Bereavement Assessment Practice in Hospice Settings: Challenges for Palliative Care Social Workers

The management and delivery of bereavement support services in palliative care settings presents practical and ethical challenges. A national survey, conducted in 2007, examined bereavement practice in ten Marie Curie hospices across the United Kingdom. This qualitative study was undertaken using semi-structured telephone interviews with Bereavement Service Leaders located in each hospice. Although findings revealed that bereavement services were in operation and had been reviewed in response to the National Institute for Clinical Excellence Guidance (2004), and all bereaved families were offered support, there was no standardisation of service delivery across sites. Multi-disciplinary team meetings facilitated shared decision-making for bereavement follow-up, and expanded and clarified documentation completed by nursing staff around the time of the patient’s death. However, there was ambiguity regarding professional ‘duty of care’ and agency responses to bereaved individuals who were suicidal. Questions were raised around clinical effectiveness, reliability and professional accountability. The study highlighted ethical issues centred on documentation, user participation and consent, and found staff training was variable across the 10 hospices. The findings have informed the development of a post-bereavement service model which has been subsequently implemented across Marie Curie Cancer Care.

The effect of essentialism in settings of historic intergroup atrocities

Three studies tested the effects of essentialist beliefs regarding the national ingroup in situations where a perpetrator group has inflicted harm on a victim group. For members of the perpetrator group, it was hypothesised that ‘essentialism’ has a direct positive association with ‘collective guilt’ felt as a result of misdeeds conducted by other ingroup members in the past. Simultaneously, it was hypothesised to have an indirect negative association with collective guilt, mediated by perceived threat to the ingroup. Considering these indirect and direct effects jointly, it was hypothesised that the negative indirect effect suppresses the direct positive effect, and that the latter would only emerge if perceived ‘ingroup threat’ was controlled for. This was tested in a survey conducted in Latvia among Russians (N?=?70) and their feelings toward how Russians had treated ethnic Latvians during the Soviet occupation; and in a survey in Germany among Germans (N?=?84), focussing on their feelings toward the Holocaust. For members of the victim group, it was hypothesised that essentialism would be associated with more anger and reluctance to forgive past events inflicted on other ingroup members. It was proposed that this effect would be mediated by feeling connected to the ingroup victims. This was tested in a survey conducted among Hong Kong Chinese and their feelings toward the Japanese and the Nanjing massacre (N?=?56). Results from all three studies supported the hypotheses.

Residential segregation in Northern Ireland in 2001: assessing the value of exploring spatial variations

Segregation measures have been applied in the study of many societies, and traditionally such measures have been used to assess the degree of division between social and cultural groups across urban areas, wider regions, or perhaps national areas. The degree of segregation can vary substantially from place to place even within very small areas. In this paper the substantive concern is with religious/political segregation in Northern Ireland—particularly the proportion of Protestants (often taken as an indicator of those who wish to retain the union with Britain) to Catholics (often taken as an indicator of those who favour union with the Republic of Ireland). Traditionally, segregation is measured globally—that is, across all units in a given area. A recent trend in spatial data analysis generally, and in segregation analysis specifically, is to assess local features of spatial datasets. The rationale behind such approaches is that global methods may obscure important spatial variations in the property of interest, and thus prevent full use of the data. In this paper the utility of local measures of residential segregation is assessed with reference to the religious/political composition of Northern Ireland. The paper demonstrates marked spatial variations in the degree and nature of residential segregation across Northern Ireland. It is argued that local measures provide highly useful information in addition to that provided in maps of the raw variables and in standard global segregation measures.

Residential segregation and health in Northern Ireland

Patterns of residential segregation in Northern Ireland reflect historic sectarian conflict as well as current animosities. A number of indices of segregation are examined in this paper and their relative merits in capturing localised societal divisions are discussed.The implications of such divisions on health as mediated through conflict-related stress are then considered. Costed datasets of hospital, community and anxiety/depression prescribing data havebeen assembled and attributed to local geographies.The association between geographical variations in these costs and levels of segregation was modelled using regression analysis.It was found that the level of segregation does not help to explain variations in costed utilisation of acute and elderly services but does explain variations in the costs of prescribing for anxiety and depression with controls for socio-economic deprivation included. Results in this paper would indicate that strategies to promote good relations in Northern Ireland have positive implications for mental health.

Why is housing tenure associated with a lower risk of admission to a nursing or residential home? Wealth, health and the incentive to keep 'my home'

Background Previous research has shown that home ownership is associated with a reduced risk of admission to institutional care. The extent to which this reflects associations between wealth and health, between wealth and ability to buy in care or increased motivation to avoid admission related to policies on charging is unclear. Taking account of the value of the home, as well as housing tenure, may provide some clarification as to the relative importance of these factors.
Aims To analyse the probability of admission to residential and nursing home care according to housing tenure and house value.
Methods Cox regression was used to examine the association between home ownership, house value and risk of care home admissions over 6 years of follow-up among a cohort of 51 619 people aged 65 years or older drawn from the Northern Ireland Longitudinal Study, a representative sample of approximate to 28% of the population of Northern Ireland.
Results 4% of the cohort (2138) was admitted during follow-up. Homeowners were less likely than those who rented to be admitted to care homes (HR 0.77, 95% CI 0.70 to 0.85, after adjusting for age, sex, health, living arrangement and urban/rural differences). There was a strong association between house value/tenure and health with those in the highest valued houses having the lowest odds of less than good health or limiting long-term illness. However, there was no difference in probability of admission according to house value; HRs of 0.78 (95% CI 0.67 to 0.90) and 0.81 (95% CI 0.70 to 0.95), respectively, for the lowest and highest value houses compared with renters.
Conclusions The requirement for people in the UK with capital resources to contribute to their care is a significant disincentive to institutional admission. This may place an additional burden on carers.