysis. Ethical considerations The study was approved by the Swedish Ethical Review Authority. The participants received oral and written information about the study and gave written consent. The study was conducted in accordance with the Declaration of Helsinki. Findings The overarching ethical challenge was Having to disregard the individual needs of the person in order to protect the group and society. This included (a) Protecting the group versus promoting the older person’s autonomy; (b) Being forced to lead care based on uncertainty instead of evidence; (c) Striving to provide dignified care but lacking opportunities; and (d) Going far beyond ordinary duty and endangering one’s own and the staff’s health. Discussion The ethical challenges meant being torn between the person’s individual needs and protecting the group and society, with clashing ethical principles as a consequence. Conclusions The leaders faced ethical situations resulting in undignified and compromised person-centred care, which has implications for stakeholders and management who need to address the work conditions in RCFs. (shrink)

Autonomy has been recognised as a key principle in healthcare, but we still need to develop a consistent understanding of older people’s perceived autonomy in residential care. This study aimed to identify, describe and synthesise previous studies on the perceived autonomy of older people in residential care. Ethical approval was not required, as this was a review of published literature. We carried out an integrative review to synthesise previous knowledge published in peer-review journals in English up (...) to September 2019. Electronic and manual searches were conducted using the CINAHL, Philosopher’s Index, PubMed, SocINDEX, Scopus and Web of Science databases. The data were analysed using the constant comparison method. The review identified 46 studies. Perceived autonomy referred to the opportunities that older people had to make their own choices about their daily life in residential care, and achieving autonomy promoted both health and quality of life. Autonomy was linked to older people’s individual capacities, including their level of independence, physical and mental competence, personal characteristics, and whether relatives shared and supported their perceived autonomy. Professionals could facilitate or hinder older peoples’ autonomy in a number of ways, including providing opportunities for autonomy, how daily care needs and activities were managed, and controlling older people’s choices. Professionals’ characteristics, such as education and attitudes, and the older people’s living environments were also associated with their perceived autonomy and included organisational characteristics and physical and social care facilitators. Older people’s perceived autonomy promoted health and quality of life in residential care. However, their autonomy was associated with a number of protective and restrictive individual and environmental factors, which influenced whether autonomy was achieved. (shrink)

There has been little previous research regarding the effectiveness of ethics education interventions for residential care‐givers. The Researching Interventions to Promote Ethics in social care project responded to the question: Which is the most effective ethics education intervention for care‐givers in residential social care? A pragmatic cluster trial explored the impact of three ethics education interventions for: (a) interactive face‐to‐face ethics teaching; (b) reflective ethics discussion groups; and (c) an immersive simulation experience. There was (...) also a control arm (d). 144 trial participants were recruited from 39 residential care homes for older people in southern England. Change scores compared across intervention arms showed a significant reduction in work‐related moral stress in the teaching arm compared with control group (p =.03); there were no significant differences between control and intervention arms in change scores for moral sensitivity, interpersonal reactivity (empathy) or ethical leadership. Qualitative data themes were as follows: ethical care; care challenges; and ethical care inhibitors. Overall findings stimulate reflection on the value of three different ethics education interventions and the most appropriate means to evaluate their impact. Findings suggest the complexity and diverse nature of ethical competence in care. We suggest a way forward for research evaluating ethics education. (shrink)

Die Pflegequalitätsprüfungen nach § 114 ff SGB XI und die Begehungen der FQA (ehemals Heimaufsicht) wurden mit Abklingen der Pandemie wieder aufgenommen. Trotz der Einführung eines neuen Prüfinstruments führt dies weiterhin zu Irritationen und auch ethisch gerahmten Problemen in der Praxis. Dies war ab Sommer 2021 Gegenstand eines Beratungsprozesses im Ethikbeirat der Hilfe im Alter gGmbH der Inneren Mission München, Diakonie München und Oberbayern und führte zu einer Bearbeitung in der Frühjahrssitzung 2022 mit Vertretern des StMGP (Staatsministerium für Gesundheit und (...) Pflege, heute StMGPP) und des MDB (medizinischer Dienst Bayern, der im Auftrag der gesetzlichen Kranken- und Pflegeversicherung tätige medizinische und pflegerische Beratungs- und Begutachtungsdienst), sowie zu einem konsentierten Papier des Beirats. Die Ziele der Prüfung, die Prozesse dazu in den Einrichtungen und ihre Auswirkungen auf die pflegebedürftigen Menschen und das Pflegepersonal wurden darin unter ethischen Gesichtspunkten thematisiert. Auch wenn die Notwendigkeit einer externen Kontrolle nicht grundsätzlich in Frage gestellt wird, ist der Aufwand für die Indikatorenerhebung, die Herausforderung des Fachgesprächs und die Art und Weise der Ergebnisformulierung weiterhin kritisch zu diskutieren und weiter zu entwickeln. Es zeigt sich die organisationsethische Relevanz der Pflegequalitätsprüfung sowohl hinsichtlich der strukturellen Verankerung im einrichtungseigenen Qualitätsmanagement als auch hinsichtlich der Notwendigkeit einer Beteiligungskultur der Betroffenen. Damit wurde einmal mehr evident, wie wichtig das Anliegen des Ethikbeirats „Betroffene zu Beteiligten zu machen“ für die Mitarbeitenden und die Kultur der Einrichtungen ist, aber auch für alle anderen Ebenen der Versorgung und politischen Willensbildung, die hierfür verantwortlich Entscheidungen treffen. (shrink)

Background: Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy. Objective: To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy. Setting: Two long-term residential care facilities: a nursing home for people with dementia and a (...) care facility for people with intellectual disabilities. Methods: Ethnographic field study. Ethical considerations: The boards representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee. Findings: Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.” Conclusion: Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach. (shrink)

Even though female food acquisition is an area of considerable interest in hunter-gatherer research, the ecological determinants of women’s economic decisions in these populations are still poorly understood. The literature on female foraging behavior indicates that there is considerable variation within and across foraging societies in the amount of time that women spend foraging and in the amount and types of food that they acquire. It is possible that this heterogeneity reflects variation in the trade-offs between time spent in food (...) acquisition and child care activities that women face in different groups of hunter-gatherers. In this paper we discuss the fitness trade-offs between food acquisition and child care that Hiwi and Ache women foragers might face. Multiple regression analyses show that in both populations the daily food acquisition of a woman’s spouse is negatively related to female foraging effort. In addition, nursing mothers spend less time foraging and acquire less food than do nonnursing women. As the number of dependents that a woman has increases, however, women also increase foraging time and the amount of food they acquire. Some interesting exceptions to these general trends are as follows: (a) differences in foraging effort between nursing and nonnursing women are less pronounced when fruits and roots are in season than in other seasons of the year; (b) foraging return rates decrease for Ache women as their numbers of dependents increase; and (c) among Ache women, the positive effect of number of dependents on foraging behavior is less pronounced when fruits are in season than at other times of the year. Lastly, in the Hiwi sample we found that postreproductive women work considerably harder than women of reproductive age in the root season but not in other seasons of the year. We discuss how ecological variation in constraints, the number of health insults to children that Hiwi and Ache mothers can avoid, and the fitness benefits they can gain from spending time in food acquisition and child care might account for differences and similarities in the foraging behaviors of subgroups of Hiwi and Ache mothers across different seasons of the year. Valid tests of the explanations we propose will require considerable effort to measure the relationship between maternal food acquisition, child care, and adverse health outcomes in offspring. (shrink)

Increasingly, both mothers and fathers are expected to play an equal role in child rearing. Nonetheless, we know little about how child care arrangements affect couples’ sexual intimacy and relationship quality. Research has focused on the effect of the division of paid labor and housework on couples’ relationships, finding that egalitarianism is problematic for sexual intimacy, relationship quality, and relationship stability. These findings, however, come almost universally from studies utilizing decades-old data that fail to examine the division (...) of child care. In this study, we update this work by utilizing data from the 2006 Marital and Relationship Study to examine how the division of child care affects the relationship quality and sexual intimacy of heterosexual couples in the United States. Results indicate that men’s performance of child care is generally associated with more satisfaction with the division of child care, more satisfying sexual relationships, and higher quality relationships. Importantly, we find that egalitarian child care arrangements have positive consequences for both men and women. These findings contribute to a growing body of research that challenges the costs of egalitarianism and indicates instead that egalitarianism is associated with higher quality, more intimate relationships than gender traditional arrangements. (shrink)

In many high-income countries, an initial response to the severe impact of Covid-19 on residential care was to shield residents from outside contacts. As the pandemic progressed, these measures have been increasingly questioned, given their detrimental impact on residents’ health and well-being and their dubious effectiveness. Many authorities have been hesitant in adapting visiting policies, often leaving nursing homes to act on their own safety and liability considerations. Against this backdrop, this article discusses the appropriateness of viewing the (...) continuation of the practice of shielding as a moral failure. This is affirmed and specified in four dimensions: preventability of foreseeable harm, moral agency, moral character, and moral practice (in MacIntyre’s sense). Moral character is discussed in the context of prudent versus proportionate choices. As to moral practice, it will be shown that the continued practice of shielding no longer met the requirements of an (inherently moral) practice, as external goods such as security thinking and structural deficiencies prevented the pursuit of internal goods focusing on residents’ interests and welfare, which in many places has led to a loss of trust in these facilities. This specification of moral failure also allows a novel perspective on moral distress, which can be understood as the expression of the psychological impact of moral failure on moral agents. Conclusions are formulated about how pandemic events can be understood as character challenges for healthcare professionals within residential care, aimed at preserving the internal goods of residential care even under difficult circumstances, which is understood as a manifestation of moral resilience. Finally, the importance of moral and civic education of healthcare students is emphasized to facilitate students' early identification as trusted members of a profession and a caring society, in order to reduce experiences of moral failure or improve the way to deal with it effectively. (shrink)

Client participation in elderly care organizations requires shifting traditional power relations and establishing communicative action that involves the lifeworlds of clients and professionals alike. This article describes a particular form of client participation in which one client was part of a team of professionals in a residential care home. Their joint remit was to plan the implementation of a new personal care file for residents. We describe the interactions within this team through an ethnodrama, based on (...) participant observations and the embodied presence of the researcher (first author). The narratives and voices of all team members are dramatized in this ethnodrama. Throughout the project the team members experienced confusion relating to the confrontation between lifeworld and system, as experienced by the client and professionals in the team. We analyze these tensions by making use of a Habermasian theoretical framework. We conclude that forms for collective client participation in residential care homes should be developed based on communicative action between clients and professionals, with room for emotional engagement. (shrink)

“Only about 25 percent of the employees in child-care operations around the country have had professional training in dealing with children.”—_Newsweek_ This book is a proven, practical approach to providing that training at a minimum of expense and disruption of services. Written for trainers, it may profitably be used by any individual who wants to know more about positive methods for working with children. The information provided here has been used extensively to train child-care providers throughout (...) Illinois. Covered in detail are discipline, professionalism, child and adult communication, child development, observation, assessment, play, nutrition, health and safety, parent involvement and education, child abuse, developmental care, and organization of the environment. Illinois Governor James Thompson, former DCFS Director Gregory Coler, and DCFS Director Gordon Johnson have all endorsed these materials by continuing to recommend them for day-care training in Illinois. (shrink)

In recent decades, many studies have examined gender-related differences in paid employment and the reconciliation of family and employment. Considering perceptions of time conflicts with regards to work at home and leisure activities, this article contributes to a more encompassing understanding of attitudes toward reconciliation problems. Special attention is given to the role of external child care services. The use of an original data set from 60 Swiss municipalities and hierarchical multiresponse regression models enable an analysis of the (...) various aspects of time conflicts simultaneously, and a consideration of how different policy contexts shape these attitudes. This study provides evidence that the communal provision of external child care is related to gender-specific perceptions of time conflicts. Most interestingly, men seem to be affected most strongly by communal policy conditions, whereby the provision of external child care is related to systematically higher levels of time conflicts. (shrink)

This article describes and interprets the impact, particularly on women and children, of pressure by multilateral organizations on contemporary Brazilian early child care and education policies. Based on an analysis of macro data and documents, the author argues that this pressure is old, existing prior to the introduction of the concept of globalization into the vocabulary of the media and the social sciences. A first wave of pressure dates from the 1970s, during the cold war, and the second, (...) beginning in the 1990s, resulted from the Washington Consensus. The central argument and supporting data presented in this article show that the early child care and education models put forward by multilateral organizations both perpetuate and are sustained by gender inequality and intersecting relations of class, race, and age domination. (shrink)

In Spain, public preschool programs have continuously expanded in the past three decades. However, this education policy has done little to support increases in the proportion of women in the paid workforce. Preschool is not child care because the former does not address the care needed by children younger than three years old and offers programs with short hours and long holidays.

Infectious disease outbreaks in residential care are complex to manage and difficult to control. Research in this setting that includes individuals who lack capacity must conform to national legislation. We report here on our study that is investigating outbreaks of scabies, an itchy skin infection, in the residential care setting in the southeast of England. There appears to be a gap in legislative advice regarding the inclusion of people who lack capacity in research that takes place (...) during time-limited acute scenarios such as outbreaks. We received inconsistent advice from experts regarding, in particular, the role of nominated consultees. There is a potential inequality for vulnerable populations who cannot themselves provide informed consent in terms of their access to participation in a range of health-related research. (shrink)

Considerable research on helpers-at-the-nest demonstrates the positive effects of firstborn daughters on a mother’s reproductive success and the survival of her children compared with women who have firstborn sons. This research is largely restricted to agricultural settings. In the present study we ask: “Does ‘daughter first’ improve mothers’ reproductive success in a hunting and gathering context?” Through an analysis of 84 postreproductive women in this population we find that the sex of the first- or second-born child has no effect (...) on a mother’s fertility or the survival of her offspring. We conclude that specific environmental and economic factors underlay the helpers-at-the-nest phenomenon. (shrink)

Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment.Methods: Multilevel multinomial regression analysis controlling for age, gender, ethnicity, and (...) referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 years] using anonymised administrative data from young people's mental health services.Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement. Similarly, they were less likely to transfer or end treatment for other reasons than by case closure due to mutual agreement.Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services. (shrink)

Background The existing literature on sexuality and intimacy in residential care tends to focus on either the question of rights, or the value of autonomy. Where the literature does reference values other than autonomy, such values are considered in the context of being a guide to whether or not a resident is autonomous, rather than being important values in their own right. Objective This paper draws on qualitative data gathered as part of a larger study in order to (...) inform practice on how care workers respond to intimacy issues that arise with residents with dementia and to inform a general ethics of sex and sexuality, demonstrating that an approach which permits value pluralism can be appropriate in certain contexts. Research Design The qualitative data referred to in this paper was gathered from semi-structured interviews undertaken as part of a larger mixed-method research project. The interview text was analysed using Thorne’s methodological approach, interpretive description. Participants and research context The qualitative arm of the project consisted of semi-structured interviews conducted between October 2018 and October 2019 with participants (staff, residents and family members) recruited from 35 residential care homes in Aotearoa New Zealand. Ethical Considerations Participation was informed, voluntary and written consent was gained before interviews. The project was approved by the Massey University Human Ethics Committee (Northern), number NOR 18/25. Findings Analysis of the scenarios presented in this paper shows that decision-making around sexual intimacy involving people with dementia in a residential care setting is complex and requires recognizing and weighing the different values that may be a in play. Conclusion A focus on safety and consent to the exclusion of other values which matter morally in this context is a mistake which prevents care workers from providing appropriately person-centred care to residents, as policies which focus on the goal of care allow space for critical examination of issues which are likely to be highly context-sensitive. (shrink)

Ethical challenges are traditionally described in a negative light, even though moral conflict can express the individual ability to perceive when something is not working and promote change. The true question, therefore, is not to how to silence moral conflict but how to educate it. Although the need for ethical support of health- and social-care professionals in elderly care is clearly perceived, there is no universal method for providing effective interventions. The authors hypothesize that adequate training sessions can (...) help care professionals enhance this skill, once clear goals and specific educational techniques are set. This research tests the hypothesis on twenty care professionals working in acute and residential care settings for the elderly, building on the ethics round method. Mixed methods drawn from literature and the experience of educators were adapted to meet different educational goals. Moral issues can hardly be removed from a context characterized by increasing demand and decreasing resources, but they can be recognized and addressed with common efforts, a critical attitude, and a growth mindset. Enhancing these skills in qualified workers can help them accept the reality of work, release pressure, and identify common team goals. Introducing these skills before graduation can help future workers avoid unreal expectations and reduce frustration and early job quit rates. (shrink)

Background Older people’s autonomy is an ethical and legal principle in everyday residential care, but there is a lack of clarity about the roles and responsibilities of the key professional stakeholder groups involved. Research objectives This study aimed to identify and define the roles and responsibilities of the key professional stakeholder groups involved in promoting older people’s autonomy in residential care settings. Research design We used a Delphi method with two iterative rounds of online group discussions (...) and collected data from experts in older people’s care in Finland in summer 2020. The data were analyzed using deductive-inductive content analysis methods. Ethical considerations According to Finnish legislation, this type of research did not need approval from a research ethics committee. Informed consent from the participants was obtained and they were informed about the voluntary nature and confidentiality of the study and their right to withdraw at any time. Results Key professional stakeholders had different roles and responsibilities, but their shared, integrated goal was to achieve older people’s autonomy in residential care settings. Their combined roles and responsibilities covered all aspects of promoting older people’s autonomy, from care and service planning and daily decision-making to service structures that included ethical competencies and monitoring. Multipronged, variable, coordinated strategies were required to identify, assess, and promote autonomy at different levels of care. Conclusion Key professional stakeholders need to work together to provide an unbroken chain of care that provides older people with autonomy in residential care settings. In future, more knowledge is needed about how to create structures to achieve the shared goal of older people’s autonomy in these settings. (shrink)

Background: There is an international trend for frail older adults to move to residential care homes, rather than ageing at home. Residential facilities typically espouse a person-centred philosophy, yet evidence points to restrictive policies and surveillance resulting in increased loneliness and diminished opportunities for intimacy and sexual expression. Residents may experience what has been termed social death, rather than perceive they are related to by others as socially alive. Aim: To consider how the loss of intimacy and (...) sexuality in residents’ lives contributes to iatrogenic loneliness experienced in residential care, and the importance of considering these issues together. Research design: The study utilised a constructionist methodology, investigating the meanings associated with intimacy, loneliness, and ageing. Participants and research context: Qualitative data used in this study are drawn from a larger dataset of a mixed-methods study. Interviews were completed as follows: staff, 21 individual interviews, and two groups with a total of 13 additional people; residents, 26 interviews with 28 people; and family members, 12 interviews with 13 people. Findings: Five key themes were identified in the data analysis: loneliness and relational identity, loneliness and functional relationships, loneliness and disrupted intimacy, loneliness and liminality, and loneliness and the built environment. Ethical considerations: The study was approved by a University Human Ethics Committee. Participation was voluntary. Consent was gained and confidentiality upheld. Discussion: Residents’ expression of intimacy and sexuality can be compromised through paternalism, ageism, restrictive policies, care-rationing and functional care, alienating residents from sustaining and developing significant relationships. Attitudes and cultural beliefs of staff and family members about ageing and intimacy, compounded by architectural design, may intensify loneliness. Conclusions: Nurses have a pivotal role in ensuring policies and practice enhance social citizenship. (shrink)

In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this (...) process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. (shrink)

Background As our society is ageing, nursing homes are finding it increasingly difficult to deal with an expanding population of patients with dementia and a decreasing workforce. A potential answer to this problem might lie in the use of technology. However, the use and application of surveillance technology in dementia care has led to considerable ethical debate among healthcare professionals and ethicists, with no clear consensus to date. Aim To explore how surveillance technology is viewed by care professionals (...) and ethicists working in the field, by investigating the ideal application of surveillance technology in the residential care of people with dementia. Methods Use was made of the concept mapping method, a computer-assisted procedure consisting of five steps: brainstorming, prioritising, clustering, processing by the computer and analysis. Various participants (ranging from ethicists to physicians and nurses) were invited on the basis of their professional background. Results The views generated are grouped into six categories ranging from the need for a right balance between freedom and security, to be beneficial and tailored to the resident, and clearly defined procedures to competent and caring personnel, active monitoring and clear normative guidance. The results are presented in the form of a graphic chart. Conclusions There appears to be an inherent duality in the views on using surveillance technology which is rooted in the moral conflict between safety and freedom. Elaboration of this ethical issue has proved to be very difficult. (shrink)

During the past thirty years a high proportion of all long stay hospital beds have been closed. The responsibility for those who would have occupied those beds previously has to a large extent been transferred from health to social services departments, or to family, voluntary and private care. The overall effect has been to prioritize acute medical care, and to expose the public provision and funding of long term residential care, whether medical or social, to the (...) direct determination of political and economic forces. These policy changes have been introduced under the banner of community care, but are dependent on complex concepts which are morally contentious and often obscure. The purpose of this paper is to analyse these processes as a prerequisite to devising better policies in future. (shrink)

Using an analysis of child care books and parenting Web sites, this article asks if second-wave feminism’s vision of gender-neutral child rearing has been incorporated into contemporary advice on child rearing. The data suggest that while feminist understandings of gender have made significant inroads into popular advice, especially with regard to the social construction of gender, something akin to “a stalled revolution” has taken place. Children’s gender nonconformity is still viewed as problematic because it is linked (...) implicitly and explicitly to homosexuality. (shrink)