Sally A. Hutchinson

Double Binds and the Reproductive and Mothering Experiences of HIV-Positive Women

In spite of the increasing number of young women infected with HIV in the United States, little is known about the reproductive and mothering experiences of these women. The purpose of the grounded-theory research discussed in this article was to describe the reproductive and mothering experiences of HIV-positive women. Twenty HIV-positive women participated in 31 in-depth interviews. The grounded-theory method was used for data analysis. A communication pattern known in the psychiatric literature as a double bind was discovered to be a basic social psychological problem that affected the women’s experiences with reproduction and mothering. An understanding of the power and influence of these double binds permits health care professionals to plan patient-centered programs and to individualize care specifically for HIV-positive women.

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.

Defensive Mothering in HIV-Positive Mothers

The grounded theory study discussed in this article provides an explanatory schema that illuminates the mothering experiences of women living with HIV infection. Eighteen HIV-positive mothers provided 24 in-depth interviews. The grounded theory method was used for data analysis. Defensive mothering was the basic social psychological process that these HIV-positive mothers used in response to their diagnosis and the inherent stigma. Their defensive posture afforded these mothers and their children some degree of psychological protection. Defensive mothering involved much mental work and included three subprocesses: preventing the spread of HIV, preparing the children for a motherless future, and protecting themselves through thought control.

From Theory to Practice: The Development of Assessment Guides from Qualitatively Derived Theory

In this article, a method of using qualitative research findings to develop a patient assessment guide is described. Qualitatively derived theory is deconstructed to form the theoretical components of the guide. Nursing assessment questions and behavioral signs are then elicited from the theory. Intervention strategies are extrapolated both from theory and from clinical nursing knowledge. Finally, the assessment guide is implemented and evaluated using techniques of qualitative outcome analysis to modify the guide and expand the repertoire of intervention strategies. This process is illustrated using two projects: hope (from concept analysis) and living with bipolar disorders (from grounded theory). Assessment guides provide a method for directly applying qualitative research to practice and constitute a valid and useful means of patient assessment and intervention.

Interviewing Young Men about Sex and Procreation: Methodological Issues

Because clear instructions for interviewing men about their developing procreative identities do not exist, the authors discuss a variety of methodological issues that surfaced during in-depth interviews with young men about relationships, sex, contraception, pregnancy, and fatherhood. The authors interviewed a diverse sample of 50 single male participants, ages 16 to 30, who had dated at least one woman in the past 3 years (or had been married). The purpose of the reflexive analysis was to sensitize researchers, social service providers, and the authors to the challenges of conducting qualitative interviews with young men. The authors present indices for assessing interview success.

Low-Income African American Adolescents who Avoid Pregnancy: Tough Girls who Rewrite Negative Scripts

The purpose of this research was to generate a grounded theory that explains the social-psychological processes of low-income African American adolescents who avoided pregnancy. Data collection included focus groups and in-depth interviews with 17 women aged 19 to 26. Data analysis using the grounded theory method revealed that these girls were the recipients of negative social-psychological scripts, putting them at risk for poverty and early childbearing. The “tough girls” struggled to rewrite these scripts by recognizing their negativity, being disenchanted with the scripts, determining to be different, and creating better lives. These aware, introspective young women believed in self-responsibility, self-protection, education, and financial independence. Practice implications and considerations for programmatic interventions can be based on this analysis.

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.

Healing from incest: resurrecting the buried self.

Writers on the incest experience estimate conservatively that 10% to 30% of all girls and 30% of all boys have had at least one childhood experience of incest. Incest is emotionally devastating to a child as it involves betrayal, and the irretrievable loss of trust in the adults in the childs life. Little is written about the healing processes of incest survivors. The purpose of this study was to generate a substantive grounded theory that provides an explanatory schema for understanding the healing process of adult female incest survivors. The sample consisted of 10 adult women who had a history of incest and who volunteered to participate in in-depth interviews. Data were analyzed using grounded theory techniques. Data analysis revealed that these women had buried an integral part of the self because of the trauma of incest; The healing process required resurrecting the buried self through a series of seven phases. The model generated from this research provides a heuristic for nurse therapists that assists in assessing and counseling incest survivors.

Warnings about Vulnerability in Clients with Diabetes and Hypertension

The purpose of the grounded theory study discussed in this article was to discover and explicate the basic social problem in clients with diabetes and hypertension that affects their adherence to health care directives. In-depth interviews with 21 clients with both diabetes and hypertension and 3 health care providers who care for such clients were concurrently conducted, coded, and analyzed according to the grounded theory method. Clients with diabetes and hypertension described being bombarded repeatedly with warnings about their vulnerability. The warnings were both external (coming from health care providers, family, and friends) and internal (coming from within themselves). Internal warnings were discovered to be far more influential in affecting adherence. This discovery can be used to shape health care provider’s social interactions and treatment plan strategies with clients with diabetes and hypertension.