Ann Kuckelman Cobb

The experiences of families with a relative in the intensive care unit

OBJECTIVE To describe the experiences of families with a relative in the intensive care unit (ICU). DESIGN Retrospective, descriptive, and qualitative. SETTING The surgical-trauma ICU in a midwestern university-affiliated tertiary medical center. PARTICIPANTS Eighteen women and 2 men with relatives in a surgical trauma ICU. OUTCOME MEASURES Focus group and individual unstructured interviews. RESULTS A group interpretive process was used to code, categorize, and identify themes found in the transcribed interviews. Four categories of experiences were identified: hovering, information seeking, tracking, and the garnering of resources. Hovering is an initial sense of confusion, stress, and uncertainty. Information seeking is a tactic used both to move out of the hovering state and to identify the patients progress. Tracking is the process of observing, analyzing, and evaluating patient care and status and the familys own satisfaction with the environment and with care givers. The garnering of resources is the act of acquiring what family members perceive as needed for themselves or their relative. CONCLUSIONS Families experience a sense of uncertainty that is eventually resolved by seeking information and resources. Health care professionals can minimize the stress associated with hospitalization of relatives in the ICU by anticipating and addressing the familys needs for information and resources.

Spirituality and well-being: an exploratory study of the patient perspective

Spirituality has become a construct of interest in American health care: however, there remains a limited understanding of how patients themselves describe spirituality and view its impact on their health and well-being. The purpose of this study was to identify and describe elements of patient-reported, health-related spirituality. A qualitative study utilized focus group interviews of 17 women with type 2 diabetes mellitus and 18 women with no self-identified illness. Purposeful sampling of participants who had prior experiences in healthcare settings, with or without a chronic illness, guided the sampling strategy. Editing analysis of the interview transcripts were coded into conceptual categories. Participant narratives were grouped into eight general categories: (1) change in functional status, (2) core beliefs, (3) medical/disease state information gathering and processing, (4) interpretation and understanding, (5) life scheme, (6) positive intentionality, (7) agency, and (8) subjective well-being. A change in functional status was the catalyst for two process-oriented categories; medical/disease state information gathering and processing, and the higher-order interpretation and understanding, or meaning making of life events. Core beliefs were sources that grounded and maintained an interpretative structure through which participants viewed their life events and positively framed their experiences. Life scheme described a heuristic framework through which all life events were viewed. Positive intentionality was participant belief in the capacity to execute a specific action that was required for a desired outcome. Participants tied the attitudes and practices of positive intentionality with agency, or the use or exertion of power through belief, practice, or community. Participants outlined both a positive affective and cognitive component of subjective well-being. Patients describe several interrelated elements and a process of events in their depiction of spirituality in healthcare settings. Patient-reported spirituality is predominantly a cognitive construct incorporating the domains of life scheme and positive intentionality.

Reciprocity between individuals with severe and persistent mental illness and their family members

Abstract Background : The focus of research on families of the severely and persistently mentally ill is on unidirectional caregiving from family members to the ill individual (consumer). It seldom addresses whether the consumer also gives something to the family. Thus the concept of reciprocity was investigated in this context. Objective : The objectives of this study were to identify differences in families who reported reciprocity from consumers with those who did not and to describe the kinds of reciprocity perceived by these families. Design : The objectives were met with the use of responses from a mailed questionnaire to family members. Results : Reciprocity was reported more by women than men, by respondents who lived with the consumer, and by families who reported giving more assistance to the consumer and who perceived the consumer as higher functioning. Neither age of family member or consumer nor type of family relationship was related to reciprocity. The kinds of reciprocity families perceived were categorized into instrumental tasks, caring, family solidarity, self-caring, peace of mind, family sensitization, and financial. Conclusion : The findings support the importance of planning nursing interventions that recognize that the severely and persistently mentally ill may give to their families as well as receive from them.

The role of the lay midwife in childbirth in rural Portugal.

The following article was written shortly after thefieldwork was completed in 1979. The research was conductedjust after Portugal s 1974 revolution, prior to which a repressive political regime allowed virtually no social science research. Since that time, some significant works have been published, but no other ethnographies focus on the role of the lay midwife. The kind of information obtained in this study required then, and would now require, heavy reliance on ethnographicfieldwork This publication may serve as a baseline for comparative research. An epilogue provides some updating of statistical information about infant mortality rates; however, little can be determined about rural-urban differences. The limited information available suggests that very little may have changed in the last 15 years for lay midwives in the rural villages studied.

P. Caplan & J. M. Bujra, Women United, Women Divided: Comparative Studies of Ten Contemporary Cultures. Bloomington, Indiana University Press, 1979, 288 pp.

This compact volume consists of nine case studies and an introductory theoretical chapter. The collection, organized around the theme of women’s solidarity, grew out of discussions by members of the London Women’s Anthropology Group. The stated aim of the book is to &dquo;...contribute to the growing academic debate on women, and ...be accessible and relevant to matters of concern to the Women’s Movement&dquo; (p. 7). Geographic areas represented in the case studies are China, India, Africa, Europe, Australia and the French Caribbean.