RESUMEN
Clinical and empirical literatures have highlighted the value of attending to distinct dyads within stepfamilies to ensure the needs of various relationships are being met. From a family systems perspective, the growth and maintenance of positive dynamics within one dyadic relationship can yield gains in other relationships and shape the larger stepfamily environment. Research seeking to link information about dyads and larger stepfamily systems is often marked by single-informant data or measures that represent individual-level constructs. Methods intended to leverage multi-informant data as indicators of dyad- or family-level constructs (i.e., common fate modeling; CFM) offer valuable opportunities to expand our understanding of stepfamily experiences. Using a sample of 291 stepparent-parent dyads, our study uses multi-informant data and CFM to assess three dyad-level constructs (i.e., marital quality, marital confidence, and stepparent-child relationship quality) as correlates of three stepfamily-level constructs (i.e., cohesion, expressiveness, and harmony). Our findings illustrate meaningful linkages among dyadic relationships and broader stepfamily-level dynamics, specifically emphasizing the role of stepparent-child relationship quality and marital confidence in shaping stepfamily cohesion, expressiveness, and harmony. The results also signal the potential for substantive findings to vary with respect to the selected unit of analysis.
Asunto(s)
Estructura Familiar , Padres , Humanos , MatrimonioRESUMEN
Divorced parents face distinct challenges in providing care for chronically ill children. Children's residence in two households necessitates the development of family-specific strategies to ensure coparents' supervision of regimen adherence and the management of children's health care. Utilizing a risk and resilience perspective, a grounded theory study was conducted with 14 divorced parents of children with chronic illnesses. The importance of trust, gender, and relationships with third-party care providers emerged as key themes related to the development of effective coparenting relationships for maintaining children's health. Divorced parents were best able to support the management of their children's chronic conditions when care providers operated as neutral third parties and intermediaries. Collaborative family care may require health care practitioners to avoid being drawn into contentious inter-parental conflicts.
Asunto(s)
Enfermedad Crónica/enfermería , Enfermedad Crónica/psicología , Niños con Discapacidad/psicología , Divorcio/psicología , Responsabilidad Parental/psicología , Padres/psicología , Adolescente , Adulto , Niño , Preescolar , Femenino , Teoría Fundamentada , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana EdadRESUMEN
Older adults who live alone are at risk for problems (e.g., falling, sudden illness). To maintain themselves safely at home they may benefit from planning to prevent problems. The purpose of this study was to evaluate an intervention designed to train family members or friends as to how to help older adults who were living alone make plans to maintain independence safely in their homes and to make behavioral and household changes to enhance safety. Support network members of 19 older adults randomly assigned to the intervention group were taught to use multiple segment vignettes to assist the older adults in creating plans for living safely. Older adults in the control group (n = 21) were asked to engage in an unstructured discussion about home safety with their network members. Older adults in the intervention group developed safer plans and made more household and behavioral changes than did control group adults.
Asunto(s)
Prevención de Accidentes/métodos , Cuidadores/educación , Vida Independiente , Seguridad del Paciente , Adulto , Anciano , Anciano de 80 o más Años , Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
The purposes of this longitudinal phenomenological study were to describe intentions of older women relative to reaching help quickly (RHQ), to place those intentions in personal-social context, and to compare intentions of subscribers to a personal emergency response system (PERS) and nonsubscribers. The 40 participants were aged 85 or older, resided alone, and needed help to leave home. Two contextual features ("recognizing my risk of being unable to RHQ" and "recognizing my need for a RHQ device to sustain myself") were basic to two phenomena ("negotiating reliance on people to reach quickly if I need help" and "reducing my risk of being unable to RHQ"). There was greater variation in intentions and context within each of the two naturally occurring groups (subscribers and nonsubscribers) than between them. Practitioners cannot assume that women intend to use available RHQ devices in specific situations; preventive nursing involves proactive exploration of intentions relative to RHQ.
Asunto(s)
Personas Imposibilitadas , Anciano , Anciano de 80 o más Años , Femenino , Estado de Salud , HumanosRESUMEN
During a longitudinal study of the experience of reaching help quickly, 34 homebound women (ages 85 to 97) who lived alone reported 106 reach-help-quickly incidents (RHQIs). The purpose of this study was to expand knowledge about RHQIs and intentions relative to them and to compare those facets of experience for subscribers to a personal emergency response system (PERS) and non-subscribers. We used a descriptive phenomenological method to analyze interview data, discerning six types of RHQIs, including finding myself down right here, realizing that I might not be alright after falling and getting up on my own, and realizing that something I cannot explain is or could be wrong with me. Intentions were focused on self-help before help seeking. The overall phenomenon was Handling a Situation When I Am Alone at Home and Probably Need Help Quickly. Practitioners should explore intentions about handling specific types of RHQIs and offer appropriate anticipatory guidance.
Asunto(s)
Servicios Médicos de Urgencia/estadística & datos numéricos , Personas Imposibilitadas , Anciano , Femenino , HumanosRESUMEN
The childhood cancer experiences of stepfamilies have not been described despite the fact that nearly one third of U.S. children will live in a stepfamily household. To describe the impact of diagnosis on parental relationships in stepfamilies, we undertook a secondary analysis of data from a study of parental decision making in structurally diverse families. As described by 13 parents of six stepfamilies, the crisis of a childhood cancer diagnosis immediately changed family dynamics. Parental relationships changed, which shifted family boundaries, creating instability in families who were trying to cope with a very stressful life experience. Through increased understanding of parental relationship changes that occur after the diagnosis of childhood cancer in stepfamilies, clinicians can anticipate these changes and provide supportive interventions to reduce overall family conflict and distress. These distinctive stepfamily responses underscore the need to include structurally diverse families in future trials targeting parental coping in childhood cancer.
Asunto(s)
Toma de Decisiones , Familia/psicología , Neoplasias/enfermería , Neoplasias/psicología , Padres/psicología , Adaptación Psicológica , Adulto , Niño , Femenino , Humanos , Entrevistas como Asunto , Masculino , Relaciones Padres-Hijo , Estrés Psicológico/psicología , Estados UnidosRESUMEN
Little is known about older persons' expectancies (or anticipations) about the possible actions of home-care professionals, although such data have implications for the ethics of home care and home-care policies. From a longitudinal study of older women's experience of home care, findings are reported concerning their expectancies of professional home-care providers. A descriptive phenomenological method was used to detail the structure of the experience and its context. Data were analyzed from a series of interviews with 13 women aged 82 to 96 years. Among the five key structures of experience were 'finding that someone has the job of helping me here' and 'determining where the helper's field lies'. Two subsets within a category of expectancies were differentiated: speculations about helpers' possible actions and expectancies about outcomes of helpers' actions. As parameters of relational ethics, clients' speculations and expectancies are appropriate bases for dialogue about older widows' relationships with home-care professionals and the foci of home-care policies.
Asunto(s)
Anciano de 80 o más Años , Enfermería en Salud Comunitaria/ética , Servicios de Salud para Ancianos/ética , Servicios de Atención de Salud a Domicilio/ética , Viudez , Actividades Cotidianas , Adaptación Psicológica , Anciano , Anciano de 80 o más Años/psicología , Enfermería en Salud Comunitaria/normas , Femenino , Servicios de Salud para Ancianos/normas , Servicios de Atención de Salud a Domicilio/normas , Humanos , Narración , Investigación Metodológica en Enfermería , Encuestas y Cuestionarios , Viudez/psicologíaRESUMEN
Despite marked interest in continuity of care and transitions experienced by older persons, there is little information available about the intentions of older women regarding changes that occur in their support networks. This article reports the findings of a descriptive phenomenological study of older widows' experience of home care and describes the experiences of 10 women who lost a key helper during the 3-year study. Compared with theories of continuity of care or transition, the findings are in keeping with the focus of nonequilibrium systems theory: bringing order out of disorder. Findings imply the need for holistic nursing interventions with older women who hope to continue living alone for as long as possible.
Asunto(s)
Anciano Frágil , Enfermería Holística/normas , Atención Domiciliaria de Salud/normas , Rol de la Enfermera , Viudez , Actividades Cotidianas , Anciano de 80 o más Años , Envejecimiento , Femenino , Anciano Frágil/psicología , Auxiliares de Salud a Domicilio/normas , Servicios Domésticos/normas , Humanos , Control Interno-Externo , Investigación Metodológica en Enfermería , Encuestas y Cuestionarios , Estados Unidos , Viudez/psicologíaRESUMEN
PURPOSE: The formal-informal dichotomy of home care, which has been a theoretical framework in quantitative and qualitative research, might not be descriptive of older persons' views about their home-care providers. This qualitative study explores the perspectives of older women about the characteristics of their home-care providers. DESIGN AND METHODS: Three interviews were conducted with each of 25 women (aged 80-94 years) during the first 4 months of participation in a 3-year phenomenological study. The women described their helpers. We differentiated helper types on the basis of the nature of the help, and we explored variations in compensation arrangements. RESULTS: We delineated a new typology of home-care helpers: regular helpers, on-call helpers, can-will doers, and mainstays. IMPLICATIONS: When home-care helpers are categorized by type of assistance provided, the potential value of their efforts is more evident. The association of formal care with paid help and informal care with nonpaid help limits the effectiveness of the dichotomy as a basis for home-care-payment policies. The new home-care-helper typology cuts across the dimensions of the dichotomy, providing an alternative theoretical framework for further research.
Asunto(s)
Actitud Frente a la Salud , Cuidadores/clasificación , Servicios de Atención de Salud a Domicilio , Análisis y Desempeño de Tareas , Anciano , Anciano de 80 o más Años , Cuidadores/economía , Femenino , Humanos , Relaciones Interpersonales , Missouri , Investigación Cualitativa , Salarios y BeneficiosRESUMEN
The individual considerations of frail women who are elderly as to the use of personal emergency response systems (PERS) are discussed within this article, and they derived from a larger longitudinal study that explores the home care experience of older widows. Participants were 11 frail women (aged 81-94) who perceived a risk of "falling and not being found" and did not have a PERS. A descriptive phenomenological method was used to analyze PERS-related data obtained during interviews with each woman in her home. With regard to considering the use of a PERS, experiences were structured variously by "getting by fine without it," "waiting to get it until I really need it," "convincing myself that I might get it later," and "borrowing no more trouble than I already have." Consistent interventions by home care professionals may perhaps be needed to increase PERS utilization rates. To develop effective interventions, further descriptive research is deemed necessary to explore drawbacks and barriers to PERS use by older frail women.