DeAnne K. Hilfinger Messias

Experiencing Transitions: An Emerging Middle-Range Theory

Changes in health and illness of individuals create a process of transition, and clients in transition tend to be more vulnerable to risks that may in turn affect their health. Uncovering these risks may be enhanced by understanding the transition process. As a central concept of nursing, transition has been analyzed, its components identified, and a framework to articulate and to reflect the relationship between these components has been defined. In this article, the previous conceptual analysis of transitions is extended and refined by drawing on the results of five different research studies that have examined transitions using an integrative approach to theory development. The emerging middle-range theory of transitions consists of types and patterns of transitions, properties of transition experiences, facilitating and inhibiting conditions, process indicators, outcome indicators, and nursing therapeutics. The diversity, complexity, and multiple dimensionality of transition experiences need to be further explored and incorporated in future research and nursing practice related to transitions.

Toward a critical social theory of youth empowerment

SUMMARY This article contributes to the development of a critical social theory of youth empowerment which emphasizes collective efforts to create sociopolitical change. It draws upon analysis of four youth empowerment models, and upon findings from a participatory research study which identified key dimensions of critical youth empowerment: (1) a welcoming, safe environment, (2) meaningful participation and engagement, (3) equitable power-sharing between youth and adults, (4) engagement in critical reflection on interpersonal and sociopolitical processes, (5) participation in sociopolitical processes to affect change, and (6) integrated individual- and community-level empowerment. It concludes with discussion of the measurement of outcomes, and the challenges and opportunities for empowerment in youth organization.

DEFINING AND REDEFINING WORK Implications for Women's Health

In this article the authors examine the ways in which the definition of work as paid employment has affected womens health research, the knowledge and understanding of the relationships between womens work and health, and health and social policies. The authors argue for research and public policy based on an expanded definition of womens work, a redefinition that goes beyond employment to reflect the multiple contexts and dimensions of womens work as well as the diversity and differences among women.

Transnational health resources, practices, and perspectives: Brazilian immigrant women's narratives.

This paper examines the representations of transnational health resources, practices, and perspectives in the narratives of Brazilian immigrant women. The results of this qualitative narrative research indicated that in taking care of their health, these Brazilian immigrants often relied on a combination of personal and collective transnational resources. They engaged in a variety of premigration and transnational health practices and demonstrated a high degree of personal responsibility for their health, although they frequently delayed or postponed seeking formal health care. In responding to health and illness concerns, these immigrant women moved back and forth across informal and formal health care systems, crossing multiple national, cultural, and health care system borders. Their stories illustrated the transnational nature of personal, cultural, and political perspectives on health and health care and highlighted the layered complexities of immigrant womens health practices and resources.

Latino social network dynamics and the Hurricane Katrina disaster

The aim of this qualitative research was to examine the dynamics of existing and emerging social networks among Latino survivors of Hurricane Katrina. Data were generated through individual, in-depth interviews conducted with 65 Latinos within six months of the storm striking the Gulf Coast of the United States in August 2005. The findings illustrated both the role of social networks in gathering information, making decisions and accessing resources, and how these existing social networks were disrupted and strained by overwhelming needs. Broader structural issues, including poverty and a lack of transportation, combined with marginalised status as immigrants, further constrained access to essential information and resources. In response, new, if temporary, social networks emerged, based primarily on shared nationality, language, and a sense of collective commitment. Practice implications include the need to consider the social network dynamics of marginalised groups in developing innovative strategies to overcome structural barriers to accessing resources essential for disaster preparedness and survival.

Embodied work: Insider perspectives on the work of HIV/AIDS peer counselors

Our aim in this study was to explore HIV/AIDS peer counseling from the perspective of women actively engaged in this work within the context of a community-based program in rural areas of the southeastern United States. Based on this research we suggest that the embodied work of HIV/AIDS peer counselors is constructed around their personal identities and experiences. This work involves gaining entry to other HIV-positive womens lives, building relationships, drawing on personal experiences, facing issues of fear and stigma, tailoring peer counseling for diversity, balancing risks and benefits, and terminating relationships. Peer counselors recognize the personal and collective value of their work, which, like much of womens work within the context of family and community, lacks public visibility and acknowledgment. We discuss implications for the training and support of peer-based interventions for HIV and other womens health issues across diverse contexts and settings.

Mississippi front-line recovery work after Hurricane Katrina: An analysis of the intersections of gender, race, and class in advocacy, power relations, and health

By disrupting the routine practices and social structures that support social hierarchy, disasters provide a unique opportunity to observe how gender, race, and class power relations are enacted and reconstituted to shape health inequities. Using a feminist intersectional framework, we examine the dynamic relationships among a government/corporate alliance, front-line disaster recovery workers, and disadvantaged residents in Mississippi Gulf Coast communities in the aftermath of Hurricane Katrina, which struck in August, 2005. Data were collected between January 2007 and October 2008 through field observations, public document analysis, and in-depth interviews with 32 front-line workers representing 27 non-governmental, nonprofit community-based organizations. Our analysis reveals how power relationships among these groups operated at the macro-level of the political economy as well as in individual lives, increasing health risks among both the disadvantaged and the front-line workers serving and advocating on their behalf. Socially situated as outsiders-within, front-line recovery workers operated in the middle ground between the disadvantaged populations they served and the powerful alliance that controlled access to essential resources. From this location, they both observed and were subject to the processes guiding the allocation of resources and their unequal outcomes. Following a brief period of hope for progressive change, recovery workers became increasingly stressed and fatigued, particularly from lack of communication and coordination, limited resources, insufficient capacity to meet overwhelming demands, and gendered and racialized mechanisms of marginalization and exclusion. The personal and collective health burdens borne by these front-line recovery workers--predominantly women and people of color - exemplify the ways in which the social relations of power and control contribute to health and social inequities.

Being involved and making a difference: empowerment and well-being among women living in poverty.

Background: The relationships between poverty, empowerment, and health are of theoretical and practical interest to nurses, yet few researchers have examined volunteerism in poor communities from a holistic health perspective. Purpose: This study explores the experiences of women engaged in community volunteer work in the context of economic poverty. Method: Individual, in-depth interviews were conducted with 8 women, ages 21 to 77 years, who qualified for federal assistance or self-identified as low-income and were currently involved in volunteer community work. Findings: Participants’ stories of being involved and making a difference illustrated women making connections, developing relationships, gaining knowledge and skills, increasing self-esteem and confidence, reaching out to help others, and strengthening communities. Conclusion: At both the individual and community level, well-being was enhanced through women’s community volunteerism in the context of economic poverty. Implications: At the individual and community levels, well-being was enhanced through women’s community volunteerism in the context of economic poverty. From a holistic nursing perspective, the findings provide support for community volunteerism as a health-promoting strategy among women living in economic poverty.

The Work of Language Interpretation in Health Care: Complex, Challenging, Exhausting, and Often Invisible

The value of qualified language interpretation services for limited-English-proficient patients is gaining increasing recognition by policy makers and researchers in the United States. Yet the actual work experiences of health care interpreters have not been adequately studied. The purpose of this qualitative research was to explore the work experiences of formal and informal interpreters (n = 27). The core narrative finding from the interview data was the complex, challenging, exhausting, and often invisible work of language interpretation. Critical examination of health care interpreters’ complex work and interactions with patients, providers, and administrators is needed to provide more effective and integrated services for limited-English-proficient patients.

The impact and implications of undocumented immigration on individual and collective health in the United States

A nation of immigrants, the United States currently has more foreign-born residents than any other country; approximately 28% of these foreign-born residents are undocumented immigrants--individuals who either entered or are currently residing in the country without valid immigration or residency documents. The complex and constantly changing social, political, and economic context of undocumented migration has profound effects on individuals, families, and communities. The lack of demographic and epidemiologic data on undocumented immigrants is a major public health challenge. In this article, we identify multiple dimensions of vulnerability among undocumented persons; examine how undocumentedness impacts health and health care access and utilization; and consider the professional, practice, and policy issues and implications for nurses.