Beverly Rosa Williams

Expanding the Notion of Researcher Distress: The Cumulative Effects of Coding

Qualitative researchers who explore the individual’s experience of health, illness, death, and dying often experience emotional stress in their work. In this article, we describe the emotional stress we experienced while coding semistructured, after-death interviews conducted with 38 next of kin of deceased veterans. Coding sensitive topic data required an unexpected level of emotional labor, the impact of which has not been addressed in the literature. In writing this discussion article, we stepped back from our roles as interviewers/coders and reflected on how our work affected us individually and as a team, and how a sequence of exposures could exert a cumulative effect for researchers in such a dual role. Through this article, we hope to generate an expanded discourse on how qualitative inquiry impacts the emotional well-being of researchers.

Bereavement among African American and White older adults.

Purpose: The authors examined epidemiology and sociodemographic predictors of spousal, nonspousal family, and friendship bereavement among African American and White community-dwelling older adults using longitudinal data from 839 participants of the University of Alabama at Birmingham Study of Aging, a prospective cohort study of a random sample of Alabama Medicare beneficiaries. Method: Authors calculated cumulative incidences of each type of loss and used logistic regression to identify factors significantly and independently associated with loss. Results: Of participants, 71% reported at least one loss; 50% reported nonspousal family loss, and 37% reported friendship loss. For married participants, the cumulative incidence of spousal loss was 8.1%. Female sex and income <

Religious involvement and physical and emotional functioning among African Americans: The mediating role of religious support

12,000 were predictors of spousal loss. Female sex and education ≥ 12 years were predictors of friendship loss. Higher educated African American women were at greater risk of nonspousal family loss. Discussion: Future research should examine bereavement burden and identify health outcomes of multiple losses.

Do-Not-Resuscitate Orders in the Last Days of Life

Objectives: Religious social support may in part account for the relationship between religious involvement and health-related outcomes. African Americans, on average, tend to have relatively high levels of religious involvement, and suffer a higher burden of health conditions than other groups. This study aimed to examine whether religious social support played a mediating role between religious involvement and physical and emotional functioning, and depressive symptoms. Design: The study used a cross sectional telephone survey among a national probability sample of African Americans (n = 803). Study participants completed telephone interviews and data were analysed using structural equation modelling. Main outcome measures: Physical and emotional functioning and depressive symptoms served as study outcomes. Results: In both the emotional functioning and depressive symptoms models, the indirect effect test from religious behaviours to emotional religious support indicated evidence for mediation. There was no mediation for the physical functioning model. Conclusion: Implications for faith-based health promotion interventions are discussed.

The Feminization of Bereavement Among Community-Dwelling Older Adults

BACKGROUND The purpose of this analysis was to describe the presence and timing of do-not-resuscitate (DNR) orders for imminently dying patients in VA Medical Centers, and to examine factors associated with these processes. METHODS Data on DNR orders in the last 7 days of life were abstracted from the medical records of 1,069 veterans who had died in one of six VA hospitals in 2005. RESULTS Of the 1069 records, 681 (63.7%) had an active DNR order at time of death. Among these, records indicated that the order was written within the last 24 hours for 219 (32.2%), 1-2 days prior to death for 54 (7.9%), 3-7 days prior to death for 256 (37.6%), and > 7 days prior to death for 152 (22.3%). Veterans with a family member present at time of death and those who received pastoral care visits were more likely to have DNR orders. African American veterans and veterans who died unexpectedly were less likely to have DNR orders. Compared with those dying on a general medicine unit, veterans dying in the emergency department or an intensive care unit (ICU) and veterans dying during a procedure or in transit were less likely to have DNR orders. Mental health diagnoses were not associated with presence of a DNR order. CONCLUSION Results suggest that the DNR process might be improved by interventions that target ICU settings, facilitate transitions to less intensive locations of care, ensure the involvement and availability of pastoral care staff, and create environments that support the presence of family members.

“Wrapped in Their Arms”: Next-of-Kin’s Perceptions of How Hospital Nursing Staff Support Family Presence Before, During, and After the Death of a Loved One

ABSTRACT We examined gender differences in frequency and socio-demographic predictors of spousal, non-spousal family, and friendship bereavement events among community-dwelling older adults using data from the UAB Study of Aging. Analysis involved a 30-month observation period of 893 subjects. There were significant differences between women and men for all types of loss. Significant differences were also found in the sociodemographic predictors of loss between and within gender categories. This study revealed the extent to which older women disproportionately bear the burden of loss and points to the need for greater attention to bereavement as a womens issue.

Nonspousal Family Loss among Community-Dwelling Older Adults

Family presence is a vital component of quality end-of-life (EOL) care. We conducted face-to-face, in-depth interviews with next-of-kin of deceased veterans to explore perceptions of how hospital nursing staff supported and facilitated family presence during the actively dying phase, at the time of death, and immediately following the patient’s death. We used content analysis to examine respondents’ accounts of the role of nursing staff in fostering and sustaining family presence in the hospital setting. We provide exemplary quotes to contextualize nursing staff behaviors that encouraged, supported, and guided families, enabling them to be present and to function adaptively before, during, and after the loved one’s death. In particular, we focus on nursing behaviors that were responsive to family members’ needs for information, privacy, intimacy, physical comfort, and emotional reassurance. Nurses’ effectiveness in optimizing family support required clinical competency in recognizing the actively dying phase of life and engaging in behaviors that facilitated the delivery EOL care, with thoughtful attention to family needs.

Assessment of Religious and Spiritual Capital in African American Communities

We examined the prevalence and correlates of recent nonspousal family loss among older adults using data from the University of Alabama at Birmingham Study of Aging, a stratified random sample of community-dwelling older adults living in central Alabama. Twenty-three percent of participants reported a recent nonspousal family loss. African American ethnicity, education <12th grade, functional difficulty, restricted life-space mobility, depressive symptomology, pain and other somatic symptoms were associated with recent nonspousal family loss. Compared to non-widowed participants, widows with family loss reported a higher proportion of mental health and activity-limiting physical problems as well as restricted life-space. Programs to improve physical function and enhance health and wellbeing in older bereaved spouses should be expanded to include older adults with nonspousal family loss, particularly targeting the mental health needs of previously widowed persons who lose another family member.

Social support as a mediator of religious involvement and physical and emotional functioning in a national sample of African-Americans

African American faith communities are an important source of social capital. The present study adapted a theory-based social capital instrument to result in religious (e.g., from organized worship) and spiritual (e.g., from relationship with higher power) capital measures. Data from a national sample of 803 African Americans suggest the instruments have high internal reliability and are distinct from general religiosity. Measurement models confirmed factor structures. Religious capital was positively associated with self-rated health status. Religious and spiritual capital were negatively associated with depressive symptoms, but these associations largely became nonsignificant in multivariate models that controlled for demographic characteristics. An exception is for spiritual capital in the form of community participation, which retained a negative association with depressive symptoms. These instruments may have applied value for health promotion research and practice in African American communities.

Intermittent Subcutaneous Furosemide Parenteral Diuretic Rescue for Hospice Patients With Congestive Heart Failure Resistant to Oral Diuretic

Researchers propose social support as one of the factors that may explain the positive relationship often observed between religious involvement and health outcomes. African-Americans are a population that tends to have higher than average levels of religious involvement and are also disproportionately impacted by most health conditions. The present study sought to determine whether social support mediates the role of religious involvement in physical and emotional functioning and depressive symptoms, among a national probability sample of African-Americans (N = 803). Study participants completed telephone interviews. We used structural equation modelling to test hypotheses based on the theoretical model. Findings suggest evidence for a mediating role of belonging and tangible support in the association between religious behaviours and physical functioning as well as depression. There was no mediational role played by appraisal support, or for emotional functioning. Implications for faith-based health promotion interventions are discussed.