Strangers in care: using literature to re-theorise care for the oldest old

Regulated fragmentation organises care of the vulnerable older people into elements provided by the caring family, professionals, care workers from public/private providers and volunteers. In this exploratory article, I consider the role of the stranger in modern care management, a role that has up to now been neglected or been understood largely in terms of a migrant worker. Using literature, applying discourse analysis and drawing upon Simmel and Kristeva, I outline dimensions of the stranger and the unfamiliar that can further research and policy considerations.

Nurses’ experiences in the care of high-risk newborns: a phenomenological study

ABSTRACT Objective: To describe nurses’ experience in the care of high-risk newborns. Method: This is a descriptive study with a qualitative approach, based on Merleau-Ponty’s phenomenology and performed at the Fernando Magalhães Maternity Hospital in the state of Rio de Janeiro, through interviews with 30 nurses who work in neonatal care, according to the phenomenological thinking of Maurice Merleau- Ponty. Results: Three categories emerged: “experienced body of the nurse practitioner on the high-risk newborn”; “experienced world of the nurse practitioner on the high-risk newborn”; and “time spent by the nurse practitioner with the high-risk newborn”. Final considerations: The study allowed us to describe, through the participants’ speeches, that the care of the high-risk newborn is broad, that is, objective, subjective and carried out with advanced technologies, their experiences and scientific improvement are composed of shared practice and theory with the family, professionals and beginners in the neonatal universe, favoring a differentiated and humanized care.

A framework for complexity in palliative care: A qualitative study with patients, family carers and professionals

Background: Palliative care patients are often described as complex but evidence on complexity is limited. We need to understand complexity, including at individual patient-level, to define specialist palliative care, characterise palliative care populations and meaningfully compare interventions/outcomes. Aim: To explore palliative care stakeholders’ views on what makes a patient more or less complex and insights on capturing complexity at patient-level. Design: In-depth qualitative interviews, analysed using Framework analysis. Participants/setting: Semi-structured interviews across six UK centres with patients, family, professionals, managers and senior leads, purposively sampled by experience, background, location and setting (hospital, hospice and community). Results: 65 participants provided an understanding of complexity, which extended far beyond the commonly used physical, psychological, social and spiritual domains. Complexity included how patients interact with family/professionals, how services’ respond to needs and societal perspectives on care. ‘Pre-existing’, ‘cumulative’ and ‘invisible’ complexity are further important dimensions to delivering effective palliative and end-of-life care. The dynamic nature of illness and needs over time was also profoundly influential. Adapting Bronfenbrenner’s Ecological Systems Theory, we categorised findings into the microsystem (person, needs and characteristics), chronosystem (dynamic influences of time), mesosystem (interactions with family/health professionals), exosystem (palliative care services/systems) and macrosystem (societal influences). Stakeholders found it acceptable to capture complexity at the patient-level, with perceived benefits for improving palliative care resource allocation. Conclusion: Our conceptual framework encompasses additional elements beyond physical, psychological, social and spiritual domains and advances systematic understanding of complexity within the context of palliative care. This framework helps capture patient-level complexity and target resource provision in specialist palliative care.