Women's Studies
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Browsing Women's Studies by Author "Armstrong, Pat"
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Item Open Access Falling Through the Cracks? An Exploration of the Conditions of Care Experienced by Younger Residents Living in Long-Term Care Facilities(2023-03-28) Seeley, Morgan Alison Robinson; Armstrong, PatThis dissertation examines the situation of younger residents living in long-term care facilities (LTCFs) in Ontario in the decades leading up to the COVID-19 pandemic. Adults under the age of 65 with disabilities and chronic health conditions were impacted by neoliberal processes of long-term care (LTC) reform and the closure of provincial residential institutions for people with disabilities. Gaps in public health and social care associated with these changes led some non-senior adults to turn to LTCFs when their needs were not being met. Very little is known about the situation of younger residents, who comprise less than eight percent of the total resident population in Ontario’s LTCFs. I address this gap by exploring non-senior residents’ “conditions of care”—the practices, interactions, relationships, and structures that make up their everyday experiences living in a LTCF. My study asks: What are the conditions of care for younger residents, do they align with their needs and preferences, and what factors account for the value of and problems with these conditions? Guided by a relational feminist disability perspective, I address these questions by drawing on data from semi-structured interviews with younger residents, direct care workers, and administrators, as well as from a focus group with family members, field notes, and facility-specific documents. I analyze the data as informed by intersecting relations of difference and inequality associated with gender, disability and age, and as situated within a particular set of contexts. My findings demonstrate that for non-senior residents, the promise of LTCFs lies in relational care—the presence of favourable interpersonal care relationships and the practice of care in relational ways. However, relational care is often prevented by the structures of LTC, particularly those associated with public funding inadequacies and the application of strategies associated with new public management (NPM). Addressing these barriers is key to transforming LTCFs into places that are better for younger residents. But LTCFs will not be appropriate until a range of accessible, high quality, public LTC and social services are also made available.Item Open Access Que(e)ring Home Care: Older Lesbian and Bisexual Women's Experiences of Accessing and Receiving Care Services(2014-07-09) Grigorovich, Alisa; Armstrong, PatThis exploratory study examined the impact of sexuality, gender and aging on older lesbian and bisexual women’s access to home care services and their experiences of receiving home care. This study had three objectives: (1) to learn about the experiences of older lesbian and bisexual women who currently access home care services in Ontario, (2) to gain an understanding of the impact of sexuality and sexual orientation on home care experiences, and (3) to explore older lesbian and bisexual women’s definitions of quality home care and the factors that enable (or hinder) quality care. This study used a qualitative case study design and was guided by a feminist political economy framework and the critical sexuality and LGBTQ studies literature. Semi-structured interviews were carried out with 16 women who have accessed home care services in Ontario in the last five years. These interviews were subsequently transcribed and analyzed using an iterative thematic analysis. The findings of this thesis reveal that attitudes around gender, sexuality and sexual practices affect individuals’ need for home care, their access to care and their experiences of receiving home care. This study highlights the necessity of incorporating a consideration of gender, sexuality and sexual orientation into home care policy and delivery, as well as into the training of home care workers and case managers. These findings may be useful in the development of respectful and effective home care services that are sensitive to diverse experiences and to those of lesbian and bisexual families.Item Open Access Reconsidering Evidence: Evidence-based Practice and Maternity Care in Canada(2016-05-30) Van Wagner, Vicki; Armstrong, PatEvidence-based practice (EBP) has been widely adopted as a scientific and objective approach to health care. Enthusiastic acceptance of EBP within maternity care appears to have had unexpected effects on the care of childbearing women. This qualitative study of an interprofessional group of maternity care providers explores EBP from a critical science studies perspective to understand the social inside the science. A literature review and interviews with family physicians, midwives, nurses and obstetricians were analyzed for themes. Initial hopes for EBP were high and often contradictory. Although many had hoped EBP would help limit rising rates of intervention in childbirth, informants noted that interventions, such as induction of labour and caesarean section, have continued to increase. Informants described patterns of uneven application and misapplication of evidence. They described how some evidence is applied quickly while other evidence is resisted. The rapid uptake of the findings of a single trial about breech birth was frequently contrasted with reluctance to implement evidence in favour of auscultation rather than electronic fetal heart monitoring. My findings reveal patterns of over application, for example, when research about post-term pregnancy is used as a rationale for induction of labour earlier than the findings justify. Informants described under interpretation when multiple or ambiguous interpretations are ignored and over interpretation when evidence is generalised to populations beyond its relevance. Informant interviews reveal underlying reasons that evidence is oversimplified and unevenly applied. Care providers are influenced by belief systems, powerful cultural trends to technologic solutions, discomfort with uncertainty, a focus on risk avoidance, and structural issues including payment systems and limited resources. Many informants expressed concern that the adoption of EBP has unexpectedly undermined support for physiologic birth. They described a profound sense of loss, including loss of skills, access to care and choices for women. Informants advocated reconsideration of EBP, calling for a conscious and reflective approach which acknowledges that scientific evidence alone cannot set goals and objectives of care. My findings are evidence of interprofessional interest in open dialogue about interpretations of evidence and revisions of EBP in the care of childbearing women.