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丧亲澳大利亚护理者的社会福利需求:来自姑息治疗和福利工作者的见解的启示。

Social welfare needs of bereaved Australian carers: Implications of insights from palliative care and welfare workers.

机构信息

Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia.

Supportive and Palliative Care, Western Sydney Local Health District, Mt Druitt, NSW, Australia.

出版信息

Health Soc Care Community. 2021 May;29(3):631-642. doi: 10.1111/hsc.13339. Epub 2021 Mar 11.

Abstract

An individual and psychological emphasis has influenced practice and research on bereavement following informal care provision in the context of life-limiting illness. Consideration of the potential for bereavement to be shaped by intersecting social and structural inequities is needed; and should include an understanding of interactions with government institutions and social policy. This qualitative study employed interpretive description to explore the way in which palliative care workers and welfare sector workers perceive and approach experiences and needs of bereaved carers receiving government income support or housing assistance in Western Sydney, an area associated with recognised socioeconomic disadvantage. A total of 21 palliative care workers within a public health service and welfare workers from two government social welfare services participated in in-depth interviews. Data were analysed using framework analysis. Participants highlighted social welfare policy and related interactions that may impact bereavement, potentially related to financial, housing and employment precariousness. Personal, interpersonal and structural factors perceived to shape the navigation of welfare needs were explored, alongside needed professional and structural changes envisioned by workers. With limited forms of capital, vulnerably positioned carers may encounter difficulties that heighten their precariousness in bereavement. Transactional organisational cultures alongside health and welfare agencies that function in a siloed manner appear to contribute to structural burden for carers, following death due to life-limiting illness. Palliative care and welfare workers also associated elements of their work with bereaved carers with their own experiences of helplessness, frustration and distress. Findings point to a need for the development of interagency strategies in addition to policy underpinned by more nuanced understandings of vulnerability in bereavement, post-caring.

摘要

个体和心理层面的关注影响了在生命有限疾病背景下非正式照护结束后的丧亲实践和研究。需要考虑丧亲可能会受到社会和结构性不平等因素的影响;这应该包括对与政府机构和社会政策相互作用的理解。本定性研究采用解释性描述方法,探索了姑息治疗工作者和福利部门工作者如何感知和处理在西悉尼接受政府收入支持或住房援助的丧亲照料者的经历和需求,西悉尼是一个与公认的社会经济劣势相关的地区。共有 21 名公共卫生服务中的姑息治疗工作者和来自两个政府社会福利服务的福利工作者参与了深入访谈。使用框架分析对数据进行分析。参与者强调了社会福利政策和相关互动,这些可能会影响丧亲,可能与经济、住房和就业不稳定有关。探讨了个人、人际和结构因素对福利需求的影响,以及工作者设想的专业和结构变革。由于有限的资本形式,处于弱势地位的照料者可能会遇到困难,这会加剧他们在丧亲过程中的不稳定性。机构之间的交易文化以及以孤岛方式运作的卫生和福利机构,似乎导致在生命有限疾病导致死亡后,照料者的结构性负担增加。姑息治疗和福利工作者还将他们与丧亲照料者的工作联系起来,认为这与他们自己的无助、沮丧和痛苦经历有关。研究结果表明,除了以更细致入微的方式理解丧亲后的脆弱性为基础的政策外,还需要制定机构间战略。

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