A systematic narrative review of consumer-directed care for older people: implications for model development

Consumer-directed care is increasingly becoming a mainstream option in community-based aged care. However, a systematic review describing how the current evaluation research translates into practise has not been published to date. This review aimed to systematically establish an evidence base of user preferences for and satisfaction with services associated with consumer-directed care programmes for older people. Twelve databases were searched, including MedLine, BioMed Central, Cinahl, Expanded Academic ASAP, PsychInfo, ProQuest, Age Line, Science Direct, Social Citation Index, Sociological Abstracts, Web of Science and the Cochrane Library. Google Scholar and Google were also searched. Eligible studies were those reporting on choice, user preferences and service satisfaction outcomes regarding a programme or model of home-based care in the United States or United Kingdom. This systematic narrative review retrieved literature published from January 1992 to August 2011. A total of 277 references were identified. Of these 17 met the selection criteria and were reviewed. Findings indicate that older people report varying preferences for consumer-directed care with some demonstrating limited interest. Clients and carers reported good service satisfaction. However, research comparing user preferences across countries or investigating how ecological factors shape user preferences has received limited attention. Policy-makers and practitioners need to carefully consider the diverse contexts, needs and preferences of older adults in adopting consumer-directed care approaches in community aged care. The review calls for the development of consumer-directed care programmes offering a broad range of options that allow for personalisation and greater control over services without necessarily transferring the responsibility for administrative responsibilities to service users. Review findings suggest that consumer-directed care approaches have the potential to empower older people.

Narrative inquiry and auto-ethnography: Interpretive approaches to research

Hermeneutic phenomenology informed two qualitative methodologies used in my doctoral research: narrative case studies and auto-ethnography. Through these methodologies I investigated the phenomenon of place and identity in visual artistic practice. Four narrative case studies of four artists were developed using experience-focused narrative inquiry and thematic analysis. Auto-ethnography was used to investigate the phenomenon of place and identity within my own practice as visual artist. This involved analysis of my artworks that encompassed place and identity and writing from different contexts of my past. Rather than relying on memory recall. This became textural writing in the phenomenon rather than describing what I already knew. This enabled me to challenge conventional ways of telling my story (big stories) and produced “small stories” from which new insights could be interpreted. The insights gained from my auto-ethnography in turn assisted me to encourage story telling to find the small stories of my artist participants.

Light the towel: narrative and the negotiated unconscious

The thesis consists of a creative component: a novel in multiple first-person voices, and a theoretical component: investigating the interaction between conscious and unconscious processes, in creative writing. The concept of alterity as ‘otherness’, at the heart of the theoretical inquiry, derives its momentum from the experience of the operation of the ‘other’ in the ‘I’ in narrative composition.

Midwifery work and the making of narrative

This paper draws on a study of birth support conducted across three Melbourne maternity units. Midwife informants were asked to participate in semistructured interviews with two researchers and describe the activity and role of lay birth support people. In the course of the study, the activity of the midwives themselves became a research focus. The study found that one of the key tasks midwives described was assisting birthing women to develop and negotiate satisfactory birth narratives that could encompass the intense and sometimes difficult experience of birth. Midwife informants offered strategies for the development of such narratives as part of their professional and personal labour in the birth room.

Fostering resilience later in life: a narrative approach involving people facing disabling circumstances, carers and members of minority groups

Over the last two decades, the concept of resilience has become the focus of a growing body of gerontological research. However, there is a dearth of qualitative research that explores how socio-economic and socio-cultural factors shape older people's resilience. This study addresses this gap and explores the concept of resilience through the lens of 25 Australians from a variety of backgrounds, investigating the resilience strategies they employed in the face of different challenging life events. A qualitative narrative methodology involving one focus group and semi-structured interviews was employed. A stratified convenience sample of 34 people aged 60 and over participated in semi-structured interviews between 2009 and 2011. The study describes the meaning participants assigned to the term resilience, and focuses on the range of resilience responses and strategies they employed, bringing to light some key commonalities and differences. The study's findings suggest that access to economic and cultural resources and the nature of the adversity older people face can shape and limit their resilience strategies. The article outlines how the concept of resilience could be incorporated into aged care practice and argues that resilience-focused interventions that potentially broaden the resilience repertoire of older people should be explored within an aged care context.

Rethinking Chinese power : a conceptual corrective to the 'power shift' narrative

A growing body of literature has focused on an alleged “power shift” from the United States to China (and from the West to the East more generally). For all its complexities and nuances, much of this power-shift literature continues to unreflectively hold onto a conventional way of conceptualizing power as a type of quantitatively measurable and zero-sum property possessed by the state.  Without critically engaging with the conceptual question of what power means, however, the power-shift debate is both inadequate and misleading. Drawing on some alternative ways of conceptualizing power, I aim to illustrate the contingent and socially constructed nature of “Chinese” economic power and, in doing so, problematize the widely held view of a US-China power shift. I contend that insofar as power is socially constructed, how it is conceptualized matters for international relations. The need to rethink power is at the core of building a new type of major power relationship.