Postpartum psychosis occurs in approximately two out of every 1000 women after childbirth. Although rare, it is a very serious illness with a potential for suicide and infanticide. The suffering associated with this illness and the effects on the entire family system are severe. Nurses need a comprehensive understanding of this disorder, how women present and experience the illness and the nursing care required to keep women and their newborns safe. They also need to promote early detection to facilitate prompt treatment. To date, there is little research examining the womens experiences and the nursing care provided to this population. Two descriptive qualitative studies were completed. One study analyzed internet narratives of ten women with the diagnosis of postpartum psychosis and the other study analyzed ten interviews with psychiatric nurses working on inpatient psychiatric units in Sweden. These two studies and subsequent secondary analyses addressed four research questions. How do women diagnosed with postpartum psychosis describe their experience? What are psychiatric nurses descriptions of women with postpartum psychosis and what are their responses to these women when caring for them on an inpatient psychiatric unit? What nursing care strategies are used by nurses in caring for women with postpartum psychosis? How do psychiatric nurses describe the use of presence when caring for women with PPP? The women described overwhelming fear, a detachment and inability to care for their babies, delusions and hallucinations, shame and guilt, sleep deprivation, a sense of being controlled, disorganized, confused and paranoia during hospitalization. A number also felt abandoned and discontented with the nursing staff and the nursing care they received. The nurses described a kaleidoscope of symptoms and a range of positive and negative emotional responses they had towards the women. Nursing strategies included satisfying basic needs, keeping the women and babies safe and secure, connecting the women with reality, creating a partnership, teaching the women and their family members, giving hope and facilitating recovery. The nurses described their use of physical presence in great detail and the learning that took place in the context of caring for this population. Future research studies need to examine the on-going interaction of patients and nurses on inpatient psychiatric units. Nurses and nursing students need education about disease manifestations, womens experiences, nursing care strategies and ways to address nurses own emotional reactions.

The purpose of this interpretive phenomenological study was to explore the meaning of loneliness in community-dwelling older adults and to understand their daily practices in coping with loneliness. The sample consisted of eight women and four men between the ages of 74 and 98 years. Participants had to be cognitively intact, scoring less than 12 on the Short Blessed Test. Participants who scored greater than 10 on the Geriatric Depression Scale, Short Form, were excluded to avoid conflating loneliness with severe depression. Data collection tools included the UCLA Loneliness Scale and a demographic survey. Interview guides included the History Interview, the Loneliness Coping Interview, and the Daily Life Interview. Interviews were conducted sequentially every 3-4 weeks for a total of three visits and 4 interviews per participant. A critical finding was that many participants experienced loneliness as a result of disrupted meaningful engagements, due to age-related changes, as well as other losses, including death of spouse, retirement, and giving up the car. Two paradigm cases, as well as themes representing the loneliness and coping experience emerged. Participant coping practices with loneliness included: reaching out to others,helping those in need, and seeking companionship with pets. Loneliness as an embodied experience showed up in participants accounts as fatigue, tension, withdrawal, and emptiness. Some participants described sleeping as a form of withdrawal which helped them to temporarily forget their loneliness. Many older adults are at risk for loneliness because of declining health and other age-related losses that prevent them from remaining engaged in meaningful relationships. Nurses can screen for loneliness to identify those at risk and can intervene to help older adults maintain connections. Recommendations for nurses caring for lonely older adults included: active listening, vision and hearing screenings, transportation needs, home visits, support groups, telephone/lifeline services, computer-assisted social support, pet therapy, volunteering, and engagement in social activities. These interventions will support social integration in older adults by helping older adults remain engaged and active.

Personal and environmental decline, described by outsiders as poor hygiene and squalid living conditions, as well as non-adherence to health care regimens, occur in competent and incompetent self-neglecting older adults. Research has repeatedly validated the links between self-neglect in incompetent community-dwelling adults and functional and/or mental impairment resulting from cognitive decline, depression, or alcohol abuse. Extensive socio-demographic data, available from these and earlier studies, reveal a wide range of self-neglect characteristics. Variables identified in the literature, essential to a framework for self-neglect include: control, culture, agency, action, age-related changes requiring new coping skills and social support. This research identified adults early in the trajectory of self-neglect, prior to the involvement of Adult Protective Services APS). The primary purposes of this qualitative study were to describe characteristics and behaviors of intentional and non-intentional) self-neglect in community-dwelling older adults who were identified by their primary health care provider and to propose a theoretical framework of self-neglect for nursing practice and research. The secondary purposes were to demonstrate the use of a diagnostic tool for early identification of older adult self-neglect in the primary care setting and to describe characteristics and behaviors of self-neglect identified by physicians who refer self-neglecting patients for participation in this research. The conceptual orientation for this research was based on Orems 1995) Self-Care Deficit Theory of Nursing. A descriptive exploratory study design, with post hoc comparison of intentional and non-intentional self-neglecters, was undertaken. Descriptive statistics were used to illustrate the study population characteristics, obtained from the personal data sheet and the geriatric screening tools. Content analysis as described by Neuendorf 2002) was used to analyze the health care provider diagnostic decision-making and the patient participant interview data. Research results indicate a need to consider coping abilities of self-neglecting patients. Self-neglect is not as much related to aging as it is to complex health and social circumstances and an individuals ability and willingness to address these. In addition to factors identified in prior studies, research findings indicate the need to include medical culture in a theoretical framework for self-neglect.

Heart failure affects more than 5 million Americans, with more than 500,000 new cases diagnosed each year. Although, most persons with heart failure are elderly, 7% of Americans or 1.4 million adults with heart failure are of pre-retirement age. Self-care, the cornerstone of heart failure management, is often challenging for individuals with heart failure and few master it. For the purposes of this study, self-care was defined as an active, cognitive process in which persons engage for the purpose of maintaining their health or managing their disease and illness. In recent years, heart failure researchers have investigated the complex interplay of biobehavioral variables on heart failure self-care maintenance, e.g., treatment adherence and symptom monitoring. However, the variables influencing self-care management symptom recognition, symptom evaluation, treatment implementation and evaluation) have not been investigated. Research on selfcare in employed persons with heart failure is nonexistent. A concurrent nested mixed methods design QUAL ＋ quan) was used to characterize the contribution of attitudes, self-efficacy, and cognition to heart failure self-care and to explore how employment interacts with these variables in heart failure self-care management. The sample n＝41) was recruited from outpatient settings associated with a large urban medical center in Philadelphia, Pennsylvania. Inclusion was based on age 18 to 65 years), history of chronic heart failure for at least three months and confirmed based on echocardiographic and clinical evidence, NYHA classification II or III), and employment within the past two years. The data were gathered using in-depth interviews, a demographic survey and a set of structured instruments on heart failure self-care, cognition, self-efficacy and knowledge. The major findings of this study were that: 1) there is a typology of self-care management: Experts, Novices and those Inconsistent in self-care management； 2) persons are Inconsistent in self-care for various reasons including impaired cognition； 3) self-care management is strongly influenced by attitudes and self-efficacy； 4) self-care management can not be evaluated without considering self-care maintenance-maintenance and management are interconnected； and 5) although self-care management and maintenance were poorer overall in employed persons, the intrinsic and extrinsic rewards of employment conferred great benefit. The results of this mixed methods study show that the biobehavioral variables of attitudes, self-efficacy and cognition play a critical role in heart failure self-care. How individuals develop expertise in self-care management and sustain self-care has important implications for clinical practice and future research. Further research is needed to design, implement and test interventions that assess these variables, facilitate positive attitudes and self-efficacy, and support self-care practices among those who are employed and patients with cognitive decline.

The study was prompted by the need for a social work response to the dramatic changes that have occurred in the home health care arena as a result of managed care policies. Social work has been a part of home health care since its inception, but the current cost constrained market threatens the viability of social work in providing services to elderly, ill, homebound individuals. Medicare home health care benefits have traditionally enabled many elderly individuals to live independently in their communities. However, passage of the Balanced Budget Act of 1997, which mandated the use of a Prospective Payment System for service reimbursement, has altered the delivery of home health services for many individuals Liu, Long & Dowling, 2003). As a result, the focus on patient outcomes and the delivery of cost effective quality care has intensified. The study examines the nature of social work services provided in the home health care arena and the relationship between home health care recipient outcomes and a variety of functional and demographic variables as well as social work services. The study utilizes final disposition at discharge from home health care services, and the length of time a recipient is maintained in the community setting through the delivery of home health care services as outcome measures. The key variables of interest are the presence of social work services, the patients functional status, caregiver status, and the demographic variables age, race and gender. This study is exploratory in nature. It identifies descriptive characteristics of the sample of home health care recipients who received home health care services from one home health care company located in South Central Louisiana between January 1, 1999 and January 1, 2005. It explores the nature of social work intervention following the passage of the Balanced Budget Act of 1997. Unfortunately, the study results indicated that social work services have become very limited in scope. The major findings indicated that the patients ability to ambulate independently was a good predictor of his or her ability to remain in the community. They also indicated that the patients ability to prepare for and plan meals was the only variable to influence the number of days the patient received home care services. Implications for social work are discussed.

This study explores what the lived experience of gardening is like for older, community-dwelling gardeners as it is uncovered through conversations, garden visits, and written notes from seven older gardeners. Over a two-year sequence, multiple in-depth individual conversations at the homes of the co-researcher participants unearth themes reflective of their gardening lives. Drawn forward by the methodology of hermeneutic phenomenology, the rich text of our dialogue mingles like compost and becomes something newly created that shows their passion for interacting with plants and living habitats. Using the existentials of lived place, lived body, lived time and lived relation we dig into how gardening is lived. Home and volunteer places for gardening keep these older adults curious and creatively engaged-characteristics of healthy agers. Their worn body parts go unnoticed in the presence of beauty they co-create, suggesting knowing the Earth through the senses is a source of tranquility and wakefulness that brings a renewed appreciation for the wonder of nearby nature. With interpretive literature, poetry, and cultural understandings of the gardeners lives, we relate to metaphors surrounding gardening； the seasons and the circle of life are ever-present. Autobiographical stories of sustained volunteerism, land trusts, and conservancies for future generations reveal their caring for the planet and spiritual aspects of this physical activity, which they love. Reaching out beyond their gardens to share their bounty and wisdom about their relationship with living earth, the gardeners model a vision of respect for the planet and an ecological consciousness. Witnessing nearby nature, they blossom in the Fall of their lives. As a community health professional, my task is to educate and raise awareness about nature for human health and well-being； thereby building on current initiatives to foster accessible nearby nature. The study also sheds light on the value of environmental activism through autobiographical notions. In supporting a gardening life for older gardeners, we advocate the importance of interacting with nearby nature that we long to preserve. Our planet needs more earth keepers like these to bring us back into balance.

This dissertation describes a study using a multiple case study approach to explore the nature of reflexology as a therapy and its effectiveness as a treatment for women with Fibromyalgia syndrome FM). The philosophical underpinnings of Traditional Chinese Medicine and the idea of organ representation of the whole in the parts guided this investigation of reflexology-as-treatment. Stakes case method was used to investigate the effects of reflexology on six cases of women with FM. The women were given ten sessions of weekly reflexology and data were collected over a period of thirteen weeks for each participant. The various forms of data that were collected included: observation, interviews with participants, treatment dairies, and interviews with the reflexologist. Data were analyzed within cases and then across cases using the following four main focus issues； changes in the feet as sensed by the reflexologist, changes in FM symptoms, the experience of reflexology and healing crisis. The findings are presented first for each case and then analyzed across cases. The findings demonstrated that reflexology affected the energy in the womens bodies. This was seen in the feet and by sensations felt in their bodies as a result of the reflexology treatments. Distinct differences in the balance of energy in feet were demonstrated in diagrams before and after the series of reflexology treatments. Symptom of pain in multiple areas started to isolate and decrease showing evidence of connection between areas of the feet and the whole body. Healing crisis occurred and was documented in a way not described before. During the series of reflexology treatments the women acknowledged that they needed to take more control of their health, although not all of the women were ready for such changes. The findings demonstrated that each woman in the study responded differently to the reflexology treatments in a number of ways. Because of the individual differences noted in treating the women in this study, the findings underscore the need for individually tailoring reflexology treatments for each person seeking this type of complementary alternative therapy.

The migration of Foreign-Educated Nurse FENs) to the United States has risen sharply in recent years. Little is known about how FENs affect the employment opportunity of U.S. registered nurses USRNs). Research questions. What are the job participation patterns of FENs? What are the determinants factors of FEN job participation? Study method. Secondary data analysis was used with data sets from 1980 to 2000 using the National Sample Survey of Registered Nurses NSSRN). Results. From 1980 to 2000, most FENs were middle-aged an average of 45 years old in 2000), female 94%), Non-white 67.7%), married 72.7%), had children at home 65%), highest education from baccalaureate degree 43.5%), were more likely to work in hospital 72%), and work more full time 84%) than part time 12%). Furthermore, higher proportions 70%) of FENs provide direct patient care. In general, FENs work more hours per week average 37 to 41 hours per week) and have higher salary Average $47675, median $48600). Most FENs live in a metropolitan area 93%) in six States: California, Florida, Illinois, New York, New Jersey, and Texas. Discussion. Supporting evidence show variations within FENs in terms of their job participation patterns. It is also questionable whether the U.S. nurse shortage can be eased by FEN recruitments. During the past 20 years from 1980 to 2000) the U.S. added more than one million RNs to the work force. However, the major challenge is to keep nurses in the profession. Changing work design to better accommodate nurses across the life span is important to attract them back to nursing. Conclusion. In the U.S., FENs come from diverse countries with approximately 75% migrating from Canada, India, Philippines, and the UK. If the U.S. immigration policies were changed to import more FENs, the most seriously affected countries might be Canada and the UK, as these countries are linked by language, culture, and social background. Another 25% of FENs were from developing countries. It is important to note that recruitment of small proportions of FENs from developing countries could cause serious inequity in global health. According to this study, the U.S. nurse supply could be self-sufficient by recruiting 2% of the inactive RNs or 1% of the FT nurses. In this global nurse market, the import of FENs needs to be balanced between domestic nurse supply and global health equity.

Falling is a common health problem that threatens older adults with serious physical, psychological, social and financial consequences. Multifactorial fall prevention trials significantly reduce the incidence of falling in high-risk community dwelling older adults, but the effects are small. The Leventhal Common Sense Model CSM) is a health behavior theory that explains how people interpret and cope with health threats. The CSM posits that a perceived health threat triggers individuals to develop a “common sense representation” set of beliefs) about the threat, and those beliefs guide the selection of coping behaviors. To date, the CSM has not been used to examine older persons beliefs about their risk of falling. This study had two primary aims: 1) to describe representations of fall risk in community-dwelling older adults who were at high risk for falling, and 2) to explore the relationships proposed by the CSM among representations of fall risk, risk of falling the health threat), prevention behavior, and falling. An exploratory, descriptive, cross-sectional study was conducted. Participants n＝69, mean age＝81.0, SD-7.1) were recruited from the Safety Assessment for Elders SAFE) Study, a randomized controlled fall prevention trial Mahoney & Shea, 2004), Representations were assessed with the Fall Perception Questionnaire FPQ), adapted from the Illness Perception Questionnaire Moss-Morris, Weinman, Petri et al., 2002). Measures of fall risk, prevention behaviors, and fall outcomes were constructed from SAFE data. At-risk older adults representations of fall risk included perceiving their risk as chronic, understandable, not serious, not emotionally distressing, and under personal but not treatment) control. They reported multiple causes for falling including: balance problems, aging, own behavior, and accidents. One third reported not feeling vulnerable to falling. In regression analyses, being at higher risk for falls predicted representations of higher vulnerability beta＝-.48, p&lt；.001), lower personal control beta＝.35, p&lt；.01), and less understanding beta＝.31, p&lt；.05). However, engaging in prevention behaviors was predicted by lower vulnerability beta＝.35, p&lt；.01), higher treatment control beta＝30, p&lt；.05), and less chronicity beta＝.35, p&lt；.01). The CSM provided a useful framework for describing fall risk beliefs and offers an important new avenue for conceptualizing and designing fall prevention interventions.

Background. Middle-aged women in Korean society have traditionally assumed multiple roles e.g. caregiver for elderly parents and children, wife, worker etc.). Having a chronic illness such as diabetes mellitus can be viewed as an additional social role that these women are obliged to manage which may result in problematic levels of role-strain. Further, the cultural experience of social role-strain in middle-aged Korean women who have diabetes has not been clearly understood. Purpose. The purpose of the study was to describe levels of role-strain, diabetes self-efficacy, depression, diabetes knowledge, and social support as well as to investigate the potential association between social role-strain, social support, depression, diabetes knowledge and diabetes self-efficacy while describing the cultural experience of role-strain in this population. Methods. A sequential mixed model design was used. In the quantitative phase, levels of role-strain, diabetes self-efficacy, diabetes knowledge, depression and social support were measured and their relationships were investigated among a convenience sample of 154 middle-aged Korean women with type 2 diabetes. In the subsequent qualitative phase of the study, 10 women representing both the upper n＝5) or lower n＝5) 25 percentile of role-strain score were recruited for in-depth interviews to explore the highest and lowest levels of role-strain, respectively. An interview guide consisting of semi-structured, open-ended questions addressing cultural experience of role-strain was used in all interviews. Results. Role-strain and social support are significant predictors of diabetes self-efficacy in middle-aged Korean women with type 2 diabetes. The level of role strain is negatively associated with diabetes self-efficacy r ＝ -.20, p&lt； 0.05) whereas social support is positively associated with diabetes self-efficacy r ＝ .22, p&lt； 0.05). Findings from the qualitative inquiry include three themes. The first theme related to the experience of role-strain, Resentment regarding previous role-strain, represent prior role-strain women project onto their current situation, thereby increasing/aggravating their current role-strain. Prioritizing others over self is a predominant characteristic of the middle-aged Korean women in which they consider other roles, especially those related to social norms, more important than their sick role as a diabetes patient. Finally, Striving to avoid burdening others is described as contributing to womens role-strain as they expend additional effort to isolate themselves and aspects of their disease from friends and family. Conclusions. Findings from this study highlight the important relationships between role-strain and perceived social support to diabetes self-efficacy. Past experiences with role-strain and how this may be projected onto middle-aged Korean womens current situation should be considered along with the tendency to prioritize culturally-related social norms/expectations and difficulties in seeking/allowing support which may serve as potential barriers to diabetes self-management.