Syfte: Syftet med litteraturöversikten var att beskriva anhörigas upplevelser av att vårda sin närstående i den palliativa vården i hemmet. Metod: Studien genomfördes som en litteraturöversikt. Insamlingen av vetenskapliga artiklar utfördes på databaserna CINAHL, PubMed, Vård I Norden och manuella sökningar utfördes i elektroniska tidskrifter. I resultatet användes sammanlagt 15 kvalitativa artiklar som svarade mot litteraturöversiktens syfte och frågeställning. Bedömningsmall med kvalitativ inriktning användes för att granska artiklarnas kvalité. Artiklar med medel till hög kvalité inkluderades i studiens resultat. Resultat: Resultatet byggde på fem huvudteman utifrån anhörigas upplevelser av palliativ vård, (1) anhörigas beslut att vårda en närstående i hemmet, beskriver anhörigas negativa syn på sjukhusmiljön och närståendes önskan om att avsluta sitt liv i hemmet. (2) positiva och negativa faktorer med vård i hemmet, beskriver trygghet i palliativa teamets tillgänglighet, negativ faktor var bland annat trötthet, isolering och brist på stöd. (3) ansvar för vården, att vara oförberedd på rollen som anhörigvårdare och 24 timmars ansvar för sin närstående. (4) relationen mellan anhörig och närstående, stöd i att kommunicera med sin närstående i existentiella frågor. (5) stöd från kvalificerad vårdpersonal, beskriver bristande information från kvalificerad vårdpersonal om sjukdomsförlopp och vårdarrollen. Psykiskt- socialt- och existentiellt stöd var bristfälligt och som anhöriga uttryckte behov av. Konklusion: De främsta faktorerna till valet att bli anhörigvårdare grundade sig i viljan att uppfylla närståendes önskan att få spendera sista tiden i hemmet och att sjukhusmiljön sågs som kall och opersonlig. Anhöriga önskade socialt- psykiskt- och existentiellt stöd.

In home support is now being provided to not only people with disabilities but also to those who are ageing or have a psychological impairment. It is preferred by both government and support recipients as a viable alternative to the more costly and disruptive institutional support. This study looks at the various parties that are involved in managing the boundaries when providing support in unconventional workplaces; workplaces that are also homes; homes that are controlled and managed by the person receiving the support, not the person supervising the worker. The distance the home is from the organisation, the place from which the employee is supervised becomes a physical boundary. Boundaries are also psychological; a home is a space that forms a safe refuge from the world, a home is comforting and secure; a space that contains precious possessions. The workers are working within someone's intimate space. This creates difficulties for both the workers and their supervisors. The study takes a psychodynamic approach. What is happening at an unconscious level influences the behaviour of the various parties and can change and distort the desired outcomes for the client. The material for the study was gathered from interviews, Murray's Thematic Apperception Techniques (TAT) (Teglasi 2001) style exercises and drawings from eight clients, five coordinators and five support workers. Two workplaces were observed and seven case studies collected. A survey of 389 support workers was conducted and analysed. The results highlight the preoccupation of organisations and through them service coordinators, with controlling risk in the workplace. This puts them at odds with clients who feel they have control over their own homes. Both clients and coordinators vigorously defend what they see as their territory. The coordinators are left feeling envious of the support workers who have a close relationship with their clients, a relationship about which, they as former support workers have personal knowledge. The support worker's role is to support. They are only able to do this by defending and smothering their own emotional responses through a veil of niceness. They are unable to express many of their own feelings, which might not only be regarded as shameful but also condemned by their employer. Most staff, both support workers and coordinators lack the skills to manage and understand their own emotional responses. Although there is no easy answer to the dilemma raised within this context. I hope by identifying what is happening organisations might be able to at least understand the origins of individual carers', clients' and coordinators' behaviours and take steps to provide a safe container in which these feelings can be explored and discussed. The in-home care industry has difficulty in recruiting and retaining staff. Organisations therefore need to invest in supporting staff who work in these situations.

Over the last decade out-of-home care in Australia has experienced a period of considerable turmoil as royal commissions, parliamentary inquiries, departmental audits, empirical research and industry reports have highlighted the dire straits of the care system. A constant theme throughout has been the failure of the sector to adequately meet the needs of children and young people in care. Within this context the purpose of this study was to examine the needs of children and young people in care in Australia, giving voice to the full range of stakeholders, whose views were expressed in multiple documentary types. Specifically, the aim was to develop an in-depth understanding of their needs and formulate this into a formal taxonomy of needs. Using document analysis and the constant comparative method within the constructivist paradigm of social inquiry, the study involved analysis of 580 non-traditional, naturalistic and secondary documents relating to out-of-home care in Australia. The document sample consisted of five data types: primary data (letters, submissions to inquiries, transcripts of interviews and public hearings, and personal accounts); secondary data (reports resulting from commissions of inquiries and departmental reviews, audits and investigations); empirical data (the published findings from empirical research); legislative and policy data (legislation, regulation and quality frameworks); and industry and practitioner data (reports by academics, peak bodies and advocacy groups, and writings by out-of-home care practitioners). Further, the document sample included stakeholders from five major groups: children and young people in care (and former wards ); their parents and extended family; carers, agency staff and practitioners; statutory workers; and academics, advocates, and representatives of state and national peak bodies. The findings include a series of prominent themes of care; salient findings that highlight the experiences and needs of children and young people in care; and the taxonomy of needs. The prominent themes include the importance of natural family connectedness, cultural identity and connectedness, and counselling and therapeutic support. Issues relating to placement stability and disruption, safety and protection and, transition from care also featured prominently. The salient findings include an exploration of the overwhelming emotions of care, emotional putdowns, vicarious trauma and the witnessing of violence and abuse in out-of-home care, characteristics of children and young people who survive and thrive in care and beyond, characteristics of quality carers, symptom intolerance, disenfranchised grief – the never-ending story, and the defensive behaviours of children and young people in care. The taxonomy of needs provides a comprehensive overview of the needs of children and young people in care across 89 attributes and 21 attribute sub-categories, within 21 dimensions, and across three domains (the personal, placement, and community-of-care domains). The dimensions in the personal domain include attachment, physical development and health, personal growth, education and vocational attainment, development of the inner-self, and hope in life and for the future. The placement domain includes basic needs, basic entitlements, caring relationships, positive-parenting-practices, activity programming, focused-support, peer-relations and positive group management, and preparation for and transition from care. The community-of-care domain includes clinical intervention, family connectedness and involvement in placement, friends and social outlets, significant others, cultural-religious-spiritual connectedness, departmental worker capacity and support, and after care support. The principal theoretical, practice, and methodological conclusions derived from this study are that children and young people in care in Australia have considerable needs, are largely unable to meet their own needs, and experience harm when their needs are not met. Consequently, the out-of-home care sector has an inescapable obligation to provide for these needs if children and young people in care are to avoid harm and experience personal wellbeing. Further, children and young people in care have experienced considerable need deprivation, and if their needs are not to be forgotten, then a shift to a ‘needs-based’, ‘needs-focused’ paradigm of care is needed to inform out-of-home care policy, service design, and day-to-day practice. And finally, document analysis using non-traditional, naturalistic, and secondary data (representing the full range of stakeholder perspectives) within a constructivist paradigm of inquiry, provides an effective, indeed powerful methodology for exploring the needs of children and young people in care, and for giving voice to the many stakeholders who voices may never have been heard again.

Over the last decade out-of-home care in Australia has experienced a period of considerable turmoil as royal commissions, parliamentary inquiries, departmental audits, empirical research and industry reports have highlighted the dire straits of the care system. A constant theme throughout has been the failure of the sector to adequately meet the needs of children and young people in care. Within this context the purpose of this study was to examine the needs of children and young people in care in Australia, giving voice to the full range of stakeholders, whose views were expressed in multiple documentary types. Specifically, the aim was to develop an in-depth understanding of their needs and formulate this into a formal taxonomy of needs. Using document analysis and the constant comparative method within the constructivist paradigm of social inquiry, the study involved analysis of 580 non-traditional, naturalistic and secondary documents relating to out-of-home care in Australia. The document sample consisted of five data types: primary data (letters, submissions to inquiries, transcripts of interviews and public hearings, and personal accounts); secondary data (reports resulting from commissions of inquiries and departmental reviews, audits and investigations); empirical data (the published findings from empirical research); legislative and policy data (legislation, regulation and quality frameworks); and industry and practitioner data (reports by academics, peak bodies and advocacy groups, and writings by out-of-home care practitioners). Further, the document sample included stakeholders from five major groups: children and young people in care (and former wards ); their parents and extended family; carers, agency staff and practitioners; statutory workers; and academics, advocates, and representatives of state and national peak bodies. The findings include a series of prominent themes of care; salient findings that highlight the experiences and needs of children and young people in care; and the taxonomy of needs. The prominent themes include the importance of natural family connectedness, cultural identity and connectedness, and counselling and therapeutic support. Issues relating to placement stability and disruption, safety and protection and, transition from care also featured prominently. The salient findings include an exploration of the overwhelming emotions of care, emotional putdowns, vicarious trauma and the witnessing of violence and abuse in out-of-home care, characteristics of children and young people who survive and thrive in care and beyond, characteristics of quality carers, symptom intolerance, disenfranchised grief – the never-ending story, and the defensive behaviours of children and young people in care. The taxonomy of needs provides a comprehensive overview of the needs of children and young people in care across 89 attributes and 21 attribute sub-categories, within 21 dimensions, and across three domains (the personal, placement, and community-of-care domains). The dimensions in the personal domain include attachment, physical development and health, personal growth, education and vocational attainment, development of the inner-self, and hope in life and for the future. The placement domain includes basic needs, basic entitlements, caring relationships, positive-parenting-practices, activity programming, focused-support, peer-relations and positive group management, and preparation for and transition from care. The community-of-care domain includes clinical intervention, family connectedness and involvement in placement, friends and social outlets, significant others, cultural-religious-spiritual connectedness, departmental worker capacity and support, and after care support. The principal theoretical, practice, and methodological conclusions derived from this study are that children and young people in care in Australia have considerable needs, are largely unable to meet their own needs, and experience harm when their needs are not met. Consequently, the out-of-home care sector has an inescapable obligation to provide for these needs if children and young people in care are to avoid harm and experience personal wellbeing. Further, children and young people in care have experienced considerable need deprivation, and if their needs are not to be forgotten, then a shift to a ‘needs-based’, ‘needs-focused’ paradigm of care is needed to inform out-of-home care policy, service design, and day-to-day practice. And finally, document analysis using non-traditional, naturalistic, and secondary data (representing the full range of stakeholder perspectives) within a constructivist paradigm of inquiry, provides an effective, indeed powerful methodology for exploring the needs of children and young people in care, and for giving voice to the many stakeholders who voices may never have been heard again.

Over the last decade out-of-home care in Australia has experienced a period of considerable turmoil as royal commissions, parliamentary inquiries, departmental audits, empirical research and industry reports have highlighted the dire straits of the care system. A constant theme throughout has been the failure of the sector to adequately meet the needs of children and young people in care. Within this context the purpose of this study was to examine the needs of children and young people in care in Australia, giving voice to the full range of stakeholders, whose views were expressed in multiple documentary types. Specifically, the aim was to develop an in-depth understanding of their needs and formulate this into a formal taxonomy of needs. Using document analysis and the constant comparative method within the constructivist paradigm of social inquiry, the study involved analysis of 580 non-traditional, naturalistic and secondary documents relating to out-of-home care in Australia. The document sample consisted of five data types: primary data (letters, submissions to inquiries, transcripts of interviews and public hearings, and personal accounts); secondary data (reports resulting from commissions of inquiries and departmental reviews, audits and investigations); empirical data (the published findings from empirical research); legislative and policy data (legislation, regulation and quality frameworks); and industry and practitioner data (reports by academics, peak bodies and advocacy groups, and writings by out-of-home care practitioners). Further, the document sample included stakeholders from five major groups: children and young people in care (and former wards ); their parents and extended family; carers, agency staff and practitioners; statutory workers; and academics, advocates, and representatives of state and national peak bodies. The findings include a series of prominent themes of care; salient findings that highlight the experiences and needs of children and young people in care; and the taxonomy of needs. The prominent themes include the importance of natural family connectedness, cultural identity and connectedness, and counselling and therapeutic support. Issues relating to placement stability and disruption, safety and protection and, transition from care also featured prominently. The salient findings include an exploration of the overwhelming emotions of care, emotional putdowns, vicarious trauma and the witnessing of violence and abuse in out-of-home care, characteristics of children and young people who survive and thrive in care and beyond, characteristics of quality carers, symptom intolerance, disenfranchised grief – the never-ending story, and the defensive behaviours of children and young people in care. The taxonomy of needs provides a comprehensive overview of the needs of children and young people in care across 89 attributes and 21 attribute sub-categories, within 21 dimensions, and across three domains (the personal, placement, and community-of-care domains). The dimensions in the personal domain include attachment, physical development and health, personal growth, education and vocational attainment, development of the inner-self, and hope in life and for the future. The placement domain includes basic needs, basic entitlements, caring relationships, positive-parenting-practices, activity programming, focused-support, peer-relations and positive group management, and preparation for and transition from care. The community-of-care domain includes clinical intervention, family connectedness and involvement in placement, friends and social outlets, significant others, cultural-religious-spiritual connectedness, departmental worker capacity and support, and after care support. The principal theoretical, practice, and methodological conclusions derived from this study are that children and young people in care in Australia have considerable needs, are largely unable to meet their own needs, and experience harm when their needs are not met. Consequently, the out-of-home care sector has an inescapable obligation to provide for these needs if children and young people in care are to avoid harm and experience personal wellbeing. Further, children and young people in care have experienced considerable need deprivation, and if their needs are not to be forgotten, then a shift to a ‘needs-based’, ‘needs-focused’ paradigm of care is needed to inform out-of-home care policy, service design, and day-to-day practice. And finally, document analysis using non-traditional, naturalistic, and secondary data (representing the full range of stakeholder perspectives) within a constructivist paradigm of inquiry, provides an effective, indeed powerful methodology for exploring the needs of children and young people in care, and for giving voice to the many stakeholders who voices may never have been heard again.

Over the last decade out-of-home care in Australia has experienced a period of considerable turmoil as royal commissions, parliamentary inquiries, departmental audits, empirical research and industry reports have highlighted the dire straits of the care system. A constant theme throughout has been the failure of the sector to adequately meet the needs of children and young people in care. Within this context the purpose of this study was to examine the needs of children and young people in care in Australia, giving voice to the full range of stakeholders, whose views were expressed in multiple documentary types. Specifically, the aim was to develop an in-depth understanding of their needs and formulate this into a formal taxonomy of needs. Using document analysis and the constant comparative method within the constructivist paradigm of social inquiry, the study involved analysis of 580 non-traditional, naturalistic and secondary documents relating to out-of-home care in Australia. The document sample consisted of five data types: primary data (letters, submissions to inquiries, transcripts of interviews and public hearings, and personal accounts); secondary data (reports resulting from commissions of inquiries and departmental reviews, audits and investigations); empirical data (the published findings from empirical research); legislative and policy data (legislation, regulation and quality frameworks); and industry and practitioner data (reports by academics, peak bodies and advocacy groups, and writings by out-of-home care practitioners). Further, the document sample included stakeholders from five major groups: children and young people in care (and former wards ); their parents and extended family; carers, agency staff and practitioners; statutory workers; and academics, advocates, and representatives of state and national peak bodies. The findings include a series of prominent themes of care; salient findings that highlight the experiences and needs of children and young people in care; and the taxonomy of needs. The prominent themes include the importance of natural family connectedness, cultural identity and connectedness, and counselling and therapeutic support. Issues relating to placement stability and disruption, safety and protection and, transition from care also featured prominently. The salient findings include an exploration of the overwhelming emotions of care, emotional putdowns, vicarious trauma and the witnessing of violence and abuse in out-of-home care, characteristics of children and young people who survive and thrive in care and beyond, characteristics of quality carers, symptom intolerance, disenfranchised grief – the never-ending story, and the defensive behaviours of children and young people in care. The taxonomy of needs provides a comprehensive overview of the needs of children and young people in care across 89 attributes and 21 attribute sub-categories, within 21 dimensions, and across three domains (the personal, placement, and community-of-care domains). The dimensions in the personal domain include attachment, physical development and health, personal growth, education and vocational attainment, development of the inner-self, and hope in life and for the future. The placement domain includes basic needs, basic entitlements, caring relationships, positive-parenting-practices, activity programming, focused-support, peer-relations and positive group management, and preparation for and transition from care. The community-of-care domain includes clinical intervention, family connectedness and involvement in placement, friends and social outlets, significant others, cultural-religious-spiritual connectedness, departmental worker capacity and support, and after care support. The principal theoretical, practice, and methodological conclusions derived from this study are that children and young people in care in Australia have considerable needs, are largely unable to meet their own needs, and experience harm when their needs are not met. Consequently, the out-of-home care sector has an inescapable obligation to provide for these needs if children and young people in care are to avoid harm and experience personal wellbeing. Further, children and young people in care have experienced considerable need deprivation, and if their needs are not to be forgotten, then a shift to a ‘needs-based’, ‘needs-focused’ paradigm of care is needed to inform out-of-home care policy, service design, and day-to-day practice. And finally, document analysis using non-traditional, naturalistic, and secondary data (representing the full range of stakeholder perspectives) within a constructivist paradigm of inquiry, provides an effective, indeed powerful methodology for exploring the needs of children and young people in care, and for giving voice to the many stakeholders who voices may never have been heard again.

Master of Social Work / This research is about evidence based practice, which is an area of increasing interest and emphasis in social work today. Initially apparent in medical and health care settings, evidence based practice now has widened applicability to a broad range of contexts and professional disciplines. The ways in which research evidence is translated into policy and practice is itself a topic area for social work research. The study investigates evidence based practice in child welfare, specifically the out-of-home care system. Out-of-home care provides alternative placements for children and young people who cannot live with their families because of abuse and neglect, and generally consists of placement with foster carers or in a residential/group care setting. This research is an exploratory study which investigates through individual interview how nineteen out-of-home care Senior Managers and Team Leaders in the states of New South Wales, Western Australia and the Australian Capital Territory interpret and understand evidence based practice, and the degree and depth of knowledge they transfer from research awareness into out-of-home care practice and policy development. The research has three main objectives. Firstly to investigate the understanding of out-of-home care managers of evidence based practice, secondly to determine the influence of relevant research on practice and policy in out-ofhome care, and thirdly to explore potential barriers to evidence based practice. Looking After Children, a social work case management system for children and young people in out-of-home care, provides the context for this research, in which evidence based practice is critically examined. A thematic analysis of the interview data identified five major themes. These included: the benefit of broadening definitions of evidence based practice to include a wide range of influences on practice; the value and importance of 2 considering a broad range of research approaches in connecting research with policy and practice AND the potential for influencing outcomes of social work intervention via research based and influenced guided practice systems and techniques; factors which constitute barriers and also those that enhance the implementation of evidence based practice; the potential for instigating and supporting new research via the use of evidence based practice for purposes such as data aggregation, in addition to practice development and enhancement of client outcomes. Implications and conclusions are drawn from this study in relation to out-ofhome care policy and practice, with particular reference to use of the Looking After Children case management system in the Australian context. These include the potential of a consistent system such as LAC to provide common language and assessment tools and procedures in a welfare sector that is fragmented by lack of national legislation, and the potential for development of national out-of-home care research projects as a result of cross agency LAC implementation resulting in data aggregation opportunities.

This study explores the notion of resilience and, in particular, its efficacy as a framework to assist and guide professionals in their work with children placed in the care of the State, many of whom have experienced situations of severe disadvantage, including abuse and neglect, prior to their admission to the out-of-home care system. The further distress and/or trauma for children, which is engendered by separation from their families and placement with strangers, is exacerbated by circumstances of transience and instability that many children experience during their care journeys. The study examines the care system as a circumstance of adversity and seeks to find out how specialist practitioners working in the care environment understand the notion of resilience and whether they operationalise the concept in their practice to assist children in care. The study is set within a critically reflective perspective, informed by a hermeneutic process that assists in building a deeper understanding of both the notion of resilience and the care system through the lived experiences of practitioners and interpretation of the literature on both topics. An unanticipated finding that emerged from research discussions conducted with practitioners revealed that their experiences of working within the care system created a sense of adversity for them and challenged their resilience, with many parallels between their responses and their observations of the distress and trauma of children in care. The necessity to understand these practitioners? experiences more deeply led to a further exploration of literature that described the impact of working in such adverse settings. This exploration uncovered the notion of vicarious traumatisation, a phenomenon that affects workers who are in continual contact with the trauma of others. An indepth discussion of this concept is provided outlining its relevance to this study. The implications of the impact of the adversity of the care environment on professionals are summarised in the final chapter of the study together with recommendations in the areas of both practice and research.

Diss. (sammanfattning) Göteborg : Univ., 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Univ. , 2008. / Härtill 4 uppsatser.