Federal Emergency Management Agency Response in Rural Appalachia: A Tale of Miscommunication, Unrealistic Expectations, and "Hurt, Hurt, Hurt".

In spring of 2012, rural southeastern Kentucky was impacted by torrential storms and flooding that activated federal disaster response through Federal Emergency Management Agency (FEMA). This qualitative research study examines the experience of community members affected by the Kentucky floods of 2012 (N=9) and describes their interactions with FEMA representatives, in their own voice, thereby giving insight into gaps in rural disaster response. The principal investigator spent 6 weeks living in the community and conducted open-ended interviews. Narratives were transcribed verbatim and analyzed using a phenomenological approach.

U.S. Army nurses' reintegration and homecoming experiences after Iraq and Afghanistan.

OBJECTIVE: The aim of this study was to understand U.S. Army nurses' reintegration and homecoming experiences after deployment to Iraq or Afghanistan. METHOD: Employing existential phenomenology and purposive sampling, 22 U.S. Army active duty nurses were recruited from two military posts and participated in single digitally recorded interviews. RESULTS: Five themes emerged: (1) aspects of command support were articulated as "No one cares"; (2) fulfilling requirements for attendance at pre/postdeployment briefings were described as merely "check the blocks"; (3) readjustments from focusing strictly on duty requirements versus multitasking, such as family responsibilities and daily living, led to the "Stress of being home"; (4) nurses stated "They don't understand" when referring to anyone without deployment experience (family, friends, other soldiers); and (5) when referencing deployment experiences, nurses emphasized that, "It just changes you." DISCUSSION: Nurses in this study felt that the current reintegration process was not meeting their needs for a smoother homecoming; new or improved interventions to assist redeploying nurses with the transition to a noncombat environment would be beneficial. Educational programs to help nursing supervisors provide optimal leadership support through all phases of deployment are needed.

"Talk to me--I'm human": the story of a girl, her personhood, and the failures of health care.

Perspectives on the concept of personhood and its relationship to health care delivery are considered in the context of the life of an adolescent with multiple disabilities. One phenomenological interview lasting 3 hours illuminated life-long experiences of suffering, healing, and the quest to be treated as human, as perceived by a 16-year-old girl disfigured by multiple cancer treatments. Age-appropriate development is the ground of her existence, whereas the quality of relationships with care providers and the extent to which they demonstrate regard for her value as a person are figural. Health care providers have often failed to interact with her in ways supporting dignity and growth, treating her with "care" that is antithetical to the aims of their professions. The case has relevance for health care education and practice, challenging professionals to examine their views on personhood and self-care agency, and the ways in which those views impact the care they provide.

Spiritual experiences of parents and caregivers who have children with disabilities or special needs.

Despite the fact that faith has been described as a universal concern, and despite the realization that the presence of social supports is an essential element in successful coping, there has been no systematic examination of the quality of spiritual networks important to families impacted by childhood disability. There is also little understanding of how spirituality in children influences the lived experience of faith in the adults who care for them. Findings reported here come out of a larger existential phenomenology study that examined the lived experience of parents or caregivers who sought to obtain formal religious education for their children with special needs. Participants included 26 parents/caregivers representing 44 children with special needs and 15 different faith traditions. Narratives indicated that many clergy and members of faith communities either devalue or fail to recognize the spiritual lives of disabled children. This lack of recognition was associated with participant disillusionment or crises of faith and a sense of alienation from potential sources of emotional support. In contrast, those participants whose children were welcomed reported feeling sustaining support and strengthened faith. No parent or caregiver perceived nurses as having an awareness of or interest in spirituality within families of children who have special needs.

Androgen replacement in adolescents and young women with hypopituitarism.

The aim of this study was to test the hypothesis that young women with androgen deficiency due to hypopituitarism would benefit from androgen replacement in the form of dehydroepiandrosterone (DHEA). Five young women, age 15.2-23.1 years, with panhypopituitarism were studied in a 12-month double blind placebo-controlled crossover trial of DHEA replacement in a dose 50 mg/day (Belmar Pharmacy, Lakewood, CO). All had growth hormone (GH), thyroid stimulating hormone (TSH), adrenocorticotropic hormone (ACTH) and antidiuretic hormone deficiencies. Gonadotropin deficiency was complete in three and partial in two. The patients were evaluated at baseline, 6 months and 12 months. Serum hormone levels, body composition, lumbar bone mineral density (BMD), exercise capacity and tests of psychological function were performed. DHEA replacement restored serum DHEA levels to normal, 359.8+/-337 ng/dl (12.5+/-11.7 nmol/l). The Life Situation Survey showed significantly better life satisfaction on DHEA than placebo (110 vs 102, p = 0.05). Trends for improved maximal oxygen uptake (VO2), and decreased percent body fat did not reach statistical significance. In conclusion, androgen replacement with DHEA should be considered in young women with panhypopituitarism. Further studies over longer periods in larger groups of patients are necessary to better evaluate the effects of DHEA replacement on BMD, muscle strength and body composition.