Julie McGarry

Informal caring in late life: a qualitative study of the experiences of older carers

AIM OF THE STUDY This study examined the experiences of informal carers who were aged 75 years and over. BACKGROUND It has been estimated that 13% of those aged over 65 years are providing some form of informal care. Although there is a substantial body of work reporting the experiences of informal carers, little attention has been paid to the specific situation faced by older carers. DESIGN AND METHODS Potential study participants were identified during one round of annual over-75 health checks carried out in one large general practice. Data were collected through personal interviews, which were transcribed and analysed using a thematic approach. RESULTS Fifty-eight carers were identified and 14 were approached to take part in the study. Of the 14 interviewees, 13 were caring for a spouse and one was caring for a sibling. There were 10 female and four male carers in the study (age range 76-92 years). Themes to emerge from the interviews were categorized under four headings: (1) the organizational demands and structure of the caring relationship, (2) informal support networks, (3) formal services and (4) the constancy of caring and the need for the role of carer to be recognized. CONCLUSIONS The over-75 health check may provide a valuable tool to identify older carers who are not known to care providers. This paper concludes that nurses can take a lead role in working with this group in three ways. Firstly, in identifying older carers; secondly, in developing strategies to assist older carers in their caring role and finally, in responding swiftly to crises that can develop among this vulnerable group.

Defining roles, relationships, boundaries and participation between elderly people and nurses within the home: an ethnographic study.

Recently there has been a marked shift in the location of nursing care in the UK from the hospital setting to the community and more particularly the home, with elderly people identified as key recipients of care in this setting. A number of commentators have highlighted the particular situation of elderly people with regard to care provision, illuminating the often disempowering nature of care interactions between nurses and elderly people. However, although there is clear evidence from a number of settings that care for elderly people has been less than optimal, to date there is little comparable evidence available regarding elderly peoples experiences of nursing care within the home environment. Utilising an ethnographic approach, incorporating participant observation and semistructured interviews with nurses and elderly people (aged 65 years and over), the aim of this study was to explore the nature of the care relationship within the home setting. Thirteen elderly people who were receiving nursing care within the home and 16 community nurses within one Primary Care Trust in the UK took part in the study and data were collected over a period of 1 year. Three themes emerged from the data: the location of care; the nature of nurse-patient relationships; and the meaning of health and illness. These offer an account of the ways in which roles and relationships are constructed, negotiated and experienced by nurses and elderly people in the home, illuminating the centrality of relationships between nurses and elderly people in defining the experiences and perceptions of both groups of the quality of care overall. As the location of care continues to move closer to home, it is crucial that the implicit qualities that are valued within nurse-patient relationships in this context are recognised and made more explicit at both the organisational and policy level.

The impact of domestic abuse for older women: a review of the literature

The consequences of domestic abuse are far reaching, impacting significantly on long-term health and emotional wellbeing of those affected. However, while the literature offers an insight into the scope and nature of domestic abuse among the younger population in the UK, there is currently little available data regarding older women and domestic violence. This is increasingly being recognised as a significant deficit in awareness and understanding within society as a whole and more particularly for those responsible for support and care provision. While research in this area may be scarce the work that has been undertaken to date would suggest that domestic abuse is both a significant and an under-recognised phenomenon, which has a wide-ranging impact on the lives and health of older women. It also suggests that older womens experiences of domestic abuse are markedly different from those in younger age groups and that these differences have not been adequately acknowledged or accounted for. Given that the UK has an ageing population and that emerging national policy initiatives are beginning to recognise domestic abuse as an issue for older women, it is fundamental that health and social care professionals are able to both identify domestic abuse and understand the particular experiences and needs of older women affected by domestic abuse. The aim of this literature review is threefold: (i) to provide a comprehensive summary of the impact of domestic abuse for older women particularly within the context of health, (ii) to explore the particular barriers to recognition and reporting abuse and (iii) to highlight the particular gaps in our knowledge and understanding from a policy and care provision perspective. A systematic approach to a review of the literature was used to identify key literature and available evidence relating to domestic abuse among older women.

Domestic abuse and older women: exploring the opportunities for service development and care delivery

Purpose – The purpose of this paper is to explore the impact of domestic abuse on the health and lives of older women.Design/methodology/approach – A qualitative research design was used and data were collected using in‐depth interviews with 16 older women who had experienced domestic abuse. The interviews varied between one and two hours in length and, with the participants permission, all of the interviews were audio recorded and transcribed verbatim. Analysis was undertaken utilising an iterative approach. In the present study all data were manually indexed and coded.Findings – The findings of this study illustrate that the consequences of domestic abuse for older women are far reaching, impacting significantly on the long‐term health and emotional wellbeing of those affected. This paper also highlights that there is currently little available data regarding older women and domestic abuse within the particular context of health. This is increasingly being recognised as a significant deficit in awarene...

An exploration of the perceptions of emergency department nursing staff towards the role of a domestic abuse nurse specialist: a qualitative study.

There is a clear body of evidence which indicates that a substantial number of people who have experienced domestic violence and abuse attend the emergency department (ED). However, many individuals do not receive effective identification or support. The present study sought to explore the perceptions of ED staff about the perceived value and utilisation of a new domestic abuse nurse specialist role that has been created in one ED in the UK. A qualitative design was used and involved sixteen in-depth interviews with a range of practitioners. The findings highlight that staff highly valued the role of the nurse specialist as one which offered support both professionally and personally. However, the study has also drawn attention to the conundrum that surrounds identification and management of abuse and of enquiry more generally. The ED is ideally suited to identify at risk individuals but is not institutionally organised in a way that prioritises the social concerns of their patients and this nursing role is one way that this issue can be addressed. In light of recent UK and global policy directives further research is needed to explore the development and implementation of identification, management and support in the future.

Reflexivity and habitus: opportunities and constraints on transformative learning

This paper will explore the relationship between Mezirows concept of reflexivity and Bourdieus theory of habitus in order to develop a more robust framework within which critical reflection can take place. Nurse educators have sought to close the theory practice gap through the use of critical reflection. However, we are not convinced that this has produced the depth and quality of reflection required. Furthermore, the contexts in which critical reflection takes place is often sidelined or erased so that the whole impetus in the literature is to educate nurses in reflection rather than empower nurses to understand the complex circumstances and barriers that obstruct critical reflection. This paper argues that the reason for this position is that nurse education does not always acknowledge the role that personal and cultural values systems have on reflective practices. The literature search was undertaken using CINHAL and MEDLINE. Keywords included: values systems, habitus, and critical reflection. Inclusion criteria were determined by the theoretical approach and included seminal texts, from as far back as 1956, to identify key themes. Although critical reflection is a potentially powerful way of enhancing care it has often failed to do so. It is suggested that this is because nurse educators have frequently used models of reflection without considering the impact that students personal values systems has on their perceptions of care and subsequently care delivery. The purpose of this paper is to promote deeper levels of reflection and is part of a programme of research aimed at developing a more robust approach to reflection in educational practice.

A Different Drum An Arts-Based Educational Program

The authors in this article describe the background and development of a drama-based educational initiative for student nurses in the United Kingdom (UK) Forty-five student nurses from Adult and Mental-Health fields of study took part in a one-day experience where they worked alongside individuals with learning disabilities to produce art, dance, and drama sketches. The workshop was evaluated using a validated questionnaire to explore the experience from the students’ perspectives. Students felt challenged as they were pushed beyond the comfort zone of a regular classroom environment. Moreover, a greater understanding of core concepts such as empathy, dignity, stigma, and social exclusion were identified as key outcomes of the experience. The focus for future work in this field is to explore the ways in which arts-based learning and teaching initiatives can be developed within mainstream curricula.

An exploration of service responses to domestic abuse among older people: findings from one region of the UK

Purpose – Domestic abuse continues to be largely hidden phenomenon. For older survivors this invisibility is further compounded by conceptual confusion surrounding domestic abuse and other forms of family violence. The purpose of this paper is to explore service responses to abuse among older people from across a range of sectors. Where possible the perspectives of older people themselves were explored. Design/methodology/approach – A mixed methods approach incorporating postal questionnaires and semi-structured telephone interviews. Agencies and organizations from both the statutory and voluntary sector who provided specific domestic abuse support services or general services and support for older people (aged 59 years and over) and older people, either as survivors of abuse or with an interest in the development of services for older people within one region of the UK were invited to take part in the project. In total, 18 individuals from a range of agencies and three older women survivors agreed to tak...

Older women, intimate partner violence and mental health: a consideration of the particular issues for health and health care practice

AIMS AND OBJECTIVES To explore qualitative evidence in older women with a history of intimate partner violence and their accounts and experiences of mental health. BACKGROUND Intimate partner violence significantly impacts the health and well-being of women who experience it. However, women who experience intimate partner violence do not form a homogenous group and the effect on older women has not been adequately distinguished. While there is a growing body of evidence to address this deficit, studies to date have tended to concentrate on older womens experiences of intimate partner violence in totality and as such mental health issues have been subsumed as a part of the whole. DESIGN Meta-ethnographic synthesis of qualitative evidence. METHODS A systematic search of PUBMED, Cumulative Index to Nursing and Allied Health Literature, COCHRANE, Medline and PsycInfo, Sci was completed. The search included articles published up until the end of December 2015. RESULTS The review identified that intimate partner violence exerts a significant impact on the mental health of older women. Intimate partner violence for women in later life is inherently complex, especially where the boundaries of violence and vulnerability have been blurred historically both within the intimate partner violence discourse and through provision and practice. CONCLUSIONS This study adds to the developing knowledge and understanding of intimate partner violence for older women as a part of the growing body of evidence of the impact of intimate partner violence on the health and well-being of those who experience abuse more generally. When age and gender intersect with intimate partner violence, there are specific implications and health professionals and service providers need to be aware of these. RELEVANCE TO CLINICAL PRACTICE urses and healthcare professionals are professionally accountable for the effective management and support of women who have experienced abuse. It is therefore crucial that they are able to understand and identify the possible complexity of presentations of abuse and this includes older women.

Identifying signs of intimate partner violence.

Intimate partner violence is a major public health and social problem that affects people everywhere. Nurses can play an important role in identifying victims who present to healthcare settings with domestic abuse-related health issues. Evidence suggests that most women who present to emergency departments have experienced domestic abuse at some point in their lives, but that only 5% are identified by healthcare professionals. To identify and respond to victims effectively, emergency nurses must understand domestic abuse and its associated complexities. This article provides an overview of these issues, including the different types of abuse, and their prevalence, causes and effects on health. The article also explores how emergency nurses can identify and manage the effects of violence at work.