Remembering My Hat

13th September 2013

BSG 2013, Oxford, Part 3

Partial and particularly incomplete notes from a conference. Part one here and part two here

Symposium: Using the Arts to humanise healthcare education about people with dementia

Sherry Dupuis, University of Waterloo, Canada

The pedagogical possibilities of research-based drama in dementia care

Project came out of desire to resist dominant popular discourses of dementia ‘shell of himself’ ‘burden of care’ ‘long goodbye’ ‘36 hour day’ ‘loss of self’ as well as bio-medical versions.

Looking at effects on audience members  – how images and actions changed for families and workers of PWD over a one year period, after seeing film called ‘I’m still here’ – research based drama – script much from transcripts of interviews, result of collaborations with PWD, workers, actors and playwrite.

(cc) Nico Macdonald

Pre and immediately post-performance focus groups (n=106 people)

Interviews 6 weeks and 12 months after viewing (no.s reduced at each stage as you’d expect to 83 at end)

Participants had vivid memories at 6 weeks – feelings of compassion and better understanding of PWD’s perspective. Talked about scenes flickering into their brains months later. Expanded perspective, deepened understanding

Some people felt they are unchanged because already knew this – affirmed their existing awareness. But often in the interview they then went on to talk about ways they had changed [this is surely about face and presenting yourself as a competent member to start with – dynamics of interview].

Some evidence of changed behaviours as a result – family members joking more, recognising humour in situations + focusing more on person, not trying to get other jobs done at the same time. Care workers talked about checking for UTIs more, having a better admission form, running support groups for families.

Cathartic experience for some family members, transformative healing process, emotional release.

DVD and teaching-learning tool available from www.marep.uwaterloo.ca

New study will do observational work in care homes about whether it actually changes care worker’s practices. There is some evidence of practical changes already e.g. policy changes, support group set up etc.

Dialogue with others after the performance was really important for deepening learning.

 

Ruth Bartlett, Univ of Southampton

Agnes & Nancy – a short film about two women with dementia

A documentary film she commissioned. Comes out of her ESRC First Grants study of PWD who are activists and campaigners for dementia (like Terry Pratchett but he didn’t take part!) – ‘No Limits: reimagining life with dementia’. 16 people took part, 11 men, 5 women.

Agnes and Nancy are real people, real names – offered pseudonym but all but 2 didn’t want that – being named and known is part of their activism. Film is available on vimeo or email Ruth and she can also send teaching resources / resource pack for facilitators to use.

Documentary film definition: about real life, but not itself real life. Term first used in 1926.

Health Equity Institute in San Francisco is leader in the field, have 35 documentary films ‘For Health and Social Justice’ made by and for students, incl ‘Old Age is not for Cissies’ about LGBT ageing.

Paper by Aagje Swinnen in The Gerontologist (2013) on dementia in documentary films – way it is always a representation of reality, not always helpful.

Common responses to film:

  • lovely film.
  • But also lots of challenges ‘do they really have dementia?’ – still living quite independently, travelling and so on.
  • It’s about friendship, not demetia
  • ‘She shdnt be allowed to chop wood (one memorable scene)
  • The PWD I support aren’t like Agnes and Nancy

Raises interesting questions about perceived authenticity – if someone doesn’t seem to be behaving like PWD, their illness identity gets challenged.

Bartlett, R (2012) ‘The emergent modes of dementia activism’ Ageing & Society

Interesting discussion among audience about both the importance of positive role models but also the pressure they create for other people who can’t be like that because of physical health, cognitive issues, social class, race etc. Ruth: someone with dementia saying ‘I thought I was doing well’ until they saw the Agnes and Nancy film [gulp!]

Ransackers Association – group for PWD – audience member.

 

Hannah Zeilig, UEA

Descartes: Using the arts to educate the dementia care workforce.

Still no clear regulatory framework for the dementia care workforce.

Staff in care home they worked in initially hostile to word ‘Arts’ and also to researchers, seeing them as ‘experts’ coming in to tell them how to do a job they’d been doing for 20 years.

People usually think of Arts hierarchically: Opera, poetry, classical music, sculpture at top. Pop music, tv, comics, cartoons, as lower, not really Arts even.

Tried to get staff to talk about their feelings about their work (in focus groups). 4 themes emerged:

  • Identity of staff as well as PWD
  • Awareness – how to behave sensitively, how to understand the condition
  • Language and communication. Care home staff refered to themselves as ‘bum-wipers’ and PWD as ‘nutters’ or ‘fruitcakes’. Powerful derogatory language. Invented game ‘word salad’ – magnetic words. As way of conveying that we all struggle with language sometimes
  • Practice of caring – lifting, toileting, moving, feeding.

So then researchers went away to find Arts resources addressing these themes. Everybody on staff wanted music.

[Frustratingly, at this point I had to leave, so I don’t know what happened next! I’m planning to contact the authors to find out though and I’m sure they’d welcome enquiries from anyone else who is interested]

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BSG 2013, Oxford, Part 2

Partial and personal notes from some parts of this conference. Part one here

Plenary: John Beard, World Health Organisation

Global ageing and health: From talk to action

(cc) US Mission Geneva

Pace of ageing of population much quicker in e.g. Brazil, Thailand than West, so no time to get infrastructure in place.

Pop ageing was initially about more and more people surviving childhood and women childbirth. That ?led to reducing birth rate (+avail of contraception)

Dependency ratios are pretty valid in relation to proportion of children in pop (kids do need lots more care than contribute), but not so much for OP because OP aren’t necessarily, or simplistically, dependent. Changes in behaviour, attitude and policy can reduce dependency effect of ageing pops.

Fab graphs from Mathers et al 2013 on female deaths across the life course – low income countries v. middle v high income. Really clear and interesting graphics [use for K118?]

What is WHO doing about pop ageing? Now a formal priority at WHO, via:

  • Partnerships and political commitment
  • Build evidence base
  • Knowledge translation (evidence into policy and practice)
  1. Health promotion across life course – OP are not too old to change diet, behaviour etc.
  2. Early detection and screening, primary health care and long term care. EoL care.
  3. Age-friendly environments
  4. Rethinking ageing – toss out the stereotypes

Showed a video WHO produced for World Health Day 2012 about challenging stereotypes.  [Nice pictures. Might be a good resource for K118 LG13]

People get more diverse as they grow older, especially in terms of physical function (graphs to show across lifecourse. Physical function falls off with age, but range within age cohorts is much bigger). So generalising about later life even more unhelpful.

[Cd do one of those ‘see what the other students thought’ polls on ‘how old is an old person’ or similar, then follow on activity problematizing. Or one of these for awareness of own ageing (similar to K319 but not too similar?)]

Importance of getting beyond demography. Just because societies have pop ageing doesn’t tell us anything. Most healthcare costs are in the last 18 months of life, at whatever age those 18 months occur.

Need to move beyond gerontology and geriatrics as only disciplines that think about later life to include urban planners, architects, designers, technologists, people who make stuff.

Demographer in audience: working now on new ways of doing demography that are less ageist! Better measures.

[I am amused that this kind of thing always happens at academic conferences: speaker somewhat caricatures and demonises some group (in this instance Demographers) and in the questions slot, a member of the group resists and problematises this characterisation. I love academia!]

27th June 2012

Sex in care homes: On the World Service

I got to put my media training to use yesterday, when I did a short piece on the BBC World Service’s Newshour programme at lunchtime.

They only rang me up 30 minutes beforehand, and their starting point was an article which I’d not read (because it was embargoed until that day – you can see the abstract now here). They wanted someone to provide an academic perspective on the issue of sex in later life and particularly in care homes for people with dementia, alongside Jilly Cooper and a non-famous older woman.

I remembered that my media training course had suggested not accepting things at very short notice if you didn’t feel prepared, but actually I felt that I could do this one – the topic felt safely within the domain of things I feel competent to talk about.

The trickiest thing proved to be installing Skype onto my work computer in the timeframe because my landline turned out not to be good quality enough to use. Because I was a little flustered, I couldn’t remember my Skype name, so couldn’t log on to install it. So my personal top tip would be ‘install Skype on any computer you might use, and keep a record somewhere safe of your name and password’.

The actual interview went fine. I didn’t manage to get in one of points I wanted to (that not all older people are heterosexual and that not all older people’s sexual activity is within marriage, as the other speakers were rather assuming) but I got in the others. I was getting some delayed feedback at the beginning – that thing where you hear your own words again about half a second later, which was really difficult to ignore and I presume that’s why my voice sounds rather peculiar at the beginning of the interview, and why I’m leaving oddly large gaps between my sentences. My other personal additional tip would be to take off any dangly earrings you might be wearing if you are going to use headphones – I got slightly distracted by mine scratching against my neck.

Listening to the recording, I’m struck by how much better is sounds when I was smiling and being mildly humourous. I heard a bit of a Radio 4 programme a few weeks ago about smiling, which included an interview with Jenni Murray where she said that she always smiles before she starts speaking and demonstrated the difference it makes. It was really striking. I didn’t remember that at the time, but I’m noting it here in the hope that I might in future.

But overall, a good experience that I’d be happy to repeat.

If you’d like to hear the interview, it’s here, at the beginning of the programme.

11th October 2011

End of life care for LGBT people

I’ve been at a seminar on End of Life Care for LGBT people today, mostly focusing on older people, although with briefer mention of younger people who are also coming to the end of their lives.

I’m no specialist in end of life issues, although I know a bit because of knowing about later life, which is when end of life issues come up for most people. I went along partly out of guilt because one of the organisers had asked me for help with recruiting older bi people to attend and I had tried but (as far as I know) failed.

(cc 19melissa68)

We started by going round the table, saying what our particular interests were in later life and why we were there. At the beginning of that process someone said ‘same sex partners’ as if that was a common experience to all of us and I prepared to start banging the bi and trans drum of ‘same sex partners does not cover us all, all of the time’. But then someone said how important it was to include trans issues in our discussions and gave some examples of how and why. And then someone else said that they particularly wanted to include bi issues because they are bi. And then someone else mentioned bi stuff again, and someone else trans and, really, by the time it came round to me, I felt almost redundant. Which was very nice indeed, and very encouraging. We also had some good discussion of particular issues for LGBT people of colour and people who have been living with HIV for decades.

Someone other than me was talking about the importance of separating out data from bi people from data from lesbians and gay men, which was very encouraging in terms of the likely reception of BiUK (and friends)’s forthcoming The Bisexuality Report (watch this space) which is going to argue just that.

I was delighted to hear that Age of Diversity, which is the successor organisation to Polari, are going to launch their website next month (it’s still in construction at the moment, but you can find it by googling).

There was quite a lot of discussion of the issue of people using a different name than their official name and the difficulties and distress this creates when someone is not fully compos mentis, or when their friends ring the hospital to ask after them but don’t know their legal name. I don’t know whether using a name other than your legal one is particularly common in the LGB community (I know it is in the trans community). I can imagine that it might be, but to me it feels an entirely standard issue in later life because, I now realise, 3 out of my 4 grandparents/pseudo-grandparents went by a middle name, so it’s an old chestnut to me (but none the less important).

People also talked about the importance of debunking the notion and scrapping the phrase ‘next-of-kin’. It has no legal meaning when someone is alive, only once they are dead, and it’s one of the main routes by which LGBT people do not get to have their nearest and dearest involved in their care. Lots of (sadly familiar to me) stories of estranged family turning up and making decisions for someone they had not seen for twenty years, while their partner or close friend is shut out.

I loved a passing comment made by a hospice chaplain when introducing himself and his organisation ‘we’re lovely. In fact, like most hospice people, you could say we’re terminally nice’.

One of the outcomes of the meeting was that the organisers are going to collect together useful resources on this topic. I’ll post the link for that once I know it. But for now, a few resources that I managed to jot down:

  • REGARD (organisation for LGBT disabled people) and their campaign for ‘Sue’s Law’ (if you just search for ‘Regard and Sue’s Law you should find it)
  • Kathy Allmack published a lit review on End of Life Care for LGBT people about three years ago
  • NHS (don’t know which bit) has apparently just produced a guide on bereavement for (re?) trans people.
  • Report on palliative care for LGBT people: National Council for Palliative Care (2011) Open to all?, NCPC and Consortium of LGBT voluntary and community organisations, London ISBN 978-1-898915-89-8
  • Opening Doors Camden (part of Age UK) is launching a checklist for care homes and care providers on practical ways to be LGBT friendly. Out next week, should be available as a pdf on their website.

12th April 2011

Fiction and the cultural mediation of ageing: Final part (I promise)

Later, I gave a paper in a panel on narrativity and non-normativity and only seem to have made notes on one of the other papers:

The successful failure of narrative in Lisa Genova’s Still Alice

Sarah Falcus

Novel about psycho-linguistics prof who gets early onset dementia [want to read this one too]

(cc) quimby

‘Everything she was was about words’, one of first words she can’t remember is ‘lexicon’. Metafictional concerns in the novel. 3rd person narra but privileges PWD’s point of view. This conflicts somewhat with coherence and chronology demanded by novel form. (not experimental text, fairly trad)

Reader too experience something of Alice’s experience but not to get lost in it, as Alice is lost. Her missing words are also absent from the text, at the beginningn of novel. People’s names too ‘that man’ as she can’t remember her hus. Repeated sentences and paras. Don’t know some things because she doesn’t.

Alice is only 49 at onset – resists association of dementia with ageing. Activities of Daily Living questionnaire – is incontinence because of dementia or because of ageing? But pre diagnosis, attributes her anxiety, confusion, memory loss to menopause = natural v. monster of dementia

Nearly all fiction about ageing contains a ‘mirror-moment’ (Kathleen Woodward)

[Notes definitely getting more sparce as I got more tired]

Naomi Richards from the Look at Me project

Putting older women in the picture

Phototherapy. Working with Rosie Martin, who worked with Jo Spence in 1980s to create phototherapy! As before, using photography to heal, beyond the family album, dressing up.

Aged 47-60 women. 5 full days over 4 week period. Photo diaries to familiarize with camera, over one week. And to help them think visually. Not as a prompt to talk, they were as interested in the product as the process, unlike traditional creative methodolgies in social science which tend to focus on the process [and particularly the talk about the process] [very interesting. Think some more about the implications of this]. Re-enactment session on theme ‘transformation’ transformative visual narrative using props.

One participant’s theme was Gaga to Lady Gaga.

Photos within her grasp rather than the spectre over her shoulder [kind of literal/metaphorical thinking I’m not good at but really like. Seeing something that is literally true as well as metaphorically].

Marta Miquel-Baldellou, Univ of Lleida

From pathology to invisibility: the discourse of ageing in vampire ficture

Vampires don’t show their age and don’t age. Vampires first in fiction looked old. No longer. Repulsive, now generally attractive. Bram Stoker, foreign, aristocratic and old. Anne Rice Interview with the Vampire started trend of young vampires, and introduced vampire children. Also first to be sympathetic

Aged vampires in Vict fiction as sign of difference.As became younger, became more sympathetic, true hero of the novel. Appears in mirrors in modern novels [not in the novels I’ve read]

Fiction and the cultural mediation of ageing: Part 2

Barbara Czarniawska, Univ of Gothenburg

Narrative medicine: or why doctors do not like to listen to the stories of older patients.

Narr medicine, not just about patient narratives of illness/experience, also about patients writing as part of their therapy, medics stories about patients and about themselves.

Arthur Frank ‘illness is an occasion for autobiog’ – more time, more need. [Is illness particularly an occasion for autobiography? Depends on the sort of illness. Flu is not an occasion for autobiography. Was Frank referring to chronic illness? I ought to read Frank again]

Robertson Davies 1994, The Cunning Man, another recommended book.

RD Summarizing the WHO definition of ‘health’ as ‘health is when nothing hurts very much’ [This is not the WHO definition but I quite like it as an aphorism – it’s quite realistic, workable and everyday, rather than the unachievableness of the WHO definition. And it makes it clear that disability is not ill-health. Although what about disabilities which involve chronic pain? Would someone describe themselves as healthy but in pain? Seems possible that they might. And it also falls down a bit because you may not be in pain with a blood clot that will kill you, but you’re not healthy (are you?)]

Audience comment after: this definition is also good in relation to ageing – more realistic that positive ageing agenda – ‘if your body is as much like a young person’s as possible’ [that’s my phrase/critique]

(cc) nursing pins

Was the cunning man:

–       a doctor from the past, before evidence-based medicine and standardization?

–       or from the future with the growth of holistic and alternative medicine?

–       just a patient’s dream, never existed?

Annemarie Mol (2008) The logic of care. Philosopher contrasting logic of choice (customer/citizen) v logic of care (patient, albeit active).

Audience comment: both are available to medics in care settings, they chose which one they draw on according to discursive purposes [does it make a diff if you call it a logic, rather than a discourse? I think it does. Discourse emphasizes variability, logic suggests discrete system. Interpretative repertoire, of course, is supposed to indicate even higher degree of variability]

Not everybody wants to tell stories about their experience. Shouldn’t become a new imperative (no danger of that in medicine. Might be in management)

Nurses’ handover abolished in some hosps – loss of a storytelling opportunity for nurses.

Then I chaired a panel on Fictional stategies and metaphors

Joan Walker, Loughborough

Love and relationships over 65, do comtemporary  british novels reflect the new reality?

Non-fiction since 1972 de Beauvoir Coming of Age, has known that older women have sex and relationships. Gerontology textbooks routinely acknowledge this now. But contemporary novels don’t seem to know this.

Alison Lurie ‘Foreign Affairs’ 1984 novel

Covers of novels about 65+ women’s relationships don’t show the women, have abstract design, objects, cartoons, younger woman shown.

Elena Bendien, Utrecht

A metaphor for ageing: shrinking

Dutch writer, not trans eng Inez van Dullemen ‘past is dead’ Vroeger is dood’, older woman (born 1920s?) still writing.

Metaphor of ‘shrinking’ is a key one in writing about ageing, also in policy – shrinking resources/social contact/shrinking workforce.

Is a spatial metaphor – reduction, contraction, drying out, loss of moisture and volume. Etmology [in Dutch? Or also in English?] shrinking like a snail going back into its shell – snail isn’t reduced by shrinking, just going home!

(cc) daveograve

OP’s bodies often described as shriveled, shrunken. Contracting is not about loss, it’s about making more dense. Signif for thinking about ageing.

Zoe Brennan, UWE

Fictional strategies for representing the older woman as fully human: reclaiming the everyday.

(in novels)

Make the older woman the central character

Then:

1)    inspirational, extraordinary female characters. Smash preconceptions about what older women are like e.g. Happy Ever After Jennie Diskie, has rela with much younger man, but then leaves him to go off and travel round the world. Rhode Island Blues, Fay Weldon, much quoted this conf. Challenge the idea that character is set by the time you are old. Show people developing and changing. Complex

2)    Re-evalutes the day-to-day: May Sarton Spinster, Barbara Pym – not remarkable charcters. Don’t do remarkable things, live everyday lives as you might expect for older people – visit family, cook, have hobbies. Activities not dismissed as time-filling – absorbing. (hobby as dismissive term)

3)    Angry texts, texts that rage. Bodies that don’t work. Texts about embodiment. May Sarton As we are now Frustration, society makes it worse. Ist person narrator is a powerful way of doing this, as Carrie in As we are now – can see her decline through her own journal writing. [read this! Has been on my (metaphorical) ‘novels to read’ longlist for years – move it to shortlist!]

7th September 2010

LGBT Health Summit

Filed under: Uncategorized — rememberingmyhat @ 22:50
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I’ve just got back from the annual LGBT Health Summit which, handily for me, this year was at the University of Hertfordshire.

I was invited to run a workshop on ‘something to do with bisexuality’, so did one partly about how bisexual identities play out in health care, and partly trying to problematise the idea of ‘outness’ for LGBT people generally in health care settings.

I did a bit of teaching about bisexuality and life course perspectives, reusing the case studies from my chapter in my book and creating some new diagrams (which I might post later, as they’re pretty and might be something I reuse as an analytic tool). And I did a lot of getting them to discuss things in small groups and generate their own diagrams and accounts of their own experiences of outness in health settings. I was hoping to get enough/rich enough data from that to form the basis of a paper about outness in health and social care settings, but a quick skim of what I’ve got doesn’t look as if that one’s a go-er.

There was a startlingly biphobic person in my workshop (bisexual people break up relationships and are incapable of fidelity) but they weren’t too disruptive, not least because I spotted that one of the other participants wanted to respond so let her speak first. She made different, probably more effective, points from the ones I was going to (because she spoke without academic hedging and using a voice of personal experience) and that made me think about the general point about how you handle participants’ and students’ existing expertise in both workshops and teaching.

When I’m writing course material I sometimes feel as if I’m perpetuating a terrible OU cliché by constantly asking students to reflect on their experience and draw on their existing expertise. But this experience, and things witnessed in other workshops, have reminded me that actually, it’s a really good way of teaching, especially with mature students. In terms of ‘class’ management, it can stop people being disruptive because they don’t feel the need to assert their expertise if you’re already treating them as expert. And it provides the group with resources beyond those of the ‘teacher’ who [gasp] may not know it all, or be best placed to explain it. We’re writing quite a lot of online collaborative work into K319 and I’m going to be very interested to see how that works out in practice. I have high hopes (but also anxieties).

The other thing it confirmed in me was my love of case studies as a teaching tool. I stupidly hadn’t anticipated that there might be people with learning disabilities in my workshop, despite the fact that I had spotted that at another point in the conference there was a workshop run by a person with learning difficulties and his support worker. Some of the activities I had designed were not accessible to the PWLD who attended my workshop but the case studies, apparently, worked really well for them. Case studies, they’re great.

It was one of the most trans inclusive generic LGBT conference I have ever been to. There were trans plenary speakers, several trans workshops, a high number of delegates who appeared to be trans, and plenary speakers never forgot to include the ‘T’ in their general remarks e.g. they said ‘gay men, lesbians and transpeople [blah blah blah]’ Oops, notice anything missing? Don’t get me wrong, I’m delighted that trans issues were so foregrounded.  But, oh my, it did throw into contrast the invisible bisexuals.

What came home to me most strongly around trans issues (something I did already know but felt more powerfully today) was how strongly invested some trans people are in the discourse of the authentic self. The idea that a transwoman’s essential, true self is female and a transman’s male. In a context of awful transphobia, and as a cis-gendered person myself, I don’t want to do anything that undermine’s people’s sense of self and the narratives they find necessary for self preservation.

But as a social constructionist I just don’t belive it. I don’t think gender works like that. I don’t think selves work like that. And I really don’t like the ways those narratives disallow other forms of gender variance, such as androgyny, genderqueerness and two-gender people.

I’ve got a new PhD student starting in October who’s planning to look at some aspects of transwomen’s experiences of the NHS. I’m really looking forward to exploring these issues with him.

7th January 2010

To see ourselves as others see us

The other day a Physiotherapist asked me what I lectured in. I replied ‘Health and Social Care’ and she responded:

“We did 13 weeks on health and social care in my degree. We had to write an essay about treating everyone equally. I was, like, ‘I’ve got to memorise every muscle in the body, I haven’t got time for this. I promise I will treat everyone equally, just let me get on with this’.”

I was very amused by her perception of what constitutes the discipline of health and social care and it made me think about how I would characterise it.

Understanding Health and Social Care: An Introductory Reader - Published in Association with the Open University

I’m starting here from the assumption that, as for all academic disciplines, the main way you can distinguish it from other disciplines is the way practitioners (academics, researchers, students) describe themselves, and reference the literature, debates and issues that everyone else references. Or put, more positively, the academic discipline of health and social care is a discourse community. So what are the major feature of the discourse community called ‘health and social care?’

I recognise the focus on equality as a key concern, although I’m disappointed that she seemed to have no perception that there is anything systematic or difficult about inequality. I’d hope that students of health and social care come away with some understanding of the ways it’s not just about being nice to people.

I think I’d say that understanding the major features of the current provision of health and social care, including the history from which it arises (as overviewed in Block 6 of K101), is important. So things like the (somewhat arbitrary) division between health and social care; the historic privileging of health, and especially hospital based, care over secondary health care and especially social care; the implications of the changes in funding systems; the loss of trust in professionals and the increased demand for input from service users [1]; the evidence-based practice movement and its limitations. What else?

A focus on particular client groups, such as people with learning difficulties, older people or mental health service users is common, and is often the route by which people move into the study of health and social care more generally, but I’m not sure that’s essential. You would need detailed study of the particular issues affecting those groups to study Learning Difficulty or Gerontology or Mental Health Issues, but I don’t think it’s core to Health and Social Care.

I don’t think I’d say there are distinctive research methods or methodologies for health and social care, although participative/user-controlled/action/change-oriented types of research are more common than in many other fields. Likewise, there aren’t distinctive epistomological or theoretical starting points, although vaguely constructionist approaches seem particularly common.

What else?

I was also amused and discouraged in equal measure by her privileging of the concrete and physical (‘every muscle in the body’) over the wiffly-waffly interpersonal stuff. It reminded me of the privileging of the quantitative over the qualitative, which is one of my major beefs with the evidence-based practice movement.

[1] Not failing already, deliberately using this term here, since the policy generally still does.

21st November 2009

Out now

Filed under: Uncategorized — rememberingmyhat @ 22:03
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From the blurb:

The editors provide a thought-provoking resource for anyone concerned with sexuality and gender identity in health and social care settings. Drawing on current research and debates, the contributors explore some of the tensions between the different ways in which sexuality is understood and experienced.

A focus of the book is on how categories like ‘lesbian’, ‘gay’, ‘bisexual’, and ‘trans’ shape everyday practice and service use. It looks at the circumstances in which people choose to describe themselves with these identity labels and the situations in which they reject or feel constrained by them. A particular feature of the book is its combination of a nuanced understanding of the nature of sexual identities with practice-relevant and grounded examples taken from health and social care settings, with a Scottish focus.

Intended primarily for a practitioner audience and for those studying in the field of health and social care this volume will also interest academics and an international audience because of its distinctive theoretical sophistication about the nature of sexual identities.

From one of the editors/authors:

And a bargainaceous £12.33 on Amazon

2nd September 2009

The changing nature of health advice-seeking behaviours

Filed under: Uncategorized — rememberingmyhat @ 12:42
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My pre-schooler is very partial to the counting rhyme Five Little Monkeys. For those not privileged enough to have encountered this little gem, it goes:

Five little monkeys bouncing on the bed
One fell off and bumped his head
Mummy called the doctor and the doctor said:
‘No more monkey business, bouncing on the bed!’

And so on, counting downwards until there are no little monkeys left.

Thankfully, no head-injuries have been sustained yet, but it always makes me think about the changed ways in which we interact with the NHS and health advice nowadays.  I don’t know when this ditty dates from, so I don’t know whether ‘called’ means ‘telephoned’ or ‘called in for a house-visit’ but neither is terribly likely to happen in my experience (although Swine Flu does seem to be mean that GPs are spending more time telephoning  patients rather than seeing them in person).

Here, instead, is my version of the health-advice seeking behaviours of the modern parent:

Five little monkeys bouncing on the bed
One fell off and bumped his head
Mummy called the doctors’ and the receptionist said:
Well, if it’s really urgent, you can see this trainee doctor with bad breath that nobody ever wants to see tomorrow, or you can wait a fortnight to see your own doctor.

Four little monkeys bouncing on the bed
One fell off and bumped his head
Mummy called the doctors’ and the practice nurse said:
Has he got asthma or diabetes and did you know you’re overdue a cervical smear?

Three little monkeys bouncing on the bed
One fell off and bumped his head
Mummy called the Health Visitor and the Health Visitor said:
You’re rewarding him for bad beahaviour, you have to do controlled crying.

Two little monkeys bouncing on the bed
One fell off and bumped his head
Mummy called NHSDirect and the nurse there said:
Better take him to A&E just to be on the safe side.

One little monkey bouncing on the bed
He fell off and bumped his head
Mummy looked it up on the internet and the internet said:
If he seems fine and his pupils are the same size as each other, he’s probably fine.

ETA:  With thanks to Sara and Ina May’s Pinard, and in the light of my next post about social workers taking your children away (and with apologies to my social worker friends and colleagues):

No little monkeys bouncing on the bed
They’d all fallen off and bumped their heads.
Mummy called the doctor and the doctor said:
A clear case of neglectful parenting, we need an interagency referral to social services who will take them into care immediately, you’re an unfit mother.

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