Stressors, mediators, and health care outcomes of home enteral nutrition in family caregivers and their older adult care recipients

Family caregivers manage home enteral nutrition (HEN) for over 77% of an estimated 1 of every 400 Medicare recipients. Increasing usage of HEN in older adults combined with reliance on family caregivers raises concerns for the quality, outcomes, and costs of care. These concerns are relevant in light of Medicare limitations on nursing assistance and non-reimbursement for nutrition services, despite annual costs of over $600 million. This study applied stress process theories to assess stressor, mediator, and outcome variables salient to HEN and caregiving. In-home structured interviews occurred with a multi-ethnic sample of 30 caregiving dyads at 1–3 months after discharge on HEN. Care recipients were aged ≥60 (M = 68.4 years) and did not have dementia. Caregivers were aged ≥21, unpaid, and lived within 45 minutes of care recipients. Caregivers performed an average of 19.7 tasks daily for 61.9 hours weekly. Training needs were identified for 33 functional, care management, technical, and nutritional tasks. Preparedness scores were low (M = 1.73/4.0), and positively correlated with competence, self-rated quality of care and positive feelings, and negatively with overload, role captivity, and negative feelings (Ps < .05). Caregivers had multiple changes in lifestyle and dietary behaviors. Lifestyle changes positively correlated with overload, and negatively with preparedness and positive feelings. Dietary changes positively correlated with number of tasks, overload, role captivity and negative feelings, and negatively with preparedness (Ps < .01). Fifty-seven percent of caregivers aged >50 were at nutrition risk. Care recipients fared worse. Average weight change was −4.35 pounds (P < .001). Physical complications interrupted daily enteral infusions. Water intake was half of fluid need and associated with signs of dehydration (P < .001). Physical and social function was poor, with older subjects more impaired ( P < .04). Those with better prepared or less overloaded caregivers had higher functionality and QOL (P < .002). Complications, type of feeding tube, and caregiver preparedness correlated with frequency of health care utilization (Ps < .05). Efficacy of HEN in older adults requires specialized caregiver training, attention to caregivers' needs, and frequent monitoring from a highly skilled multidisciplinary team including dietitians. ^

Once a Catholic : a novel in stories and poems

"Once A Catholic" is a novel about the indelible effects of growing up Catholic. The novel is told in a series of stories and poems. The first story, "Credo," offers an overview of the rich culture of Catholicism that binds the Daley family together. "Before The Fall" recalls the safety and warmth of that Catholic faith. Subsequent stories focus on individual family members and events, and the Catholicity that lies at their core. "Holy Orders" tells the story the firstborn male child whose destination is the priesthood. "Finding Ecstasy" is a daughter's story of rebellion through sexual exploration. "Sweet Reconciliation" is the story of a search within oneself for forgiveness, the cornerstone of Catholic upbringing. "Acts of the Apostle" demonstrates the hopelessness of a faith under attack. The final story, "Holy Relics," demonstrates the never-ending desire for redemption and the important act of returning sacredness to its rightful place.

Stephen Dedalus' Search for Identity in Catholic Ireland

The purpose of my research was to explore the interplay between religion and art in James Joyce’s novel, A PORTRAIT OF THE ARTIST AS A YOUNG MAN. My aim was to trace the development of the protagonist, Stephen Dedalus by analyzing how Catholicsim is an institution that forms him, yet must reject to realize his artistic potential. I researched Joyce’s background to gain an understanding of the exilic experience on the literature. Through the exilic lens, I realized that Catholicism was the predominant influence on Stephen’s need to embark on a self-imposed exile at the end of the novel. Complicating his decision is the fact that he does not stop believing in religious constructs such as heaven and hell. In conclusion I found by following his artistic longing, and turning away from the church he is committing a sin and, as a result, damning his soul.