„Machen Sie ihm doch seine Lieblingssuppe“: Gefühls- und Emotionsarbeit in Dienstleistungsbeziehungen der ambulanten Palliativversorgung

Bei personenbezogenen Dienstleistungen ist die Ko-Produktion von Leistungsgeber/‑in und Leistungsnehmer/‑in zentral. Dienstleistungen wird daher Potential zugeschrieben, Machtasymmetrien und gesellschaftliche Polarisierungen im konkreten Miteinander abzumildern (Dunkel und Weihrich 2014). Im Gesundheitsbereich sind Rollen im Rahmen der „Dienstleistungsbeziehung“ typischerweise asymmetrisch angelegt. Sie basieren auf Seiten der professionellen Akteur/‑innen auf Fachautorität, während es sich bei den Adressat/‑innen oft um vulnerable Gruppen handelt. Palliative Care, die Begleitung und Versorgung von Schwerstkranken und Sterbenden, hat den Anspruch, den Belangen der Patient/‑innen absoluten Vorrang zu geben, auch vor professionellen oder organisatorischen Erwägungen. Sie kann damit als Versuch gewertet werden, das klassische asymmetrische Verhältnis „umzukehren“. Ausgehend von diesen Überlegungen beleuchtet der Beitrag die Interaktionsarbeit von Akteur/‑innen der ambulanten Palliativversorgung mit einem Fokus auf die Gefühls- und Emotionsarbeit, bei der geschlechtsspezifische Erwartungen aufscheinen. Die Auswertung stützt sich auf das Konzept der Interaktionsarbeit (Böhle und Weihrich 2020), das zwischen Gefühls- und Emotionsarbeit unterscheidet, wobei die Gefühlsarbeit die Beeinflussung der Gefühle anderer bezeichnet, während Emotionsarbeit die eigenen Gefühle in Übereinstimmung mit Gefühlsregeln bzw. Erwartungen bringt. Zwei Aspekte werden herausgearbeitet: Erstens leisten auch Patient/-innen und Angehörige Gefühls- und Emotionsarbeit. Zweitens werden anhand der geschilderten Gefühle bzw. Emotionen Herstellungs- und Umkehrungsprozesse von Asymmetrien erkennbar

Host-microbe cross-talk in the lung microenvironment:implications for understanding and treating chronic lung disease

Chronic respiratory diseases are highly prevalent worldwide and will continue to rise in the foreseeable future. Despite intensive efforts over recent decades, the development of novel and effective therapeutic approaches has been slow. However, there is new and increasing evidence that communities of micro-organisms in our body, the human microbiome, are crucially involved in the development and progression of chronic respiratory diseases. Understanding the detailed mechanisms underlying this cross-talk between host and microbiota is critical for development of microbiome- or host-targeted therapeutics and prevention strategies. Here we review and discuss the most recent knowledge on the continuous reciprocal interaction between the host and microbes in health and respiratory disease. Furthermore, we highlight promising developments in microbiome-based therapies and discuss the need to employ more holistic approaches of restoring both the pulmonary niche and the microbial community

Structural characteristics and contractual terms of specialist palliative homecare in Germany

Background Multi-professional specialist palliative homecare (SPHC) teams care for palliative patients with complex symptoms. In Germany, the SPHC directive regulates care provision, but model contracts for each federal state are heterogeneous regarding staff requirements, cooperation with other healthcare providers, and financial reimbursement. The structural characteristics of SPHC teams also vary. Aim We provide a structured overview of the existing model contracts, as well as a nationwide assessment of SPHC teams and their structural characteristics. Furthermore, we explore whether these characteristics serve to find specifc patterns of SPHC team models, based on empirical data. Methods This study is part of the multi-methods research project “SAVOIR”, funded by the German Innovations Fund. Most model contracts are publicly available. Structural characteristics (e.g. number, professions, and affiliations of team members, and external cooperation) were assessed via an online database (“Wegweiser Hospiz- und Palliativversorgung”) based on voluntary information obtained from SPHC teams. All the data were updated by phone during the assessment process. Data were descriptively analysed regarding staff, cooperation requirements, and reimbursement schemes, while latent class analysis (LCA) was used to identify structural team models. Results Model contracts have heterogeneous contract partners and terms related to staff requirements (number and qualifications) and cooperation with other services. Fourteen reimbursement schemes were available, all combining different payment models. Of the 283 SPHC teams, 196 provided structural characteristics. Teams reported between one and 298 members (mean: 30.3, median: 18), mainly nurses and physicians, while 37.8% had a psychosocial professional as a team member. Most teams were composed of nurses and physicians employed in different settings; for example, staff was employed by the team, in private practices/nursing services, or in hospitals. Latent class analysis identified four structural team models, based on the team size, team members’ affiliation, and care organisation. Conclusion Both the contractual terms and teams’ structural characteristics vary substantially, and this must be considered when analysing patient data from SPHC. The identified patterns of team models can form a starting point from which to analyse different forms of care provision and their impact on care quality