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Understanding the Lived Experience of Caregivers Whose Spouses have Frontotemporal Dementia
No full textFrontotemporal dementia (FTD) is the most widely occurring type of early onset dementia, with an average age of 57 at the time of diagnosis (Onyike, 2017). Spouses are most often caregivers for persons with chronic illness (Adelman, 2014) yet little is known about the experience of the FTD spouse caregiver (FTDSC), although they have higher levels of burden and distress than Alzheimer’s Disease spouse caregivers (deVugt, et al., 2006). The purpose of this qualitative phenomenological study was to explore the lived experience of FTDSCs, and to find commonalities, if any, that emerged from the data. Thirteen FTDSCs were interviewed, providing approximately 24 hours of recorded oral data. Their spouses were at varying stages of FTD. Symbolic Interaction theory (Blumer, 1969; Bury, 1980) and the tasks of mourning (Worden, 2018) provided a framework for analyzing the data. The results indicate that there are commonalities, including continuously adapting andrenegotiating the spousal relationship (Blumer, 1969), and seeking routine in a deteriorating situation that is disruptive (Bury, 1980) to normal life. A pattern of loss emerged among all of the FTDSCs interviewed: intense frustration and anger with the medical system in the difficulty of getting a diagnosis; shock with a terminal diagnosis for which there is no treatment; grief for a life partner as he or she used to be; loss of a shared way of life and expected future; frustration and desperation related to a lack of appropriate support, respite, and care. The findings also reveal a common pattern of response to these losses. Using Worden’s (2018) tasks of mourning, modified to reflect the loss of someone still physically present: 1) acceptance of the reality of the loss, reflected in the FTDSCs’ continuing adaptation; 2) working through the pain, demonstrated by finding humor, and continued enjoyment, when possible, in the relationship; participation in a support group; seeing a therapist; 3) adjusting to an environment where life is changing; such as realizing that the FTDSC’s own health and future cannot be sacrificed; and 4) preparing for life after caregiving, expressed by these FTDSCs as hopes or plans.Social workIndividual & family studiescaregiver, dementia, disruption, frontotemporal, phenomenological, spouseSocial WorkDegree Awarded: Ph.D. Social Work. The Catholic University of Americ
Motherhood and Power in Middle English Romance
No full textWhile there has been considerable study into the role of women and female agency in medieval romance, there is comparatively little in-depth exploration into mothers, specifically. This may, in part, be because mothers are typically minor characters within a romance, and their importance to the larger text can be easily overlooked. Yet male aristocratic identity is central to romance, and when mothers are featured within a given text, they are often influential to some aspect of masculine identity, making them more important than they might initially appear.The purpose of this dissertation is to explore the complex role of maternal power as it relates to male aristocratic identity across a spectrum of Middle English romance. Chapter One discusses the family romances The King of Tars and Sir Gowther, both of which feature a monstrous birth, demonstrating how mothers in these texts are the ones who initiate the process of undoing their sons’ monstrosity. In Chapter Two, the hagiographic romances Emaré, The Man of Law’s Tale, and The Clerk’s Tale explore the unexpected power found in maternal suffering, which works through the power of pity engendered in those who behold the suffering mother. Chapter Three marks a turning point from positive manifestations of maternal power to negative. In this chapter, I consider The Man of Law’s Tale from the perspective of chronicle romance, examining how the villainous royal mothers attempt to seize kingly authority for their own purposes. Finally, Chapter Four focuses on Le Morte D’Arthur and ungovernable maternal sexuality. In this final chapter, I compare Malory’s treatment of Morgause against his sources to show how Malory has augmented the danger of maternal sexuality to the point where it threatens the chivalric enterprise.This study will demonstrate the complex, nuanced ways maternal power is connected to one of the central concerns of romance, that of male aristocratic identity. Regardless of whether mothers use power in acceptable or unacceptable ways, they have a significant impact on the development, restitution, or denigration of chivalric identity, and they must be considered in order to understand the full picture of the romance in question.Medieval literatureEnglish literatureChaucer, maternal agency, maternity, Middle English romance, motherhood, powerEnglish Language and LiteratureDegree Awarded: Ph.D. English Language and Literature. The Catholic University of Americ
Child Welfare Services: Father Perspectives on Engagement and Identity
No full textFor over half a century, research on father involvement has found positive outcomes for children’s cognitive development, social and emotional development, and physical health when their fathers are highly involved in their lives. Yet, within the child welfare system, fathers are frequently avoided, viewed as “all good” or “all bad,” or overlooked by child welfare workers who are focused on the mother-child dyad. These perspectives and practices persist despite the mounting evidence that father identification and engagement efforts contribute to greater financial support for children in fragile families and lead to more positive reunification outcomes for children. Recent efforts have been made to understand barriers to father engagement in the child welfare system, but there is still limited research focused on fathers’ experiences with child welfare system involvement and the effect it has on their lives. This exploratory, qualitative study examined the experience of father engagement from the perspective of fathers whose children were in foster care. In addition, this study explored the effect of father engagement on fathers’ participation in child welfare decision making processes and the effect of father engagement on father-role identity. Data were collected through semi-structured interviews with four fathers who had child welfare system involvement. Identity theory was the guiding theoretical framework for this study. Interview transcripts were analyzed using Interpretative Phenomenological Analysis to identity common experiences shared by the participants. Three superordinate themes emerged through data analysis: prominence of father identity, disaffection with the child welfare system, and despair. These fathers reported that their father-role identity remains their most important identity despite negative experiences with the child welfare system. These fathers’ negative experiences led to feelings of despair associated with father-role loss, and other feelings of loss, powerlessness, and hopelessness. These findings highlight the need for social workers in child welfare to engage in practice with fathers from the perspective that many fathers value their father-role identity and that it is of significant importance to them. Furthermore, these findings suggest that the child welfare system must do more to increase child welfare workers’ knowledge about the importance of father involvement, and it must also enhance workers’ skills for effectively engaging fathers in all aspects of the system. Finally, these findings emphasize the need to continue exploring child welfare involvement from the perspective of fathers so that the child welfare system can develop services for fathers that are more attuned to their specific needs and interests.Social workchild protective services, child welfare, father engagement, father identity, identity theory, interpretative phenomenological analysisSocial WorkDegree Awarded: Ph.D. Social Work. The Catholic University of Americ
The Impact of Falling and Fear of Falling on Elderly Residing in Homes in Saudi Arabia by Using Grounded Theory
No full textFalls, a global health concern, lead to morbidity and premature mortality in older people. Falls can lead to many health problems, such as poor quality of life. The Saudi population is ageing, so the percentage of elderly individuals is increasing. This study explored how falls, risk and fear of falling among Saudi elderly residing in community dwellings affect their activities of daily living and feelings of wellbeing. A qualitative method design was employed. This study used the grounded theory approach to assess the impact of falling and fear of falling on the activity of daily living and feelings of the wellbeing of this age group. The study used a sample of 20 elderly individuals with a history of falls while living in a home setting in Saudi Arabia who were contacted while attending orthopedic clinics or the emergency room at Prince Sultan Medical Military City in Riyadh, Saudi Arabia. The original four subthemes that were developed from the data were then characterized by the central emergent theme. The following subthemes were developed: causes, immediate impact, losses, and coping. The main theme that emerged from these categories was “A DIFFERENT LIFE.” The study demonstrated that the elderly in Saudi Arabia experience falls for several reasons. The most obvious factors leading to falls were grouped as primary causes, such as physical impediments. However, there is a set of ancillary causes that do not immediately cause the fall but do play a significant role in falls. These include the state of health and fitness, and the lack of awareness of what causes falls. After experiencing a fall, the elderly are faced with immediate impacts, which can be both physical and emotional. The long-term impacts they faced include changes to their daily routine. Predominant among these long-term impacts was an ongoing fear of falling. The totality of these factors led to a diminished quality of life. This, in turn, led to coping strategies to remediate the losses experienced by the falls. Conclusions drawn from this study indicate that the common factor for all the participants was a permanent change to their lives, which led to the name of the theory: “A DIFFERENT LIFE.”NursingActivity of daily living, Elderly, Fall risk, Falling, Fear of falling, Saudi ArabiaNursingDegree Awarded: Ph.D. Nursing. The Catholic University of Americ
An Evaluation of an Extension for Community Healthcare Outcomes (Project ECHO) training for Latino Community Health Workers on Diabetes Self-Management.
No full textType 2 diabetes (DM) accounts for close to 30 million cases in the United States (US) (Centers for Disease Control and Prevention [CDC], 2017). Training the front-line primary care team, including community health workers (CHWs), in chronic disease such as diabetes strengthens health care services in communities. The training model, Project Extension for Community Healthcare Outcome (Project ECHO), provides an innovative distance training platform for CHWs and other providers to improve evidenced-based care for underserved populations facing complex health problems (Arora, et al., 2011). Project ECHO focuses on four components, distinguishing it from other on-line teaching modalities—use of technology, sharing best practices, case-based learning, and tracking data for quality improvement. Yet, systematic evaluation of the ECHO model remains limited and includes evidence gaps in ECHO implementation fidelity and achievement of desired knowledge, efficacy, and behavioral outcomes. Furthermore, cost-effectiveness understanding of ECHO trainings is scant.The purpose of this project was to determine the effectiveness of the ECHO training model for CHW diabetes education for the non-profit Migrant Clinicians Network (MCN). Moore’s framework of evaluation was applied and a mixed-methods design used. Data collection included observation of ECHO session video recordings (n=12), open-ended participant comments after sessions, surveys on participant diabetic knowledge in one cohort (n=6), self-efficacy in two cohorts (n=10, n=7), and training costs. In-depth interviews with key informants (n= 8) and one CHW participant explored barriers and best practices to the ECHO model and to Moore’s Framework. Results demonstrated an average of 89% fidelity to the ECHO model in video sessions, with weak areas including attendance via video camera and lack of patient-led case presentation. Sixty percent of American Diabetes Association standards were covered in one cohort and 77% in the second. Scores on the Diabetes Knowledge Questionnaire (DKQ) increased from 86% to 95%, and both cohorts showed statistically significant improvements in their mean self-efficacy scores (p value <.05). Calculated cost savings were significant when comparing virtual training to in-person training. Key informants and participants provided additional insights to common obstacles including lack of cameras and other IT issues, incentives to encourage participants to present cases. Promising practices to gain more outcome data were discussed. Key informants also addressed the ECHO concept of demonopolization of medical knowledge and how collaborative communities can be constructed virtually to share best practices. Participants valued the low-literacy patient education materials shared, and learned techniques to express empathy and support goal setting for patients. This project identified strengths and weaknesses of MCN’s ECHO model of training for CHWs, and the use of evidence-based guidelines. The evaluation led to clear guidance for improving the MCN’s current model and advice for developing evaluation systems to track both CHW activities and patient and community health outcomes.NursingCommunity Health Workers, Cultural Competence, Diabetes Self Management, Migrant Health, Moore's Framework, Project ECHONursingDegree Awarded: D.N.P. Nursing. The Catholic University of Americ
“Art to Enchant”: Shakespeare’s Player-Dramatists Staging Recognition Scenes
No full textIn the mid and late twentieth century, scholars became fascinated with the way Shakespeare uses theatrical metaphors. The introduction of the term “metatheatre” in the 1960s launched a school of criticism that examines Shakespeare’s plays as self-consciously theatrical. To clarify some of the ambiguity surrounding the term “metatheatre,” this dissertation examines a class of characters I have denominated “player-dramatists.” The player-dramatists are characters who present any fiction intended for an audience inside the play. The dramas of the player-dramatists range from formal plays-within-plays, as in Hamlet, to other kinds of showmanship involving an audience, as in Don Pedro’s loud conversation staged to be overheard by Benedick. In every case, the player-dramatist attempts to hide some part of his or her artifice from the audience within the play. When the “in-play” audience comes to recognize that an artifice has been used, Shakespeare’s player-dramatists use this recognition to accomplish various goals. In the earliest plays, from Comedy of Errors to Much Ado About Nothing, the player-dramatists are largely concerned with changing behaviors in their in-play audience, almost to the point of seeming didactic. In the middle plays, from As You Like It to All’s Well That Ends Well, the player-dramatists use the recognition for a greater variety of ends; occasionally the end is related to audience behavior, but increasingly the player-dramatists use drama for private purposes of their own. Sometimes these player-dramatists overestimate the power of drama and try to use it for ends to which it is not suited. In the Jacobean plays from Measure for Measure to The Tempest the player-dramatists have a much greater impact on their audiences than their predecessors. This impact is related to the way in which the player-dramatists draw their in-play audiences into taking active part in the drama. These player-dramatists become increasingly successful as they move from using drama as a mere tool to shape an audience and begin to treat it as an opportunity for the audience to reshape itself. Although the typical effect of recognition in the late plays is a profound sense of wonder, the latest player-dramatist recognize the limitations as well as the power of drama. I conclude that the study of player-dramatists reveals something of Shakespeare’s understanding of his own drama. Like the player-dramatists, he often beguiles theater audiences into responding to the action of the play in ways that can and should lead to self-recognition, insofar as the audience is willing.English literatureTheateranagnorisis, bisociation, metatheatre, player-dramatist, recognition, ShakespeareEnglish Language and LiteratureDegree Awarded: Ph.D. English Language and Literature. The Catholic University of Americ
POLICING AND POLICE LEGITIMACY IN TIMES OF PROTRACTED CONFLICT
No full textBuilding cooperative relations with the public is necessary for an effective police force. However, establishing the legitimacy needed to motivate willing community cooperation and police empowerment is especially challenging in the world’s most war-torn states – arguably the areas where effective and legitimate police forces are needed the most. Using Kismayo city in Somalia as a typical case of protracted conflict, this dissertation relies on survey and interview data collected by the author in the field to examine public willingness to cooperate with and empower the police from three different perspectives. The first perceptive (Chapter 2) examines the role that perceived militarization of police has on residents’ willingness cooperate with the police in a region that has experienced prolonged warfare. Contrary to the prevailing Western perspective that police militarization is inherently detrimental to public perceptions of the police, results from the logit models suggest that different dimensions of militarization motivate willingness to cooperate with the police while other suppress willingness. The second perspective (Chapter 3) examines how residents conceive of police legitimacy and whether this notion of legitimacy predicts willingness to cooperate with the police. Results of the confirmatory factor analysis suggest that how the public conceive of police legitimacy in an area that has experienced prolonged warfare differs from the dominant measures of legitimacy in the West. A more valid, context-specific measure of legitimacy is developed. This context appropriate measure of legitimacy is positively associated with willingness to cooperate with the police and does so through a community co-production mechanism identified through a mixed methods approach. The third perspective (Chapter 4) compares the relative impact that the normative and instrumental models of policing have on public willingness to empower the police in a context of protracted conflict. Findings from the ordered logit regression model suggest that procedural fairness tied to the normative model has a positive relationship with police empowerment, while the instrumental model does not. Importantly, field interviews suggest that residents’ willingness to ‘co-produce’ security with the police is the causal mechanism driving the observed relationship between procedural fairness and police empowerment.CriminologyPublic policyConflict, Legitimacy, Policing, Procedural FairnessJustice, Law and SocietyDegree Awarded: Ph.D. Justice, Law and Society. American Universit
The Franciscans of the Holy Land: Religion and Politics of the Mediterranean in the Age of Queen Sancia
No full textThis dissertation examines the fourteenth-century foundation of the Franciscan Custody of the Holy Land within the context of broader religious and political phenomena of the late medieval Mediterranean. The thesis both revises previous conceptions of the Franciscans’ establishment in the Levant, which have oversimplified the many challenges the friars faced, and contributes to the study of the Mediterranean by analyzing the friars’ position within the inter-connected religious and political networks of the fourteenth-century sea. Considering the various difficulties the Franciscans confronted both locally in Syria-Palestine and as a result of larger developments, this project argues that, in the their commitment to maintain a physical and territorial establishment in and around Jerusalem, the friars demonstrated a willingness and ability to contend with the driving Mediterranean forces of their day. Specifically, this dissertation examines the challenges posed by: repeated outbreaks of persecution in Syria-Palestine, perceived problematic interactions between Latin pilgrims and Eastern Christians, the place of the Custody as a dhimmī foundation in the politically unstable Mamluk Empire, papal preoccupations with combatting heresy and upholding crusading ideals, and the Aragonese-Angevin contest for power and prestige. Approaching each of these topics in separate chapters through the study of different sets of documents—pilgrimage accounts, Mamluk decrees and deeds of purchase, papal bulls, and royal embassies—this project demonstrates that, contrary to traditional interpretations, the establishment and maintenance of the friars’ fourteenth-century foundation did not come about with ease through the cooperative support of numerous great Mediterranean powers. Rather, the Franciscans’ continued presence in the Holy Land necessitated their deliberate commitment to retain a territorial hold on the holy sites in the face of numerous challenges. In short, viewed from the wider perspective of the religious and political realities of the late medieval Mediterranean, the history of the Custody is not one of triumph but rather struggle and determination.Medieval historyFranciscan CustodyHistoryDegree Awarded: Ph.D. History. The Catholic University of Americ
Antonious Bui Interview, May 14, 2020
No full textArtist Antonious Bui, a fellow at the Fine Arts Work Center in Provincetown, MA discusses the impact of COVID-19. Antonious shares how, as a cultural worker, there have been a number of postponements and cancellations that have impacted the ability of fellows at the Fine Arts Work Center to work collaboratively in person. Antonious discusses how the pandemic presented an opportunity to critique institutions and demand a more equitable future, thanking the Fine Arts Work Center for responding to demands for stipend and stay increases. Antonious talks about how family, loved ones, and other artists have provided invaluable support, and also shares how it's been inspiring to see how the pandemic can provide a model for collective movement on other issues like the climate crisis. Antonious ends by hoping that we see how our "normal" is unsustainable, as it only serves the richest and most privileged. We need to recognize that we are not all equal, and that we all need to continue to pay attention to understand that collective movement -- and art -- is more important than ever. This video is part of the Humanities Truck's From Me To You: A Covid-19 Oral History Project. https://humanitiestruck.com/frommetoyou
Kerrie Cotten Williams Interview, May 15, 2020
No full textKerrie Cotten Williams reflects upon how COVID has impacted her. She works for the DC Public Library, but lives in Baltimore, and discusses that she has not taken public transit for many weeks. She rarely leaves the house, and has started using grocery delivery systems for safety. Kerrie shares how she had a cousin die of COVID-19, and the deep personal effect it had on her and her family who could not attend the funeral. In the difficulty, she has learned to appreciate her home and the support of her wife, neighbors, and community. She shares how porch meetings with her neighbors in Baltimore have led to closer interactions with her community and have allowed her to connect with people in a deeper, more authentic way. This video is part of the Humanities Truck's From Me To You: A Covid-19 Oral History Project. https://humanitiestruck.com/frommetoyou