Eileen J. Porter

Reducing my risks: a phenomenon of older widows' lived experience.

While scholars and practitioners often use the concept of “risk” in relation to older persons who live at home, there has been limited exploration of risk from the perspective of older persons themselves. During a phenomenologic study of the lived experience of seven older widows who were living alone at home, the participants articulated the risks they experienced and described the ways in which they attempted to reduce these risks. The results have meaningful implications for home care providers and policy makers.

Older Widows' Experience of Home Care

Background: Scholars and practitioners have defined home care as a set of services that older persons receive at home. There have been few empirical studies of the essence of the experience. Objectives: To describe the experience of home care for older widows living alone in their own homes. Findings are reported from one aim of the study, which was to discern the phenomena that were descriptive of the experience of the sample as a whole. Method: A descriptive phenomenological method was used. Participants met inclusion criteria for duration of widowhood, continuing residence in their own homes since the husbands death, number of adult children, self-rated health, and study-specific mental competence. Over a 3-year period, seven tape-recorded interviews were conducted in the homes of 25 widows over the age of 80. Foci of interest were the womens perceptions, actions, and intentions relative to their helpers and the help they had while living alone. The structures of the experience and its context were discerned and detailed in the form of taxonomies of phenomena and contextual features. Results: The common phenomena were sorting out who can best do what needs to be done, protecting my standby, mobilizing my standby to help with this job too, and working together to get the job done. A new definition of home care was proposed, incorporating those phenomena. Discussion: These older widows were not merely receiving home-care services. They were negotiating reliance on their standby helpers in specific ways. As home-care nurses plan care with widows and their other helpers, they should set aside standard definitions of home care that pertain to providing services and focus on the intentions of the older widows whom they serve.

Problems with preparing food reported by frail older women living alone at home.

Although nutritional risk is a critical health concern for older persons, there are few data about day-to-day problems with nutrition-related tasks. Such data were reported by 18 frail women during a longitudinal descriptive phenomenological study of the home care experience. Six problems were understood as elements of the life-world of older women, including having trouble figuring out what to fix, having trouble getting the food cooked right, and struggling with moving and standing while cooking. The results suggest topics for research and underscore the need for partnership between frail older women and helpers relative to food preparation.

The Church Family and Kin: An Older Rural Black Woman’s Support Network and Preferences for Care Providers

Although kin and church are considered premier support sources for rural elders, few scholars have undertaken descriptive studies to explore the nature of rural Black elders’ support networks and their preferences for in-home service providers. In the case study described in this article, methods of support network analysis and descriptive phenomenology were used to analyze data from five lengthy, open-ended interviews with a 94-year-old rural Black woman. The various groups and individuals of her network are labeled in her words, the network’s supportive functions are described, and preferences for providers are noted. In addition, the varying structures of her home care experience with the support network members are described. Her attempts to voice and exercise her preferences for in-home service providers are explained in terms of two contrasting processes: preference uptake and preference suppression. Based on these findings, implications for appraising the appropriateness of rural elders’ in-home services are discussed.

Considering the use of a personal emergency response system: an experience of frail, older women.

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 draw-backs and barriers to PERS use by older frail women.

Intentions of Older Homebound Women to Reduce the Risk of Falling Again

PURPOSE Researchers have tested interventions to prevent recurrent falls for older people without exploring their intentions to prevent another fall. Lack of knowledge about such intentions is an impediment to intervention effectiveness. The purpose was to describe intentions to prevent another fall as discerned during a study with older homebound women. METHODS Data were obtained during a series of four in-home interviews over 18 months with monthly telephone contacts between interviews; fall history was updated at each contact. A descriptive phenomenological method was used to analyze data. FINDINGS Of the 40 women, 36 (aged 85 to 98 years) had fallen at home at least once before enrolling in the study, or had a subsequent or initial fall during the study. The overall intention was reducing my risk of falling again at home, with its components figuring out the reason that I fell and changing my ways to reduce my risk of falling again at home. Most women explained reasons for a fall and voiced intentions to prevent a similar fall. Women who viewed falls as unexpected events were uncertain that they could prevent a fall or felt unable to do so and voiced few preventive intentions. A few women voiced generalized preventive intentions to change health-related behaviors or habits. CONCLUSIONS Most intentions were tied directly to the situation in which a fall had occurred. Such specificity could limit effectiveness of personal efforts to prevent falls in other situations. CLINICAL RELEVANCE Practitioners should converse with older women who have fallen about their intentions to prevent another fall and weigh the need to help them generalize both the risk of falling again and their risk reduction intentions.

Helping Young Adult Children With Traumatic Brain Injury: The Life-World of Mothers

Few scholars have described the personal–social context of the maternal experience of helping young adult children who have survived a traumatic brain injury (TBI). Viewing context as life-world, we used a descriptive phenomenological method to explore the life-world of 7 mothers whose young adult children had suffered a moderate or severe TBI at least 6 months earlier. Conducting three interviews with each mother, we discerned five features of life-world: having a child who survived a TBI as a young adult, perceiving that life has really changed, having sufficient support/feeling bereft of any help, believing that my child is still able, and believing that I can help my child. Compared to the literature, findings led to more definitive practice implications about postinjury uncertainty and maternal role change. In studies with such mothers, researchers should focus on the continuity of mothering rather than the initiation of caregiving.

Changes in Family Life Perceived by Mothers of Young Adult TBI Survivors

Little is known about changes in family life perceived by mothers of young adult survivors of a traumatic brain injury (TBI). A phenomenological method was used to describe the changes that seven mothers of TBI survivors perceived in family life 6 months or more after the TBI. The five basic changes in family life reported by mothers were: getting attention from each other for different reasons now, getting along with each other since the injury, facing new financial hurdles, going our separate ways down this new path, and splitting the family apart against our will. Compared to literature on stress and coping, the findings offered a unique perspective on changes in family life. Nurses can use the findings to initiate therapeutic conversations with mothers about changes in family life after a TBI.

Older Homebound Women: Negotiating Reliance on a Cane or Walker

Canes and walkers are commonly characterized as assistive devices that serve the same purpose: as walking aides. These general views were reappraised and tempered in this descriptive phenomenological study with 40 older women (aged 85 to 98 years) who were unable to leave their homes without help. The purpose was to describe the phenomena of negotiating reliance on canes and walkers as walking devices and the lifeworld context underlying each phenomenon. Relative to lifeworld, there were differences between coming to terms with using a cane and coming to terms with using a walker. Data revealed similarities and distinctions between the basic intentions of relying on canes and walkers and the associated purposes served by canes and walkers. Participants did not view either device as consistently assistive. Findings evoke opportunities for dialogue among older persons, scholars, practitioners, and designers of these devices about coming to terms with such devices and relying on them.

Older Widows’ Speculations and Expectancies Concerning Professional Home-Care Providers

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.