Carol Komaromy

Dying in long-term care facilities: support needs of other residents, relatives, and staff.

This paper explores the support needs of residents, relatives, and care staff when someone dies in a facility for older people. The authors draw on the qualitative findings from an English study, which investigated the case for applying the principles and practices of palliative care to people dying in these settings. Relatives need practical as well as emotional support, which is often not met adequately by nursing home staff. Managers varied in the extent to which they recognized other residents’ emotional needs or supported relatives. Care staff members acknowledged needing practical and emotional support, but management was often unable to deliver it. Lack of training in recognizing and addressing needs in addition to financial and staffing constraints were factors that prevented managers from providing support for staff, residents, and relatives.

The sight and sound of death: The management of dead bodies in residential and nursing homes for older people

This paper explores the management of the dead body in residential and nursing homes. It asks why the sight but not the sound of death is systematically concealed. It is based on data from an earlier study into the management of death and dying in these settings, which involved a multi-method approach and included quantitative and qualitative data collection (Sidell et al., 1997). However the data examined in this paper are mainly drawn from participant observations in eight case study homes. In particular the paper focuses on the concealment of the sight of death and the lack of concealment of the sounds associated with the removal of the corpse from these homes. The paper explores the nature of this concealment through a consideration of performance, the privileging of sight above sound, and the professional strategies which staff use to manage death.

Professional performance: The case of unexpectedand expected deaths

Abstract This paper seeks to explore some commonalties and differences within observational data derived from two research studies concerned with the management of death. The studies differ in both their theoretical framework and focus of enquiry. Yet the contextual settings for both are institutions with an overarching ethic of care and control, namely a hospital and a care home for older people. However, their location on the cure – care spectrum is different. Hospitals are generally more orientated towards cure and the business of residential homes is essentially about long-term care. Both studies explored how the same event, death, may be differently and similarly constructed within these organizations. Both accounts illustrate the importance of performance around the management of death and how this performance was choreographed according to what interventions were required of staff and how staff saw their role around the death. An anthropological framework informs the first, hospital-based, study. Its focus is the dramatic life saving intervention known as cardiopulmonary resuscitation (CPR). CPR is generally used where deaths are perceived as unexpected, untimely, unfortunate, and unnatural. They are, moreover, by virtue of skilled intervention, seen as potentially reversible. The case study used here highlights the pressurized, action orientated deathbed scene that accompanies most CPR situations with all its attendant rituals, symbols, and technical wizardry (cf. Timmermans, 1997 1999). It serves as a quintessential example of the medical appropriation of death (Hockey, 1990; Illich, 1995; Skrabanek, 1994). The second study, underpinned by a sociological framework, examines the production of death and dying in care homes for older people. Here death was not an unexpected or even unwanted event, but one that was constructed as “timely” and “natural” coming as it often did at the end of a long life (Komaromy & Hockey, 2001). However, the case study material used here concerns the death of a resident called James and explores the problems perceived by the staff in managing a “good death” for him. The notion of a lonely death amidst a crowd of “carers” is implicit in both cases.

Conceptualizing reproductive loss: a social sciences perspective.

This paper defines and explores reproductive loss and, drawing on a social sciences perspective, reflects on the lack of attention that has been given to the subject within the study of human fertility. The authors argue that whilst reproductive loss (broadly defined) is exceptionally common, scholars have – with some exceptions – focused on the study of reproductive ‘success’, and continue to do so. The paper examines the implications of this for policy, practice and the role of healthcare professionals and focuses on the significance of appreciating difference and diversity in the study of reproductive loss and the importance of placing such experiences within the social structure.

From hope to hope: The experience of older Chinese people with advanced cancer

In our study that explored the current end-of-life care provision for Chinese older people with advanced/terminal cancer, hope emerged as a significant aspect of coping with their condition. Drawing on data from in-depth interviews with a group of older people, their family carers and health professionals, this article explores participants’ constructions of hope in terms of what they were hoping for, how their hopes helped them cope with their illness and what sociocultural resources they drew on to build and sustain these hopes. While acknowledging similarities to Western studies of hope in terminal illness, this article identifies significant divergences in terms of the impact of different sociocultural values and their implications for clinical practice in light of an unfavourable health care environment for patients with advanced cancer and a social support system sustained mainly by Chinese families. It argues that hope represents an important resource for coping with terminal illness among these patients.

Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care

BACKGROUND Diabetes mellitus is a global health problem and one of the most common medical conditions in pregnancy. A wide range of modifiable risk factors are associated with diabetes mellitus in pregnancy, and it is widely acknowledged that preconception care (PCC) is beneficial for women with pre-existing diabetes mellitus. However, uptake of PCC services is low. OBJECTIVES To systematically review qualitative research on PCC for women with pre-existing diabetes mellitus of childbearing age, identify facilitators of and barriers to uptake of PCC and establish themes and gaps in knowledge. Through qualitative interviews explore views on the provision of, and facilitators of and barriers to the uptake of, PCC. DESIGN Mixed methods encompassing a systematic review and qualitative interviews. SETTING Two secondary care sites and 11 primary care sites. PARTICIPANTS Women of childbearing age with pre-existing type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) of white British or Pakistani origin. INTERVENTIONS None. ANALYSIS A narrative synthesis of the literature using thematic analysis and a thematic analysis of the qualitative interview data using the method of constant comparison. RESULTS Eighteen qualitative studies were included in the systematic review and a quality appraisal was carried out using relevant criteria for qualitative research appraisal, including a narrative summary of study quality. Twelve interviews with women with pre-existing T1DM or T2DM were carried out. This fell short of the original aim of interviewing 48 women owing to challenges in recruitment, especially in primary care. A synthesis of these data shows that uptake of PCC is influenced by a range of factors, including the complexity of pregnancy planning, the skill and expertise of health professionals who provide care to women with diabetes mellitus, the role of health professionals in the delivery of PCC, and the quality of relationships between women and health professionals. LIMITATIONS Owing to significant challenges with recruitment of participants, particularly in primary care, 12 interviews with women with pre-existing T1DM or T2DM were carried out, which fell short of the a priori sample size. CONCLUSIONS Reconceptualising PCC to place greater emphasis on pregnancy planning, fertility and contraception would lower some of the existing barriers to uptake of care. It is important to clarify who is responsible for the delivery of PCC to women with pre-existing diabetes mellitus and to ensure that the correct expertise is available so that opportunities for advice giving are maximised. Relationships between women and health professionals should be based on a partnership approach that encourages mutual trust and respect, focusing on positive change rather than negative outcomes. FUTURE WORK Further research is needed to investigate the views and experiences of stakeholders that commission, design and deliver PCC services for women with pre-existing diabetes mellitus; to explore experiences of women from minority or ethnically diverse backgrounds; to investigate the role of family support in contraception, pregnancy planning and PCC; and to investigate the management of diabetes mellitus in neonatal care and its role in breastfeeding. STUDY REGISTRATION This study is registered as PROSPERO CRD42014015592 and ISRCTN12983949. FUNDING The National Institute for Health Research Health Technology Assessment programme.

A missing link? The role of mortuary staff in hospital-based bereavement care services

Abstract In this paper we argue that anatomical pathology technologists (APTs) have been overlooked as a key group of healthcare practitioners who play a role in bereavement care. Drawing on an ethnographic case study of a mortuary team in a large urban hospital, we examine the technical and emotional components of the APT role, including how the concept of patient care is utilised in the mortuary. We argue that their work with other healthcare practitioners and professionals illustrates how APTs offer a ‘bridge’ between the immediacy of a death, after-death care and subsequent viewing of the deceased person, thereby providing a vital and under-acknowledged service for bereaved people. We conclude that through education and the promotion of mortuary activities APTs are developing a ‘community of practice’ that moves beyond an outdated perception of ‘dirty work’ towards a more enlightened vision of mortuary settings and APTs as important components of hospital-based bereavement care services.

At Home and Abroad

This chapter tells the story of the three men who go to war, Carol’s father James, Jenny’s father David and her uncle Arthur. It covers the key causes of World War Two and the enlistment of these three men into the army and the RAF. Each took very different routes and had very different experiences of that war. David served in the RAF—staying in England as part of the home defence and marrying Jenny’s mother in 1942; Arthur joined the army and served in the Middle East before being killed in Italy in 1943; while Jim joined the RAF in 1942 and began training in preparation for D-Day. He also married in war-time. The chapter includes the tragic event of Jenny’s father learning that Arthur had been killed in action while he was looking after his dying mother.

War in Prospect, 1930–1939

This chapter sets out the story of the Manning family from 1930 to the beginning of World War Two in 1939. It covers the time when Jenny Hockey’s father left school at the age of 16, his return from school to a new home with his mother in Bristol and his early employment as an apprentice in the family trade at a wholesale and retail drapers. Arthur Manning, David’s older brother, is working in a bank and moving to different branches. The chapter conveys the home life of her father, David, and the domestic life he shared with his mother, his hobbies and pastimes before the dramatic disruption of world war that impacted on the family, again.

Recovery, Retrieval and Healing

This chapter documents the authors’ histories and explains how their academic and personal concerns have come to mesh in this book. It introduces their thinking about death, trauma and loss and shows why the concept of ‘recovery’ is important to them, both in terms of healing and recollection. It also provides a rationale for the form and style of the book, explaining the importance of reflexivity in areas of heightened emotional and political sensitivity, and the value of life writing as a vehicle for participating in a reflexive turn. Finally, it sets up the notion of legacy and the requirements legacies can impose, whether they come in the form of oral histories or material inheritance.