Long-term community reintegration: concepts, outcomes and dilemmas in the case of a military service member with a spinal cord injury.

PURPOSE: Despite growing knowledge about medical and functional recovery in clinical settings, the long-term issue of community reintegration with a spinal cord injury (SCI) in the military context remains virtually unexamined. Thus, the U.S. Department of Defense created the SCI Qualitative Research Program to advance knowledge about service members' reintegration into civilian life. The purpose of this paper is to better characterize the long-term outcomes related to the community participation experienced and desired vis-à-vis a case study of a military veteran who suffered a service-related traumatic SCI. METHODS: An in-depth anthropological interview was used with Jake, a 28-year old marine with a service-related C5/C6 SCI. Data were analyzed using content analysis. FINDINGS: Three significant themes were identified: opportunities for better engaging socially meaningful others may not be adequately included in so-called "client-centered" interventions; how management of the social self in inter-personal interactions and public spaces is critical to gaining broader societal acceptance; and how meaningful age normative relationships and activities are essential to establish lasting inclusive social connections. CONCLUSIONS: Jake's case challenges existing models of rehabilitation predominantly focused on physical capacity building. Study findings point to the need for rehabilitation to invest more resources in efforts to address the existential and social elements of long-term social reintegration. Implications for Rehabilitation Both the veteran with SCI and their meaningful support network face challenges socially reintegrating after injury and rehabilitation. Empowering clients to envision future possibilities in terms of family, intimate relationships, and meaningful work are important to successful long-term social reintegration. Addressing the existential desires and social capacities of the individual may be as important as addressing physical functioning skills after SCI.

Refashioning One's Place in Time: Stories of Household Downsizing in Later Life.

Older adults face a daunting task: while continuing engagements in multiple relationships, investment in their own and others' futures, and developing life interests and capacities, they also reexamine and sometimes reconfigure the place where their social lives and objects are housed. Some relocate, downsize, to a new smaller place and reducing possessions to ensure an environment supportive of their capacities and desired daily activities. This article examines how key contours of the experiences of place during residential downsizing are infused with unexpectedly heightened awareness and cultivation of one's sense of place in multiple timeframes. In a discovery mode, the downsizing stories of 40 older adults in southeast Michigan are examined. Findings indicate conflicting temporalities and the natures of cognitions related to decision-making and thinking about being leave-taking and being in place. Findings also highlight in particular how making sense of one's place is predicated on notions of its time, of being on time and downsizing on time. Further, these characterizations of the lived worlds of older adults' modes of conceptualizing the nature of downsizing show how an understanding of the meaningfulness of place in later life relocations requires a layered sense of home as places-in multiple timelines.

Organizational climate determinants of resident safety culture in nursing homes.

PURPOSE OF THE STUDY: In recent years, there has been an increasing focus on the role of safety culture in preventing costly adverse events, such as medication errors and falls, among nursing home residents. However, little is known regarding critical organizational determinants of a positive safety culture in nursing homes. The aim of this study was to identify organizational climate predictors of specific aspects of the staff-rated resident safety culture (RSC) in a sample of nursing homes. DESIGN AND METHODS: Staff at 4 Michigan nursing homes responded to a self-administered questionnaire measuring organizational climate and RSC. Multiple regression analyses were used to identify organizational climate factors that predicted the safety culture dimensions nonpunitive response to mistakes, communication about incidents, and compliance with procedures. RESULTS: The organizational climate factors efficiency and work climate predicted nonpunitive response to mistakes (p < .001 for both scales) and compliance with procedures (p < .05 and p < .001 respectively). Work stress was an inverse predictor of compliance with procedures (p < .05). Goal clarity was the only significant predictor of communication about incidents (p < .05). IMPLICATIONS: Efficiency, work climate, work stress, and goal clarity are all malleable organizational factors that could feasibly be the focus of interventions to improve RSC. Future studies will examine whether these results can be replicated with larger samples.

Self-rated health appraisal as cultural and identity process: African American elders' health and evaluative rationales.

PURPOSE: We explored self-rated health by using a meaning-centered theoretical foundation. Self-appraisals, such as self-rated health, reflect a cultural process of identity formation, whereby identities are multiple, simultaneously individual and collective, and produced by specific historical formations. Anthropological research in Philadelphia determined (a) how African American elders appraise their health, and (b) how health evaluations reflect cultural and historical experiences within a community. DESIGN AND METHODS: We interviewed and observed 35 adults aged 65 to 80, stratified by gender and self-rated health. We validated theme analysis of focused interview questions against the larger data set of field notes and transcripts. RESULTS: Health appraisal reflected a complex process of adaptation and identity. Criteria for health included: independent functioning, physical condition, control and responsibility for health, and overall feeling. Evaluative rationales that shaped health appraisals were comparisons, restricted possibilities for self-evaluation, and ways of handling adversity. Evaluative rationales mitigated undesirable health identities (including low self-reported health) and provided mechanisms for claiming desired health identities despite adversity. IMPLICATIONS: Describing the criteria and evaluative rationales underlying self-appraisals of health extends current understandings of self-rated health and illustrates the sociohistorical context of individual assessments of well-being.

Cross-cultural perspectives on the concept of retirement: an analytic redefinition.

A cross-cultural valid analytic definition of retirement remains elusive in gerontology despite a long tradition of research on the topic. Inadequate attention has been paid to consistently defining the key concepts used to examine retirement and to specifying its occurrence in non-Western, non-industrial societies. This paper critically reviews basic cultural tenets in the notion of retirement, and proposes a more comparatively valid definition. It then proposes a three part comparative categorization by exploring retirement in contemporary Western nations and comparing it with retirement-like practices from a range of non-Western cultures including Thai, Chinese, Ladak, Fulani, Lusi and Aymara.

Sampling in Qualitative Research: Rationale, Issues, and Methods.

In gerontology the most recognized and elaborate discourse about sampling is generally thought to be in quantitative research associated with survey research and medical research. But sampling has long been a central concern in the social and humanistic inquiry, albeit in a different guise suited to the different goals. There is a need for more explicit discussion of qualitative sampling issues. This article will outline the guiding principles and rationales, features, and practices of sampling in qualitative research. It then describes common questions about sampling in qualitative research. In conclusion it proposes the concept of qualitative clarity as a set of principles (analogous to statistical power) to guide assessments of qualitative sampling in a particular study or proposal.

The Retirement process: Making the Person and Cultural Meanings malleable.

In research on life-course transitions, the dynamics of reorganizing meanings and lives were examined in interviews with 32 retiring workers in the United States. New retirees engaged in reorganization of self and social identity by work in special projects involving physical labor to demolish and rebuild backyards and household interiors. Findings indicate that the work in these projects conjoins the reshaping of subjective experience and social life. The projects express a behavioral narrative of the transition in that the spatial sequence of activities (moving from households to the community) parallels the temporal order of reorganization (from self to social identity). Individuals invent and recapitulate partially formed symbols (i.e., dirt, birth, and death) and prior life events to develop new self-images and social lives. These metaphors and processes of separation and death foster creativity and reintegration and must be viewed as integral to transition rather than interpreted as phenomena to be avoided as they are in gerontology and medical practice. Transitions need to be understood as situated within individual histories and cultural contexts.

THE CULTURAL ADVERSITY OF PHYSICAL DISABILITY: Erosion of Full Adult Personhood.

Adversities facing people with disabilities include barriers to meeting daily needs and to social life. Yet, too, fundamental social devaluation erodes an individual's capacity to retain title to the cultural category of a full person. These cultural adversities are important components in the disablement process. The cultural meanings for physical dependency convey images of childlike, dependent, incomplete persons near death. Using interviews with middle aged and elderly polio survivors, the author identifies key cultural categories, the expectations and values linked with disability and describe the strategies people use to confront, or not, the erosion of personhood. The importance of understanding the category of the person, its historical setting, and evolution are highlighted. Finally, the inversion of traditional cultural logics for defining the personhood of individuals with disabilities is illustrated.

Alchemists' Visions: Cultural Norms in Eliciting and Analyzing Life History Narratives.

Comparative study within a group of systematically elicited life narratives revealed key variations in narrative sequencing and conceptual templates. These dimensions are associated with significant differences in subjective meaning, frames for interpreting experience, and personal adjustment. This paper describes the study methods and results, and proposes that life histories be studied in the context of other similarly collected narratives, instead of one at a time. It outlines limitations of current methods of eliciting, analyzing, and writing up texts which may systematically obscure important dimensions of subjectivity and of cultural norms.