According to the Bureau of Labor Statistics, there were approximately 1.7 million home health aides and personal and home care aides in the United States as of 2008. These home care aides are rapidly ...becoming the backbone of America's system of long-term care, and their numbers continue to grow. Often referred to as frontline care providers or direct care workers, home care aides-disproportionately women of color-bathe, feed, and offer companionship to the elderly and disabled in the context of the home. InThe Caring Self, Clare L. Stacey draws on observations of and interviews with aides working in Ohio and California to explore the physical and emotional labor associated with the care of others.
Aides experience material hardships-most work for minimum wage, and the services they provide are denigrated as unskilled labor-and find themselves negotiating social norms and affective rules associated with both family and work. This has negative implications for workers who struggle to establish clear limits on their emotional labor in the intimate space of the home. Aides often find themselves giving more, staying longer, even paying out of pocket for patient medications or incidentals; in other words, they feel emotional obligations expected more often of family members than of employees. However, there are also positive outcomes: some aides form meaningful ties to elderly and disabled patients. This sense of connection allows them to establish a sense of dignity and social worth in a socially devalued job. The case of home care allows us to see the ways in which emotional labor can simultaneously have deleterious and empowering consequences for workers.
Caring on the Clock Duffy, Mignon; Armenia, Amy; Stacey, Clare L ...
2015, 20150122, 2015-01-30
eBook
A nurse inserts an I.V. A personal care attendant helps a quadriplegic bathe and get dressed. A nanny reads a bedtime story to soothe a child to sleep. Every day, workers like these provide critical ...support to some of the most vulnerable members of our society.Caring on the Clockprovides a wealth of insight into these workers, who take care of our most fundamental needs, often at risk to their own economic and physical well-being.
Caring on the Clockis the first book to bring together cutting-edge research on a wide range of paid care occupations, and to place the various fields within a comprehensive and comparative framework across occupational boundaries. The book includes twenty-two original essays by leading researchers across a range of disciplines-including sociology, psychology, social work, and public health. They examine the history of the paid care sector in America, reveal why paid-care work can be both personally fulfilling but also make workers vulnerable to burnout, emotional fatigue, physical injuries, and wage exploitation. Finally, the editors outline many innovative ideas for reform, including top-down and grassroots efforts to improve recognition, remuneration, and mobility for care workers.
As America faces a series of challenges to providing care for its citizens, including the many aging baby boomers, this volume offers a wealth of information and insight for policymakers, scholars, advocates, and the general public.
Empathy is a well-established facet of clinical competency that research suggests is associated with enhanced medical student well-being. Since little is known about empathy and well-being before ...students enter medical school-during pre-medical education-the main goal of this study is to test a conceptual model of how clinical empathy is related to two indicators of well-being, depression, and burnout among pre-medical students. The theoretical model hypothesizes that three dimensions of clinical empathy-Perspective-Taking, Compassionate Care, and Standing in Patients' Shoes- will be directly and negatively related to depression, as well as indirectly through its inverse relationship with three facets of burnout, Emotional Exhaustion, Poor Academic Efficacy, and Cynicism.
Using survey data from a sample of 132 pre-medical students at an American Midwestern university, this study employs structural equation modeling (SEM) to test the theoretical model of the relationships between empathy, burnout, and depression among pre-medical students. We identify the direct effects of the three dimensions of the Jefferson Scale of Physician Empathy (JSE-S) on depression (CES-D), as well as the indirect effects of clinical empathy on depression through the three dimensions of the Maslach Burnout Inventory (MBI-S).
SEM analyses show that while none of the three dimensions of the JSE-S are directly related to depression, clinical empathy does significantly affect depression indirectly through burnout. Specifically, as predicted, we find that Perspective-Taking decreases Emotional Exhaustion, but, contrary to expectations, Compassionate Care increases it. And, the positive relationship between Compassionate Care and Emotional Exhaustion is particularly strong. In turn, Perspective-Taking and Compassionate Care are associated with depression in opposite directions and to different degrees.
Findings suggest that clinical empathy as measured by the JSE-S produces both positive and negative effects on personal well-being. We conclude that further conceptual clarity of clinical empathy is needed to better discern how the different dimensions impact different indicators of well-being. Given that pre-medical education is a crucial time for emotional socialization, the challenge for medical education will be fostering the positive, cognitive aspects of clinical empathy while simultaneously mitigating the adverse effects of affective empathy on medical student well-being.
The ageing of the population in the US and elsewhere raises important questions about who will provide long‐term care for elderly and disabled people. Current projections indicate that home care ...workers – most of whom are unskilled, untrained and underpaid – will increasingly absorb responsibility for care. While research to date confirms the demanding aspects of the work and the need for improved working conditions, little is known about how home care workers themselves experience and negotiate their labour on a daily basis. This paper attempts to address this gap by examining how home care workers assign meaning to their ‘dirty work’. Qualitative interviews suggest that home care workers have a conflicted, often contradictory, relationship to their labour. Workers identify constraints that compromise their ability to do a good job or to experience their work as meaningful, but they also report several rewards that come from caring for dependent adults. I suggest workers draw dignity from these rewards, especially workers who enter home care after fleeing an alienating service job, within or outside the healthcare industry.
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In 1965, Glaser and Strauss (1965) offered the concept of “awareness contexts” to explain what patients in hospitals do or don't know about their death trajectories. Awareness ranges from closed ...(where patients are completely unaware and family and providers protect “the secret”) to open (where all parties communicate openly and honestly). While closed awareness was the norm in 1960s, open awareness is now considered standard practice in US, a reflection of mounting evidence that patients, families, and providers benefit from clear and honest communication at end of life (Seale et al., 1997; Wright et al., 2008). Despite the known benefits of open awareness, many terminal patients remain unaware or confused about their prognoses (Chen et al., 2017). This paper asks why, in an era of open awareness, are patients and families uncertain about dying? To answer this question, we focus on an aspect of Glaser and Strauss's theory that remains relatively understudied by researchers, namely the role of institutional and organizational realities in shaping awareness contexts. Based on interviews with 43 family members of deceased patients who died at General Hospital in the Midwestern US, we argue that two related conditions in hospitals—the increased specialization of medical professionals and the fragmentation of patient care—serve as important context for the death awareness of patients and families.
•Specialized and fragmented health care impacts end of life experiences for patients and families.•Patients and families experiencing specialized and fragmented care experience uncertain prognoses.•Uncertain prognoses at end of life can leave families unprepared for death and/or grief stricken.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Numerous links have been reported between immune response and DNA damage repair pathways in both plants and animals but the precise nature of the relationship between these fundamental processes is ...not entirely clear. Here, we report that XAP5 CIRCADIAN TIMEKEEPER (XCT), a protein highly conserved across eukaryotes, acts as a negative regulator of immunity in
and plays a positive role in responses to DNA damaging radiation. We find
mutants have enhanced resistance to infection by a virulent bacterial pathogen,
pv.
DC3000, and are hyper-responsive to the defense-activating hormone salicylic acid (SA) when compared to wild-type. Unlike most mutants with constitutive effector-triggered immunity (ETI),
plants do not have increased levels of SA and retain enhanced immunity at elevated temperatures. Genetic analysis indicates
acts independently of
(
), which encodes a known SA receptor. Since DNA damage has been reported to potentiate immune responses, we next investigated the DNA damage response in our mutants. We found
seedlings to be hypersensitive to UV-C and γ radiation and deficient in phosphorylation of the histone variant H2A.X, one of the earliest known responses to DNA damage. These data demonstrate that loss of
causes a defect in an early step of the DNA damage response pathway. Together, our data suggest that alterations in DNA damage response pathways may underlie the enhanced immunity seen in
mutants.
It has become
for healthcare systems to tout their ability to provide compassionate medical care that addresses the emotional as well as physical needs of patients. Not surprisingly, then, there is ...considerable pressure on medical schools to train their students to be empathic. Existing literature on empathy training in medicine tends to focus on how to build emotional intelligence in individual trainees, largely ignoring the sociocultural factors that contribute to or thwart empathy development in medical school. Additionally, research tends to examine student perspectives, with little attention given to medical educators and their viewpoints.
In this paper, we adopt an "emotion practice" framework and utilize an inductive descriptive study design to qualitatively consider how first year medical students (
= 23) and their instructors (
= 9) perceive empathy training at a site we call Midtown Medical School.
We find that both groups have an understanding of empathic capital but differ in their beliefs about the utility and legitimacy of this capital. Both educators and students also recognize the limitations of standardized empathy curriculum but do not agree on the implications of such rote learning. Finally, students and instructors alike find the hidden curriculum of medical school to be antithetical to empathy development, concurring that it is difficult to cultivate empathy in spaces where biomedical coursework is prioritized over social-emotional learning. In short, both groups find it difficult to
.
Service learning is a well-established part of the sociology curriculum in many American universities and colleges. Less well known is student-led philanthropy (also known as experiential ...philanthropy), a form of service learning that encourages students to donate money to the community partners they are serving. Underwritten by national foundations or regional Campus Compacts, student-led philanthropy (SLP) positions undergraduates as donors as well as doers. In this paper, we ask how sociology students perceive the role of donor and how it enhances or detracts from their volunteer experiences with community partners. To answer this question, we draw on qualitative and quantitative data from 24 SLP students enrolled in an Honors Social Problems course. We find that students overwhelmingly welcome the shift from doer to donor in so much as it affords them a greater perceived sense of purpose and impact, enriching their relationships with community partners. Students lament being donors, however, when they have to collectively decide which organizations "deserve" funding. The award process is especially fraught when organizations become maligned and deemed unworthy by a subset of students. We conclude with a discussion of how SLP can be integrated into the sociology classroom and how instructors might pursue this form of service learning when resources for philanthropic giving are limited.
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Background:
Patients with advanced disease often overestimate their life expectancy, which potentially impacts decision making.
Objective:
To examine the nature and source of hospice patients’ life ...expectancy estimates, about which little is known.
Design:
Using semi-structured interviews, patients were asked to estimate their life expectancy and elaborate on their response.
Setting/Subjects:
Participants were hospice patients (n = 20, 55% male; 60% cancer).
Measurement:
We conducted thematic analysis using open and focused coding.
Results:
Many participants had difficulty answering the life expectancy question and expressed uncertainty about when they would die. One-third overestimated their length of life relative to actual survival. The most common source of patients’ prognostic beliefs was knowledge about their body, including physical symptoms and change over time. Half of patients reported that a provider had given them a prognostic estimate, and one-third agreed with, or gave estimates consistent with, the provider’s estimate. Some patients said providers do not know prognosis or that time of death was unknowable.
Conclusions:
Key findings were that 1) many hospice patients had difficulty estimating life expectancy, and 2) hospice patients’ life expectancy estimates were frequently based on their body and not on information from medical providers. These findings have implications for measuring prognostic awareness, as valid assessment is a necessary component of determining whether prognostic awareness is beneficial for patients. Future research should examine how life expectancy estimates are associated with well-being and whether results extend to larger samples of patients with advanced disease not in hospice.
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10.
The empathic capital of pre-medical students Harvey, Sarah D.C.; Stacey, Clare L.; MacArthur, Kelly Rhea
SSM. Qualitative research in health,
June 2023, 2023-06-00, 2023-06-01, Volume:
3
Journal Article
Peer reviewed
Open access
Literature on the professional and emotional socialization of medical trainees in the US tends to focus on students who have already matriculated into medical school, leaving pre-medical student ...experiences largely understudied. Specifically, little is known about how these students develop and understand empathy during their pre-medical years. We draw on qualitative interviews with 25 pre-medical students at Midwest University and find that students at this stage possess considerable empathic capital, a resource that they will likely draw on in medical school and beyond. Specifically, pre-medical students understand empathy in cognitive, affective, and action-oriented ways; recall instances of empathic action in their everyday lives; and view empathy as a learned emotional state, shaped in the context of social relationships and the pre-medical curriculum. These understandings of empathy reflect a crucial stage in the development of students' empathy careers (Ruiz-Junco, 2017), as they shift from primary (home and family) to secondary (education, peers) emotional socialization. It behooves medical educators and researchers to understand the empathic capital that medical students “bring to the table” so that empathy training can better incorporate or challenge learners’ existing conceptualizations.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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