The Living–Dying Interval in Nursing Home-Based End-of-Life Care: Family Caregivers' Experiences

Guided by concepts from the living–dying interval (Pattison, 1977 Pattison, E. M. 1977. The experience of dying, Englewood Cliffs, NJ: Prentice Hall.  [Google Scholar]) this study sought to explore family members' experiences with a dying nursing home resident. In-depth interviews were conducted with 31 caregivers of residents who had died. Interviews were audiotaped and transcribed. Themes that illuminated families' experiences on the living–dying interval were: an acute medical crisis (trigger events, accumulation of stressors, level of care crisis); the living–dying phase (advance care planning, hospitalization, end-stage decisions); and the terminal phase (beginning of the end, awareness of dying). The results illustrate critical periods for social work intervention with families of dying nursing home residents.     

New methodology: Measuring racial or ethnic disparities in child welfare

Understanding the disparate treatment of African American children in the child welfare system requires consideration of the dynamics at a community level and the state level. Looking across a state allows one to target policies and practices to areas within the state that are most in need. This paper argues for a new method of assessing disparate treatment in child welfare that takes into consideration the racial or ethnic makeup of the community in conjunction with the racial or ethnic makeup across the state. This paper uses decision based enumeration which helps to pinpoint decisions where disparities are the greatest, and helps target decisions that most impact disparate treatment. This paper utilizes a methodology that is both accessible to state and county child welfare administrators and utilizes data that is readily available to child welfare policy makers and administrators. Using data from Illinois to illustrate this methodology, this paper highlights the regions within the state where limited resources may be targeted to address disproportionate representation and disparate treatment in Illinois' child welfare system.     

Confessions of a baseball mom: the impact of youth sports on parents' feelings and behaviors

To explore parents' emotional investment in and behaviors in response to youth sports, the author conducted a mixed-methods investigation to answer four research questions: (1)How do parents feel about their children's participation in organized youth team sports? (2) Which situations trigger which feelings? (3) How do parents' feelings influence their behaviors? (4) What parental characteristics (such as personal histories or demographics) are linked to different feelings and behaviors? The research indicated that many parents' feelings are triggered by their children's sports experiences and that adults must learn how to translate these feelings into productive behaviors.     

Impact on parents of receiving individualized feedback of psychological testing conducted with children as part of a research study

While many researchers accept the principle that participants have a right to receive information learned from their participation in research, there are few studies examining the impact of receiving results on participants. This study was developed to examine the impact on parents of the receipt of individual results of research-based psychological testing of their children. A summary of the child's individual results of standardized measures of language and development was sent by mail with the questionnaire designed to assess the impact of receiving results. Response rate from the mailed questionnaire was 55.6% (n=74/133). Most parents reported the results as helpful and positive. The majority would receive results again. Overall, the sharing of individualized feedback from psychological testing conducted as part of a research study was well accepted by parents. This practice appears ethically permissible with appropriate support options for addressing participant concerns upon receiving the results as well options for clinical follow-up for the child.     

Women's financial planning for retirement: the impact of disruptive life events

Providing care for an aged parent has immediate financial, emotional, psychological, and physical consequences for the primary caregiver. This pilot study of 138 middle aged and older females analyzes the long term financial consequences of providing care to aged relatives for female caregivers. The impact of this disruptive life event (e.g., caring for an aged relative) on retirement planning among middle aged and older adult women was analyzed using quantitative data collected from women residing in the Midwest region of the United States.     

Entry into marriage and parenthood by young men and women: The influence of family background

We investigate the influence of family background on early entry into marriage and parenthood among white, Hispanic, and black men and women ages 14 to 22 in the first (1979) wave of the National Longitudinal Survey of Youth. Family background is highly associated with early entry into marriage for whites of both genders and female Hispanics and also with early entry into parenthood for all groups except black males. Large group differences in family characteristics explain most of the difference between white and Hispanic women in early marriage and parenthood and about half the difference in early parenthood between black and white women but do not explain the observed variations among other race-gender groups.     

Migration and the latino family: The union formation behavior of Puerto Rican women

This study examines the transition to first union among Puerto Rican women. I argue that understanding the behavior of mainland Puerto Ricans requires attention to family patterns in Puerto Rico and to the dynamics of migration between Puerto Rico and the United States. The study therefore is based on pooled data from comparable surveys undertaken in the two settings. These data allow for event history analyses that compare the union formation behavior of migrants with that of nonmigrants, and consider the role of migration in producing the observed union patterns. Multivariate models show that migrants are more likely than nonmigrants to form unions early and to enter informal unions. Additional analyses show that selective migration plays a role in producing this pattern. Overall the findings demonstrate the importance of using data from both origin and destination locales for understanding the behavior of migrant groups.     

How to evacuate a psychiatric hospital: a Hurricane Katrina success story

This article describes the successful evacuation of an entire psychiatric hospital from New Orleans, Louisiana, to Memphis, Tennessee, on a weekend night. The destination site was 400 miles away and buses were used for transport. The evacuation occurred shortly before Hurricane Katrina struck New Orleans and included 73 adult, adolescent, and child acute psychiatric patients. Thirty-five staff members also participated in the evacuation with their families and pets. This report is significant because little is known about how to implement a disaster plan that involves the transport of an entire psychiatric hospital-patients, nurses, physicians, staff, and family members--to another city. The knowledge gained can also benefit psychiatric nurses and their organizations when establishing or modifying their disaster plans.     

Cumulative cohort design for dose-finding

We introduce a new design for dose-finding in the context of toxicity studies for which it is assumed that toxicity increases with dose. The goal is to identify the maximum tolerated dose, which is taken to be the dose associated with a prespecified “target” toxicity rate. The decision to decrease, increase or repeat a dose for the next subject depends on how far an estimated toxicity rate at the current dose is from the target. The size of the window within which the current dose will be repeated is obtained based on the theory of Markov chains as applied to group up-and-down designs. But whereas the treatment allocation rule in Markovian group up-and-down designs is only based on information from the current cohort of subjects, the treatment allocation rule for the proposed design is based on the cumulative information at the current dose. We then consider an extension of this new design for clinical trials in which the subject's outcome is not known immediately. The new design is compared to the continual reassessment method.