Living on social assistance with chronic illness: Buffering and undermining features to well-being

<p>Abstract</p> <p>Background</p> <p>In Sweden, the social security and sickness insurance systems are comprehensive and aim to provide people whose illness prevents them from earning their own living, with either sickness benefits or disability pension. Some, however, are not entitled to these benefits or receive social insurance benefits at a level too low for subsistence, and are referred to social assistance. The purpose of this study was to explore in depth how social assistance recipients with chronic illness perceive and respond to the experience of living on social assistance.</p> <p>Methods</p> <p>Seventeen in-depth interviews were carried out with chronically ill people who had received social assistance for several years. Grounded theory informed the design of the study.</p> <p>Results</p> <p>The study showed that different strategies (living one day at a time, taking steps forwards and backwards and making attempts to find ways out of the situation) were employed by social assistance recipients to maintain or improve their well-being. Contextual features like the prevailing welfare system, public services and the local neighbourhood could buffer or undermine these strategies and their overall well-being. These features together influenced how interviewees perceived their situation, the possible ways out of the situation and the consequences for their well-being.</p> <p>Conclusion</p> <p>From this study it is evident that the way in which individuals on social assistance interact with services and how they are treated by professionals plays an important role in their well-being, in combination with what kind of help and support is available for recipients through the welfare system. In this respect, persons living on social assistance with chronic illness are particularly vulnerable. This study suggests that more effort should be made to find long term solutions concerning income support, rehabilitation and other services provided to this group.</p

Struggling for recognition and inclusion—parents' and pupils' experiences of special support measures in school

During the last decade an increasing use of differentiated support measures for pupils with special educational needs, indicative of a discrepancy between educational policies and practices, has been witnessed in Sweden. Another trend has been the increased use of medical diagnoses in school. The aim of this study was to explore the main concern of support given to pupils with special educational needs and how pupils and parents experience and handle this. Interviews were conducted with eight pupils in Grades 7–9—and their parents—at two compulsory schools in a city in northern Sweden. A grounded theory approach was used for analyzing the interview data. A conceptual model was generated illuminating the main concern of special support measures for pupils and parents. The core category of the model, struggling for recognition and inclusion, was related to two categories, which further described how this process was experienced and handled by the participants. These categories were labeled negotiating expertise knowledge within a fragmented support structure and coping with stigma, ambivalence, and special support measures. The developed conceptual model provides a deeper understanding of an ongoing process of struggle for recognition and inclusion in school as described by the pupils and parents

Patient-nurse interactions : relationships between person characteristics, empathy, content of communication, and patients' emotional reactions

Relationships between antecedent person variables (sex and age), empathic understanding, content of communication, and patients' emotional reactions were studied in 3200 patient-assistant nurse dyadic interactions. The sample consisted of 32 psychiatric patients (20 males and 12 females, mean age: 61 years) and eight female assistant nurses at a nursing-home in Sweden. Four assistant nurses were younger (25 years old or less) and four were older (45 years old or more). All interactions were regular morning meetings at which the patient's activity plans for the day were discussed. These meetings were held in each patient's private room, and lasted for about 15 min. High empathic understanding on part of the helper covaried with more communication of "everyday character" and communication dealing with "personal and emotional qualities", with less communication dealing with "facts and practical issues", and with a more cheerful emotional state among the patients during the encounters. Male patients were more cheerful during encounters with younger assistant nurses while female patients were more cheerful when interacting with older assistant nurses. Helpers with higher scores on empathic understanding seemed to have a higher awareness of relational history.</p

Contributions of stress theory to the understanding of helping

The paper is theoretical, patient centred, and focuses on the two following questions: (1) In what way might a stress theoretical approach further our understanding of how helping can affect somatic and psychological processes in patients, and (2) in what way might stress theory offer action oriented guidelines for those who offer help ? A stress model is outlined involving relationships between a patient's cognitive appraisal of a given care situation, his or her coping efforts, and emotional and physiological reactions. Several conditions, related to the patient and to the care giving situation, which might influence the patient's appraisal process are discussed. Possible short- and long-term effects of helping in the somatic and psychological domains are presented. Two examples of common care situations are analysed to show how stress theory may offer helpers an action oriented tool. The concept of participatory caring, implying not only patient involvement but actual power sharing between patients and health professionals, is discussed.</p