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Meaning-in-life in nursing-home patients: A valuable approach for enhancing psychological and physical well-being?
Abstract
To investigate the associations between meaning-in-life and physical, emotional, functional and social well-being in a cognitively intact nursing-home population.
Meaning-in-life is understood as an influential psychological variable that promotes health and well-being; meaning-in-life has been found to be a mediating variable in both psychological and physical health.
The study employed a cross-sectional design. Data were collected in 2008 and 2009 using the purpose-in-life test and the FACT-G quality-of-life questionnaire. A total of 250 cognitively intact nursing-home patients who met the inclusion criteria were approached and 202 attended. The hypothesised relationships between meaning and multidimensional well-being were tested by means of structural equation modelling.
The structural equation modelling model fit well with the present data, showing significant direct relationships between meaning-in-life and emotional and functional well-being, and a significant mediated influence of meaning on social and physical well-being.
Meaning-in-life is associated with all dimensions of well-being and likely plays an important role in both emotional and physical well-being.
Facilitating patients' perceived meaning-in-life might help ease emotional distress and physical symptoms, thus fostering well-being in cognitively intact nursing-home patients. Therefore, advancing staff nurses' competence in facilitating meaningful involvement, connectedness, nurse-patient interaction and symptom management is important for care quality and global well-being in nursing homes.
... Difficulties in finding answers to these questions can result in existential suffering and distress (Grech and Marks, 2017). Existential loneliness (Ettema et al, 2010;Larsson et al, 2017;Sjöberg et al, 2018) and meaning-in-life (Haugan, 2014a;Haugan et al, 2016) represent key phenomena in relation to existential concerns, late life and thus NH care. Meaning-in-life involves the experience of life as coherent, purposeful and significant (Martela and Steger, 2016), while existential loneliness entails a deep awareness of being fundamentally separated from other people (Bolmsjö et al, 2018). ...
... Meaning-in-life and existential loneliness are two key existential concerns that receive increasing attention in the life stage of advanced age and especially in NH residents (Haugan, 2014a;Drageset et al, 2015;Haugan et al, 2016;Sjöberg et al, 2018;Dewitte et al, 2021). On the one hand, meaning-in life is a concept central to the existential tradition and is regarded as an important aspect of human thriving and well-being (Hupkens et al, 2018;Haugan and Dezutter, 2021). ...
... And all of this is somehow related to the problem of meaning.' Among older adults, on the one hand, the experience of meaning-in-life buffers holistic well-being when life stressors arise (Haugan, 2014a). On the other hand, the ill-being and isolation of older adults are likely to lead to depression and reduced meaning-in-life (Crewdson, 2016). ...
This study expands understanding of how existential loneliness and meaning in life might be connected in the lived experience of nursing home residents. A secondary analysis of interviews with nursing home residents (n=8) was conducted. The analysis started inductively using Template Analysis, and later deductively, where a theoretical framework guided the process. Existential loneliness and meaning in life are prominent in nursing home residents’ everyday life and relate to relationships and vulnerable situations involving 1) being seen, 2) trust in life, and 3) looking forward. To enhance existential well-being in nursing home residents, facilitating meaningful relationships and experiences is essential.
Keywords: Existential loneliness, meaning in life, nursing home residents, template analysis
... In general, NH residents face daily losses, disease, severe symptom and grief, and spend a lot of time in passive activities such as doing nothing, sleeping and waiting, which can lead to feelings of boredom, loneliness, meaninglessness, and indignity (Brownie & Horstmanshof, 2011;Slettebø et al., 2017). Moreover, the NH life is institutionalised and as such represents the loss of social relationships, privacy, meaning-in-life, and connectedness (Haugan, 2014b;Barca et al., 2009). Yet, the focus on palliation and spiritual/existential care in NHs has been scarce. ...
... In NHs, spiritual care takes place through the interaction between the nurse and the patient, through relational qualities that support and strengthen the human spirit. The experience of being respected, understood, listened to and taken seriously, of being seen and acknowledged as the person you are, fosters a sense of trust and nourishes the resident's spirit and thus also their body, which in turn strengthens their health and wellbeing (Haugan, 2014b). Excellent nursing care can therefore be defined as the nurse being "present" with the older adult while performing nursing activities. ...
... Na splošno se stanovalci DSO vsakodnevno soočajo z izgubo, boleznijo, hudimi simptomi in žalostjo ter preživijo veliko časa v pasivnih dejavnostih, kot so mirovanje, spanje in čakanje, ki vodijo v občutke zdolgočasenosti, osamljenosti, nesmiselnosti in pomanjkanja dostojanstva (Brownie & Horstmanshof, 2011;Slettebø et al., 2017). Poleg tega je življenje v DSO institucionalizirano in kot tako predstavlja tudi izgubo družbenih odnosov, zasebnosti, smisla življenja in povezanosti (Haugan, 2014b;Barca et al., 2009). Kljub temu se paliativni in duhovni/eksistencialni oskrbi v DSO posveča vse premalo pozornosti. ...
... Symptoms of depression have been found unrecognized and inadequately treated in this population (Beerens et al., 2013;Emilsdóttir & Gústafsdóttir, 2011). NH residents report poorer health-related quality of life (QoL) than the general elderly population (Haugan, 2014b;Barca et al., 2009). In addition, the NH life is institutionalized, representing loss of social relationships, privacy, meaning in life, and connectedness (Haugan, 2014b;Barca et al., 2009). ...
... NH residents report poorer health-related quality of life (QoL) than the general elderly population (Haugan, 2014b;Barca et al., 2009). In addition, the NH life is institutionalized, representing loss of social relationships, privacy, meaning in life, and connectedness (Haugan, 2014b;Barca et al., 2009). Insight into the prevalence of common symptoms such as pain, dyspnea, fatigue, insomnia, constipation, depression, and anxiety in NH residents is important with respect to QoL and health care quality. ...
... Mean age of the participants were 88.3 years for woman and 86 years for men, which is in accordance with previous NH studies (Haugan, 2014b;Halvorsen et al., 2017). JoL was strongly and positively correlated with total QoL (Hypothesis 1), but not with pain, appetite loss, and nausea. ...
Abstract
Background: Finding new approaches to increase health and wellbeing among nursing home (NH) residents is highly warranted. In a holistic perspective, several Norwegian municipalities have implemented the certification scheme framed ‘Joy-of-Life Nursing Home’.
Aims: In a holistic perspective on NH care, this study investigated if NH residents despite potential symptom severity experience joy-of-life. Therefore, we examined the frequency of common symptoms and the association between common symptoms and Joy-of-Life (JoL) in cognitively intact NH residents.
Methods: A cross-sectional design was employed. Using the QLQ-C15–PAL quality-of-life questionnaire, Hospital Anxiety and Depression Scale and Joy-of-Life scale, a total of 188 cognitively intact NH residents participated.
Results: Symptom severity was high; 54% reported fatigue, 52% constipation, 45% pain, 43% dyspnea and 32% insomnia, 22% reported appetite loss and 20% had nausea, while 20% had anxiety and 23% reported depressive symptoms. Nevertheless, 59% of the NH residents reported high JoL, which was significantly positively related with quality-of-life and negatively associated with anxiety and depression.
Keywords: nursing home, residents, joy-of-life, health-related quality of life, symptom severity.
... Research in this area is critical, as an increasing number of older people in ALCs are susceptible to depression, illness, and suffering due to the circumstances which brought them to a life situation requiring increasing amounts of personal care. Nurses, professionals and paraprofessional caregivers are often the residents' only source of engagement (Leedahl et al., 2018), thus creating a sense of community, meaning, hope, and well-being for the residents (Haugan, 2014a(Haugan, , 2014b. Prior research in this area has demonstrated that empathy, responsiveness, and reciprocity foster meaning-in-life for residents when caregivers listen to, and actively engage with AL residents (Haugan, 2014c). ...
... As meaning is derived through relationships, residents in ALCs often turn to the nursing staff, professionals, and paraprofessional caregivers when engaging in normal daily life (Leedahl et al., 2018), further emphasizing the role of caregiver interactions (Haugan, 2014a). Meaning-in-life is well established in the nursing literature, extending the healing work of nurses and caregivers to the benefits of therapeutic and empathetic relationships (Teófilo et al., 2019), which generate hope and well-being (Haugan, 2014a(Haugan, , 2014b. ...
... First, the results from this qualitative study demonstrate a connection between the empathy and responsiveness dimensions of SERVQUAL in the ALC context as a predictor of meaning-in-life, which is critical for well-being (Haugan, 2014a(Haugan, , 2014b) (see Figure 2). Findings from this study revealed how compassionate care from the ALC staff made residents feel looked after and engaged with daily life, thus promoting a sense of well-being. ...
The growing number of persons aged 65 and older, combined with their greater reliance on care outside the family unit, has contributed to the rapid growth of older people residing in assisted living (AL) communities. Given the increased attention paid to service standards in older adults’ housing models, this qualitative study was conducted in AL to generate residents’ perspectives on service and meaning-in-life outcomes. Utilizing the attributes of service quality through a transition theory lens, the data revealed empathy and responsiveness as most essential to the perceptions of service and meaning-in-life among residents. Theoretical results from this study suggest that linking current service theory to meaning-in-life outcomes would be of benefit to AL service standards research. Practical application of the research outcomes revealed how appropriate personalized attention provided in a timely manner to residents is critical to their well-being, and to their successful transition to AL.
... Empirical studies seem to confirm that the experience of meaning is related with well-being and optimal health, representing an important resource when adjusting to or recovering from an illness [36,40]. Accordingly, experiencing meaning-in-life is regarded as a highly desired psychological quality ("my life is meaningful") (ibid.). ...
... Accordingly, experiencing meaning-in-life is regarded as a highly desired psychological quality ("my life is meaningful") (ibid.). Positive associations between meaningin-life and psychological well-being have been found across the lifespan, including adolescence [41], emerging adulthood [42], midlife, and older adulthood [40,43]. The experience of meaningin-life seems fundamental to humans [1,2,44] and is of significance in health and well-being particularly in later years [45][46][47]. ...
... In this context, some authors speak of a "demoralizing syndrome" [61,62] that can occur in terminal patients when the disorder bodily-psychological-existential becomes intolerable and one's existence seems meaningless. Perceived meaning has also shown to have a strong impact on physical well-being in nursing home residents [40] and seems to moderate the relationship between illness, ailments, and functional loss on the one hand and QoL and well-being on the other. ...
Based in evidence and theory, we state that facilitating and supporting people's meaning-making processes are health promoting. Hence, meaning-in-life is a salutogenic concept.
Authors from various disciplines such as nursing, medicine, psychology, philosophy, religion and arts argue that the human search for meaning is a primary force in life and one of the most fundamental challenges an individual faces. Research demonstrates that meaning is of great importance for mental as well as physical well-being, and crucial for health and quality of life. Studies have shown significant correlations between meaning-in-life and physical health measured by lower mortality for all causes of death; meaning is correlated with less cardiovascular disease, less hypertension, better immune function, less depression and better coping and recovery from illness. Studies have shown that cancer patients who experience a high degree of meaning have a greater ability to tolerate bodily ailments than those who do not find meaning-in-life. Those who, despite pain and fatigue, experience meaning report better quality-of-life than those with low meaning. Hence, if the individual finds meaning despite illness, ailments and imminent death, well-being, health and quality-of-life will increase in the current situation. However, when affected by illness and reduced functionality, finding meaning-in-life might prove more difficult. A will to search for meaning is required, as well as health professionals who help patients and their families not only to cope with illness and suffering but also to find meaning amid these experiences. Accordingly, meaning-in-life is considered a vital salutogenic resource and concept.
The psychiatrist Viktor Emil Frankl's theory of ‘Will to Meaning’ forms the basis for modern health science research on meaning; Frankl's premise was that man has enough to live by, but too little to live for. According to Frankl, logotherapy ventures into the spiritual dimension of human life. The Greek word "logos" means not only meaning but also spirit. However, Frankl highlighted that in a logotherapeutic context, spirituality is not primarily about religiosity - although religiosity can be a part of it - but refers to a specific human dimension that makes us human. Frankl based his theory in three concepts; meaning, freedom to choose and suffering, stating that the latter has no point: People should not look for an inherent meaning in the negative events happening to them, or in their suffering, because the meaning is not there. The meaning is in the attitude people choose while suffering from illness, crises etc.
KEY WORDS
Freedom to choose; Health; Human values; Meaning-in-life; Meaning-making; Spiritual care; Spirituality; Suffering; Well-Being; Will to Meaning;
... ©Gørill Haugan have shown that a specific kind of white blood cells called "natural killer cells," increase during cognitive therapy, as well as by various relaxation and visualization techniques [19,20]. Recent research implies that for example perceived meaning-in-life is important for maintaining not only mental/emotional well-being, but physical and functional well-being as well [21][22][23]. A novel study demonstrated humans' holistic existence showing that perceived meaning-in-life as well as loneliness affected older adults' brain function [23]. ...
... Experience of meaning, which is a central aspect of spiritual and emotional well-being, has also shown a clear connection with belonging/affiliation [54,55], as well as with satisfaction [56] and dignity [37] among NH residents. Self-transcendence [57] and meaning [21,22] are shown to explain variation in wellbeing, physically, emotionally, socially, functionally, and spiritually, among older adults in NHs. This means that if self-transcendence, joy-of-life, and perceived meaning-in-life increase, also the resident's well-being-physically, emotionally, socially, functionally, and spiritually-will increase. ...
... Statistical analyzes showed that residents' experience of these qualities in the nurse-patient interaction contributed to the experience of selftranscendence, meaning, hope, joy-of-life, and sense of coherence, and alleviation of loneliness, anxiety and depression. What is more, positively perceived nurse-patient interaction strengthens residents' joy-of-life [105], meaningin-life, and self-transcendence [55,97]; the latter two have shown significant impact on physical, emotional, social, functional, and spiritual wellbeing [21,57,119,[130][131][132][133][134]. Thus, the interaction between the nurse and the older adult can be used to promote health and well-being. ...
We are now witnessing a major change in the world’s population. Many people globally grow very old: 80, 90, and 100 years. Increased age is followed by an increased incidence of functional and chronic comorbidities and diverse disabilities, which for many leads to the need for long-term care in a nursing home. Quality of life and health promotive initiatives for older persons living in nursing homes will become ever more important in the years to come. Therefore, this chapter focuses on health promotion among older adults living in nursing homes. First, this chapter clarifies the concepts of health, salutogenesis, and pathogenesis, followed by knowledge about health promotion. Then insight and knowledge about the nursing home population is provided; what promotes health and well-being in nursing home residents?
Health promotion in the health services should be based on integrated knowledge of salutogenesis and pathogenesis. The salutogenic understanding of health is holistic and considers man as a wholeness including physical, mental, social, and spiritual/existential dimensions. Research indicates that various health-promoting interventions, specifically the nurse–patient interaction, influence on older adults in nursing homes as a wholeness of body–soul–spirit, affecting the whole being. Hence, dimensions such as pain, fatigue, dyspnea, nausea, loneliness, anxiety, and depressive symptoms will be influenced through health-promoting approaches. Therefore, two separate studies on the health-promoting influences of nurse–patient interaction in nursing home residents were conducted. In total, nine hypotheses of directional influence of the nurse–patient interaction were tested, all of which finding support.
Along with competence in pain and symptom management, health-promoting nurse–patient interaction based on awareness and attentional skills is essential in nursing home care. Thus, health care workers should be given the opportunity to further develop their knowledge and relational skills, in order to “refine” their way of being present together with residents in nursing homes. Health professionals’ competence involves the “ being in the doing ”; that is, both the doing and the way of being are essential in health and nursing care.
... As an essential aspect of spirituality, the concept of meaning-in-life is commonly addressed in the nursing literature [20] and is seen to be of importance to wellbeing in older adults [17,18,21,22], in NHs [23][24][25], and at the end of life [26][27][28]. Research implies that perceived meaning-in-life is important for maintaining not only mental/emotional wellbeing, but physical and functional wellbeing as well [11,29]. A novel study demonstrates humans' holistic existence showing that life meaning as well as loneliness affected older adults' brain function [30]. ...
... Therefore, the nurse-patient interaction might be crucial for wellbeing in NHs. Self-transcendence and meaning-in-life have demonstrated significant relations with both physical, emotional, social, functional [29,48] and spiritual [49] wellbeing among cognitively intact NH residents, indicating that enhancing self-transcendence and meaningin-life positively influences on all aspects of wellbeing. ...
... Thus, the two-factor construct of self-transcendence (where ST1 embraces interpersonal aspects whereas ST2 covers intrapersonal aspects) along with the one-factor models of nurse-patient interaction [51] and meaning-in-life (PIL) [52] were applied in the present study. Based on the theoretical and empirical knowledge of nurse-patient interaction, self-transcendence (ST) and meaning-in-life, the following hypotheses were formulated: A hypothesized structural equation model (SEM) with bases in existing theory [39,40,53,54] and previous empirical research [29,31,48,55] was tested. Figure 1 shows the hypotheses representing the relationships implying the influences between the latent constructs in the model. ...
Background: Due to the shift to an older population worldwide and an increased need for 24-hours care, finding new and alternative approaches to increase wellbeing among nursing home (NH) residents is highly warranted. To guide clinical practice in boosting wellbeing among NH residents, knowledge about nurse-patient interaction (NPI), inter- (ST1) and intra-personal (ST2) self-transcendence and meaning-in-life (PIL) seems vital. This study tests six hypotheses of the relationships between NPI, ST1, ST2 and PIL among cognitively intact NH residents.
Methods: In a cross-sectional design, 188 (92% response rate) out of 204 long-term NH residents representing 27 NHs responded to NPI, ST, and the PIL scales. Inclusion criteria were: (1) municipality authority's decision of long-term NH care; (2) residential time three months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. The hypothesized relations between the latent constructs were tested using structural equation modeling (SEM) using Stata 15.1.
Results: The SEM-model yielded a good fit (χ2=146.824, p=0.021, df=114, χ2/df=1.29 RMSEA=0.040, p-close 0.811, CFI=0.97, TLI=0.96, and SRMR=0.063), supporting five of the six hypothesized relationships between the constructs of NPI, ST1, ST2 and PIL.
Conclusion: NPI significantly relates to both ST1, ST2 and PIL in NH residents. ST revealed a fundamental influence on perceived PIL, while NPI demonstrated a significant indirect influence on PIL, mediated by ST.
Keywords: interpersonal and intrapersonal self-transcendence, meaning-in-life, nursing, nurse-patient interaction, nursing home, older adults, wellbeing
... As an essential aspect of spirituality, the concept of meaning-in-life is commonly addressed in the nursing literature [20] and is seen to be of importance to wellbeing in older adults [17,18,21,22], in NHs [23][24][25], and at the end of life [26][27][28]. Research implies that perceived meaning-in-life is important for maintaining not only mental/emotional wellbeing, but physical and functional wellbeing as well [11,29]. A novel study demonstrates humans' holistic existence showing that life meaning as well as loneliness affected older adults' brain function [30]. ...
... Therefore, the nurse-patient interaction might be crucial for wellbeing in NHs. Self-transcendence and meaning-in-life have demonstrated significant relations with both physical, emotional, social, functional [29,48] and spiritual [49] wellbeing among cognitively intact NH residents, indicating that enhancing self-transcendence and meaningin-life positively influences on all aspects of wellbeing. ...
... Thus, the two-factor construct of self-transcendence (where ST1 embraces interpersonal aspects whereas ST2 covers intrapersonal aspects) along with the one-factor models of nurse-patient interaction [51] and meaning-in-life (PIL) [52] were applied in the present study. Based on the theoretical and empirical knowledge of nurse-patient interaction, self-transcendence (ST) and meaning-in-life, the following hypotheses were formulated: A hypothesized structural equation model (SEM) with bases in existing theory [39,40,53,54] and previous empirical research [29,31,48,55] was tested. Figure 1 shows the hypotheses representing the relationships implying the influences between the latent constructs in the model. ...
Background: Due to the shift to an older population worldwide and an increased need for 24-hours care, finding new and alternative approaches to increase wellbeing among nursing home (NH) residents is highly warranted. To guide clinical practice in boosting wellbeing among NH residents, knowledge about nurse-patient interaction (NPI), inter- (ST1) and intra-personal (ST2) self-transcendence and meaning-in-life (PIL) seems vital. This study tests six hypotheses of the relationships between NPI, ST1, ST2 and PIL among cognitively intact NH residents.
Methods: In a cross-sectional design, 188 (92% response rate) out of 204 long-term NH residents representing 27 NHs responded to NPI, ST, and the PIL scales. Inclusion criteria were: (1) municipality authority's decision of long-term NH care; (2) residential time three months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. The hypothesized relations between the latent constructs were tested using structural equation modeling (SEM) using Stata 15.1.
Results: The SEM-model yielded a good fit (χ2=146.824, p=0.021, df=114, χ2/df=1.29 RMSEA=0.040, p-close 0.811, CFI=0.97, TLI=0.96, and SRMR=0.063), supporting five of the six hypothesized relationships between the constructs of NPI, ST1, ST2 and PIL.
Conclusion: NPI significantly relates to both ST1, ST2 and PIL in NH residents. ST revealed a fundamental influence on perceived PIL, while NPI demonstrated a significant indirect influence on PIL, mediated by ST.
Keywords: interpersonal and intrapersonal self-transcendence, meaning-in-life, nursing, nurse-patient interaction, nursing home, older adults, wellbeing
... The literature presents a trichotomy of meaning comprising of three facets: (1) coherence, which means a sense of comprehensibility, (2) purpose, directing a sense of core goals, aims, direction in life, and (3) signi cance, implying a sense of life's inherent value and having a life worth living (24). Recent research implies that meaning is important for maintaining not only mental/emotional wellbeing, but physical and functional wellbeing as well (5,25). A novel study demonstrates humans' holistic existence showing that life meaning as well as loneliness affected older adults' brain function (26). ...
... Accordingly, perceived nurse-patient interaction has shown to in uence on meaning (32,45), self-transcendence (46) and hope (47), as well as anxiety and depression (48) among cognitively intact NH patients. Moreover, self-transcendence and meaning have demonstrated signi cant relations with both physical, emotional, social, functional (25,49) and spiritual (50) wellbeing among cognitively intact NH residents, indicating that enhancing self-transcendence and meaning positively in uences on all aspects of wellbeing. ...
... Moreover, dignity signi cantly predicts older adults' satisfaction with NH staff (34), and has been related to the nurse-patient relationship (29). Consequently, nurse-patient interaction involving time for listening with interest to NH residents, supporting self-acceptance, dignity, and adjustment, as well as meaningful engagements in hobbies and interests, emerge as vital for selftranscendence and meaning (35,(96)(97)(98)(99), both of which found to boost global wellbeing (25,49). Consequently, nurse-patient interaction in uences on NH residents' wellbeing; physically, emotionally, socially, functionally and spiritually. ...
Background. Today, we face a shift to an older population worldwide and its consequences; a noteworthy part of older adults will need 24-hours nursing home care at the end of life. Finding new and alternative approaches to increase wellbeing among nursing home residents is highly warranted. Knowledge about nurse-patient-interaction, self-transcendence and meaning-in-life seems vital in order to guide clinical practice in how to best and efficiently boost wellbeing among older adults in nursing homes. Methods In a cross-sectional design, 188 (92% response rate) out of 204 long-term NH patients representing 27 NHs responded to the nurse-patient interaction, self-transcendence, and the purpose-and-meaning-in-life scales. Inclusion criteria were: (1) municipality authority’s decision of long-term NH care; (2) residential time three months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. The hypothesized relations (five hypotheses) between the latent constructs were tested by means of structural equation modelling (SEM) using Stata 15.1. Results The SEM-model yielded a good fit (χ2=146.824, p=0.021, df=114, χ2 /df=1.29 RMSEA=0.040, p-close 0.811, CFI=0.97, TLI=0.96, and SRMR=0.063), showing significant relationships between the constructs of nurse-patient interaction, inter- and intra-personal self-transcendence and meaning-in-life. Nurse-patient interaction significantly relates with both inter- and intra-personal self-transcendence and meaning in NH patients. Self-transcendence revealed a fundamental influence on perceived meaning, while nurse-patient interaction demonstrated a significant influence on meaning, mediated by self-transcendence Conclusion According to the rapidly growing number of people over 65 in the world, and the growing segment of people 80-100, the present results are significant in their suggestions that nurse-patient-interaction is a crucial resource in relation to nursing home residents’ wellbeing. Knowledge of how nurse-patient-interaction, self-transcendence and meaning relate to each other among older adults in NHs is important for researchers, nurses, caregivers, nursing educators, and clinicians. Health professionals in nursing homes should learn how to competently use the nurse-patient interaction as a health promoting asset for self-transcendence, meaning and thus well-being. Nursing home nurses should be given more time for interacting with the residents, continuity and mutuality in nurse-patient relationships should be prioritized and facilitated.
... This means that NH care includes both terminal (dying well) and long-term residential care as well as short-term care for rehabilitation and family alleviation. Hence, the main goals of NH care are quality of life (QoL), wellbeing and a good death, which include more than treating residents' diseases and symptoms (Haugan, 2014c;Haugan et al., , 2020b. Currently, about 40 000 people are living in Norwegian NHs (Statistics Norway, 2020); the mean age is about 86 years, and the mean residential time is 2 years. ...
... The long-term NH population is characterized by a high incidence of chronic illness and functional impairments (Hoben et al., 2016), multiple simultaneous and complex diagnoses with a severe symptom burden, impaired functioning, various losses and fewer social relationships (Haugan, 2014b;Söderbacka et al., 2017;Rinnan et al., 2022). Typically, NH residents are characterized by frailty and vulnerability; pain, fatigue, dyspnoea, constipation and insomnia are common symptoms (Haugan, 2014c;Rinnan et al., 2022), and depression, anxiety and loneliness are common psychological ailments (Brownie and Horstmanshof, 2011;Beerens et al., 2013;Drageset et al., 2013;Hoben et al., 2016;Erdal et al., 2017;Drageset and Haugan, 2021). Moreover, many NH residents struggle with existential issues, such as 'what makes my life worth living' and 'how do I cope with the finality of my life'. ...
The nursing home (NH) population is characterized by a high symptom burden resulting from chronic illnesses and functional impairments that cannot be cured. Largely, long-term NH residents are in the last phase of life and in need of palliative care. Hence, health and wellbeing are important aims of salutogenic NH care, which includes more than the treatment of residents’ diseases and symptoms. Research shows that cognitively intact long-term NH residents with a high score on sense of coherence (SOC) experience better wellbeing. Therefore, NH care should be developed in a salutogenic direction, promoting residents’ health and wellbeing by identifying general and specific resistant resources (GRR/SRR) and facilitating residents’ perceived SOC. Based on Antonovsky's salutogenic health theory and focusing on SOC comprising comprehensibility, manageability and meaningfulness along with resistance resources, this article discusses how nurses can apply the salutogenic knowledge as a salutary guide to promote wellbeing among long-term NH residents.
... Moving to a NH result from numerous losses, illnesses, disabilities, loss of functions and social relations and facing an end-of-life situation. Accordingly, the long-term NH population is characterised by a high incidence of chronic illness and functional impairments (Hoben et al., 2016), multiple simultaneous and complex diagnoses with a severe symptom burden, impaired functioning, various losses and fewer social relationships (Haugan, 2014b;Rinnan et al., 2022;Söderbacka et al., 2017). All of these increase an individual's vulnerability and distress. ...
... In several municipalities 35% of NH (Grech & Marks, 2017;Larsson et al., 2017;van der Vaart & van Oudenaarden, 2018). The few available studies indicate the need of NH residents to talk about existential issues (Sjöberg et al., 2018;Smedbäck et al., 2017;Haugan et al., 2013, Haugan, 2014b, 2014c, 2014d. By contrast, while the perception of existential suffering is emphasised in research on cancer care and palliative medicine (Gautam et al., 2019;Kissane, 2012), this is hardly studied in the NH context. ...
Aims and objectives:
To investigate the association between perceived nurse-patient interaction and quality-of-life among nursing home residents, adjusted for loneliness, anxiety and depression.
Background:
Symptoms of anxiety and depression are known to residents of nursing homes along with cognitive impairment, physical inactivity and low quality-of-life. Anxiety, depression and loneliness are found detrimental to NH residents' quality-of-life. The nurse-patient relationship is important for patient's well-being, both in terms of illness and symptom management.
Design:
Cross-sectional design.
Methods:
Data were collected in 2017 and 2018 from 188 residents in 27 nursing homes resided in two large urban municipalities in Middle and Western Norway. The inclusion criteria were: (1) local authority's decision of long-term NH care; (2) residential stay 3 months or longer; (3) informed consent competency recognised by responsible doctor and nurse; (4) capable of being interviewed, and (5) aged 65 years or older. This article is executed in accordance with STROBE statement.
Results:
Adjusting for age, sex, anxiety, depression and loneliness, perceived nurse-patient interaction was statistically significant to quality-of-life. While anxiety and depression showed insignificant estimates, loneliness demonstrated a significant relation with quality-of-life. Nurse-patient interaction and loneliness explained together 25% of the variation in quality-of-life.
Conclusion:
This study suggests that loneliness is frequent as well as more detrimental to quality-of-life among nursing home residents compared to anxiety and depression. Furthermore, the present results show that the nurse-patient interaction represents an essential health-promoting resource for Quality-of-life in this population.
Relevance to clinical practice:
Staff nurses need to exercise their awareness of loneliness to meet residents' needs. Nursing educations should provide knowledge about nurse-patient interaction, and students as well as staff nurses in NHs should be trained, for instance by simulation, to use the nurse-patient interaction as a health-promoting resource. Finally, loneliness represents a bigger challenge than depression and anxiety; accordingly, building nurses that are capable of meeting patients' needs and facilitate care that counteracts loneliness is highly warranted.
... recovery from surgery, survival in chronic diseases, reduced risk of stroke, mortality) and subjective measures of health (e.g. selfreported health, disability, pain, physical symptoms) [34][35][36][37]. Up to now, research on explaining mechanisms has been more limited, though. ...
... While in general levels of meaning in life may be lower in nursing homes, retaining higher levels of meaning might be especially protective in this context. Studies have shown that nursing home residents who experience higher meaning in life reported fewer physical and emotional symptoms such as insomnia, nausea and depressive symptoms [70,71] and higher emotional and functional well-being [37,72]. Another study even showed that the association between meaning in life and psychological well-being was stronger for nursing home residents than for community-dwelling older adults [69], which emphasizes the importance of meaning for the potentially vulnerable population of older adults in nursing homes. ...
Dementia is increasingly being recognised as a public health priority and poses one of the largest challenges we face as a society. At the same time, there is a growing awareness that the quest for a cure for Alzheimer's disease and other causes of dementia needs to be complemented by efforts to improve the lives of people with dementia. To gain a better understanding of dementia and of how to organize dementia care, there is a need to bring together insights from many different disciplines. Filling this knowledge gap, this book provides an integrated view on dementia resulting from extensive discussions between world experts from different fields, including medicine, social psychology, nursing, economics and literary studies. Working towards a development of integrative policies focused on social inclusion and quality of life, Dementia and Society reminds the reader that a better future for persons with dementia is a collective responsibility.
... With regard to physical health, meaning has been associated with better outcomes in both objective measures of health (e.g., recovery from surgery, survival in chronic diseases, reduced risk of stroke, mortality) and subjective measures of health (e.g., self-reported health, disability, pain, physical symptoms) [34][35][36][37]. Up to now, research on explaining mechanisms has been more limited, though. ...
... While in general levels of meaning in life may be lower in nursing homes, being able to retain relatively higher levels of meaning might be especially protective in this context. Studies have shown that nursing home residents who experience higher meaning in life reported less physical and emotional symptoms such as insomnia, nausea, and depressive symptoms [70,71] and higher emotional and functional well-being [37,72]. Another study even showed that the association between meaning in life and psychological well-being was stronger for nursing home residents than for community-dwelling older adults [69], which emphasizes the importance of meaning for the potentially vulnerable population of older adults in nursing homes. ...
... Meaning in life (MIL) is generally considered to encompass three facets: coherence, significance, and purpose (Martela & Steger, 2016). Research has identified MIL as a critical contributor to human functioning (Czekierda et al., 2017;Haugan, 2013), whereas the underlying mechanism behind the effects of MIL remains controversial and lacks empirical evidence (Hooker et al., 2018). In the present research, we focused on the self-regulatory mechanism of MIL in relation to time perspective (TP). ...
... Increasingly, research evidence indicates that MIL is a protective factor for physical and mental health (Czekierda et al., 2017;Haugan, 2013), relating to health-promoting behaviors (Brassai et al., 2011), reduced stress (Park & Baumeister, 2017), and adaptive coping (Jim et al., 2006). Based on the substantial evidence, Hooker et al. (2018) proposed a model linking MIL to health, in which adaptive coping strategies are included as selfregulatory processes accounting for the effects of MIL. ...
The purpose of this article was to investigate the relationship between meaning in life and time perspective among Chinese youngsters. Two studies were conducted. In Study 1, 323 participants were sampled and completed the Presence of Meaning in life Scale, short version of the Zimbardo Time Perspective Inventory as well as the Proactive Coping Scale. The results showed that time perspective mediated the relationship between meaning in life and proactive coping. In Study 2, 346 participants were sampled and completed the Meaningful Life Measure, the full Zimbardo Time Perspective Inventory, the Reappraisal Scale as well as the General Self Efficacy Scale. The results showed that meaning in life predicted time perspective and this relationship was partially mediated by cognitive reappraisal and self-efficacy. The findings demonstrated that time perspective played a role in the self-regulatory mechanism of meaning in life, involving both emotional and motivational processes. Self-regulatory processes in the relationship between meaning in life and time perspective were discussed.
... Buna göre yaşlıların kişisel anlam profili ve kaynakları, psikolojik iyi oluşu pozitif yönde etkilemektedir. Literatürde bazı kültürlerdeki yaşlıların kişisel anlam ve kaynaklarının psikolojik iyi oluşlarıyla pozitif ilişkili olduğu belirtilmektedir (Reyes ve ark., 2020;Hoeyberghs ve ark., 2019, Krok, 2015Haugan, 2014). Mantovani ve ark. ...
... Yaşlıların kişisel anlam deneyimlerinin pozitif psikolojik girişimlerle geliştirilebileceği belirtilmektedir. Bu girişimlerden yaşamı yeniden değerlendirme ve anımsama terapisi sıklıkla kullanılmaktadır (Haugan, 2014). ...
Amaç: Araştırma yaşlılarda kişisel anlam profili ve psikolojik iyi oluş düzeylerini belirlemek amacıyla gerçekleştirilmiştir. Yöntem: Bu çalışma, kesitsel olarak 27.07.2020-30.09.2020 tarihlerinde, Osmaniye merkez ilçesinde yürütülmüştür. Evrenin temsili için %95 güven aralığı ve %3 hata marjini ile minimum 353 kişinin örnekleme alınması uygun bulunmuştur. 440 yaşlı birey çalışmaya alınmıştır. Veriler; Kişisel Bilgi Formu, Kişisel Anlam Profili Ölçeği ve Psikolojik İyi Oluş Ölçeği ile toplanmıştır. Veriler; Student’s t test, Tek Yönlü Varyans Analizi, Pearson korelasyon katsayısı, Çoklu Lineer Regresyon Analizi ile değerlendirilmiştir. İstatistik anlamlılık seviyesi p
... The study participants perceived gardening to be both a positive and beneficial activity, confirming previously reported findings. 2,13,14,21 Finding meaning in life after a move to aged care is essential due to its positive correlations with spiritual, physical and social well-being. 22 Whether it was the satisfaction that came from being outdoors, the pleasure of seeing plants prosper, the solace felt in the natural environment or the thrill experienced in night-time potato digging, people had found meaning through various garden activities and spaces. ...
... 22 Whether it was the satisfaction that came from being outdoors, the pleasure of seeing plants prosper, the solace felt in the natural environment or the thrill experienced in night-time potato digging, people had found meaning through various garden activities and spaces. If being able to continue with important activities after moving into a RACF means life can continue to hold meaning 15,21 for those who identify as gardeners, gardening can be that important activity. ...
Objective
To explore residential aged care facility (RACF) residents’ use of communal garden sites as spaces for gardening and social connection.
Methods
Phenomenological inquiry using semi‐structured interviews with 13 residents, family members and staff of a rural RACF.
Results
Interest, ability and willingness to engage in communal garden sites were evident but limited by multiple factors. Data highlighted the complexities of accessing gardens, gardening and other people. An enduring identity as a gardener provided a framework for maintaining a link between gardening, finding meaning and maintaining a sense of self.
Conclusions
Communal garden sites can improve quality of life and enable connectedness for RACF residents. However, a range of personal, attitudinal, institutional and resource‐related challenges create barriers to gardening, and in the RACF isolation and inactivity persist. We conclude that these challenges might be overcome through provision of physical and emotional support for positive risk‐taking, autonomy and access to the outside to continue gardening.
... Moreover, dignity significantly predicts older adults' satisfaction with NH staff (100) and has been related to the nurse-patient relationship (41) and 'slow care' (73). Consequently, spending time without rushing anything, listening with interest to NH residents, supporting self-acceptance, dignity and adjustment, as well as meaningful engagements in hobbies and interests, represent vital health-promoting nursing activities (20,71,72,92,(101)(102)(103)(104). ...
... Previous research holds that meaning serves as a mediating variable in psychological and physical health (103,115). By facilitating joy-of-life, nurse-patient interaction might positively influence symptoms such as fatigue and pain (116), depression and anxiety (32) mediated by self-transcendence and meaning (39). ...
Background: The nursing-home population is at a high risk of declined wellbeing and quality-of-life. Finding approaches to increase wellbeing among older adults in nursing-homes is highly warranted. Responding to this need, the approach framed ‘Joy-of-Life-Nursing-Homes’ (JoLNH) was developed in Norway.
Aim: To investigate the association between nurse-patient-interaction and joy-of-life in the nursing-home population.
Methods: Cross-sectional data were collected in 2017 and 2018 using the Nurse-Patient-Interaction Scale and the Joy-of-Life Scale. A total of 204 cognitively intact nursing-home residents met the inclusion criteria and 188 (92%) participated. A structural equation model (SEM) of the relationship between nurse-patient-interaction and joy-of-life was tested by means of STATA/MP 15.1. Ethical approval was given and each participant provided voluntarily written informed consent.
Results: The SEM-model yielded a good fit with the data (χ2=162.418, p=0.004, df=118, χ2/df=1.38, RMSEA=0.046, p-close 0.652, CFI=0.97, TLI=0.96, and SRMR=0.054). As hypothesized, nurse-patient-interaction related significantly with JoL (γ1,1=0.61, t=7.07**).
Limitations: The cross-sectional design does not allow for conclusions on causality. The fact that the researchers visited the participants to help fill in the questionnaire might have introduced some bias into the respondents’ reporting.
Conclusion: Relational qualities of the nurse-patient-interaction should be essential integral aspects of nursing-home care. Consequently, such qualities should be emphasized in clinical practice, and research and education should pay more attention to nurse-patient-interaction as an important, integral part of the caring process promoting joy-of-life and thereby wellbeing.
Key words: compassionate nursing; joy-of-life; loneliness; nurse-patient-interaction; nursing home residents; structural equation modeling; wellbeing
... Perceived "meaning-in-life" is found to positively affect nursing home patients' wellbeing, in physical, emotional, social and functional ways (Haugan, 2014a). Moreover, significant associations between meaning-in-life and physical symptoms, such as pain, fatigue, nausea and vomiting, insomnia and dyspnoea, have been shown (Haugan, 2014b). Patients with high scores on meaning-in-life displayed a significantly lower perceived symptom burden and better physical and emotional functioning, compared to those experiencing low meaning (Haugan, 2014a(Haugan, , 2014b. ...
... Moreover, significant associations between meaning-in-life and physical symptoms, such as pain, fatigue, nausea and vomiting, insomnia and dyspnoea, have been shown (Haugan, 2014b). Patients with high scores on meaning-in-life displayed a significantly lower perceived symptom burden and better physical and emotional functioning, compared to those experiencing low meaning (Haugan, 2014a(Haugan, , 2014b. These findings are probably transferable to longterm ICU patients who suffer from similar symptoms. ...
Aims and objectives:
To explore aspects that promote and challenge long-term ICU patients' inner strength and willpower.
Background:
Considerable research has been devoted to ICU patients' experiences, however research on long-term ICU patients is limited. Studies in a health promoting perspective focusing on long-term ICU patients' inner strength and willpower are scarce.
Design:
A qualitative, hermeneutic-phenomenological approach, using in-depth interviews.
Methods:
Seventeen long-term Norwegian ICU patients were interviewed once, at six to 18 months after ICU discharge. The consolidated criteria for reporting qualitative research was used (Supplementary File 1).
Results:
The lived experience of the phenomenon 'inner strength and willpower' and what promotes and challenges this phenomenon in long-term ICU patients were represented by four main themes and nine sub-themes. Promoting aspects comprised of two main themes and five sub-themes: (1)'No doubt about coming back to life' with sub-themes; 'Strong connectedness to life; feeling alive and present', 'Meaning and purpose; feeling valuable to somebody'. (2)'How to ignite and maintain the spark of life', with the sub-themes: 'Practical solutions, coping skills from previous life experiences', 'Provocative and inspiring experiences', and 'Vivid dream experiences that ignite the willpower'. Two main categories and four sub-categories represented challenging aspects,: (1) Exhaustion, weakness, and discomfort; sub-themes; 'Physical challenges' and 'Mental discomfort', and (2)'Tiring delusions', sub-themes; 'Living in the worst horror movie', and 'Feeling trapped'.
Conclusion:
This study expands on previous studies by providing insights about what promotes and challenges long-term ICU patients' inner strength and willpower during their recovery trajectory. This article is protected by copyright. All rights reserved.
... [21] A healthy workplace promotes a feeling of joy and understanding of the meaning of life. Positive beliefs may create positive thinking that involves finding meaning of life in daily life [10] , so health care workers can provide better holistic care to clinical patients. [21] Using meaning of life [31] and positive beliefs can help patients change their negative moods and psychological problems [3,22] and increase mental health and quality of life in the clinical setting. ...
... [9] In addition, meaning in life may promote positive beliefs and well-being. [10] Therefore, there are relationships among meaning of life, positive beliefs, and well-being. ...
Background: Nursing educators should train nursing students to pursue physical, psychological, spiritual, and social health promotion. The purpose of this study was to explore relationships between nursing students’ meaning of life, positive beliefs, and well-being. Methods: A cross-sectional correlational study with a quantitative approach was adopted. Purposive sampling was used. A total of 170 nursing students voluntarily participated in this study. A 56-item questionnaire was used to examine nursing students’ meaning of life (1-25 items), positive beliefs (1-11 items), and well-being (1-20 items). The content validity index (CVI) of the study questionnaire was established as 0.95 by seven expert scholars. The reliability values for the three parts of the measure were as follows: meaning of life, Cronbach’s α 0.96; positive beliefs, Cronbach’s α 0.93; and well-being, Cronbach’s α 0.95. Percentages, frequencies, means, SDs, Kruskal-Wallis one-way analysis of variance by rank, Spearman’s rank correlation, one-way analysis of variance, Spearman’s rho correlation, and regression analysis were used for the data analysis. Results: Nursing students had the following mean scores: meaning of life with 4.02 (SD 0.56); positive beliefs with 3.92 (SD 0.62); and well-being with 3.95 (SD 0.57). The results indicate that for all nursing students, meaning of life was positively correlated with positive beliefs, r=0.83 (P<.01); similarly, all nursing students had positive beliefs that were positively correlated with meaning of life, r=0.83 (P<.01). In the results of the study, the nursing students’ background, meaning of life and positive beliefs explained 63% of the variance in well-being (Adjusted R2 squared =0.63, F=33.41, P<.001). Conclusions: Nursing students’ sense of meaning of life and positive beliefs may impact their well-being. Therefore, nursing educators can promote meaning of life and positive beliefs to nursing students as a way to increase their well-being for physical, psychological, spiritual, and social health promotion.
... However, studies in NHs showed mixed results, varying from low (e.g. (Haugan, 2014;Tseng & Wang, 2001) to moderate and high QoL (e.g. (Degenholtz, Kane, Kane, Bershadsky, & Kling, 2006;King et al., 2012;Lai, Leung, Kwong, & Lee, 2015;Tu, Wang, & Yeh, 2006). ...
... From the present study, it can be concluded that QoL was not associated with how many activities somebody currently performs, nor how many activities someone loses when moving to the NH, nor by the autonomy and the satisfaction with activities. Perhaps it is rather having access to meaningful activities which are freely chosen and the possibility of actively participating in activities that influence QoL (Edvardsson, Sandman, & Borell, 2014;Haugan, 2014;Ljubic, 2003;Milte et al., 2016;Moyle, Rickard, Chambers, & Chaboyer, 2015). For example, a NHresident wants to make coffee by herself in her room not for the coffee an sich but because she wants to offer her visitors home made fresh coffee and thus the value 'friendliness', 'autonomy' or 'sociability' is strived for. ...
Objectives: This study aimed to investigate quality of life in nursing home residents and the relationship with personal, organizational, activity-related factors and social satisfaction.
Methods: In a cross-sectional survey study in 73 nursing homes in Flanders, Belgium, 171 cognitively healthy residents were randomly recruited (mean age 85.40 years [±5.88]; 27% men, 73% women). Quality of life, as the dependent/response variable, was measured using anamnestic comparative self-assessment (range −5 to +5). Multiple linear regression (forward stepwise selection) was used (1) to investigate which factors were significantly related to nursing home residents’ quality of life and (2) to model the relationship between the variables by fitting a linear equation to the observed data.
Results: Nursing home residents reported a quality of life score of 2.12 (±2.16). Mood, self-perceived health status, social satisfaction and educational level were withheld as significant predictors of the anamnestic comparative self-assessment score (p < 0.001), explaining 38.1% of the variance in quality of life.
Conclusions: Results suggest that a higher quality of life in nursing homes can be pursued by strategies to prevent depression and to improve nursing home residents’ subjective perception of health (e.g. offering good care) and social network. It is recommended that nursing homes prepare for future generations, who will be more educated.
... Evidence also suggests that residents can maintain high QoL despite co-morbid health conditions, including dementia [39,53], pain [38,54], and diminished physical and cognitive functioning [38,54]. Internal personal resources, such as resilience [45], meaning or purpose in life [55], sense of coherence [56,57], and religiosity/ spirituality [40,46] effectively helped residents to cope with health and life adversities (including pain). Similarly, residents who perceived better support from family/friends and LTC staff in terms of their availability, attachment, and quality of relationship had a better HRQoL [39,56]. ...
Background
Pain is highly burdensome, affecting over 30% of long-term care (LTC) residents. Pain significantly reduces residents’ health-related quality of life (HRQoL), limits their ability to perform activities of daily living (ADLs), restricts their social activities, and can lead to hopelessness, depression, and unnecessary healthcare costs. Although pain can generally be prevented or treated, eliminating pain may not always be possible, especially when residents have multiple chronic conditions. Therefore, improving the HRQoL of LTC residents with pain is a priority goal. Understanding factors influencing HRQoL of LTC residents with pain is imperative to designing and evaluating targeted interventions that complement pain management to improve residents’ HRQoL. However, these factors are poorly understood, and we lack syntheses of available research on this topic. This systematic review protocol outlines the methods to identify, synthesize, and evaluate the available evidence on these factors.
Methods
This mixed methods review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We will systematically search Medline, EMBASE, PsycINFO, CINAHL, Scopus, Cochrane Database of Systematic Reviews and ProQuest Dissertation and Thesis Global from database inception. We will include primary studies and systematically conducted reviews without restrictions to language, publication date, and study design. We will also include gray literature (dissertation and reports) and search relevant reviews and reference lists of all included studies. Two reviewers will independently screen articles, conduct quality appraisal, and extract data. We will synthesize results thematically and conduct meta-analyses if statistical pooling is possible. Residents and family/friend caregivers will assist with interpreting the findings.
Discussion
This proposed systematic review will address an important knowledge gap related to the available evidence on factors influencing HRQoL of LTC residents with pain. Findings will be crucial for researchers, LTC administrators, and policy makers in uncovering research needs and in planning, developing, and evaluating strategies in addition to and complementary with pain management to help improve HRQoL among LTC residents with pain.
Systematic review registration
PROSPERO CRD42023405425
... It is stated that the level of psychological well-being decreases with age (Kovalenko & Spivak, 2018). The personal meaning and resources of the elderly affect their level of psychological well-being (Eryılmaz & Atak, 2011;Haugan, 2014;Krok, 2015;Hoeyberghs et al., 2019;Reyes et al., 2020). In studies conducted by Mantovani et al. (2016) and Inel et al. (2021), it is stated that the experience of personal meaning in life in the elderly improves the positive aspects of old age and increases psychological well-being. ...
Introduction: With the enhancement of technology, health services and living conditions are improving as well as increased life expectancy, which are associated with gradually increasing number of elderly population. Gardening is an activity that contributes to the active aging process of the elderly. This research will be conducted in order to determine the effect of gardening activities applied to elderly people in nursing homes on their psychological well-being and depression.
... In this sense, low levels of MIL would be associated with psychopathology (Yalom, 1980;Marco et al., 2017aMarco et al., ,b, 2020aGarcía-Alandete et al., 2018) while achievement in MIL would be related to personal dedication, the presence of defined values and life goals, and life satisfaction and psychological well-being (García-Alandete, 2015). Many studies show that having higher levels of MIL is associated with better health and psychological functioning (e.g., Haugan, 2014;Czekierda et al., 2017;Miao and Gan, 2018). ...
The main objective of this study was to analyze the mediating role that meaning in life has between emotion dysregulation and depressive symptomatology in Spanish university students. Five hundred and sixty-six Spanish university students participated in the study. All of them completed the Difficulties in Emotion Regulation Scale (DERS), the Patient Health Questionnaire (PHQ-9) and the Purpose in Life Test (PIL-10). A mediation model was performed to test the hypothesis that meaning in life mediates the effect of emotional dysregulation on depressive symptomatology in college students. The results show a positive, moderate, and statistically significant correlation between depression and emotional dysregulation. In addition, a negative, moderate, and statistically significant correlation was found between depression and meaning in life, and a negative, small, and statistically significant correlation between emotional dysregulation and meaning in life. Finally, the results of the mediation model evidence the role of meaning in life in different emotional dysregulation strategies and depressive symptomatology. These findings suggest the importance of incorporating the meaning in life variable in the development and implementation of prevention and treatment programs for psychological disorders.
... Several studies argue that good nurse-patient interaction is fundamental in enhancing the experience of meaning in life for nursing home recipients (Haugan, 2014;Haugan, 2013a;2013b;Hupkens et al., 2019Hupkens et al., , 2020Halldorsdottir, 2008). The relational competences of professional caregivers seem crucial to meet their patients' meaning needs because older people turn out to be reluctant to express their existential questions and needs towards nursing staff. ...
The population in Europe is ageing, and the number of older citizens is growing. Consequently, projections predict an increase in care needs. The literature points towards two main challenges.
First, older adults with care needs are susceptible to social exclusion. Second, there are growing challenges in professional care services (i.e., overburdened workforce, and budget cuts). Currently, professional care focuses on the medical and physical aspects of care from a deficit approach (looking at what older adults cannot do anymore). However, many caregivers claim that an innovative paradigm shift is needed towards a positive approach (looking at the potentials of older people) and towards caring for social and meaning needs (Machielse et al., 2022). However, they often lack the competences for this as this is not part of their professional training. Nor does a lifelong learning course on these topics exist.
The SeeMe project aims to improve the quality of care for older adults by contributing to the knowledge of the needs of older adults and by increasing the skills and competences of different
groups of caregivers to respond to that needs. The emphasis here is on caregivers' competences to 'see' care as something more than physical and medical care, to 'see' the older person behind
the patient, 'see' social and meaning needs, and 'see the positive talents and dreams of older adults, not only their needs. In this way, the SeeMe project contributes to the social inclusion of
older adults.
This report focuses on caregivers' competences and skills to 'see' older adults. It is based on an extensive literature review complemented by qualitative interviews with caregivers. The report starts with a summary of recent developments regarding the care systems in European countries (Chapter 2). Then, we describe some innovative trends in healthcare to meet the needs of older adults and the consequences of caregiving in general (Chapter 3). Next, we describe the different types of caregivers involved in the care of older people (Chapter 4). Subsequently, we address the competences and skills of professional caregivers, volunteers, and informal caregivers, respectively (Chapter 5). After that, we present the perspectives of the SeeMe informants (Chapter 6). We conclude with some points of attention for caregivers and a summary of required competences and skills for caregivers (Chapter 7).
... Acının dönüştürücü gücünün de yaşam doyumuyla pozitif bir ilişkisinin olduğu (Sarı, 2018;İzgüden ve Erdem, 2017) ve yaşam doyumunu arttırdığı kanıtlanmıştır. Bunun yanında acının dönüştürücü gücünün öznel iyi oluşla (Joshanloo, 2015;Haugan, 2014) yüksek psikolojik mutlulukla, benlik saygısıyla (Taubman-Ben-Ari ve Weintroub, 2008) ve psikolojik sağlamlıkla arasında pozitif yönde ve anlamlı ilişkilerin olduğu ortaya çıkmıştır (Dinçer vd., 2015). Mevcut araştırmalar, acının dönüştürücü gücünün olumlu sonuçlara yol açtığını göstermektedir. ...
Bu çalışmada, Yatılı İlköğretim Bölge Okullarında (YİBO) yatılı olarak okumuş bireylerin çektikleri zorluk ve acıların dönüştürücü gücünün yaşamlarının anlamı üzerindeki etkisi araştırılmaktadır. Bu amaçla çeşitli bölgelerde bulunan YİBO’lardan mezun olmuş 237 kişiden anket tekniğiyle veri toplanmıştır. Yapılan analizler sonucunda acının dönüştürücü gücü ile yaşamın anlamı arasında pozitif bir ilişkinin olduğu ortaya çıkmıştır. Bunun yanında acının dönüştürücü gücünün yaşamın anlamını pozitif etkilediği ve bu anlamın artmasında rol oynadığı görülmüştür. Sonuç olarak hayatın belli bir döneminde acı ve zorluklarla mücadele etmenin; yaşamın yeniden gözden geçirilerek hayatın değerine ve önemine dair farklı bir bakış açısının geliştirilmesine ve bu mücadelenin anlamlı bir armağana dönüşmesine yol açabileceği söylenebilir.
... Due to its goal-oriented nature, gardening may also provide a stronger sense of purpose in life (PIL) for participants. Recent studies have shown that increased sense of purpose can improve overall physical health, decrease depression, and improve cognitive function in older populations [21][22][23][24][25][26][27][28]. Conversely, decreases in PIL have been linked to lower self-efficacy, higher risk of mortality, depression, and loss of hope [29][30][31][32][33]. ...
Background:
Gardening has been shown to have positive effects on persons living with dementia, but no studies have explored the effects of gardening on sense of purpose.
Objective:
Explore how gardening may influence sense of purpose for people with dementia.
Methods:
Ten residents with dementia diagnoses living in a skilled care facility participated in hour-long gardening sessions twice weekly at outdoor raised beds over a two-month duration. One group (n = 5) donated vegetables to a food pantry while the other (n = 5) harvested produce for personal use. Semi-structured interviews with participants and their caregivers conducted post-intervention were analyzed for themes.
Results:
Participants and caregivers reported biopsychosocial benefits of gardening, identifying four main themes: 1) Gardening outdoors provided specific physical benefits that improved quality of life; 2) Working on a project in a group setting improved mood and fostered a sense of community; 3) Gardening promoted reminiscence and reinforced a sense of self; 4) Gardening provided participants with a sense of purpose and pride.
Conclusion:
Gardening has biopsychosocial benefits for persons living with dementia, and there appears to be additive benefit linked to improved sense of purpose via charitable giving.
... Previous research indicates that having a greater sense of global MiL is associated with favorable psychological health outcomes (e.g., Haugan, 2014;Pinquart, 2002;Van der Heyden, Dezutter, & Beyers, 2015), and also appears to be a strong predictor of physical health outcomes (Czekierda, Banik, Park, & Luszczynska, 2017;Roepke, Jayawickreme, & Riffle, 2014). The literature indicates that individuals who have a greater sense of MiL tend to live longer (Alimujiang et al., 2019;Boyle, Barnes, Buchman, & Bennett, 2009;Cohen, Bavishi, & Rozanski, 2016;Hill & Turiano, 2014;Krause, 2009;Tanno & Sakata, 2007) and have reduced morbidity, including reduced risk for Alzheimer's disease and mild cognitive impairment (Boyle, Buchman, Barnes, & Bennett, 2010;Boyle et al., 2012;Lewis, Turiano, Payne, & Hill, 2017), myocardial infarction (Kim, Sun, Park, Kubzansky, & Peterson, 2013) and other cardiac events (Cohen et al., 2016). ...
A growing body of evidence suggests that meaning in life (MiL) is a predictor of health behaviors and outcomes. However, previous research has relied on self-report ratings of a global sense of MiL (i.e., how meaningful individuals perceive their lives to be in general or overall) to study the relationships between MiL and health. Meaning salience is a recently introduced construct in the literature that allows for more nuanced investigation of the ways in which MiL may influence individuals on a day-to-day or moment-to-moment basis. The purpose of the present study was to continue the development of a measure of meaning salience, the Meaning Awareness Scale (MAS), which assesses for phenomenological salience of MiL in everyday life. Using a cross-sectional design, this study included a
nationwide sample of adults (N = 342) to: (a) explore the factor structure of the MAS, (b) conduct item reduction of the MAS, (c) assess the internal consistency of the MAS, and (d) conduct a preliminary analysis of the criterion-related validity of the MAS. Results indicate that the 6-item MAS represents one factor and demonstrates strong internal consistency. Findings provide preliminary evidence in support of the criterion-related validity of the MAS. This study offers a means to measure a new and innovative construct related to MiL (i.e., meaning salience) that may lend itself well to intensive longitudinal methods and a more precise investigation of the relationships between MiL, health behaviors, and outcomes.
... Besides, NH care requires communicating with residents about symptoms and ailments, accompanied by high palliative competence in managing pain and relieving symptoms. 4,64 Interacting with the residents in a manner that makes the NH resident feel "attended to as a person" requires high communication and interactional competence. Good nurseÀpatient interaction is a healthÀpromoting resource in NHs 26,65 that contributes to reducing loneliness and thereby improving well-being. ...
BACKGROUND:
The Covid-19 pandemic affects both students and teachers with its sudden change in study design, causing students studying remotely at home with much uncertainty, and minor relatedness. By only use of digital tools, teachersupport has possibly worsened, affecting students’ motivation, study-effort and learning.
AIM:
To investigate the associations between teacher-support, students’ intrinsic motivation, study-effort and learning during the pandemic.
METHODS:
In a cross-sectional design, quantitative data were collected from 329 nursing students at a large university in Norway. Six hypotheses of the associations between teacher-support, intrinsic motivation, study-effort and learning were tested by means of structural equation modelling. To gain more understanding, qualitative data were included.
RESULTS:
Teacher-support showed significant direct effects on students’ learning and intrinsic motivation, as well as significant indirect effects on learning mediated by intrinsic motivation and study-effort.
CONCLUSION:
Teacher-support is important to students’ learning, when teaching goes digital in the context of a pandemic. To facilitate students’ learning teachers should provide students with structure and study demands, accompanied by a follow-up. To meet students’ demands and needs teachers need support by their employer to be fully prepared technologically.
KEYWORDS:
Digital learning, Teacher-support, Study-effort, Covid-19, Pandemic
... Besides, NH care requires communicating with residents about symptoms and ailments, accompanied by high palliative competence in managing pain and relieving symptoms. 4,64 Interacting with the residents in a manner that makes the NH resident feel "attended to as a person" requires high communication and interactional competence. Good nurseÀpatient interaction is a healthÀpromoting resource in NHs 26,65 that contributes to reducing loneliness and thereby improving well-being. ...
Nursing home (NH) residents risk loneliness because of many losses. Nurse–patient interaction includes core aspects contributing to thriving and well-being among long-term NH residents. We performed a cross-sectional observation study of 188 residents 65 years and older from 27 NHs with ≥3 months’ residence. All had informed consent competence recognized by the responsible doctor and nurse and could converse. We asked “Do you sometimes feel lonely?” and used the Nurse–Patient Interaction Scale (NPIS) in face-to-face interviews. We identified associations between nurse–patient interaction and loneliness and investigated the prevalence of loneliness. Eighty-eight (47%) respondents reported loneliness often or sometimes and 100 (53%) rarely or never. Adjusted for sex and age, 10 of the 14 NPIS items were significantly correlated with loneliness. Loneliness is common among cognitively intact NH residents. Nurse–patient interaction associates with residents’ loneliness and might be important in alleviating loneliness.
... Besides, NH care requires communicating with residents about symptoms and ailments, accompanied by high palliative competence in managing pain and relieving symptoms. 4,64 Interacting with the residents in a manner that makes the NH resident feel "attended to as a person" requires high communication and interactional competence. Good nurseÀpatient interaction is a healthÀpromoting resource in NHs 26,65 that contributes to reducing loneliness and thereby improving well-being. ...
Nursing home (NH) residents risk loneliness because of many losses. Nurse–patient interaction includes core aspects contributing to thriving and well-being among long-term NH residents. We performed a cross-sectional observation study of 188 residents 65 years and older from 27 NHs with ≥3 months’ residence. All had informed consent competence recognized by the responsible doctor and nurse and could converse. We asked “Do you sometimes feel lonely?” and used the Nurse–Patient Interaction Scale (NPIS) in face-to-face interviews. We identified associations between nurse–patient interaction and loneliness and investigated the prevalence of loneliness. Eighty-eight (47%) respondents reported loneliness often or sometimes and 100 (53%) rarely or never. Adjusted for sex and age, 10 of the 14 NPIS items were significantly correlated with loneliness. Loneliness is common among cognitively intact NH residents. Nurse–patient interaction associates with residents’ loneliness and might be important in alleviating loneliness.
Keywords:
Loneliness; Nurse–patient interaction; Nursing home; Older
... While people face various life stressors, such as serious illness leading to a long-term stay in an ICU, research has shown that those who, despite the difficulties, experience meaning-inlife cope better and report more well-being than those who experience meaninglessness. Meaning is an important psychological variable that promotes well-being [27][28][29], protects individuals from negative outcomes [30,31], and serves as a mediating variable in psychological health [32][33][34][35][36]. The concept of meaningfulness is also crucial in the salutogenic theory of health [19,24] that focuses on health promoting resources, among which sense of coherence (SOC) is vital. ...
Few patients are as helpless and totally dependent on nursing as long-term intensive care (ICU) patients. How the ICU nurse relates to the patient is crucial, both concerning the patients’ mental and physical health and well-being. Even if nurses provide evidence-based care in the form of minimum sedation, early mobilization, and attempts at spontaneous breathing during weaning, the patient may not have the strength, courage, and willpower to comply. Interestingly, several elements of human connectedness have shown a positive influence on patient outcomes. Thus, a shift from technical nursing toward an increased focus on patient understanding and greater patient and family involvement in ICU treatment and care is suggested. Accordingly, a holistic view including the lived experiences of ICU care from the perspectives of patients, family members, and ICU nurses is required in ICU care as well as research.
... Finding meaning-in-life involves understanding the nature of one's life, and to feel that life is significant, important, worthwhile or purposeful (53)(54)(55)(56)(57). Meaning-in-life is seen to be of particular importance to wellbeing and quality of life (QoL) among older people (17,18,58) in care facilities (21,22,(59)(60)(61) and at the end of life (22)(23)(24)(25)62). Recent research implies that meaning, similar to ST, is important for maintaining not only mental/emotional wellbeing, but also physical and functional wellbeing (63,64). ...
Introduction: Self-transcendence is a human capacity for wellbeing by expanding one's personal boundaries and may act as a health-promoting resource among adults ≥65 years. Therefore, the objectives of this meta-analysis were to determine the mean score of self-transcendence based on place of residence and gender, and to evaluate the correlations of self-transcendence with meaning, sense of coherence, resilience and depression.
Methods: Based on inclusion criteria, 13 studies were included. Orwin Safe N and Egger's test assessed publication bias. The mean score of self-transcendence and the correlation coefficients of the selected variables were estimated by random effects models.
Results: The self-transcendence mean score (n = 1634) was low (M = 43.6) and a bit lower among those staying in care facilities (M = 42.8), but did not vary significantly across gender. The correlation coefficients were self-transcendence_depression (r = −0.40), self-transcendence_meaning-in-life (r = 0.53), self-transcendence_resilience (r = 0.50) and self-transcendence_sense of coherence (r = 0.28). The correlation coefficients, except for meaning-in-life, were homogeneous.
Conclusion: In a health-promoting perspective, the concept of self-transcendence can help to better understand wellbeing among older individuals and provide guidance for health professionals in facilitating wellbeing and health. The concept and theory of self-transcendence can inspire health professionals in realising new health-promoting approaches to support older individuals in maintaining health, wellbeing and independency.
... While people face various life stressors, such as serious illness leading to a long-term stay in an ICU, research has shown that those who, despite the difficulties, experience meaning-inlife cope better and report more well-being than those who experience meaninglessness. Meaning is an important psychological variable that promotes well-being [27][28][29], protects individuals from negative outcomes [30,31], and serves as a mediating variable in psychological health [32][33][34][35][36]. The concept of meaningfulness is also crucial in the salutogenic theory of health [19,24] that focuses on health promoting resources, among which sense of coherence (SOC) is vital. ...
Few patients are as helpless and totally dependent on nursing as long-term intensive care (ICU) patients. How the ICU nurse relates to the patient is crucial, both concerning the patients’ mental and physical health and wellbeing. Even if nurses provide evidence-based care in the form of minimum sedation, early mobilization and attempts at spontaneous breathing during weaning, the patient may not have the strength, courage and will-power to comply. Interestingly, several elements of human connectedness have shown a positive influence on patient outcomes. Thus, a shift from technical nursing toward an increased focus on patient understanding, and greater patient and family involvement in ICU treatment and care is suggested. Accordingly, a holistic view including the lived experiences of ICU care from the perspectives of patients, family members and ICU nurses is required in ICU care as well as research.
Considerable research has been devoted to long-term ICU patients’ experiences from their ICU stays. However, less attention has been paid to salutogenic resources which are essential in supporting long-term ICU patients’ inner strength and existential will to keep on living. A theory of salutogenic ICU nursing is highly welcome. Therefore, this chapter draws on empirical data from three large qualitative studies in the development of a tentative theory of salutogenic ICU nursing care. From the perspective of former long-term ICU patients, their family members and ICU nurses, this chapter provides insights into how salutogenic ICU nursing care can support and facilitate ICU patients’ existential will to keep on living, and thus promoting their health, survival and well-being. In a salutogenic perspective on health, the ICU patient pathway along the ease/dis-ease continuum reveals three stages; (1) The breaking point, (2) In between, and (3) Never in my mind to give up. The tentative theory of salutogenic long-term ICU nursing care includes five main concepts: (1) the long-term ICU patient pathway (along the salutogenic health continuum), (2) the patient’s inner strength and willpower, (3) salutogenic ICU nursing care (4), family care, and (5) pull and push. The salutogenic concepts of inner strength, meaning, connectedness, hope, willpower and coping are of vital importance and form the essence of salutogenic long-term ICU nursing care.
Keywords:
critical care nursing; family care; health promotion; ICU care; long-term ICU patient
... The best way to help residents generate a positive view of life is to create calm experiences within a comfortable and satisfying living environment. For instance, residents often achieve ego integrity by carrying out small tasks (Haugan, 2014;Lim & Chang, 2018a). This feeling may lead to quality relationships that have a positive effect on residents' abilities to articulate problems and reduce their own distress (Roberts & Bowers, 2015). ...
Background:
The number of older people admitted to nursing homes has continued to rise with the recent expansion of the Republic of Korea's long-term care system. Maintaining ego integrity is a major task for older people approaching the end of life. As efforts to maintain ego integrity include the final stages of life, this concept is critically important for older people in nursing homes. This study was designed to assess issues related to ego integrity in the nursing home environment to determine how nurses should play a key role in managing this important life task.
Purpose:
The management by nurses of the ego integrity of residents of nursing homes is a new phenomenon that is central to promoting long-term, quality care. This study was designed to clarify and conceptualize this management phenomenon in the context of nursing homes.
Methods:
A hybrid model of concept development was used to analyze the ways in which nurses manage the ego integrity of residents of nursing homes. In the theoretical phase, a working definition of the management by nurses of residents' ego integrity is developed using a literature review. In the fieldwork phase, in-depth interviews are conducted with eight nurses from six nursing homes in Seoul and three other provinces. Finally, in the final analytical phase, the theoretical and fieldwork findings are interpreted and compared.
Results:
Two components, assessment and intervention, of the approach by nurses to managing the ego integrity of residents of nursing homes were identified. Assessment incorporates 10 attributes in the following three dimensions: "identifying the extent to which residents' basic needs are being fulfilled," "determining how residents achieve friendly relationships with others," and "determining how each resident creates a harmonious view of his or her life." Intervention incorporates nine attributes in the following two dimensions: "helping residents develop a positive view of life" and "helping residents make the best use of their remaining functional abilities."
Conclusions/implications for practice:
By managing the ego integrity of residents, nurses have a significant influence on residents' sociopsychological adaptation, especially in the challenging environment of a nursing home. This study supports that managing the ego integrity of residents of nursing homes is an important and practical component of the role played by nurses and of the aid and care they provide. Furthermore, the findings verify the effectiveness of intervention studies in examining assessment tools and developing guidelines for ego-integrity management.
... The JoLNH is a national strategy for promoting well-being, meaning and quality of life (QoL) among NH patients (11). In accordance with recent research (12)(13)(14), the JoLNH national strategy implies implementation of the 'Joy-of-Life' philosophy and working approach emphasising that spiritual and emotional needs such as perceived meaning and joy-oflife, culture, meaningful activity, connectedness, relationships and enjoyment shall be integrated essentials of the NH care. However, no scientific studies have so far evaluated the effects of this strategy on patients' well-being and QoL. ...
... This is especially important, as it also aligns with existing research that indicates older adults experience meaning at similar levels to those of other ages [45] and that certain "rights" should be afforded to those in longterm care settings (e.g., being respected as a person, giving back and serving others) [46]. Promoting meaning in life, including daily rituals for residents in nursing homes, seems vital to ensure enhanced quality of life among nursing home residents, including emphases on both physical and mental health [47]. ...
Purpose
Quality of life has been defined in various ways by nursing home stakeholders over the years. As such, analyzing the levels of agreement or disagreement among these stakeholders to ascertain if staff and leadership align with resident-identified factors for “good” quality of life has become important to include in the literature. This study sought to identify contributory factors to resident quality of life, as well as analyze areas of commonality in qualitative responses.
Methods
Semi-structured interviews were conducted at 46 Midwestern nursing homes, with residents (n = 138), nursing assistants (n = 138), social workers (n = 46), activities directors (n = 46), and administrators (n = 46), on whether each stakeholder felt residents had a good quality of life and the factors contributing to resident quality of life.
Results
Overall, the majority of residents perceived their quality of life as “good,” though differences were noted in their main contributing factors when compared to staff members’ and management’s perspectives. Findings also demonstrated that nursing assistants most closely aligned with resident perspectives.
Conclusions
Given the implications of resident satisfaction with quality of life on multiple facets of a nursing home (e.g., survey process, financial reimbursement), it remains ever critical for management to engage residents and to truly listen to resident perspectives to enhance and ensure an optimal quality of life.
... Accordingly, our understanding of QoL among individuals living in NHs is still limited. During the last decades, spirituality [6][7][8], a sense of meaning-in-life, hope, self-transcendence [9][10][11][12][13][14][15][16][17], social relationships and social support [5] have become vital aspects of wellbeing and QoL among older adults. ...
Background: Well-adapted and validated quality-of-life measurement models for the
nursing home population are scarce. Therefore, the aim of this study was to test the
psycho-metrical properties of the OPQoL-brief questionnaire among cognitively intact
nursing home residents. The research question addressed evidence related to the
dimensionality, reliability and construct validity, all of which considered interrelated
measurement properties.
Methods: Cross-sectional data were collected during 2017-2018, in 27 nursing homes
representing four different Norwegian municipalities, located in Western and Mid-
Norway. The total sample comprised 188 of 204 (92% response rate) long-term
nursing home residents who met the inclusion criteria: (1) municipality authority’s
decision of long-term nursing home care; (2) residential time three months or longer;
(3) informed consent competency recognized by responsible doctor and nurse; and (4)
capable of being interviewed.
Results: Principal component analysis and confirmative factor analyses indicated a
unidimensional solution. Five of the original 13 items showed low reliability and validity;
excluding these items revealed a good model fit for the one-dimensional 8-items
measurement model, showing good internal consistency and validity for these 8 items.
Conclusion: Five out of the 13 original items were not high-quality indicators of qualityof-
life showing low reliability and validity in this nursing home population. Significant
factor loadings, goodness-of-fit indices and significant correlations in the expected
directions with the selected constructs (anxiety, depression, self-transcendence,
meaning-in-life, nurse-patient interaction, and joy-of-life) supported the psychometric
properties of the of the OPQoL-brief questionnaire. Exploring the essence of quality-oflife
when residing in a nursing home is highly warranted, followed by development and
validation of new tools assessing quality-of-life in this population. Such knowledge and
well-adapted scales for the nursing home population is beneficial and important for the
further development of care quality in nursing homes, and consequently for quality-oflife
and well-being in this population.
Keywords: Factor analysis, Nursing home residents, Nursing home care, OPQoL-brief
questionnaire, Psychometric properties, Quality of life, Wellbeing.
... Considerable research (e.g. Ardelt 2003;Krause 2007;Shao et al. 2013;Haugan 2014) has indicated a positive association between the meaningfulness of life and physical and psychological well-being in old age. For example, Krause's (2009) study of a nationwide representative sample of older people revealed that those having a deep sense of meaning in life had a lower likelihood of dying over the study follow-up period than those without a deep sense of meaning. ...
The current dominant approach to active ageing policy in the EU and the UK is the productivist approach. Drawing on Weber’s concepts of instrumental rationality and value rationality, this article argues that this approach is principally informed by instrumental rationality and thus has the potential to instrumentalize older persons, to become an oppressive ideological narrative, and to ignore the unique developmental meanings in late life. To avoid these pitfalls, the article proposes balancing instrumental rationality with value rationality. The balancing can occur in three dimensions. First, the value of internally oriented activities for late life should be recognized. Second, the value of participatory policy development needs to be upheld. Third, the value of meaning-in-life for the well-being and growth of older adults should be validated.
... The JoLNH is a national strategy for promoting well-being, meaning and quality of life (QoL) among NH patients (11). In accordance with recent research (12)(13)(14), the JoLNH national strategy implies implementation of the 'Joy-of-Life' philosophy and working approach emphasising that spiritual and emotional needs such as perceived meaning and joy-oflife, culture, meaningful activity, connectedness, relationships and enjoyment shall be integrated essentials of the NH care. However, no scientific studies have so far evaluated the effects of this strategy on patients' well-being and QoL. ...
Aim
To develop and psychometrically test the Joy‐of‐Life Scale. The research question addressed evidence related to the dimensionality, reliability and construct validity, all of which considered inter‐related measurement properties.
Methods
Cross‐sectional data were collected during 2017–2018, in 27 nursing homes representing four different Norwegian municipalities, located in Western and Mid‐Norway. The total sample comprised 188 of 204 (92% response rate) long‐term nursing home patients who met the inclusion criteria: (i) local authority's decision of long‐term nursing home care; (ii) residential time 3 months or longer; (iii) informed consent competency recognised by responsible doctor and nurse; and (iv) capable of being interviewed.
Results
Exploratory and confirmative factor analyses clearly suggested a unidimensional solution. Five of the original 18 items showed low reliability and validity; excluding these items revealed an acceptable model fit for the one‐dimensional 13‐item measurement model. Reliability and construct validity were acceptable, indicating good internal consistency.
Conclusion
Significant factor loadings, several goodness‐of‐fit indices and significant correlations in the expected directions with the selected constructs (anxiety, depression, self‐transcendence, meaning‐in‐life, sense of coherence, nurse–patient interaction and quality of life) supported the psychometric properties of the Joy‐of‐Life Scale.
Impact
The ‘Joy‐of‐Life‐Nursing‐Home’ is a national strategy for promoting quality of life, meaning and quality of life among nursing home patients in Norway. Therefore, exploring the essence of the Joy‐of‐Life phenomenon and developing a measurement scale assessing joy‐of‐life in this population is important for the further development of care quality in nursing homes.
The study aimed to evaluate a logotherapeutic program for its potential to improve mental well-being in the elderly. Group logotherapy programs comprising eight sessions were provided to 44 older adults. Participants completed baseline, postintervention, and follow-up questionnaires assessing mental well-being, self-esteem, life satisfaction, meaning in life, and psychological distress. The logotherapeutic program did not affect outcome measures when analyzed for the total sample. Separate analyses by participants scoring below or above the respective thresholds at baseline revealed increased well-being and self-esteem and decreased symptoms of depression, anxiety, obsessive–compulsive disorders, and somatoform symptoms, but only in individuals who were already experiencing poor well-being, poor self-esteem, or some level of psychological distress before the intervention. Results suggest that the logotherapy-based group program can be particularly effective for older adults who are already experiencing psychological distress or have lower self-esteem.
Background: The Functional Assessment of Cancer Therapy-General (FACT-G) is a widely used quality-of-life measure. However, no studies have examined the FACT-G among patients with life-limiting illnesses who present to emergency departments (EDs). Objective: The goal of this study was to examine the psychometric properties of the FACT-G among patients with life-limiting illnesses who present to EDs in the United States. Methods: This cross-sectional study pooled data from 12 EDs between April 2018 and January 2020 (n = 453). Patients enrolled in the study were adults with one or more of the four life-limiting illnesses: advanced cancer, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, or End-Stage Renal Disease. We conducted item, exploratory, and confirmatory analyses (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]) to determine the psychometric properties of the FACT-G. Results: The FACT-G had good internal consistency (Cronbach's alpha α = 0.88). The simplest EFA model was a six-factor structure. The CFA supported the six-factor structure, evidenced by the adequate fit indices (comparative fit index = 0.93, Tucker-Lewis index = 0.92, root-mean-square error of approximation = 0.05; 90% confidence interval: 0.04 - 0.06). The six-factor structure comprised the physical, emotional, work and daily activities-related functional well-being, and the family and friends-related social well-being domains. Conclusions: The FACT-G is a reliable measure of health-related quality of life among patients with life-limiting illnesses who present to the ED. Clinical Trial Registration: NCT03325985.
Background:
Meaning in life plays an important role in, and is associated with all dimensions of, well-being. Finding meaning in life has been shown to increase life satisfaction in residents of long-term care (LTC) institutions, whereas social support has been found to relate positively with meaning of life. Interactions with LTC staff are the main source of social support for LTC residents.
Purpose:
The purpose of this study was to explore the factors related to meaning in life in LTC residents, especially those associated with interactions between nursing assistants and residents.
Methods:
A cross-sectional study design was applied to interview participants from October 2015 through July 2016. One hundred fifty-four residents from six LTC institutions participated in this study. The Staff-Patient Interaction Scale and Meaning-in-Life Scale were used to collect data. The statistical methods of t test, Pearson's correlation, and stepwise regression of forward selection analysis were used to explore the factors related to meaning in life in the study population.
Results:
The participants were found to perceive a moderate level of meaning in their lives, with a Meaning-in-Life Scale average total score of 42.75 (range: 17-63, SD = 10.19). Staff-patient interaction (β = .50), financial support from government subsidies and social assistance (β = -.41), and number of medical diagnoses (β = -.18) were the three most important factors related to meaning in life, explaining 44.2% of the variance.
Conclusions/implications for practice:
Improving the quality of interactions between nurse assistants and residents and health promotion may increase meaning in life in LTC residents.
Til tross for økt forskningsinteresse innen demensomsorgen er det fortsatt lite kunnskap om hvordan salutogen omsorg kan anvendes, og hvordan den påvirker kvaliteten på omsorgen som ytes for personer med demens. I denne studien presenteres funn fra en sekundæranalyse av originale kvalitative data fra en tidligere studie. Funn presentert i dette kapittelet viser hvordan Slow nursing kan være en salutogen tilnærming som kan forbedre kvaliteten på omsorgen som ytes til personer med demens.
Chapter 7 is a chapter in Norwegian on "Verdighet innen e-helse og velferdsteknologi i
kommunehelsetjenesten – en litteraturstudie"
written by associate professor Jorunn Bjerkan and professor Lisbeth Uhrenfeldt. Parts of the scoping review method is used to initiate the discussion of why it is important to include a discussion of dignity while introducing e-health in the communities.
Purpose
This mixed‐methods study evaluated a group logotherapy program's efficacy on Korean older adults with depressive symptoms.
Design and Methods
An intervention group (n = 23) participated in eight sessions of group logotherapy; a control group (n = 21) received the usual care. Participants completed the pretest, posttest, and 4‐week follow‐up questionnaires. Ten participants also had focus group or individual interviews.
Findings
A linear mixed model showed significant differences between groups in terms of changes in purpose in life, depression, self‐esteem, and quality of life over time. These quantitative findings were supported and enriched by qualitative data.
This Open Access textbook represents a vital contribution to global health education, offering insights into health promotion as part of patient care for bachelor’s and master’s students in health care (nurses, occupational therapists, physiotherapists, radiotherapists, social care workers etc.) as well as health care professionals, and providing an overview of the field of health science and health promotion for PhD students and researchers.
Written by leading experts from seven countries in Europe, America, Africa and Asia, it first discusses the theory of health promotion and vital concepts. It then presents updated evidence-based health promotion approaches in different populations (people with chronic diseases, cancer, heart failure, dementia, mental disorders, long-term ICU patients, elderly individuals, families with newborn babies, palliative care patients) and examines different health promotion approaches integrated into primary care services.
This edited scientific anthology provides much-needed knowledge, translating research into guidelines for practice. Today’s medical approaches are highly developed; however, patients are human beings with a wholeness of body-mind-spirit. As such, providing high-quality and effective health care requires a holistic physical-psychological-social-spiritual model of health care is required. A great number of patients, both in hospitals and in primary health care, suffer from the lack of a holistic oriented health approach: Their condition is treated, but they feel scared, helpless and lonely. Health promotion focuses on improving people’s health in spite of illnesses. Accordingly, health care that supports/promotes patients’ health by identifying their health resources will result in better patient outcomes: shorter hospital stays, less re-hospitalization, being better able to cope at home and improved well-being, which in turn lead to lower health-care costs.
This scientific anthology is the first of its kind, in that it connects health promotion with the salutogenic theory of health throughout the chapters. We here expand the understanding of health promotion beyond health protection and disease prevention. The book focuses on describing and explaining salutogenesis as an umbrella concept, not only as the key concept of sense of coherence.
Aims and objectives
To identify whether meaning in life has moderating and mediating effects on the relationship between depression and quality of life in patients with dysphagia.
Background
Dysphagic patients typically have multidimensional problems, such as depression, which can negatively influence their quality of life. Meaning in life, therefore, can be used as a psychological resource that may enhance quality of life for these patients.
Design
A descriptive cross sectional research design was used.
Methods
Ninety patients with dysphagia were recruited for a survey from eight general and rehabilitation hospitals in Korea. The questionnaires, which included the Korean version of the Swallowing Quality of Life scale developed by Cha, the Center for Epidemiological Studies‐Depression Scale (CES‐D) developed by Radloff, and the Purpose in Life test developed by Crumbaugh and Maholick were used for data collection. Descriptive statistics, Hayes’ PROCESS macro, and Cronbach's alpha were used for data analyses.
Results
Meaning in life was found to mediate the relationship between depression and quality of life in patients with dysphagia. However, the index of moderation was not statistically significant, which mean that meaning in life did not moderate the relationship between the patients’ depression and quality of life.
Conclusions
Meaning in life had a mediating effect on the relationship between depression and quality of life in patients with dysphagia. Thus, in order to improve the quality of life of patients with dysphagia, nurses should apply interventions to help them find meaning in life.
Relevance to clinical practice
Meaning in life can be used as a nursing intervention strategy to improve the quality of life for patients living with dysphagia and depression.
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This study evaluated the sensitivity of maximum likelihood (ML)- generalized least squares (GLS) - and asymptotic distribution-free (ADF)-based fit indices to model misspecification under conditions that varied sample size and distribution. The effect of violating assumptions of asymptotic robustness theory also was examined. Standardized root-mean-square residual (SRMR) was the most sensitive index to models with misspecified factor covariance(s) and Tucker–Lewis Index (1973; TLI)Bollen's fit index (1989; BL89) relative noncentrality index (RNI) comparative fit index (CFI) and the ML- and GLS-based gamma hat McDonald's centrality index (1989; Mc) and root-mean-square error of approximation (RMSEA) were the most sensitive indices to models with misspecified factor loadings. With ML and GLS methods we recommend the use of SRMR supplemented by TLI BL89 RNI CFI gamma hat Mc or RMSEA (TLI Mc and RMSEA are less preferable at small sample sizes). With the ADF method we recommend the use of SRMR supplemented by TLI BL89 RNI or CFI. Finally most of the ML-based fit indices outperformed those obtained from GLS and ADF and are preferable for evaluating model fit.
The purpose of the present study was to examine the relationship of meaning in life and its dimensions to depression and general psychological health, as well as the differences concerning the meaning of life among individuals with low, moderate and high depressive symptomatology. A sample of 401 newly re-cruited young men for their national service in the navy, completed four questionnaires on meaning in life, depressive symptomatology, psychological health and socio-demographic factors. Significant associations were found between meaning in life and depressive symptoms. As expected, subjects with higher life meaning were found to have lower depressive symptomatology, while subjects with higher depression scores were found to have a lower sense of meaning in life. However, concerning the meaning in life di-mensions, only the "contentedness with life" and the "goal achievement" significantly differentiated indi-viduals of low, moderate and high depressive symptomatology. Furthermore, statistical significant corre-lations were found between meaning in life and the four dimensions of general health. In the same vein, the comparison between individuals with the lower and the higher meaning of life has shown that the two groups differ significantly with regards to psychological health: those with higher meaning of life present a better psychological health. Finally, being married or involved in a romantic relationship, as well as par-ticipation in social activities are proven to be significant sources of meaning. These findings point to a definite relationship of meaning in life with depression and psychological health. Implications for psy-chotherapy and counselling are discussed.
Recognizing that spiritual needs often emerge in health care settings, the Joint Commission requires spiritual assessments in numerous organizations frequented by older adults. Given that many gerontological practitioners have received little training in identifying spiritual needs, a qualitative meta-synthesis (N = 9 studies) was conducted to identify and describe older adults’ perceptions of their spiritual needs in health care settings. Five interrelated categories emerged: (a) spiritual practices; (b) relationship with
God; (c) hope, meaning, and purpose; (d) interpersonal connection; and (e) professional staff interactions. The implications of the findings are discussed as they inform the spiritual assessment process.
The following paper presents current thinking and research on fit indices for structural equation modelling. The paper presents a selection of fit indices that are widely regarded as the most informative indices available to researchers. As well as outlining each of these indices, guidelines are presented on their use. The paper also provides reporting strategies of these indices and concludes with a discussion on the future of fit indices.
For structural equation models, a huge variety of fit indices has been developed. These indices, however, can point to conflicting conclusions about the extent to which a model actually matches the observed data. The present article provides some guide-lines that should help applied researchers to evaluate the adequacy of a given struc-tural equation model. First, as goodness-of-fit measures depend on the method used for parameter estimation, maximum likelihood (ML) and weighted least squares (WLS) methods are introduced in the context of structural equation modeling. Then, the most common goodness-of-fit indices are discussed and some recommendations for practitioners given. Finally, we generated an artificial data set according to a "true" model and analyzed two misspecified and two correctly specified models as examples of poor model fit, adequate fit, and good fit. In structural equation modeling (SEM), a model is said to fit the observed data to the extent that the model-implied covariance matrix is equivalent to the empirical co-variance matrix. Once a model has been specified and the empirical covariance matrix is given, a method has to be selected for parameter estimation. Different estimation meth-ods have different distributional assumptions and have different discrepancy functions to be minimized. When the estimation procedure has converged to a reasonable
Aims. This study's aim was to test the effects of self-transcendence on depression among cognitively intact nursing home patients. Background. Depression is considered the most frequent mental disorder among the elderly population. Specifically, the depression rate among nursing home patients is three to four times higher than that among community-dwelling elderly. Therefore, finding new and alternative ways to prevent and decrease depression is of great importance for nursing home patients' well-being. Self-transcendence is related to spiritual as well as nonspiritual factors, and it is described as a correlate and resource for well-being among vulnerable populations and at the end of life. Methods. A two-factor construct of the self-transcendence scale (interpersonal and intrapersonal) and the hospital anxiety and depression scale (HADS) was applied. A sample of 202 cognitively intact nursing home patients in central Norway was selected to respond to the questionnaires in 2008/2009. Results. A hypothesized SEM model demonstrated significant direct relationships and total effects of self-transcendence on depression. Conclusion and Implication for Practice. Facilitating patients' self-transcendence, both interpersonally and intrapersonally, might decrease depression among cognitively intact nursing home patients.
Two groups of Norwegian individuals 80 years of age and older, one living in nursing homes and one in the community, were compared with respect to loneliness, religiousness, purpose in life (PIL), and age group. There were no differences in loneliness identified between groups with regard to residence. Community residents between 80–89 years reported significantly higher loneliness scores than did the age group between 90–105 years. A majority of all subjects reported religion to be important, but age group comparisons yielded non-significant results. Residents living in the community reported significantly higher PIL scores than did residents in institutions. In addition, the community group 90–105 years old reported significantly higher PIL scores compared to the age group of 80–89 years. Analysis of variance showed significantly higher (negative) correlations between loneliness and purpose in life than between these phenomena and religiousness.
Meaningful living is a central focus of several humanistic theories and therapies. Measurement of life meaning meets many obstacles, including pragmatic concerns, such as measuring subjective experiences, and theoretical objections often offered by humanistic psychologists. The purpose of this article is to summarize empirical efforts related to logotherapy, a humanistic–existential paradigm, to illustrate the utility of assessment within the larger context of humanistic psychology. An overview of five logotherapeutic measures of meaning is provided. These measures include the Purpose in Life test (PIL), the Life Purpose Questionnaire (LPQ), the Seeking of Noetic Goals test (SONG), the Meaning in Suffering Test (MIST), and the Life Attitude Profile Revised (LAP–R). Directions for use of such measures in future research are also offered.
Reigning measures of psychological well-being have little theoretical grounding, despite an extensive literature on the contours of positive functioning. Aspects of well-being derived from this literature (i.e., self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life, and personal growth) were operationalized. Three hundred and twenty-one men and women, divided among young, middle-aged, and older adults, rated themselves on these measures along with six instruments prominent in earlier studies (i.e., affect balance, life satisfaction, self-esteem, morale, locus of control, depression). Results revealed that positive relations with others, autonomy, purpose in life, and personal growth were not strongly tied to prior assessment indexes, thereby supporting the claim that key aspects of positive functioning have not been represented in the empirical arena. Furthermore, age profiles revealed a more differentiated pattern of well-being than is evident in prior research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
We used a time perception task to study the effects of the subjective experience of control on emotion and cognitive processing. This task is uniquely sensitive to the emotionality of the stimuli: high-arousing negative stimuli are perceived as lasting longer than high-arousing positive events, while the opposite pattern is observed for low-arousing stimuli. We evaluated the temporal distortions of emotionally charged events in non-anxious (Experiments 1 and 5) and spider-fearful individuals (Experiments 2–4). Participants were shown images of varying durations between 400 and 1600 ms and were asked to report if the perceived duration of the image seemed closer to a short (400 ms) or to a long (1600 ms) standard duration. Our results replicate previous findings showing that the emotional content of the image modulated the perceived duration of that image. More importantly, we studied whether giving participants the illusion that they have some control over the emotional content of the images could eliminate this temporal distortion. Results confirmed this hypothesis, even though our participant population was composed of highly reactive emotional individuals (spider-fearful) facing fear-related images (spiders). Further, we also showed that under conditions of little-to-no control, spider-fearful individuals perceive temporal distortions in a distinct manner from non-anxious participants: the duration of events was entirely determined by the valence of the events, rather than by the typical valence × arousal interaction. That is, spider-fearful participants perceived negative events as lasting longer than positive events, regardless of their level of arousal. Finally, we also showed that under conditions of cognitive dissonance, control can eliminate temporal distortions of low arousal events, but not of high-arousing events, providing an important boundary condition to the otherwise positive effects of control on time estimation.
Counseling psychologists often work with clients to increase their well-being as well as to decrease their distress. One important aspect of well-being, highlighted particularly in humanistic theories of the counseling process, is perceived meaning in life. However, poor measurement has hampered research on meaning in life. In 3 studies, evidence is provided for the internal consistency, temporal stability, factor structure, and validity of the Meaning in Life Questionnaire (MLQ), a new 10-item measure of the presence of, and the search for, meaning in life. A multitrait-multimethod matrix demonstrates the convergent and discriminant validity of the MLQ subscales across time and informants, in comparison with 2 other meaning scales. The MLQ offers several improvements over current meaning in life measures, including no item overlap with distress measures, a stable factor structure, better discriminant validity, a briefer format, and the ability to measure the search for meaning.
This contribution is focused on how to write a research paper when structural equation models are being used in empirical work. The main question to be answered is which information should be reported and which results can be deleted without much loss of judgment about the quality of research and the validity of conclusions being made. The major conjecture is that all information should be reported, or referred to, that enables each member of the scientific community, at least in principle, to replicate the analysis as it is published. The recommendations are ordered in the framework of the empirical research cycle. They are meant for authors, in particular students employing structural equation models for their dissertation, as well as for editors and reviewers.
Aging and religion has been badly neglected in the field of Gerontology. This book, containing 13 chapters of original theory and research, is devoted to understanding the place that religion and spirituality hold in the lives of elderly persons. The authors, each experts in their own field, approach this issue from their backgrounds in the social sciences and the humanities.
Overall this is a ground-breaking collection: It is one of the first attempts to seek to understand the role that religion plays in the lives of elderly persons. Based on their various multi-disciplinary perspectives, the authors make use of a variety of qualitative and quantitative methodologies as well as personal narrative and literature to grapple with this issue. Finally, the book is unique in that it addresses scholars and students, including the educated layman, rather than the professional alone.
PURPOSE
We developed and validated a brief, yet sensitive, 33-item general cancer quality-of-life (QL) measure for evaluating patients receiving cancer treatment, called the Functional Assessment of Cancer Therapy (FACT) scale.
METHODS AND RESULTS
The five-phase validation process involved 854 patients with cancer and 15 oncology specialists. The initial pool of 370 overlapping items for breast, lung, and colorectal cancer was generated by open-ended interview with patients experienced with the symptoms of cancer and oncology professionals. Using preselected criteria, items were reduced to a 38-item general version. Factor and scaling analyses of these 38 items on 545 patients with mixed cancer diagnoses resulted in the 28-item FACT-general (FACT-G, version 2). In addition to a total score, this version produces subscale scores for physical, functional, social, and emotional well-being, as well as satisfaction with the treatment relationship. Coefficients of reliability and validity were uniformly high. The scale's ability to discriminate patients on the basis of stage of disease, performance status rating (PSR), and hospitalization status supports its sensitivity. It has also demonstrated sensitivity to change over time. Finally, the validity of measuring separate areas, or dimensions, of QL was supported by the differential responsiveness of subscales when applied to groups known to differ along the dimensions of physical, functional, social, and emotional well-being.
CONCLUSION
The FACT-G meets or exceeds all requirements for use in oncology clinical trials, including ease of administration, brevity, reliability, validity, and responsiveness to clinical change. Selecting it for a clinical trial adds the capability to assess the relative weight of various aspects of QL from the patient's perspective.
The purpose of this article is to present the essence of experiencing meaning in life as a patient in a nursing home. Such knowledge is important for improving the quality and ethics of nursing practice in nursing homes.The research question to be answered is: «What factors contribute to the patient experiencing meaning in life in a nursing home situation?»Seventeen in depth interviews with 9 patients in a nursing home are the basis for the data collection. The study includes seven women and two men, the average age being 79 years. Data are analysed by Giorgi's (1) phenomenological method.The interviewees contribute with many stories about their own experiences of being cared for. The results point out the essence of elderly patients' experiencing meaning and meaninglessness in life. The nurse-patient-relation is central to those experiences.
To investigate the prevalence of physical and emotional symptoms and the associations between symptoms and meaning-in-life in a cognitively intact nursing-home population.
Meaning has been found to be a strong individual predictor of successful ageing and life satisfaction as well as an important psychological variable that promotes well-being. Meaning serves as a mediating variable in both psychological and physical health.
The study employed a cross-sectional design. Data were collected in 2008 and 2009 using the QLQ-C15-PAL quality-of-life questionnaire, the purpose-in-life test and the Hospital Anxiety and Depression Scale. A total of 250 cognitively intact nursing-home patients who met the inclusion criteria were approached and 202 attended.
The prevalence of symptoms was fairly high, with fatigue (57%), pain (49%), constipation (43%) and dyspnoea (41%) as the most frequent physical symptoms, while 30% were depressed and 12% had anxiety. Significant correlations between meaning-in-life and symptom severity were displayed.
The level of symptom severity among cognitively intact nursing-home patients is high, requiring highly competent staff nurses. Meaning-in-life might be an important resource in relation to a patient's physical and emotional health and global well-being.
Facilitating patients' meaning-in-life might help reducing symptom severity and fostering quality of life in cognitively intact nursing-home patients. However, advancing staff nurses' competence in palliative care, symptom management and nurse-patient interaction is important for care quality and quality if life in nursing homes.
This study explored the relationships between creativity, depression, and successful aging. A total of 152 participants completed a demographic form, the Life Satisfaction Inventory-A, Purpose in Life Test, Similes Preference Inventory, and Geriatric Depression Scale Short Form. Level of depressive symptoms appeared to have a moderating effect on the relationship of creativity to successful aging. Significant differences in creativity, depressive symptoms, and successful aging were found by racial group and education level. These findings underscore the need for investigating the effects of creative activities on older adults, and for testing the effects of customized interventions on depression and successful aging in older adults.
This study investigated the reliability and factorial validity of the Life Regard Index, a measure of meaning in life. Principal component factor analyses performed on the responses of 122 undergraduate psychology students, gave two factors, fulfillment and framework, confirming the theoretical structure. Alpha estimates of internal consistency of the factor scales ranged from satisfactory to good. Analysis supports the predicted moderate negative correlations with anxiety, hostility and depression and a positive correlation with elation. Discriminant validity was good: the index discriminated persons who are happy and satisfied with their lives from unhappy and dissatisfied ones. A clear philosophy of life, education, and psychological counseling correlated significantly with the degree of meaning in life. The use of the instrument in further research is recommended.
This study examined factors associated with positive psychosocial functioning in 94 cognitively intact nursing home residents reporting poor physical health. It was hypothesized that greater use of meaning-based coping strategies would be associated with higher levels of positive psychosocial functioning. Participants completed an interview containing measures of coping, affect, psychological well-being, depression, and activities of daily living. Findings suggest that meaning-based coping variables (positive reappraisal, perceived uplifts) accounted for significant variance in positive psychosocial variables but not distress variables. In contrast, physical health variables accounted for significant variance in distress but not positive psychosocial variables. Results support the view that the absence of distress does not necessarily imply optimal mental health. Thus, a comprehensive assessment of mental health in older adults requires inclusion of indices of both positive and negative psychological and social functioning.
Measures that are reliable, valid, and can be used across diverse populations are vital to social work research, but the development of new measures is an expensive and time-consuming process. An array of existing measures can provide a cost-effective alternative, but in order to take this expedient step with confidence, researchers must ensure that the existing measure is appropriate for the new study. Confirmatory factor analysis (CFA) is one of the ways to do so. CFA has four primary functions-psychometric evaluation of measures, construct validation, testing method effects, and testing measurement invariance. This book provides an overview of the method, step-by-step guides to creating a CFA model and assessing its fit, and explanations of the requirements for using CFA, as well the book underscores the issues that are necessary to consider when using multiple groups or equivalent and multilevel models. Real-world examples, screenshots from the Amos software program that can be used to conduct CFA, and reading suggestions for each chapter form part of the book.
This study investigated three orientations to happiness and their relationships with subjective well‐being in a sample of 228 Chinese prospective and in‐service teachers in Hong Kong. Confirmatory item factor analyses supported a three‐dimensional model that included constructs represented by a life of meaning, a life of pleasure, and a life of engagement. These three orientations, especially the meaningful life and the engaged life were found to predict life satisfaction and positive emotions as two components of subjective well‐being. Implications of the findings on the relationships between orientations and subjective well‐being for helping teachers to promote a more satisfying life to combat against teacher burnout are discussed.
This study attempts to compare levels of depression, hopelessness, and suicidal ideation among elderly males and females, in reference to their living arrangement, i.e., community vs. nursing homes. For many elderly people, old age is characterized by various losses: physiological, functional, social, cognitive, financial, etc. The outcomes of such losses often include, more often than not, environmental isolation, a subjective feeling of loneliness, anxiety, depression, and frequently, loss of motivation to continue living. In light of the rise in life expectancy and the multitude of losses which can be associated with the aging process, it is probable that one out of five elderly persons will spend part of his/her life in a long term care institute. Such living arrangements may have negative effects on the mental health of its residents, because placement is often accompanied by feelings of lack of control over one's own life, and inability to make decisions regarding daily issues. Elderly persons living in the community (227: 78 men, 149 women) and 91 living in nursing homes (33 men, 58 women), in both independent and frail functional status (ADL), participated in the study. Findings show significantly more hopelessness, helplessness, and depression among residents of nursing homes compared to those living in the community, differences between men and women living in both environments, and a correlation between other demographic variables and the three dependent variables of the study. The conclusions of the study indicate a need to pay interdisciplinary attention to the mental health of elderly residents of nursing homes, particularly in the preliminary stages of placement and adjustment.
A sense of purpose in life is inextricably linked with a firm conviction of exercising control over it, and having one's priorities set straight. Health in turn, is affected by stress, by salutogenetic factors, as presented by A. Antonovsky. Disturbances of sense of purpose in life result in psychosomatic disorders. Hypothesis: there is a relevant statistical correlation between the level of sense of purpose in life and noopsychosomatic disorders. Methods: 1) Crumbaugh-Maholick Purpose-in-Life Test, 2) K. Mausch Questionnaire of Psychosomatic Ailments. Test group: 683 pedagogy students from the University of Szczecin. There is a relevant statistical correlation between the level of sense of purpose in life and psychosomatic disorders. The research results require comparison with other post-soviet countries, as well as democratic ones.
AimTo investigate the associations between nurse-patient interaction and meaning-in-life in a nursing home population. Background
Meaning has been found to be a strong individual predictor of successful ageing and life satisfaction as well as an important psychological variable that promotes well-being. Meaning seems to serve as a mediating variable in both psychological and physical health. Connecting and communicating with others have been seen to facilitate meaning-in-life among older individuals. DesignCross-sectional descriptive study. Methods
The data were collected in 2008-2009 using the Nurse-Patient Interaction Scale and the Purpose-in-Life test. A total of 250 cognitively intact nursing home patients met the inclusion criteria and 202 (81%) participated. A structural equation model of the hypothesized relationship between nurse-patient interaction and meaning was tested by means of LISREL 8.8. FindingsThe structural equation model fit well with the data. A significant direct relationship between nurse-patient interaction and meaning-in-life in cognitively intact nursing home patients was displayed. Conclusion
Nurse-patient interaction significantly relates to meaning and purpose-in-life among cognitively intact nursing home patients and might be an important resource in relation to the patient's mental health and global well-being. High-quality nurse-patient interaction and in-house activities aiming to increase patients' meaning might increase psychological and physical health, well-being and psycho-spiritual functioning in this vulnerable population.
Aims and objectives:
To test the effects of nurse-patient interaction on anxiety and depression among cognitively intact nursing home patients.
Background:
Depression is considered the most frequent mental disorder among the older population. Specifically, the depression rate among nursing home patients is three to four times higher than among community-dwelling older people, and a large overlap of anxiety is found. Therefore, identifying nursing strategies to prevent and decrease anxiety and depression is of great importance for nursing home patients' well-being. Nurse-patient interaction is described as a fundamental resource for meaning in life, dignity and thriving among nursing home patients.
Design:
The study employed a cross-sectional design. The data were collected in 2008 and 2009 in 44 different nursing homes from 250 nursing home patients who met the inclusion criteria.
Methods:
A sample of 202 cognitively intact nursing home patients responded to the Nurse-Patient Interaction Scale and the Hospital Anxiety and Depression Scale. A structural equation model of the hypothesised relationships was tested by means of Lisrel 8.8 (Scientific Software International Inc., Lincolnwood, IL, USA).
Results:
The SEM model tested demonstrated significant direct relationships and total effects of nurse-patient interaction on depression and a mediated influence on anxiety.
Conclusion:
Nurse-patient interaction influences depression, as well as anxiety, mediated by depression. Hence, nurse-patient interaction might be an important resource in relation to patients' mental health.
Relevance to clinical practice:
Nurse-patient interaction is an essential factor of quality of care, perceived by long-term nursing home patients. Facilitating nurses' communicating and interactive skills and competence might prevent and decrease depression and anxiety among cognitively intact nursing home patients.
Background
Spiritual dimensions such as hope, meaning in life and self-transcendence have been found to be predictors of successful ageing, life satisfaction and well-being in older individuals. Connectedness and communicating with others have been seen to facilitate hope, meaning in life and self-transcendence among nursing home patients. AimsThis study aimed to investigate the associations between hope, meaning in life, self-transcendence and nurse-patient interaction in a nursing home population. Design and methodsA cross-sectional design was employed, collecting data in 44 different Norwegian nursing homes (NHs) from 250 patients who met the inclusion criteria. Approval by all regulatory institutions dealing with research issues in Norway and the Management Unit at the 44 NHs was obtained. A sample of 202 cognitively intact nursing home patients responded to the Herth Hope Index, the Purpose in Life test, the Self-Transcendence Scale and the Nurse-Patient Interaction Scale. A structural equation model (SEM) of the hypothesized relationships between the constructs was tested. ResultsThe SEM model fit well with the present data. Significant direct relationships of nurse-patient interaction on hope, meaning in life and self-transcendence were displayed. Meaning and the interconnectedness dimension of hope appeared to be particularly dynamic resources, revealing significant influences on all the constructs in the SEM model tested. Conclusion
Nurse-patient interaction influences hope, meaning in life and self-transcendence in cognitively intact nursing home patients and might be an important resource in relation to patients' health and global well-being. Thus, care providers are above all fundamental for nursing home patients. Advancing caregivers' interacting and communicating skills might facilitate patients' health and global well-being and inspire professional caregivers as they perform their daily care practices. More research of the effectiveness of such strategies is greatly needed. LimitationsThe SEM model tested comprised 20 variables, indicating a desirable sample size of n=200, while the present effective sample was n=187. Also, cross-sectional data do not allow making conclusion on the causality.
Self-transcendence is considered a developmental process of personal maturity and a vital resource of well-being in later adulthood. Measurement of the associations between self-transcendence and spiritual well-being in cognitively intact nursing home patients has not been previously published.
The aim of this study was to identify the relationships between self-transcendence and spiritual well-being in cognitively intact nursing home patients.
A cross-sectional design using the self-transcendence scale and the FACIT-Sp spiritual well-being questionnaire was adopted. A sample of 202 cognitively intact nursing home patients in mid-Norway was selected to respond to the questionnaires in 2008 and 2009. Statistical analyses were conducted using lisrel 8.8 (Scientific Software International, Chicago, IL, USA) and structural equation modelling.
A hypothesised structural equation model comprising a two-factor construct of self-transcendence and a three-factor construct of spiritual well-being demonstrated significant direct relationships between self-transcendence and spiritual well-being and total effects of self-transcendence on spiritual well-being.
Facilitating patients' self-transcendence, both interpersonally and intrapersonally, might increase spiritual well-being among cognitively intact nursing home patients, which is seen to be of great importance to nursing home patients' overall satisfaction and satisfaction with staff. The two-factor construct of self-transcendence and the three-factor construct of FACIT-Sp allow a more complex examination of the associations between the constructs and prove more specific guidelines for nursing interventions promoting well-being in nursing home patients.
Aims and objectives. The aim of this study was to test whether nurse–patient interaction affects cognitively intact nursing home patients’ interpersonal and intrapersonal self-transcendence, as well as testing the psychometric properties of the Nurse–Patient Interaction Scale (NPIS).
Background. Self-transcendence is considered a spiritual developmental process of maturity in adulthood, and a vital resource of well-being at the end of life. The concept of self-transcendence has previously been explored in various populations, yet the nurse–patient interactions’ potential influence on self-transcendence in nursing home patients has not been published previously.
Design and methods. A cross-sectional design employing the Self-Transcendence Scale and the NPIS was adopted. A sample of 202 cognitively well-functioning nursing home patients in Norway was selected. The statistical analyses were carried out using lisrel 8.8 and structural equation modelling.
Results. Structural equation modelling-analysis indicates statistical significant effect of nurse–patient interaction on the patients’ self-transcendence. Direct influence on the intrapersonal and indirect influence on the interpersonal self-transcendence aspects was disclosed.
Conclusion. Nurse–patient interaction significantly affected both interpersonal and intrapersonal self-transcendence among cognitively intact nursing home patients. Hence, facilitating caring interventions can be significantly beneficial to older patients’ self-transcendence and thereby well-being, both emotional and physical.
Relevance to clinical practice. Caring behaviour signifies the vital and ultimate qualitative nursing behaviour, which promotes self-transcendence and thereby well-being. These findings are important for clinical nursing that intends to increase patients’ well-being.
Aims and objectives:
The aim of this study was to investigate the associations between age, gender, self-transcendence, nurse-patient interaction and multidimensional well-being as the outcome among cognitively intact nursing home patients.
Background:
Self-transcendence is considered to be a vital resource of well-being in vulnerable populations and at the end of life. Moreover, the quality of care and the nurse-patient interaction is found to influence self-transcendence and well-being in nursing home patients.
Design and method:
A cross-sectional design employing the Self-Transcendence Scale, the Nurse-Patient Interaction Scale, the FACT-G Quality of Life and the FACIT-Sp Spiritual Well-Being questionnaires was adopted. A sample of 202 cognitively intact nursing home patients from 44 nursing homes in central Norway was selected. A previous documented two-factor construct of self-transcendence was applied. The statistical analyses were carried out by means of independent sample t-test, correlation and regression analyses.
Results:
Multiple linear regression analyses revealed significant relationships between interpersonal self-transcendence and social, functional and spiritual well-being, whereas intrapersonal self-transcendence significantly related to emotional, social, functional and spiritual well-being. Nurse-patient interaction related to physical, emotional and functional well-being. Age and gender were not significant predictors for well-being, except for functional and spiritual well-being where women scored higher than men.
Conclusion:
Nurse-patient interaction and self-transcendence are vital resources for promoting well-being physically, emotionally, functionally, socially and spiritually among cognitively intact nursing home patients.
Relevance to clinical practice:
Nurse-patient interaction signifies vital and ultimate nursing qualities promoting self-transcendence and multidimensional well-being. These findings are important for clinical nursing intending to increase patients' well-being.
Reviews the literature concerning the Purpose in Life Test (PILT), an attitude scale constructed with the logotherapeutic orientation and designed to detect existential vacuum. Three areas of critical inquiry are explored: whether the PILT is so heavily contaminated with the tendency to give socially desirable responses that its usefulness is impaired, whether it is cross-culturally valid, and whether it really measures meaning and purpose in life. The PILT reflects relationship to both material and noetic success. The PILT and the Logotest may be used to determine the effectiveness of therapeutic treatments or the status of various populations and their need for such treatments. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reviews the literature concerning the Purpose in Life Test (PILT), which is used to measure the degree to which individuals experience life as meaningful. Data support the validity of the PILT as a measure of this variable. Part A, which has been used with adults and adolescents in a wide variety of settings, is well-suited for this purpose in noncompetitive situations. However, for groups that depart from middle-class American values, the generalization of the PILT is questioned. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Aim:
This article reports an empirical study of self-transcendence in cognitively intact nursing-home patients. The aim was to investigate the interrelationships between self-transcendence and nursing-home patients' physical, social, emotional and functional well-being.
Background:
Finding new and alternative approaches to increase well-being among nursing-home patients is highly warranted. Self-transcendence is considered a developmental process of maturity in adulthood and a vital resource for well-being at the end of life, thus self-transcendence could be a useful approach.
Design:
Cross-sectional
Method:
The self-transcendence scale and the Functional Assessment of Cancer Therapy General (FACT-G) Quality of Life questionnaire were used. A sample of 202 cognitively intact nursing-home patients in Mid-Norway was selected to respond to the instruments in 2008 and 2009. Analysis was applied by means of LISREL 8·8 Structural Equation Modelling.
Results:
A two-factor construct of self-transcendence showed that intrapersonal self-transcendence directly affected functional well-being and indirectly influenced physical, emotional and functional well-being. Interpersonal self-transcendence directly affected social and emotional well-being. Additionally important influences were disclosed from functional to emotional and from emotional to physical well-being.
Conclusion:
Finding nursing interventions to enhance both intrapersonal and interpersonal self-transcendence might benefit nursing-home patients' overall well-being. In a holistic perspective of body-mind-spirit, this research generates new-research questions about the pathways between the different dimensions of well-being in nursing-home patients, which is important to holistic nursing practice.
Aims and objectives:
Hypothesised that sociodemographic factors and illness variables would be associated with mortality and that emotional and social loneliness measured using the Social Provisions Scale would influence mortality among nursing homes residents with cancer.
Background:
Studies are lacking on how emotional and social loneliness influence mortality among cognitively intact older people in nursing homes with and without a diagnosis of cancer.
Design:
A cross-sectional design was used at baseline with a five-year follow-up of mortality. Methods. A cohort of 227 cognitively intact (Clinical Dementia Rating scale score ≤0·5) older residents (60 with cancer and 167 without) from 30 nursing homes were followed from 2004-2005 to 2010. Data were collected by face-to-face interview. Sociodemographic variables and medical diagnoses were obtained from the records.
Results:
Survival did not differ significantly between residents with and without cancer. After adjustment for sociodemographic and illness variables, increasing age, higher education and comorbidity were associated with mortality. In the final model from a backward selection procedure, attachment (emotional loneliness) was associated with mortality.
Conclusions:
Independent of a cancer diagnosis or not, emotional loneliness, age, education and comorbidity influenced mortality among nursing homes residents without cognitive impairment.
Relevance to clinical practice:
Nurses should pay attention to emotional loneliness among nursing homes residents independent of cancer and especially give attention to the importance to have a close confidant who provides emotional support.
This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
This study evaluated the sensitivity of maximum likelihood (ML)-, generalized least squares (GLS)-, and asymptotic distribution-free (ADF)-based fit indices to model misspecification, under conditions that varied sample size and distribution. The effect of violating assumptions of asymptotic robustness theory also was examined. Standardized root-mean-square residual (SRMR) was the most sensitive index to models with misspecified factor covariance(s), and Tucker-Lewis Index (1973; TLI), Bollen's fit index (1989; BL89), relative noncentrality index (RNI), comparative fit index (CFI), and the ML- and GLS-based gamma hat, McDonald's centrality index (1989; Mc), and root-mean-square error of approximation (RMSEA) were the most sensitive indices to models with misspecified factor loadings. With ML and GLS methods, we recommend the use of SRMR, supplemented by TLI, BL89, RNI, CFI, gamma hat, Mc, or RMSEA (TLI, Mc, and RMSEA are less preferable at small sample sizes). With the ADF method, we recommend the use of SRMR, supplemented by TLI, BL89, RNI, or CH. Finally, most of the ML-based fit indices outperformed those obtained from GLS and ADF and are preferable for evaluating model fit. (PsycINFO Database Record (c) 2012 APA, all rights reserved)