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Background: The disparate health outcomes of African American mothers living with HIV are considerable. Multidimensional approaches are needed to address the complex social and economic conditions of their lives, collectively known as the social determinants of health. Objectives: The purpose of this study was to explore the social determinants of health for African American mothers living with HIV by examining how mothers describe their social location at the intersection of gender, race, and class inequality; HIV-related stigma; and motherhood. How they frame the impact of their social location on their health experiences is explored. Methods: This exploratory study included in-depth, semistructured interviews with 18 African American mothers living with HIV at three time points. We used an intersectional framework and frame analysis to explore the meaning of these constructs for participants. Results: Findings from 48 interviews include a description of the intersecting social determinants functioning as systems of inequality and the heterogeneous social locations. Three frames of social location were used to organize and explain how African American mothers living with HIV may understand their social determinants of health: (a) an emancipatory frame, marked by attempts to transcend the negative social connotations associated with HIV and socially constructed identities of race, gender, and class; (b) a maternal frame, marked by a desire to maintain a positive maternal identity and maternal-child relations; and (c) an internalized frame, marked by an emphasis on the deleterious and stigmatizing effects of HIV, racial, gender, and class inequality. Discussion: The findings offer knowledge about the heterogeneity in how demographically similar individuals frame their social location as well as how the intersections of social determinants influence participant's health experiences. Potential health implications and interventions are suggested for the three frames of social location used to describe intersecting social determinants of health. The study offers an analytic approach for capturing the complexity inherent in intersectional methodologies examining the role of social determinants in producing health inequities. [ABSTRACT FROM AUTHOR]

This qualitative study describes the temporal patterns of fatigue found as part of a larger study designed to elicit a description of the experience and self-management of fatigue for patients on hemodialysis. Two patterns of fatigue were identified. The first pattern, continuous fatigue, was characterized by participants who experienced fatigue at all times, which was their normal, baseline feeling. Within this group, two subgroups were identified The second pattern of fatigue, post-dialysis fatigue only, was characterized by participants who experienced fatigue only after their hemodialysis session. This study is unique because it expands our knowledge about hemodialysis and fatigue by describing the patterns that fatigue follows over time from one hemodialysis session to the next. Insight into these phenomena could help ameliorate fatigue and allow nurses to tailor interventions for patients on hemodialysis. [ABSTRACT FROM AUTHOR]

Abstract: Background: Caregivers of people with dementia describe a wide spectrum of caregiving experiences, from very negative to very positive. Previous research reveals that differences exist, but how or why the experiences differ has not been well addressed. Objective: The purpose of this study was to explore how the experiences of spousal caregivers of people with dementia differ. Methods: This study was a secondary analysis of interviews collected from a longitudinal caregiver skill training intervention for caregivers of those with degenerative diseases (parent study). For the purpose of this analysis, 57 interviews from 21 spousal caregivers of people with dementia in the control group of the parent study were analyzed. The interviews from the parent study were collected at baseline, 6months, and 12months post-enrollment. Results: Three groups of caregivers were identified based on how they described their experience; a negative group, an ambivalent group and a positive group. The negative group described both past and present relationships with their spouse in negative terms. These caregivers expressed no positives in caregiving. Their focus was on their own unmet needs rather than their spouses’ needs. These caregivers reported significant caregiving burden. The ambivalent group reported that the relationship they had with the spouse was lost, but they still described satisfaction in being able to care for the spouse. They described mixed emotions about caregiving and had difficulty accepting that their partners could no longer reciprocate in the relationship. The positive group described both their past and present relationship with the care recipient in loving terms. They focused on aspects of the relationship they still had, rather than what had been lost. They expressed satisfaction with caregiving, were other-focused, and not highly burdened by caregiving. They understood that their partner could not reciprocate, and expected nothing in return. Descriptions of the positive group suggest target areas for caregiver interventions. Conclusion: Spousal caregivers of people with dementia can be encouraged toward more positive caregiving experiences through empathy-building interventions and enhanced understanding and acceptance of changes in the care recipient. [Copyright &y& Elsevier]

Fatigue is a common and debilitating symptom for adult patients with end stage renal disease on hemodialysis, and has been associated with decreased survival and quality of life. Patients on hemodialysis must find ways to manage their fatigue and mitigate its effects on their lives. The purpose of this qualitative descriptive work was to describe the experience and self-management of fatigue in patients on incenter hemodialysis. Several themes were identified, which included the nature of fatigue, management of fatigue, consequences of fatigue, and factors associated with fatigue. This information will be valuable to nephrology nurses as they continue to care for and educate patients on hemodialysis. [ABSTRACT FROM AUTHOR]