The complex health, socioeconomic, and environmental problems experienced by many American elders often place them at high risk for disease and disability. Over time, acutely or chronically ill older persons experience numerous transitions across various health care settings. Although availability of health services is improving in rural areas, barriers such as distance, geography, and poor distribution often limit access to health care. In a longitudinal rural ethnography, the health care transition experiences of older adults, families, and health care providers were examined. A major ethnographic theme emerged from analysis data from interviews, participant observations, and photographs: the crisis nature of health care transitions experienced by rural older adults and their families and observed by rural nurses and other health care providers. Several patterns were observed including the crisis was compounded by surprise; limited knowledge of local resources exacerbated the crisis; inconsistent discharge planning disrupted transitions; changing family support necessitated admission to nursing homes; continuity of care in nursing home discharge lessened transition crisis; and rural home health care was identified as a strength. Recommendations were made for community-based interventions to improve the transition experience. Comprehensive care management services provided by public health nurses (PHNs) in the local rural community were recommended.

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Health and spiritual phenomena are viewed differently depending on the cultural perspective. This study describes spirituality as perceived and experienced by older Thai persons. Specific aims were to describe how spirituality helped older Thai persons maintain their health and to describe what they valued most as they aged. A qualitative, descriptive study informed by ethnographic methods was utilized. The sample included 9 older Thai persons from an urban U.S. community. Data were generated using ethnographic interviews and participant observation. Data analysis incorporated coding, categorizing, and theme development. Rigor was guided by Lincoln and Guba. Five major themes emerged from the data: Connecting with spiritual resources provided comfort and peace, finding harmony through a healthy mind and body, living a valuable life, valuing tranquil relationships with family and friends, and experiencing meaning and confidence in death. For these Thai participants, health and spirituality coexisted and were linked to all of life.

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The use of photography is described as a method embedded within an ethnographic investigation of rural home care for older adults. Photography fostered data generation, elicited participants' stories, and illustrated patterns of rural aging. Analysis of photographic data pooled with interview and observational data facilitated an in-depth understanding of rural aging and home health care.

Rural community and public health nursing are characterized by an impressive commitment of nurses to their communities and a connectedness of people to one another. Home care as an integral part of long-term and acute care for the older adult population has emerged as a vital practice area in community health nursing. The purpose of this ethnographic field study was to describe rural home care for frail older adults from the perspective of those providing and receiving care. More than 250 interviews were conducted with home care providers, recipients and their families, and other community members. The setting included eight culturally and geographically diverse counties in rural Colorado. One major theme is presented: the perceived change in the spirit of rural community nursing due to the overwhelming documentation required for home care reimbursement. Oppressive paperwork requirements impeded practice and resulted in fewer home visits per day, low job satisfaction, increased nursing staff turnover, decreased quality of care, and changed the spirit of community nursing from an emphasis on caring and community service to a focus on reimbursement. The study results have timely implications for health policy formulation as the United States undergoes major health care reform.

<h4></h4> <p>The purpose of this study was to describe the characteristics, work perceptions, and factors influencing employment of second-career certified nursing assistants (CNAs) in nursing homes. The qualitative descriptive design included a purposeful sample of 17 participants from 5 nursing homes. Data generation consisted of demographic surveys and audiotaped interviews that were transcribed, coded, and analyzed for emerging themes. Four themes were identified: negative first impressions of the work did not deter second-career CNAs, second-career CNAs lived out personal ideals and values through their work, positive relationships and job benefits retained second-career CNAs, and second-career CNAs expressed hopes for transforming nursing homes. Results revealed a group of committed, mature workers to fill labor shortages in an essential health care setting.</p>

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