The care crunch: changing work, families and welfare in Australia

Structural shifts in labour markets and in households are impacting on the capacity of households and families to deal with risk. In Australia the post-Federation and post-war social settlement, based on the gendered assumptions underpinning the male breadwinner/female carer model, is no longer viable in an era of increasingly precarious employment, diverse family forms and deepening inequalities. Labour market and industrial relations changes, when combined with major demographic shifts such as divorce and population ageing, and increasing expectations for community care are contributing to a 'care crunch'. The article canvasses the challenge of developing a social risk protection framework that balances caring, work and quality of life.

The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients' illness characteristics on depression and anxiety

A diagnosis of cancer is a very stressful event for the patients and their families. Patients, partners and other family members can suffer from clinical levels of depression and severe levels of anxiety and stress reactions. The similarity in levels of distress between patients and partners and patients and offspring suggests that there are common factors that impact on families' distress levels. The current study examined levels of depression and anxiety in newly diagnosed adult patients (n = 48) and their adult relatives (n = 99). Family functioning and patients' illness characteristics were identified as factors that might impact on families' depression and anxiety. Results from multilevel models indicated that family functioning was important. Families that were able to act openly, express feelings directly, and solve problems effectively had lower levels of depression. Direct communication of information within the family was associated with lower levels of anxiety. Aside from differences anxiety due to cancer type, patients' illness characteristics appear to be risk factors in patients' but not relatives' depression and anxiety. The results from the current study suggest that researchers and clinicians need to be family-focused as cancer affects the whole family, not just the patient.

Economic deprivation and its effects on subjective wellbeing in families of people with multiple sclerosis

Background: There has been limited research on the role of financial strain on the adjustment of people with multiple sclerosis.

Aims: This study examined the financial costs of MS and the impact of financial strain on the quality of life and adjustment of people with MS and their families.

Methods: Interviews were conducted with 16 health professionals, 26 people with MS and 11 family members of people who have MS.

Results: Economic deprivation impacted on the subjective well being of many families living with MS. Concerns included adjustment to a lower income if the person with MS reduced or ceased work, and meeting the costs of home alterations, mobility equipment, and special transport. The additional cost of living with MS is a stress factor, especially for people dependent on disability support pensions.

Conclusions: It is anticipated that the findings from this study will raise the awareness of health professionals and politicians regarding the potential impact of financial stress on people with MS and their families.

Stories seldom told: paediatric nurses` experiences of caring for hospitalized children with special needs and their families.

Stories seldom told: paediatric nurses' experiences of caring for hospitalized children with special needs and their families

Aims of the study. This study explored paediatric nurses' experiences of caring for children with special needs and their families in an acute care setting. The aim of the study was to increase understanding of nurses' experiences of caring for these children and their families. The study was designed to reveal the caring practices embedded within these relationships through exploring nurses' stories.

Study design/methods. Gadamerian hermeneutic phenomenology and feminist research principles were the approaches used to guide the study. Interviews were held with experienced paediatric nurses and interpretation of interview transcripts using a Gadamerian hermeneutic phenomenological approach resulted in the identification of four themes.

Findings. The four themes revealed were: Special Relationships; Multiple Dimensions of Who is Expert; Development of Trust Between Nurses and Families; and Feelings of Frustration and Guilt.

Conclusions. The study emphasized the context-specific nature of relationships between nurses and children and their families. The nurses spoke about the difficulties they encountered in their practice and some of the ways that they dealt with these problems. They discussed the things that they valued and those that made them feel guilty and frustrated. In doing so, they revealed their warmth, strength, humanity and caring.

Families needs in emergency departments: instument development

Background. Families who accompany critically ill relatives in emergency departments (EDs) are an integral part of the care unit. However, there are few empirical data on their needs during this phase of care. In order to guide quality care, general and specific needs of families accompanying these critically ill relatives should be systematically examined.

Aim. The aim of this pilot project was to test the tool, methods and analysis plan for a study to examine the perceived needs of family members accompanying critically ill patients in EDs and their perceptions of ED staff's ability to meet these needs.

Method. Over a 6-week period in 1996, 84 relatives who met the inclusion criteria were recruited to the study. A postal questionnaire, to uncover the needs of family members, was pilot tested. The questionnaire consisted of 40 need statements reflecting five major themes: meaning, proximity, communication, comfort and support. Of the 84 relatives selected for the study, 73% returned completed questionnaires.

Results. The findings of this pilot study suggest that the questionnaire is a valid and reliable tool for researchers wishing to examine and rank the needs of family members who accompany critically ill people in EDs. In addition, the analysis plan was found to be appropriate.

Conclusions. This pilot study provides both a method and a tool for further research into family needs. Examination of the pilot data supported the reliability and validity of the tool and produced findings that challenge nurses to move beyond traditional practice that has excluded families from being an integral part of caring for critically ill patients in EDs.

Families divided : culture and control in small family business

In this article, we explore the dynamics of control, compliance and resistance using two case studies where ‘family’ has symbolic, material and ideological significance. While the ‘family’ metaphor is often invoked to suggest a normative unity and integration in large organizations, we investigate the use of shared understandings of divisions (Parker 1995) and difference, as well as unity and similarity, in constituting organizational culture in two small family-owned firms. Diverging from mainstream family business research, we adopt a critical and interpretative approach that incorporates employee perspectives and explores how forms of control and resistance need to be understood in relation to their local contexts. We also argue that organization studies could benefit from revisiting progressive assumptions that equate developments in forms of organization with forms of organizational control.

Reflexivity: a concept and its meanings for practitioners working with children and families

Reflexivity is a concept that is increasingly gaining currency in professional practice literature, particularly in relation to working with uncertainty and as an important feature of professional discretion and ethical practice. This article discusses how practitioners working in child and family welfare/protection organisations understood and interpreted the concept of reflexivity for their practice, as one of the outcomes of larger, collaborative research project. This project was conducted through a series of workshops with practitioners. The overall research that aimed to expand practitioners’ practice repertoires from narrowly-defined risk assessment, to an approach that could account for the uncertainties of practice, included the concept of reflexivity as an alternative or a complement to instrumental accountability that is increasingly a feature in child welfare/protection organisations. This article discusses how the concept of reflexivity was explored in the research and how practitioners interpreted the concept for their practice. We conclude that while concepts like reflexivity are central to formal theories for professional practice, we also recognise that individual practitioners interpret concepts (in ways that are both practically and contextually relevant), thus creating practical meanings appropriate to their practice contexts.

Family, school, peer and individual influences on early adolescent alcohol use: first-year impact of the Resilient Families programme

Introduction and Aims:  This study aimed to examine: (a) the influence of family factors relative to school, peer and individual influences on the development of adolescent alcohol use during the first year of secondary school; and (b) the feasibility of preventing adolescent alcohol use by modifying family factors. Design and Methods:  Twenty-four schools in Melbourne, Australia were randomly assigned to either the 'Resilient Families' intervention or a control condition. A baseline cohort of 2315 grade 7 students (mean age 12.3 years) were followed-up one year later (n = 2128 for longitudinal analyses). A sub-set of parents (n = 1166) also returned baseline surveys. Results: The prevalence of lifetime alcohol use in year 7 was 33% and rose to 47% by year 8. Student-reported predictors of year 8 alcohol use included baseline alcohol [Odds Ratio (OR) 3.64] and tobacco use (2.68), and school friend's alcohol (1.41) and tobacco use (1.64). After adjusting for other influences, student-reported family factors were not maintained as significant predictors of year 8 alcohol use. Parent-report predictors of student-reported alcohol use included allowing alcohol use in the home (2.55), parental alcohol use (1.88) and child hyperactivity (1.85). Protective factors included attendance at brief parent education (0.60) and parent involvement in school education (0.65). Discussion and Conclusions: The intervention appeared to benefit education-related outcomes, but no overall effect in reducing student alcohol use was found in year 8. Intervention effects on alcohol misuse may become significant in later secondary school once the entire program has been implemented. Considerable alcohol use was detected in early secondary school,   suggesting that interventions to reduce alcohol use may be usefully implemented prior to this period.

Domestic violence in refugee families in Australia : rethinking settlement policy and practice

It has been identified that immigrant and refugee women are particularly at risk in cases of domestic violence. This article reveals the qualitative research findings from a study into the significance of traumatic history, social and economic context, cultural differences and changed gender identities on the perceptions and experiences of domestic violence in refugee families. The study was undertaken with a sample of refugee men and women from Iraq, Ethiopia, Sudan, Serbia, Bosnia and Croatia. Compounding contextual factors concerning structurally based inequalities, culturally emerged challenges, social dissonance, psychological stress and patriarchal foundations are revealed. Informed by an intersectional framework that recognizes gender oppression as modified by intersections with other forms of inequality, the article argues the case for community-managed projects involving multi-level empowerment-based interventions to prevent domestic violence.

Families as carers-information needs in a cultural context

While the important role of family as a carer has been increasingly recognised in healthcare service provision, particularly for patients with acute or chronic illnesses, the carer’s information needs have not been well understood and adequately supported by current health information systems. In order to effectively provide continuous and home-based care for the patient, a family relative as the primary carer needs sufficient access to medical knowledge and patient’s health information. There are two challenges. First, being a family relative, the primary carer is often a non-medical practitioner. Second, in Australia, many primary carers are family relatives of patients from a non-English speaking background. They are often seen as interpreters in clinical consultation sessions. Their roles and responsibilities as an interpreter and a carer are often mixed and blurry.
Therefore, their information needs are often seen as secondary to the patient or neglected. The primary carer’s information needs are currently not yet well understood.

This paper reports finding from a case study which examines an on-line diary of a husband-carer who provided support and care for his wife, who at the time of care was a lung cancer patient. The case study examines an ongoing learning process that the husband went through, identifies information needs by the carer and cultural factors which played an important role in the husband’s interpretation of information, decision making and provision of care. The finding extends a current model of the user’s information needs in the literature and suggests implications for further research into developing health information systems to meet information needs by the family carer.

After hMSH2 and hMLH1- what next? Analysis of three-generational, population-based, early-onset colorectal cancer families

The aim of our study was to examine the role of genetic factors on early-onset colorectal cancer after excluding the impact of germline mutations in the two major mismatch repair genes. A total of 131 incident probands, under 45 years at diagnosis of a first primary colorectal cancer selected from the Victorian Cancer Registry, and their first-and second-degree relatives, were interviewed. Germline DNA from all 12 probands with a family history meeting the modified Amsterdam Criteria for Hereditary Non-Polyposis Colorectal Cancer (HNPCC) and a random sample of 31 of the remaining probands was screened for mutations in hMSH2 and hMLH1 via manual sequencing. Germline mutations were identified in 6 of the 131 probands (5%), all from the "HNPCC" families. Of the remaining 125 probands, 51 (41%) reported at least one first-or second-degree relative with colorectal cancer with an excess of colorectal cancer in first-degree relatives (SMR = 2.7, 95% CI = 1.7-4.1, p < 0.001). The lifetime risk to age 70 for first-degree relatives was 8.0% (5.0-12.8%), compared to the Victorian population risk of 3.2% (p = 0.01). The best fitting major gene model was a recessively-inherited risk of 98% to age 70 (95% CI = 24-100%) carried by 0.17% of the population and would explain 15% of all colorectal cancer in cases with a diagnosis before age 45. Early-onset colorectal cancer is strongly familial even after excluding families found to be segregating a mutation in either of the 2 major mismatch repair genes. There is evidence for a role of yet to be identified genes associated with a high recessively-inherited risk of colorectal cancer.