Vehicle of Hope: Faith-based Disaster Response

In August 2005, the United States experienced one of the most catastrophic and costly disasters in its history: Hurricane Katrina. Faith-based Organizations (FBOs) made a major contribution to the response and recovery efforts. Whereas the activities and skill sets of FBOs vary, their core missions are very similar: they want to provide hope. As a concept, hope has been purported to be essential for health and well-being, is viewed as multidimensional and a life force, as well as is highly individualized. This mixed methods study used interviews of the phenomenology tradition and the Herth Hope Index.

Adaptation by Elders to New Living Arrangements Following Hospitalization: A Qualitative, Retrospective Analysis

Relocation experience emerged as a major finding from two previous studies that tracked elders in the community after discharge from a transitional unit. This study involved follow-up of 5 elders from the two previous studies who relocated to a variety of new living arrangements. Purposes were (a) to identify how decisions were made to change living arrangements, (b) to describe the process of adaptation to relocation as it evolved over time including challenges and strategies used to address them, and (c) to identify indicators of effective adaptation. A phenomenological approach based on interviews, observations, and comparative analysis was used to capture the insiders' views of these elders. An account of each individual adaptive process was developed. Comparison across cases led to two major themes—sense of place and sense of self—which are proposed as indicators of effective adaptation. Implications of findings for service provision, public policy, and future research are examined.

Elders' and Family Caregivers' Experience of Place at an Assisted Living Center

This study was designed to explore elders' and their family caregivers' collective experience of place within an assisted living center. Using an ethnographic approach, data were collected through participant observation, interviews, and focus groups. This study found key features of the assisted living center that most influenced residents' and family caregivers' phenomenological experience of place. These features included the characteristics, experiences, and meanings that participants attributed to the assisted living center's structure, physical nature, sociocultural nature, and temporal-occupational nature. In this place, occupational forms stood out as important, naturally occurring features of place that, over time, helped characterize the place's temporal-occupational nature. Occupational performance pointed to people's experience of that place.

Effect of an Occupation-Based Cultural Heritage Intervention in Long-Term Geriatric Care: A Two-Group Control Study

OBJECTIVE. We investigated the effectiveness of an occupation-based cultural heritage intervention to facilitate adaptation to relocation into long-term care (LTC) facilities as measured by quality of life, activity engagement, and social participation.

METHOD. We used a quasi-experimental nonequivalent control group design with pre- and posttests. Residents receiving the cultural intervention were compared with residents in a typical activity group. Eight sessions, two per week for 4 wk, were facilitated by certified occupational therapy assistants.

RESULTS. Twenty-nine participants completed the group sessions. Quality-of-life scores improved significantly over time for both groups. Statistically, a greater percentage of time was spent in discretionary than obligatory time, pretest and posttest, with no significant difference between groups.

CONCLUSION. The study demonstrated effectiveness of a structured, occupation-based social group intervention that improved quality of life, an indicator of adaptation. It also provided a description of activity patterns and social participation of LTC residents.

Voices of Elders

Purpose: The aim of this study was to investigate person and environment factors of elders that facilitate adaptation to relocation to long-term care skilled nursing facilities. Results represent findings from Phase 1 of three phases of a 2-year study to develop and test a cultural heritage intervention to improve adaptation to nursing home relocation. Design: Qualitative interviews were conducted with 23 newly admitted Caucasians and African Americans residing in skilled nursing facilities. Findings/Results: Themes that emerged include (a) spirituality, death and dying, and philosophy of life; (b) life experiences with change; (c) cultural heritage; (d) health; (e) ethnicity; (f) social support, family and friends; (g) long-term care facility (LTCF) relationships; (h) LTCF system maintenance; and (i) LTCF support of personal growth. Comparison of African Americans and Caucasians showed more similarities than differences between the groups. Discussion: Implications for research, clinical practice, and cultural heritage interventions for LTCF adaptation are discussed.

The Conceptualisation of Residential Home Environments: Implications for Occupational Therapy

This paper examines the views of staff about the environments of two residential homes: one representative of a homely environment and the other more reminiscent of a hotel. A qualitative study using in-depth semi-structured interviews was conducted with a purposive sample of 21 staff. Emerging themes in the data from the first facility related to kinship, recognition of history, individuality and meaningful relationships in the homely environment. This contrasted with a more conscious awareness of the tone of the second facility, the need for correct behaviours and a bureaucratic organisation in the hotel-like home.

The findings showed that the meanings attached to a residential home and its press for occupational behaviours are shaped by cultural, social and historical experiences. Such meanings are strongly influenced by management, with staff and residents adjusting to expectations as indicated by the social and physical environment. There is very little in the literature that reflects how one should conceptualise a residential home, yet it is the very nature of this perception that is crucial to the development of an atmosphere that indicates expectations for actions – for both staff and residents.

The Language of Caring: Nurse's Aides' Use of Family Metaphors Conveys Affective Care

PURPOSE

Using a conceptual framework from the field of care work and the theory of boundary work, we explore the use of family metaphors by nurse's aides to describe their affective care for nursing home residents. We focus on how nurse's aides can express affective care in spite of experiencing racial abuse.

METHODS

Using the technique of domain analysis, we present a secondary analysis of semistructured interviews with 30 African American and immigrant aides working in three nursing homes about their experience of racism on the job.

RESULTS

Aides used metaphors associated with family, relationships, and attachment to describe their affective care of residents. They expressed the value of their caring by contrasting it with "uncaring" families. Immigrant aides expressed a form of caring culture shock about the uncared-for situation of American elders.

IMPLICATIONS

Through their use of metaphors of family and attachment, these aides define family care as their gold standard of affective care and communicate that they are attempting to provide good care. Aides distinguished caring tasks from affective care in that they applied affective care in an elective way, so that the caring task was the minimum, universal form of care and added affective care created an enriched form of care. They held out informal elder care in their cultures of origin as a model that is superior to the system of formal elder care in which they work. We use the theory of boundary work to explain how these aides provided affective care in the face of racial abuse.