Taking Care of Our Own最新文献

Work Shifts 轮班

Taking Care of Our Own Pub Date : 2020-10-15 DOI: 10.7591/cornell/9781501751448.003.0007

S. Mong

{"title":"Work Shifts","authors":"S. Mong","doi":"10.7591/cornell/9781501751448.003.0007","DOIUrl":"https://doi.org/10.7591/cornell/9781501751448.003.0007","url":null,"abstract":"This chapter takes a closer look at caregiver/nurse interactions. It includes an analysis of the identities and emotional labor of home health nurses. As professionals who possess valuable disciplinary knowledge, how do they feel about transferring their skills to lay caregivers? Nurses' orientation to the labor and the effects on interactions with caregivers are key features in the labor transfer. Nurses were able to gradually transfer the skilled labor through strategies such as “gently encouraging” or “forcefully 'pushing' ”caregivers to learn, and “if the caring work appeared too difficult or technical, nurses simplified or 'downplayed' these aspects, or they would insist that the caregiver was 'smart enough' to learn.” Nurses often stated that the goal was to make patients and families “independent” in their care. Nurses thus draw heavily on the ability of home care to provide holistic nursing practices. Nurses' focus on patients' physical and emotional health refutes a vision of nurses as purely “ideological workers” — an image that implies an insensitive and coercive nature in the transfer of skills. The relationship between nurses and caregivers is critical for nurses, who identify heavily with the education component of their profession.","PeriodicalId":357124,"journal":{"name":"Taking Care of Our Own","volume":"75 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126018355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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On-the-Job Training 在职培训

Taking Care of Our Own Pub Date : 2020-10-15 DOI: 10.7591/CORNELL/9781501751448.003.0003

S. Mong

{"title":"On-the-Job Training","authors":"S. Mong","doi":"10.7591/CORNELL/9781501751448.003.0003","DOIUrl":"https://doi.org/10.7591/CORNELL/9781501751448.003.0003","url":null,"abstract":"This chapter talks about the different teaching strategies nurses employ to train caregivers, and the different ways in which caregivers learn in training. Nurses develop strategies based on caregivers' and care recipients' readiness and different levels of knowledge. One of the first things they report doing when making initial contact is to find out what the expectations are, and manage them. Another strategy nurses say they use, especially if someone is hesitant or has anxiety, is to give emotional reassurance, including “lots of praise,” positive reinforcement, and encouragement. In terms of hands-on work, all nurses state that the general process is to demonstrate to the caregiver and/or care recipient exactly what they are going to do, allow them to watch and ask questions, and then observe a return demonstration. It is evident that there is a great deal of variability in how home health nurses convey information. While some of this may be due to agency policies or norms, nurses have different teaching philosophies and styles and are often given much leeway as to how they transmit information. The fragmented nature of the system means that caregivers may experience vast differences in communication processes and in the training they receive. The chapter discusses how caregivers train in three different conditions: caregivers who received prolonged training in rehabilitation facilities and hospitals, caregivers who received some training in hospitals, and caregivers who received little or no training in hospitals.","PeriodicalId":357124,"journal":{"name":"Taking Care of Our Own","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129176971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Conclusion 结论

Taking Care of Our Own Pub Date : 2020-10-15 DOI: 10.7591/cornell/9781501751448.003.0008

S. Mong

{"title":"Conclusion","authors":"S. Mong","doi":"10.7591/cornell/9781501751448.003.0008","DOIUrl":"https://doi.org/10.7591/cornell/9781501751448.003.0008","url":null,"abstract":"This chapter proposes how positive change can be made for families who are enacting skilled medical labor. Caregivers' journeys with care recipients reflect varied experiences in interactions with medical professionals and in the training they receive. Though many caregivers experience feelings of anxiety and worry, they say they “do what they have to do” to provide care for those they love. It is the relationship with the care recipient that motivates their labor, and despite some ambivalent feelings, many have strong feelings against institutionalization. Positive change can be made for families who are enacting skilled medical labor and improve the work process for caregivers, care recipients, and nurses alike through robust national policies that support family care work are in order. Home support would also increase the confidence of caregivers and reduce emotional burdens by having credentialed nurses and health care professionals make regular home visits and providing more in-home support are essential. Adequate work leave policies for families should also be in place. The financial needs of caregivers should be considered, including their loss of jobs and income. The existing policies have been fragmented, state driven, targeted only to certain care recipients and their caregivers, and highly dependent on complicated Medicaid waivers. It is time to recognize and compensate caregivers for the work they do and to make sure that care recipients also have adequate support.","PeriodicalId":357124,"journal":{"name":"Taking Care of Our Own","volume":"13 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116593094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Who Pays? 谁支付?

Taking Care of Our Own Pub Date : 2020-10-15 DOI: 10.7591/cornell/9781501751448.003.0004

S. Mong

{"title":"Who Pays?","authors":"S. Mong","doi":"10.7591/cornell/9781501751448.003.0004","DOIUrl":"https://doi.org/10.7591/cornell/9781501751448.003.0004","url":null,"abstract":"This chapter talks about the different medical care programs available in the United States. Medicare and Medicaid were both created in 1965 and are administered by the U.S. Department of Health and Human Services. Medicare is a federally funded program, while Medicaid is funded by both the federal and state governments. Unlike Medicare, Medicaid is managed by individual states based on federal guidelines that stipulate the services that must be provided to specific groups of poor individuals. Medicare has historically been a driving force in U.S. health policy due to its conversion of typical fee-for-service medical reimbursements into a standardized prospective payment system. The differences in state regulations and mandates, as well as specific policy guidelines, mean that private insurance has significant variation. In regard to home health care, home visits are limited and home health agencies must get approval for the number of visits they make. These limitations have significant impacts on care recipients, and they structure the work processes for caregivers and nurses alike. The chapter also talks about the system's complexity and the disparities in coverage among various payer sources. The fragmented nature of payer sources greatly affects patients and caregivers, who often negotiate systems with limited knowledge. A large problem for people interviewed in this book was that they didn't know about waivers and other services that were available to them and didn't apply for them when they could have. Caregivers often found out about waivers from acquaintances, family members, or others. Currently, the multiple-payer system promotes confusion, additional stress, and uncertainty.","PeriodicalId":357124,"journal":{"name":"Taking Care of Our Own","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131837068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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3. Who Pays? 3.谁支付?

Taking Care of Our Own Pub Date : 2020-09-15 DOI: 10.1515/9781501751479-005

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Index 指数

Taking Care of Our Own Pub Date : 2020-09-15 DOI: 10.1515/9781501751479-013

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5. “You Do What You Gotta Do” 5. “你做你该做的”

Taking Care of Our Own Pub Date : 2020-09-15 DOI: 10.1515/9781501751479-007

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6. Work Shifts 6. 轮班

Taking Care of Our Own Pub Date : 2020-09-15 DOI: 10.1515/9781501751479-008