Life after stroke in Appalachia

Objective The purpose of this study was to describe the structure of meaning in the experience of surviving stroke for adults living in Appalachia. Methods This qualitative phenomenological study includes a sample of 6 adult survivors of ischemic stroke who were discharged from either a community or university hospital to home in the Appalachian region. Data was collected through semi-structured interviews, transcribed, and analyzed thematically by two investigators. The explicated themes were verified by the survivors as representative of their experience. Results Five main themes emerged: 1) Frustration with new physical and functional impairment, 2) Negative emotions including anger, guilt, loneliness, and depression 3) Need for accessible support, 4) Longing for home during recovery and, 5) Stepping forward after stroke which included sub-themes of perseverance, acceptance, and retraining. Anger was described as contributing to delayed recover and emotional lability was described as a source of anger. The familiarity of home was viewed as key to reestablishing control over one\u27s life. Survivors described how they developed perseverance to move forward and emphasized that willingness to participate in retraining led to adapting to impairments. Acceptance was described as letting go of prior expectations of self and others so one could live in the present

The Benefits and Risks of Telling and Listening to Stories of Difficulty Over Time: Experimentally Testing the Expressive Writing Paradigm in the Context of Interpersonal Communication Between Friends

The overarching goal of the current study was to determine the impact of talking interpersonally over time on emerging adults’ individual and relational health. Using an expressive writing study design (see Frattaroli, 2006), we assessed the degree to which psychological health improved over time for college students who told and listened to stories about friends’ current difficulties in comparison with tellers in control conditions. We also investigated the effects on tellers’ and listeners’ perceptions of each other’s communication competence, communicated perspective taking, and the degree to which each threatened the other’s face during the interaction over time to better understand the interpersonal communication complexities associated with talking about difficulty over time. After completing prestudy questionnaires, 49 friend pairs engaged in three interpersonal interactions over the course of 1 week wherein one talked about and one listened to a story of difficulty (treatment) or daily events (control). All participants completed a poststudy questionnaire 3 weeks later. Tellers’ negative affect decreased over time for participants exposed to the treatment group, although life satisfaction increased and positive affect decreased across time for participants regardless of condition. Perceptions of friends’ communication abilities decreased significantly over time for tellers. The current study contributes to the literature on expressive writing and social support by shedding light on the interpersonal implications of talking about difficulty, the often over looked effects of disclosure on listeners, and the health effects of talking about problems on college students’ health

The Benefits and Risks of Telling and Listening to Stories of Difficulty Over Time: Experimentally Testing the Expressive Writing Paradigm in the Context of Interpersonal Communication Between Friends

The overarching goal of the current study was to determine the impact of talking interpersonally over time on emerging adults’ individual and relational health. Using an expressive writing study design (see Frattaroli, 2006), we assessed the degree to which psychological health improved over time for college students who told and listened to stories about friends’ current difficulties in comparison with tellers in control conditions. We also investigated the effects on tellers’ and listeners’ perceptions of each other’s communication competence, communicated perspective taking, and the degree to which each threatened the other’s face during the interaction over time to better understand the interpersonal communication complexities associated with talking about difficulty over time. After completing prestudy questionnaires, 49 friend pairs engaged in three interpersonal interactions over the course of 1 week wherein one talked about and one listened to a story of difficulty (treatment) or daily events (control). All participants completed a poststudy questionnaire 3 weeks later. Tellers’ negative affect decreased over time for participants exposed to the treatment group, although life satisfaction increased and positive affect decreased across time for participants regardless of condition. Perceptions of friends’ communication abilities decreased significantly over time for tellers. The current study contributes to the literature on expressive writing and social support by shedding light on the interpersonal implications of talking about difficulty, the often over looked effects of disclosure on listeners, and the health effects of talking about problems on college students’ health

Capturing complexity: developing an integrated approach to analysing HRM in SMEs

This article presents a framework to evaluate HRM in small and medium-sized enterprises (SMEs), using an open systems theoretical perspective. In presenting an open systems perspective the objective is to overcome the limitations of existing theorising in HRM, in particular to facilitate a move away from the ‘small is beautiful’ versus ‘bleak house’ stereotypes evident in much of the literature concerned with HRM in SMEs. The evidence is drawn from six SMEs operating in the Republic of Ireland, using a case study method. The findings show that a complex interplay of external structural factors and internal dynamics shaped HRM in each of the companies. HRM was not the coherent set of practices typically identified in the literature but rather was often informal and emergent. It is argued that the open systems theoretical framework enables a move beyond mere recognition of the complexity and heterogeneity of HRM in SMEs, towards an understanding, accommodation and explanation of particularistic factors

‘Looking after country two-ways’: Insights into Indigenous community-based conservation from the Southern Tanami

This paper offers insights and practical lessons for a ‘two-way’ approach to combining Indigenous and non-Indigenous ecological knowledge in environmental planning and management. It is based on the experience of developing an Indigenous Protected Area to conserve 10 million hectares of biologically and culturally significant land in the Southern Tanami region of Central Australi

Communicated perspective-taking (CPT) and storylistening: Testing the impact of CPT in the context of friends telling stories of difficulty

Grounded in communicated narrative sense-making theory (CNSM), the purpose of the current study was to test the effects of storylisteners’ communicated perspective taking (CPT) on storytellers’ well-being and evaluations of storylisteners’ communication skills in the context of telling stories about difficulty. Pairs of friends (n = 37) engaged in a storytelling interaction in which one person told a story of a difficult life experience (DLE). Listeners’ CPT was rated by observers using the Communicated Perspective-Taking Rating System (CPTRS) and tellers reported on listeners’ behaviors and their own psychosocial health. Results indicate that observed CPT relates positively to tellers’ perceptions of listeners’ communication competence and CPT, and negatively to listeners’ perceived face threat. Particularly important were the identity validation, agreement, and affective tone dimensions of the CPTRS. The links between observed CPT and communication skills were moderated by the degree to which the DLE was considered upsetting, significant, and based on how often the DLE story had been told. Despite previous research, observed CPT was not related to psychosocial health in the current study

Communicated perspective-taking (CPT) and storylistening: Testing the impact of CPT in the context of friends telling stories of difficulty

Grounded in communicated narrative sense-making theory (CNSM), the purpose of the current study was to test the effects of storylisteners’ communicated perspective taking (CPT) on storytellers’ well-being and evaluations of storylisteners’ communication skills in the context of telling stories about difficulty. Pairs of friends (n = 37) engaged in a storytelling interaction in which one person told a story of a difficult life experience (DLE). Listeners’ CPT was rated by observers using the Communicated Perspective-Taking Rating System (CPTRS) and tellers reported on listeners’ behaviors and their own psychosocial health. Results indicate that observed CPT relates positively to tellers’ perceptions of listeners’ communication competence and CPT, and negatively to listeners’ perceived face threat. Particularly important were the identity validation, agreement, and affective tone dimensions of the CPTRS. The links between observed CPT and communication skills were moderated by the degree to which the DLE was considered upsetting, significant, and based on how often the DLE story had been told. Despite previous research, observed CPT was not related to psychosocial health in the current study

Examining out-of-pocket expenditures on reproductive and sexual health among the urban population of Nepal

Poor health is unpredictable and, in circumstances where a significant fraction of the household expenditure is required for purchasing health care, can have disruptive impact on household budgets and an impoverishing effect on living standards. This article provides an account of a recently-completed representative cross-sectional survey on out-of-pocket costs for reproductive and sexual health (RSH) care in urban Nepal. The study, which is the first of its kind, was conducted in nine towns of Nepal covering about 50% of the total urban population of the country. The survey used a two-stage cluster sample design and face-to-face structured interviews were carried out with 1,669 respondents from 992 households. Overall, 1.1% of total annual household expenditure was spent on RSH excluding HIV/AIDS care and 2.9% was directed towards costs associated with HIV/AIDS care. The costs related to emergency obstetric care were the highest; 9% of the total health care expenditure went on the payments for obstetric care alone. The distribution of out-of pocket expenditure by the major components of RSH care services shows that almost half of all out-of-pocket payments were spent on maternal care (46%), followed by STIs (27%) and RTIs (13%) respectively. Out-of-pocket expenditure on family planning and related care was modest, accounting for about 7% of overall RSH spending. This is attributed to the supply of contraceptives and related services free-of-charge mainly from public facilities. A high share of out-of-pocket expenditure to total health financing is considered as a major concern in any health financing system, and in Nepal this can be seen as a major impediment to achieving poverty reduction and the Millennium Development Goals