摘要:

AbstractFollowing its remarkable success over the past 25 years the hospice movement is now at a watershed in its development. The growing legitimacy of palliative care as a health care specialty has coincided with the development of the internal market within public sector services, and the promotion of community care. The impact of these changes is now being felt by the hospice movement and may well result in radically new forms of service provision. The focus of this paper is on the future direction of the hospices. We argue, that in the present policy context the main priority must be palliative care in the community, using two case studies of innovative services to illustrate how this might be achieved. We also explore a variety of factors which may constrain the development of community care for dying people. These include the diminishing experience of families and primary health care workers in managing death and dying and the often strongly held belief that hospice care must be in‐patient care. New community services may also face difficulties both in finding a market niche which complements rather than supersedes existing provision, and in securing service contracts where provision cuts across the health and social care divide. These issues are explored through an examination of the models of care developed by the two hospice groups, their integration within existing networks of provision, and their relationship with purchasing authoritie

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1994.tb00166.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThe concept of need and the practice of needs assessment are both subject to a wide range of interpretations, to the likely detriment of individual assessments and to multidisciplinary working. Clear definition is important for individual assessment, for the development of multidisciplinary tools and in gathering planning information. The concept of need is clarified, firstly by distinguishing between need and the difficulties that engender it, and secondly through a taxonomy of need. These assist clear definitions of both need and needs assessment when linked with a consideration of the current help a person receives and a specification of the type of help required by a person to meet their needs. Such definitions have implications for the role of needs assessment in individual assessment, service evaluation, service management and planning and in the development of multidisciplinary needs assessment tools.

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1994.tb00167.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThis paper describes qualitative findings from a study which was designed to explore the nursing needs of elderly people in the community who experience persistent pain. Participants were 190 elderly people who were receiving visits from a district nurse and who reported pain of more than 6 weeks’ duration. The most common reported cause of pain was arthritis. Respondents participated in structured interviews which included open questions about their experiences and expectations. The district nurses completed questionnaires that included a combination of open and closed questions concerning pain and coping factors, for each individual respondent known to them. They were also asked questions about their general attitudes and beliefs about pain management. Data from all open questions were subjected to content analysis. The results indicate that most elderly respondents valued having someone who was prepared to listen to them, understand how they felt and provide information and encouragement. Most did not expect the nurse to relieve their pain. On the other hand, the nurses appeared to feel relatively helpless when medical treatments failed and although the importance of good social support visits was well recognized by most, the concept of ‘support’ tended to be vaguely defined. These findings highlight the importance of psychosocial care for the elderly in the community and the need for a strong focus upon psychosocial assessment and management during training for health professi

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1994.tb00168.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThe importance of housing in the implementation of community care policies is increasingly being recognized. Adapted housing is particularly important for people with physical disabilities if they are to remain living in their own homes or to return to their homes after leaving hospital. In 1990 there was a major change in the funding arrangements for adaptation work with the introduction of a new disabled facilities grant. This paper draws on the findings of several research studies carried out by the authors to provide an assessment of the implementation of this new grant. It identifies a number of problems including: the need for more involvement of users in the planning of services, an overall shortage of resources making it difficult to meet mandatory needs in some areas, inadequacies in the test of resources used to determine the amount of grant aid, a lack of top‐up contributions for social services departments in some areas, and difficulties in liaison between the various statutory and voluntary agencies involved in the adaptation process. A current review of the grant system raises the prospect of further restrictions on grant availability which may have considerable implications for organizations involved in the provision of care and support for people with disabilities. The paper concludes by suggesting ways in which health and welfare organizations could respond to this review. It also suggests ways in which services may need to change if grant resources continue to be cut back. There is a need for alternative funding sources for adaptations to be developed, for improvements in the working relationships between all the organizations involved in providing adaptations, for more agency services to be developed to provide practical help with arranging finance and organising building work, and for users and carers to be more involved in the planning and implementation of service

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1994.tb00169.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractAlthough there is extensive literature on carers and their care‐giving role, the circumstances of carers after care‐giving remains largely uninvestigated. This paper documents the socio‐economic and psychological legacies of care‐giving among 157 ex‐carers who were included in a larger national study of the effectiveness and targeting of social security help to carers, which was carried out in 1989. Therefore, the sample included only those whose care‐giving responsibilities had been relatively substantial, that is, over 35 hours a week. Survey data covering the employment status and income levels of these ex‐carers are presented, as is in‐depth interview material on the psychological and social circumstances of a small group of ex‐carers. The article concludes that there are long‐term negative financial effects of caring, which the social security system appears to ignore. In addition, the psychological, social and physical health consequences of caring may leave some carers poorly equipped for life after care, a situation which might call for the development of support services in the immediate post‐care period. Further investigation of the material and non‐material circumstances of ex‐carers, preferably on a longitudinal basis, should be a priority in health and social care research. Without such research, our knowledge of the costs of caring borne by individuals, and our assessment of the appropriate contributions that should be made by statutory welfare agencies, remains incomplete. Finally, given the prevalence of informal care‐giving, our lack of knowledge of the legacies of care‐giving limits our understanding of the causes of income and health inequalities between people appr

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1994.tb00170.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1994.tb00171.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Book Reviews in this ArticleChanging Patterns of Mental Health CareFamilies Work and BenefitsPublic Education on Diet and Cancer: Proceedings of the 9th Annual Symposium of the European Organization for Cooperation in Cancer Prevention Studies (ECP) Madrid, Spain, October 17–18, 1991The Future of Public Health: A Scenario StudyThe Mistreatment of Elderly Peop

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1994.tb00172.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0966-0410    

DOI:10.1111/j.1365-2524.1994.tb00173.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY