Linda Rose

Voices of Strength and Resistance A Contextual and Longitudinal Analysis of Women's Responses to Battering

An ethnically and economically heterogeneous (majority well educated, African American, and poor) urban community sample of women, self-identified as having a serious problem in an intimate relationship, were interviewed three times over 2½ years. The inclusion criteria of battering was repeated physical and/or sexual assault within a context of coercive control. Feminist action research was used, combining interview and measurement instruments. Thematic analysis (coding, clustering, “subsuming particulars into the general,” confirming) was used for a random subset of 31 womens in-depth interviews. The patterns of response identified were complicated and iterative, demonstrating resistance and resourcefulness. A process of achieving nonviolence was identified for most of the participants, although relationship status did not necessarily correspond to abuse status and there was continued violence after leaving the relationship. Identifiable themes included (a) active problem solving, including conscious decisions to “make do” in a relationship and/or subordinate the self; (b) responding to identifiable pivotal events, and (c) a negotiating process first with the self and then, directly and/or indirectly, with the male partner.

Sleep alterations in cancer patients

This multi-institutional sleep study involved two phases aimed at investigating sleep alterations in patients with any stage of breast and lung cancer. The first phase of this study used an 82-item, 20-minute telephone survey to elicit information regarding the impact of sleep disturbances on a convenience sample of 150 patients. Of these patients, 44% reported a sleep problem during the month before the interview. Significant relations included these: report of sleep problems prediagnosis over the past month (x = 5.82; p = 0.02), duration of sleep medication use and frequency of sleep problem (r = 0.58; p = 0.05), age and severity of sleep problems (r = 0.38; p = 0.05), and frequency and severity of the sleep problem over the past month (r = 0.21; p < 0.10). Communication with health care providers occurred in 16.6% of patients reporting a sleep disturbance. The second phase of this study explored the type, frequency, and severity of sleep problems and perceptions of causation, support, and methods of coping with the sleep problem. A qualitative approach to the problem was used in this phase. A one-time telephone interview of 42 patients, derived from a convenience sample, revealed a 45% prevalence of sleep problems a month before the interview. A qualitative analysis of the responses suggested that sleep problems are related to experiences of other symptoms and perceptions of cancer and treatment. Content analysis of the responses identified the following categories: figuring out the reason, seeking help, seeking support and relation to the overall cancer experience.

The role of social support and family relationships in women's responses to battering

For women who are in abusive relationships, social support and close family relationships may be critical to the successful resolution of the abuse. Efforts to enhance battered womens support must be predicated on an understanding of womens perceptions of effective support and the constraints they experience to seeking support. In this paper we present findings from a qualitative analysis of semistructured interviews with 31 women who were in abusive relationships. The women were interviewed three times over two-and-a-half years. Results of the analysis included that women used female friends for support more often than family members, and that women were constrained from seeking support by (a) cultural and societal sanctions against leaving the relationship; (b) a pattern of caution in relating to others or forging new relationships; and (c) forced isolation/seeing self as isolative. Relationships with family members, especially parents, were not consistently seen as useful sources of support.For women who are in abusive relationships, social support and close family relationships may be critical to the successful resolution of the abuse. Efforts to enhance battered womens support must be predicated on an understanding of womens perceptions of effective support and the constraints they experience to seeking support. In this paper we present findings from a qualitative analysis of semistructured interviews with 31 women who were in abusive relationships. The women were interviewed three times over twoand-a-half years. Results of the analysis included that women used female friends for support more often than family members, and that women were constrained from seeking support by (a) cultural and societal sanctions against leaving the relationship; (b) a pattern of caution in relating to others or forging new relationships; and (c) forced isolation/seeing self as isolative. Relationships with family members, especially parents, were not consistently seen as useful sources of support.

Depression, substance use, adherence behaviors, and blood pressure in urban hypertensive Black men

Relationships between depression, alcohol and illicit drug use, adherence behaviors, and blood pressure (BP) were examined in 190 urban hypertensive Black men enrolled in an ongoing hypertension control clinical trial. More than one fourth (27.4%) of the sample scored greater than 16 on the Center for Epidemiological Studies- Depression Scale (CES-D), indicating a high risk of clinical depression. Depression was significantly associated with an increased likelihood of meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for alcohol abuse or dependence (odds ratio = 5.2; 95% confidence interval = 1.897–14.214). The level of depression was significantly correlated with poor medication (r = .301) and poor dietary compliance (r = .164). Both alcohol intake and illicit drug use were significantly correlated with poor dietary compliance (r = .195 and .185, respectively) and smoking (r = .190 and .269, respectively). Although no direct relationship between depression and the level of BP was substantiated by multivariate analysis, findings of descriptive analyses revealed statistically significant associations among depression, substance use, poor adherence, and poor BP outcomes. Given the harsh environment in which a large number of young urban Black men live, the high prevalence of substance abuse might be an attempt to fight off depression. Further in- depth investigation is needed to identify the role of depression and BP control in urban young Blacks in order to construct effective interventions that address their unique needs.

A grounded theory of families responding to mental illness.

Despite decades of research documenting family burden related to mental illness of a relative, little is known about families’ responses over time. A grounded theory study was designed to describe families’ responses to these severe mental illnesses. Twenty-nine participants representing 17 families were interviewed 3 times over 2 years. Interviews were analyzed using constant comparison. Living with ambiguity of mental illness was the central concern. The basic social process was pursuing normalcy and included confronting the ambiguity of mental illness, seeking to control impact of the illness, and seeing possibilities for the future. Goals were managing crises, containing and controlling symptoms, and crafting a notion of “normal.” Strategies were being vigilant, setting limits on patients, invoking logic, dealing with sense of loss, seeing patients’ strengths, and taking on roles. The study revealed that families were profoundly affected by the social contexts of mental illnesses.

African American couples merging strengths to successfully cope with breast cancer

PURPOSE/OBJECTIVES To explore the process of coping with breast cancer among African American women and their spouses. DESIGN Exploratory, qualitative study using grounded theory methods. SETTING Large metropolitan area in the mid-Atlantic United States. SAMPLE 12 African American couples (N = 24). METHODS African American women and their spouses were asked to complete a background data sheet and participate in a face-to-face semistructured interview. Qualitative data were audiotaped and transcribed verbatim. Themes were identified using the constant comparative method. Quantitative data were analyzed with descriptive statistics. MAIN RESEARCH VARIABLES The process of coping with breast cancer among African American couples. FINDINGS The basic social concern was living through and beyond a breast cancer diagnosis. The core variable was merging strengths to cope with and survive a breast cancer diagnosis. Six main categories emerged to describe how African American couples actively worked together to cope with a breast cancer diagnosis: walking together, praying together, seeking together, trusting together, adjusting together, and being together. CONCLUSIONS African American couples described the importance of combining their strengths and working together as a couple to cope with a breast cancer diagnosis. IMPLICATIONS FOR NURSING Nurses must understand the importance of developing culturally sensitive and culturally relevant interventions to assist African American couples with effectively coping with a breast cancer diagnosis. When providing care to African American couples, nurses should incorporate the six categories of walking, praying, seeking, trusting, adjusting, and being together to help couples cope with the various phases of the breast cancer experience.

Gaining control: Family members relate to persons with severe mental illness

Decades of empirical research regarding families of persons with serious mental illnesses has documented the stress and burden associated with the caregiving role. Recent changes in health care delivery have increased responsibilities of family caregivers without appreciably alleviating their stress. The complexities of the caregiving role need to be investigated if effective interventions are to be realized. To date, a critical but understudied area of investigation is the meaning of this experience for family caregivers and how that meaning affects their responses to the caregiving role. The purpose of this interpretive study was to increase understanding of the meaning of caregiving that caregivers derived from ongoing interactions with the ill relative. In-depth interviews were conducted with 15 family caregivers of psychiatric inpatients. Thematic analysis of the textual data revealed that the meaning of caregiving was constituted by the following concerns: finding the essence of the person obscured by the illness, finding a place for self in influencing the illness, and helping the relative to move forward.

EFFECTS OF MENTAL ILLNESS ON FAMILY QUALITY OF LIFE

Worldwide, at least 25% of persons and their families are affected by mental illness resulting in significant stress and burden; yet little is known about how the illness affects quality of family life. In this paper, we report a secondary analysis of a grounded theory study that identified the process by which 17 families managed mental illness over time. Families were characterized as Hanging On, Being Stable, or Doing Well based on their responses to caring for relatives with mental illness. Most of the families perceived themselves as Being Stable or Doing Well and four families perceived themselves as Hanging On. In this paper, these descriptors of family quality of life, interpreted within the context of family development and illness trajectories, are presented as a focus of professional support and intervention.

Impact of intimate partner violence on pregnant women's mental health: mental distress and mental strength

The mental health consequences of living with intimate partner violence (IPV) are substantial. Despite the growing awareness of the incidence of depression and PTSD in women experiencing IPV, few studies have examined prospectively the experience of IPV during pregnancy and the impact of the abuse on womens mental health. As a component of a larger clinical trial of an intervention for pregnant abused women, 27 women participated in a qualitative study of their responses to the abuse in the context of pregnancy and parenting. Results indicate that womens changing perceptions of self was related to mental distress, mental health, or both mental distress and mental health.

A Clinical Academic Practice Partnership: A Clinical Education Redesign

The clinical academic practice partnership (CAPP), a clinical redesign based on the dedicated education unit concept, was developed and implemented by large, private school of nursing in collaboration with 4 clinical partners to provide quality clinical education, to explore new clinical models for the future, and to test an innovative clinical education design. An executive steering committee consisting of nursing leaders and educators from the school of nursing and the clinical institutions was established as the decision-making and planning components, with several collaborative task forces initiated to conduct the work and to accomplish the goals. This article will describe methods to initiate and to organize the key elements of this dedicated education unit-type clinical model, providing examples and an overview of the steps and elements needed as the development proceeded. After 18 months of implementation in 4 different nursing programs in 4 different clinical institutions, the clinical redesign has shown to be a positive initiative, with students actively requesting CAPP units for their clinical experiences. Preliminary findings and outcomes will be discussed, along with nursing education implications for this new clinical redesign.