This study examines the relationships of spiritually and physically related variables to well-being among homeless adults. A convenience sample of 61 sheltered homeless persons completed the Spiritual Perspective Scale, the Self-Transcendence Scale, the Index of Well-Being, and items measuring fatigue and health status. The data were subjected to correlational and multiple regression analysis. Positive, significant correlations were found among spiritual perspective, self-transcendence, health status, and well-being. Fatigue was inversely correlated with health status and well-being. Self-transcendence and health status together explained 59% of the variance in well-being. The findings support Reed's theory of self-transcendence, in which there is the basic assumption that human beings have the potential to integrate difficult life situations. This study contributes to the growing body of evidence that conceptualizes homeless persons as having spiritual, emotional, and physical capacities that can be used by health care professionals to promote well-being in this vulnerable population.

Objective:  To construct a substantive theory of postpartum fatigue. Design:  Grounded theory. Setting:  Participants were recruited in the hospital after delivery and interviewed in their homes. Participants:  Thirteen primiparae (n = 5) and multiparae (n = 8) women between 2 and 5 weeks postpartum from diverse ethnic, age, obstetric, and financial contexts were theoretically sampled. Results:  Persevering was the central human process around which the grounded theory emerged. The process of persevering was explained through the relationships of influencing factors, postpartum fatigue, coping techniques, self‐transcendence, and caregiving. Participants persevered in caregiving of infants and older children in spite of an overwhelming desire to rest and sleep using self‐identified coping techniques in combination with the belief that their children brought purpose and meaning to their lives. Conclusions:  The theory “Persevering Through Postpartum Fatigue” contributes a more complete understanding of the complex phenomenon of postpartum fatigue as it is expressed in the everyday lives of women during the postpartum period. The results may be used to develop and implement health‐promoting nursing interventions to reduce postpartum fatigue and its health‐related consequences. JOGNN, 36, 28‐37; 2007. DOI: 10.1111/J.1552‐6909.2006.00116.x

The purpose of this study was to identify whether severe postpartum fatigue at 1 and 3 months postpartum was associated with depressive symptomatology at 6 months in lower-income urban women. A convenience sample of 43 lower-income postpartum women completed the Modified Fatigue Symptoms Checklist and Edinburgh Postpartum Depression scale at 1, 3, and 6 months postpartum. Participants who were severely fatigued at both 1 and 3 months postpartum were significantly more likely to exhibit depressive symptomatology at 6 months. Fatigue and depressive symptoms were moderately to strongly correlated at 1 (r = .68), 3 (r = .74), and 6 (r = .70) months postpartum (p = .001). Severe fatigue and depressive symptomatology often co-exist for months after childbirth. Future research should examine whether interventions to targeting severe postpartum fatigue in lower-income urban women may also effectively reduce depressive symptoms.

Fatigue is both a symptom and a predictor of depression in women after childbirth. At the same time, postpartum fatigue is experienced by most non-depressed women. Health care providers experientially know that not all women who experience postpartum fatigue will manifest depression. However, while researchers agree that fatigue and depression are distinct concepts, they have not yet identified a means for describing or measuring this distinctness. A new model proposing how fatigue may be differentiated from depression after childbirth is presented. The Depressive Symptoms Responsiveness Model proposes that depression-related postpartum fatigue may potentially be differentiated from non-depression-related postpartum fatigue on the basis of whether depressive symptoms abate when fatigue is relieved. The ability to differentiate between fatigue and depression in postpartum women has the potential to improve women's health through improvements in practice and resource utilization. Furthermore, differentiation may lead to a better understanding of the role of fatigue in postpartum depression.

Although the grounded theory method was not designed with nursing science in mind, it is one of the most prevalent and theory-producing qualitative methods in nursing. Changes in the grounded theory methodology have been debated in numerous articles. What has not received much attention, however, is a central idea of the grounded theory method - the basic social process. The goal here is to raise for consideration the idea that change is needed in nurse researchers' understanding of the basic social process; there is a need to reformulate this substantive concept of the grounded theory method so as to render it more congruent with nursing ontology and productive of nursing knowledge.