The experiences of place: Veterans with dementia making meaning of their environments
Little research has examined how older veterans view the long-term care facility as place and how they make meaning of their experiences within specific places. This study examined seven older veterans’ meanings of place within the cognitive support unit of a veteran's hospital and in a summer camp setting. In the facility, the environment was interpreted as restrictive. At camp, the environment was interpreted as freeing. Each of the environments was experienced within the horizons of meaning of residents’ lives [Gubrium, J.F., 1993. Speaking of Life: Horizons of Meaning for Nursing Home Residents. Aldine de Gruyter, Hawthorne, NY.]. What was evident here was that the experiences in both places, both in the moment and through horizons of meaning, contributed to how residents created a sense of place in these two distinct environments.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.