Holly Skodol Wilson

Family Caregiving for a Relative With Alzheimer's Dementia: Coping with Negative Choices

The constant comparative method was used to generate a grounded theory explicating the process of family caregiving for a relative with Alzheimers dementia. Findings from 20 in-depth, face-to-face interviews conducted with a purposive sample of family caregivers in their homes revealed that much of the caregiving experience consists of coping with negative choices wherein all possible alternatives are undesirable. The three stages of Surviving on the Brink, (1) Taking it on, (2) Going through it, and (3) Turning it over, capture the variation in behavior, Continued validation of this process of coping and decision making offers promise for substantive theory development on which nursing intervention programs for easing caregiver burdens might be based.

Personal risking: lesbian self-disclosure of sexual orientation to professional health care providers.

Thirty three lesbians ranging in age from 18–68 participated as respondents in this qualitative, theory-generating study. Data were obtained through a written demographic questionnaire and in-depth taped interviews. Findings revealed a two-phase basic social process (BSP) identified as personal risking that is used by lesbians to secure their physical and/or psychological safety within the health care system. In the anticipatory phase, the risk of self-disclosure is calculated using both imaginative and cognitive strategies to determine a disclosure stance. In the interactional phase, scanning and monitoring enable the lesbian client to reevaluate the stance assumed. The data confirm that lesbians are uncomfortable in many health care situations and suggest provider responses to improve their comfort and the level of health care they receive.

Alzheimer's disease and family caregiving: critical synthesis of the literature and research agenda.

This paper is a synthesis of knowledge about Alzheimers disease (AD) and AD family caregiving published over the last decade (approximately 1979–1990). While there has been an increase in the volume of scientific work in this area, methodological difficulties, unclear findings, and gaps, particularly with regard to inclusion of ethnic minority populations, persist. The current research priority on evaluating intervention programs represents a worthy direction, yet such a focus may be premature until basic knowledge builds on, extends, and transcends the foundation established in the past decade.

Reconciling Incompatibilities: A Grounded Theory of HIV Medication Adherence and Symptom Management:

The purpose of this grounded theory study was to explain how ethnically diverse men and women living with HIV manage their interacting illness symptoms, medication side effects, and treatment adherence choices. The authors used the constant comparative method to analyze textual data from in-depth interviews with 66 HIV-infected people representing the changing HIV demographic profile in the San Francisco Bay area and generate a theory of Reconciling Incompatibilities. Adherence options of complying, not complying, or self-tailoring occurred in a context of attributional uncertainty as to whether distress was illness-or treatment-related, a sometimes silent virus, and perceived fickle medical markers. Conditions, including self-identity, illness ideology, concurrent treatment regimens, the meaning of time, medication burden and side effects, and lifestyle, coalesced to produce a state of mind that shaped adherence choices on a dose-by-dose basis. This theory offers a basis for interventions designed to promote optimal adherence choices concerning HIV therapies.

Early probable Alzheimer's disease and awareness context theory.

The purpose of this research was to explore the explanatory value of Awareness Context Theory for social interactional issues in early probable Alzheimers Disease (AD). Glaser and Strausss Awareness Context Theory [Glaser and Strauss (1965) Awareness of Dying, Aldine, New York] served as the framework for the analysis of interview data from 14 early probable AD clients and 14 family caregivers, a written autobiographical account, a fictionalized account, observations of a family care-giver focus group, and excerpts that focused on early AD from field notes recorded during two years of participant observation at a specialized AD daycare center and a family caregiver support group. Initial open-ended study questions focused on the experience of early AD from the diverse perspectives represented in the data. After preliminary analysis of data suggesting emergent fit with Awareness Context Theory, questions were refocused to address awareness contexts. Data were coded and analyzed for fit with the theory. Awareness Context Theory provided a useful heuristic for thinking about the nuances and complexities of social interaction in early AD. Attention to awareness contexts should enable health care providers to suggest interventions to improve caregiver-client interactions.

Limiting intrusion-social control of outsiders in a healing community: an illustration of qualitative comparative analysis.

The analytic scheme of “limiting intrusion” was generated in this study, using research strategies that involved direct contact with subjects under natural living conditions. Data were collected in an experimental treatment community for diagnosed schizophrenics, where conventional psychiatric control structures are muted and denied. Approximately 200 hours of field observation, in-depth interviews with staff members, and documents related to the setting formed the data base. Qualitative comparative analysis is presented in detail to emphasize its relevance to theory building in nursing science.

Wandering in Alzheimer's Dementia Patients

The purpose of this research was to describe wandering behaviors of institutionalized patients with Alzheimers disease in their natural environment. Such descriptive information is necessary before successful product and/or nursing intervention programs can be developed. Videotaped behavioral observations yielded detailed data descriptive of patients with middle and late dementia. These patients have the physical ability to perform various functions, activities, or actions; the individuals mental ability is less supportive of physical ability. The degree of task simplicity required to enable the patient to complete unsupervised tasks depends on the level of dementia. The need for interventions is greatest during unstructured periods of the day.