Investing in self-care: a midrange theory of self-care grounded in the lived experience of low-income HIV-positive white women.

Little is known about the types of interventions that invite low-income women into partnerships that motivate self-care practices when living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The increasing incidence of HIV infection in low-income women with histories of inattention to self-care calls for nursing theories that address self-care practices. The purpose of this article is to describe a midrange theory developed from grounded theory research and to discuss implications of theoretical construction for future knowledge development. For the 12 women in this study, self-care practices developed over time and through four categories: focusing self, fitting resources, feeling emotions, and finding meaning. The core category, investing in self-care, linked the categories and carried explanatory power for developing midrange theory. Implications for nursing knowledge development through partnerships with low-income women are discussed.

The disconnected self: consequences of abuse in a cohort of low-income white women living with HIV/AIDS.

An infrequently acknowledged social factor influencing the health of low-income women is a history of physical/emotional abuse. In this article I address how abusive relationships influenced women's self-care practices. In this grounded theory study, vulnerability to abuse was established before diagnosis of HIV infection and promoted "lingering images" of a damaged self. The damaged self-images that grew out of abusive relationships provided a barrier to self-care. Data analysis uncovered a core category of disconnection from self-care. Experiences of being cared for, particularly the care of health professionals, offered supportive relationships that encouraged women to care for themselves through self-care practices.

Barriers to self-care in a cohort of low-income white women living with HIV/AIDS.

In this cohort of 12 low-income White women with HIV disease, five conditions at diagnosis emerged as barriers to self-care: (a) health care provider (HCP) failure to mobilize resources, (b) HCP devaluing of women, (c) social devaluing, (d) economic problems, and (e) legal problems. The core category, disconnection from self-care, linked the five barriers. The self-care barriers were shaped by complex intra- and interpersonal relationships. Motivation to engage in self-care was promoted by relationships that valued women's health. Relational dialogue within a partnership provided the model for HCP relationships that encouraged women to build knowledge and skills for self-care. At diagnosis, HCP interactions were critical in the HIV-disease trajectory because HCPs held knowledge and power to mobilize needed resources, as well as the power to offer (or withhold) the caring and compassion that encouraged women to engage in self-care.

Nursing care models increase care quality while reducing costs.

Unique models of care delivery, such as the Nursing Care Partnership model for practice used at the Denver Nursing Project in Human Caring, have demonstrated a reduction in inpatient admissions, mean length of stay, and total charges. This descriptive study identified and described clients' (N = 75) perceptions of care and explored the cost-effectiveness of this model. Findings suggest nursing care partnerships play a key role in reducing healthcare costs by providing services in a more cost-efficient setting and by having an impact on client utilization of services. Savings in potential hospital costs were estimated at $1,590,384 for 1993.