Fear and overprotection in Australian residential aged care facilities: the inadvertent impact of regulation on quality continence care

Aim: Most residents in residential aged care facilities are incontinent. This study explored how continence care was provided in residential aged care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care.

Methods: Using grounded theory methodology, 18 residential aged care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures.

Results: Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use.

Conclusion: There is a need to rethink the quality of continence care and its measurement in Australian residential aged care facilities.

‘It should be a big responsibility’: Separated low-income mothers’ evaluation of child support arrangements and the conduct of fathers

The Australian Child Support Scheme was established as a means of ensuring adequate financial support for children of separated parents. However, within the financial transfer of child support exist notions of ‘trust’ and ‘fairness’ based on parents navigating their changed relationship post-separation. Previous research has explored the assessment and outcomes of child support for both payee and payer parents, however little attention has been given to how women evaluate the assessment and outcomes of child support. As such, this research aimed to explore payee mothers’ evaluation of their child support experiences based on the value of their child support assessment and the extent to which these payments were received. Following the methods of constructivist grounded theory, in-depth interviews were conducted with 20 low-income single mothers. Analysis revealed that payee mothers evaluated child support based on the moral assumptions and the rationalities they perceived were underlying payer fathers’ child support compliance. While payee mothers desired arrangements that reflected joint parental financial responsibility, in reality many experienced problematic child support payments, which may ultimately undermine payee parents’ confidence in the Child Support Scheme.

"It's got to be more than that". Parents and speech-language pathologists discuss training content for families with a new speech generating device.

PURPOSE: Although parent-implemented interventions for children with a speech-generating device (SGD) have been well researched, little is known about parents' or speech-language pathologists' (SLPs) views around parent training content. In this project, we aimed to identify areas that parents and SLPs consider should be included in training for families with a new SGD.

METHODS: Seven parents of children with an SGD and three SLPs who were new to the SGD field, participated in individual semi-structured interviews. Ten SLPs experienced in SGD practice took part in two focus groups. Data were analysed using grounded theory methods.

RESULTS: Participants identified the following areas suitable for inclusion in a family SGD training package: (a) content aimed at improving acceptance and uptake of the SGD, including technical guidance, customisation and reassurance around SGD misconceptions; (b) content around aided language development and (c) home practice strategies, including responsivity, aided language stimulation and managing children's motivation.

CONCLUSIONS: Participants identified diverse training targets, many of which are unexplored in parent-training research to date. Their recounted experiences illustrate the diversity of family capacity, knowledge and training priorities, and highlight the need for collaborative planning between families and SLPs at all stages of SGD training. Implications for Rehabilitation Training needs for families with a new speech generating device (SGD) are diverse, ranging from technology-specific competencies to broader areas, such as advocacy, teamwork and goal-setting skills. Each family with a new SGD will have a unique profile of training needs, determined by individual learning capacity, priorities, prior knowledge and experience, as well as their child's current communication skills and future support needs. Parents and speech-language pathologists (SLPs) may hold different priorities concerning family SGD training, necessitating ongoing team discussion.

'We just do the dirty work': dealing with incontinence, courtesy stigma and the low occupational status of carework in long-term aged care facilities.

AIMS AND OBJECTIVES: To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities. BACKGROUND: Incontinence is a highly stigmatising condition that affects a disproportionally large number of people living in long-term aged care facilities. Its day-to-day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long-term aged care facilities. This paper presents one finding, i.e. how careworkers in long-term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work. DESIGN: Grounded theory. METHODS: Eighty-eight hours of field observations in two long-term aged care facilities in Australia. In addition, in-depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long-term aged care facility in Australia. RESULTS: Occupational exposure to incontinence contributes to the low occupational status of carework in long-term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers' affective and behavioural responses are characterised by: (1) accommodating the context; (2) dissociating oneself; (3) distancing oneself and (4) attempting to elevate one's role status. CONCLUSION: The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long-term aged care facilities. RELEVANCE TO CLINICAL PRACTICE: This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long-term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as 'dignity work'.

An investigation of the role of using IS/IT in the delivery of treatments for ADHD in university students

Over the last decade, the popularity of incorporating advances in information systems and information technology (IS/IT) has been steadily growing. IS/IT can improve the delivery for better intervention and treatment with many different mental illnesses; however, there appears to be great potential for IS/IT in the context of young adults with mental disorders such as Attention Deficit Hyperactivity Disorder (ADHD). ADHD affects approximately 11% of the university population; negatively impacting students' academic performance, study skills, and social life. The study design outlined in this paper suggests a possibility for the role of IS/IT in the delivery of treatments and management of ADHD in university students to be examined with the view to introduce IS/IT into the traditional treatment context. This research involves collecting data from psychologists in the form of semi-structured interviews and a grounded theory methodology using multiple cases is adopted.

Communication changes experienced by adults with cerebral palsy as they age

PURPOSE: Adults with cerebral palsy (CP) experience multiple, functional changes as they age, including changes to communication modes and methods that enable development and maintenance of relationships, communicative participation and quality-of-life. Little is known about the nature of communication changes experienced by this group. The aim of this study was to better understand how adults with CP experience changes in their communication abilities as they age and the subsequent psychosocial impact.

METHOD: Twenty adults with cerebral palsy aged 40-72 years with complex communication needs (CCN) participated in a series of in-depth interviews, framing their experiences of loss and grief throughout their lives. The impact of changing communication abilities emerged as an important area of focus. Data were analysed using constructivist grounded theory methodology.

RESULT: Themes arising from the participants' perceptions of their communication included experiencing communication change as a loss with subsequent impact on self-concept; and how communication is integral to the process of managing losses associated with older age.

CONCLUSION: Implications for speech-language pathologists working with older people with cerebral palsy and CCN include the need to understand the psychosocial impact of communication changes on social interaction, relationships and communicative participation. It is important to promote positive and meaningful communication options that maintain a coherent sense of self in addition to promoting functional communication skills and communicative participation.

Social inclusion and social protection in Nepal

This thesis explores the contribution of social protection to building an inclusive state in the post-conflict democratic era in Nepal. A grounded theory methodology is used to understand the roles of different actors including development partners, civil servants, politicians, the private sector, trade unions, journalists, academics and how recipients of five government funded cash transfers perceive these funds and view their own sense of citizenship.What emerges from the research is insights into how structural and practised forms of exclusion are reproduced, and changed, and the roles of the different actors involved.