Williams Allison
Department of Geography, University of Saskatchewan, Saskatoon, Canada.
Soc Sci Med. 2002 Jul;55(1):141-54. doi: 10.1016/s0277-9536(01)00209-x.
Changes in health care service delivery have resulted in the transfer of care from formal spaces such as hospitals and institutions towards informal settings such as home. Due to the degree of this transfer, it is increasingly important for geographers to explore the experience and meaning of these changing geographies of care in order to reveal and understand the impact and effect on particular individuals and places. Recognizing that the home environment not only designates a dwelling but also represents a multitude of meanings (such as personal identity, security and privacy) that likely vary according to class, ethnicity and family size (among other socio-demographic variables), it presents a complex site for study. This paper suggests research directions to further understand the role of caregiving in contributing to the experience and meaning of the home environment by informal caregivers, the majority of which are women. Using a political economy approach, this paper first reviews the reorganization of health care services and discusses how this is reshaping the experience of informal caregivers at home. A review of the place identity literature contextualizes the specific discussion of the literature on the meaning of home, both of which are then critically examined. Next, the concept of therapeutic landscapes is discussed as an idealized framework to explore the health-promoting properties of home on informal caregivers. Questions for research are outlined before conclusions highlight how research on home space can allow a better understanding of the impact and effect of caregiving on family caregivers and the places where they live. Such research can inform the changes and trends in health care service policy.
医疗服务提供方式的变化已导致医疗护理从医院和机构等正式场所转向家庭等非正式环境。鉴于这种转变的程度，地理学家探索这些不断变化的护理地理环境的体验和意义变得越来越重要，以便揭示和理解其对特定个人和场所的影响。认识到家庭环境不仅是一个住所，还代表着多种意义（如个人身份、安全和隐私），而这些意义可能因阶级、种族和家庭规模（以及其他社会人口变量）而有所不同，这使得家庭成为一个复杂的研究场所。本文提出了研究方向，以进一步理解非正式护理人员（其中大多数为女性）的护理工作在塑造家庭环境体验和意义方面所起的作用。本文采用政治经济学方法，首先回顾了医疗服务的重组，并讨论了这如何重塑非正式护理人员在家中的体验。对场所认同文献的回顾为关于家的意义的文献的具体讨论提供了背景，随后对这两者进行了批判性审视。接下来，讨论了治疗性景观的概念，将其作为一个理想化的框架，以探讨家庭对非正式护理人员的健康促进特性。在结论强调关于家庭空间的研究如何有助于更好地理解护理工作对家庭护理人员及其居住场所的影响之前，概述了研究问题。此类研究可为医疗服务政策的变化和趋势提供参考。
