Quality of life in nursing homes: perception of physically frail elderly residents

The purpose of this research was to disclose the characteristics of quality of life as perceived by physically frail but lucid elderly people living in nursing homes to increase the understanding of the phenomenon of quality of life in this setting. Eight elderly residents living in two nursing homes in Iceland were interviewed on two occasions. The interviews were audio-taped and transcribed to generate text for hermeneutic phenomenological analysis. Observation was also undertaken at both nursing homes to enhance the understanding of the residents' narration. The participants' concern in relation to quality of life emerges in the following main themes: (i) Securing the insecure body; (ii) Seeking solace; (iii) Preparing for departure; and (iv) Affirmation of self. The findings indicate that the phenomenon quality of life is manifold and complex, having many dimensions. The most important aspects of quality of life were for the residents to feel secure in the nursing home, have a place of their own where they could be alone with their thoughts, set their affairs in order and be prepared for death. Furthermore, it mattered to be recognized as an individual with his or her roots in their own respective family and doing meaningful things. These aspects of life in a nursing home contribute to living in a meaningful world in which humanity is preserved. It is important in caring for this particular group of residents in the nursing home to know what matters most in relation to their quality of life.     

Meanings and expressions of care and caring for elders in urban Namibian families: a transcultural nursing study

Since Namibia's Independence in 1990, the population of elders--persons 65 years old and older--in urban communities is growing steadily. As such, requests for home health care, health counselling, respite care and residential care for aging members of society are overwhelming nurses and the health care system. This study expands transcultural nursing knowledge by increasing understanding of generic (home-based) patterns of elder care that are practised and lived by urban Namibian families. Guided by Madeleine Leininger's theory of culture care diversity and universality and the ethnonursing research method, emic (insider) meanings and expressions of care and caring for elders in selected urban households have been transposed into five substantive themes. The themes, which depict what carring for elders means to urban families, include: 1 nurturing the health of the family, 2 trusting in the benevolence of life as lived, 3 honouring one's elders, 4 sustaining security and purpose for life amid uncertainty, and 5 living with rapidly changing cultural and social structures. These findings add a voice from the developing world to the evolving body of transcultural nursing knowledge. Synthesis of findings with professional care practices facilitates the creation of community-focussed models for provisioning culturally congruent nursing care to elders and their families in urban Namibia.     

关怀照护的本质及内涵

融人文关怀于临床护理工作之中，是现代护理学发展的方向，是病人健康所需。通过分析关怀照护的本质及内涵，区分护理关怀行为和非关怀行为，提出在临床护理中要把人文精神表现出来，把关爱和尊重人的理念和意识付诸于行动。     

Producing a caring environment for staff: forging old paradigms

Modern health care has evolved into technological wizardry that defies the traditional concept of caring by the bedside nurse. Industry constraints have created an environment where caring for the patient and employee has become easily discarded in favor of the rigors of technological care. With an aging and diminished work force, nursing leaders must be prepared to create a caring environment where nurses are empowered to deliver the humanitarian as well as technological aspects of caring. From a concept of work redesign that mirrors traditional nursing paradigms, nurses can enrich not only their professional work environment but also deliver the high touch aspect of care in their daily work.     

Perceptions of Public Health Nursing Practice by Municipal Health Officials in Norway

ABSTRACT Objectives: The objective of this study was to describe and analyze municipal decision-maker's views on public health nursing and to reflect upon and discuss the relevance of those views to the future of public health nursing in Norway.
Design: This explorative qualitative study using face-to-face interviews is part of a larger project, comprising 5 studies, that explores perceptions of public health nursing.
Sample: A purposeful sample of 11 municipal decision-makers was selected for interview during 2006–2007 to reflect variation in community size and perspective.
Results: Thematic content analysis of the transcribed interviews revealed 4 content categories: contribution, collaboration, challenges , and visibility . The decision-makers expressed satisfaction with the public health nursing services, showed concern about lack of visibility and clear boundaries, and some expressed irritation over lacking collaboration. The interviewees elaborated on their past experiences as the public health nurses coworkers, leaders, collaborators, and service users.
Conclusions: The respondents recognized public health nursing's contribution to public health but they lack sufficient knowledge of its content and tend to take services at local health clinics for granted. Dialogue between nurses and decision-makers is necessary in order to ensure updated evaluation and continued development of public health nursing services.     

Parent and nurse partnership model for teaching therapeutic relationships

The development of trusting, caring, boundaried, mutual relationships between staff, patients, and families in health care settings demands a set of staff skills that reflect an understanding of the perspective of patient/family as well as one's colleagues. When nurse leaders collaborate with families in teaching nurses, they offer a powerful means of gaining an understanding of the complexities inherent in the health care partnership. This shared nurse leader/family approach to education provides an opportunity to apply relationship principles to real life care situations and creates a forum for discussion of the various perspectives.     

Existential aspects of living with addiction - part II: caring needs. A hermeneutic expansion of qualitative findings

Aim. This paper aims to describe caring needs associated with existential aspects of living with addiction. Background. Spirituality is considered a driving force within and the concept relates to self, others and God and the relationships between them. The spiritual dimension is of great importance in both the addiction itself as well as in recovery and addressing caring needs relating to spirituality is important in nursing. Design. Hermeneutic inquiry was used to explore caring needs related to peoples experiences of living with addiction. Method. This paper is a hermeneutic expansion of findings presented in Part I. Existential themes in the form of spiritual challenges and caring needs are reflected upon as a process between figure and background. Results. The themes presented are: meaning – meaninglessness, connectedness – loneliness, life – death, freedom – adjustment, responsibility – guilt, control – chaos. Caring needs associated with them are identified as; the need to create a new frame of reference for interpreting of life, the need to experience coherence in life, a restored dignity as well as the need for a sense of community and attachment, confirmation and acceptance. The caring need for forgiveness and reconciliation is also identified as well as the need for continuity, comprehensibility and manageability. Conclusions. When caring for patients suffering from addiction nurses should address patients’ spirituality. The caring communion is vital, as it is the foundation for meeting the patients’ needs. Intervention by nurses should focus on aspects that will help patients feel alive and in communion with others. Relevance to clinical practice. Understanding and being able to identify patients’ caring needs associated with existential aspects of living with addiction will enable nurses to provide professional care and promote patient’s recovery.     

Transcendence and transformation in the life patterns of women living with rheumatoid arthritis

Considering personal life stories as the context for health transitions can enhance understanding of what is meaningful in living with chronic illness. Informed by Margaret Newman's theory of Health as Expanding Consciousness, this interpretive study described the life patterns of three women with rheumatoid arthritis as a process of expanding consciousness. The women's stories revealed transcendence of self-boundaries and personal transformation as new ways of living, including "simple pleasures" and "being positive." Through understanding life patterns within caring nursing partnerships, transitions in an entire life story can be appreciated as complex processes involving transcendence and transformation.     

A 35-item version of the Caring Dimensions Inventory (CDI-35): multivariate analysis and application to a longitudinal study involving student nurses

The present study was designed to investigate the perceptions of caring among student nurses and how these develop throughout the course of a programme of pre-registration nurse education. A 35-item version of the caring dimensions inventory was administered to a cohort of nursing students in a department of nursing in Scotland at entry to the programme, after 12 months and after 24 months on the programme. Caring was largely perceived through a technical dimension, demonstrated by factor analysis, but other dimensions such as intimacy, support and unnecessary and inappropriate aspects of nursing also became apparent as students progressed through the programme.     

Being with the carer: a dimension of the caring process

This study presents one of the dimensions of the caring process in nursing, under the nurses' view, in a hospital reality. It was brought to understanding through a qualitative study with a phenomenological-hermeneutical approach. One of the dimensions revealed was to be with the carer in the world of the cared patient which revealed the following constructs: the being-there of the nursing carer; sharing decision making processes; sharing knowledge; building up a caring relationship. The caring process in nursing manifests itself by meeting caring among carers, where the way of being of its existence happens in an authentic way, promoting an exchange of lived experiences, feelings and emotions, building up a caring relationship.     

North Carolina Center for Nursing health policy fellowship: a strategy for developing nursing leaders for the future

In the midst of ongoing concern about succession planning to develop the next generation of nursing leaders, the profession cannot afford to overlook succession planning in regard to the next generation of nurse leaders in health policy. This article describes a project of the North Carolina Center for Nursing that provides a fellowship in state-level health policy for North Carolina nurses who have completed a graduate level health policy course. Policy fellows are exposed to health policy analysis through the public policy arena, regulatory and administrative arenas, and organizational and institutional arenas. As part of this journey, all major state stakeholders in health policy are involved in the mentoring process. The North Carolina Center for Nursing Health Policy Fellowship is described here as a potential model related to policy initiatives in other states.     

Health and service utilization patterns among homeless men in transition: exploring the need for on-site, shelter-based nursing care.

Between September 1999 and May 2000, as part of a larger faculty/student teaching project, data describing the demographic, health problem and service utilization patterns of 183 newly sheltered homeless men (mean age = 42) seeking on-site nursing clinic services were collected and analyzed. Upon arrival to the transitional shelter, 46% of the study participants were medically uninsured or received state subsidized health benefits (49%). Almost all (99%) were in recovery from substance addiction. Despite numerous self-reported health problems, 44% had no primary care provider and 35% were seen only sporadically in local hospital clinics or in emergency departments. During the study period, nurse practitioner students and faculty managed most of the residents' episodic illnesses on-site, while assisting them to secure insurance coverage and medical appointments as a prelude to independent living. This was an attempt to curtail residents' previous pattern of waiting until medical problems became serious before seeking treatment. These findings mirrored those in studies of similar populations equating on-site delivery of health care to cost reduction. Unfortunately, many nurse-managed clinics, like our study site, fail to generate data supporting nurses' clinical efficiency and cost effectiveness in caring for homeless individuals. As such, nurses' work remains invisible and underappreciated. This article argues that future studies examining nurses' work and worth in caring for homeless individuals are necessary in determining future health care service planning with this vulnerable population.     

A discussion of the concept of spirituality

The purpose of this article is to discuss the concept of spirituality. There is a recognized connection between spirituality and health, and nurse leaders have acknowledged the importance of the spiritual as well as the physical in providing optimal nursing care. Spirituality goes beyond religious or cultural boundaries. Spirituality is characterized by faith, a search for meaning and purpose in life, a sense of connection with others, and a transcendence of self, resulting in a sense of inner peace and well-being. A strong spiritual connection may improve one's sense of satisfaction with life or enable accommodation to disability.     

To represent needs of nursing care using nursing diagnoses: potentials and restrictions of the NANDA classification and ICNP

Nursing diagnoses represent individual reactions to existing or potential changes in one's state of health. They are result of a diagnostic process, which is part of the dynamic nursing care process in its whole. Thus, as a basis of nursing interventions diagnoses have to be proved continuously. The classification of the North American Nursing Diagnosis Association (NANDA) as well as the International Classification for Nursing Practice (ICNP) can be account to the international well-known classifications of nursing diagnoses. Comparing their structures, some fundamental differences between both classifications become obvious. While the NANDA classification represents a systematic structured body of nursing knowledge with regard to human health reactions patterns, the ICNP reflects a more comprehensive part of the nursing reality, since it also contains nursing interventions and outcomes. Until the latest changes by establishing the taxonomy II, NANDA diagnoses have primarily focused deficits. But in contrast to the diagnoses of the ICNP they also comprise etiological factors. To prove the applicability of both classifications to nursing practice, they have been applied to a case study of a female resident living in a nursing home. The results of analysis show that because of their different structures the NANDA classification and ICNP have their own possibilities and limitations in covering the resident's individual needs of nursing care. These characteristic potentials and restrictions have to be taken into account when one of the classification systems is going to be implemented into nursing practice.     

Spirituality and caring in old age and the significance of religion – a hermeneutical study from Norway

Scand J Caring Sci; 2013; 27; 275–284 Spirituality and caring in old age and the significance of religion – a hermeneutical study from Norway Spirituality is an important part of caring for the whole human being. However, there is lack of consensus about the concept parameter, and there is an ongoing discussion in nursing regarding the relation between religion and spirituality. Spirituality and religion is found to support health and well‐being in old age, and this article portrays how older Norwegians understand religion and religious support as part of spirituality and caring. The theoretical framework in this study is Eriksson’s caritative caring theory, and the research aim is to broaden the understanding of spirituality from a caring science perspective. The methodology is hermeneutical according to Gadamer. The study is based upon qualitative content analysis of 30 interviews with 17 participants above 74 years, six men and 11 women. The findings portray connectedness with a Higher power, including how Christianity has influenced upon the philosophy of life of the participants, wonders about the end of life/afterlife, and the meaning of religious symbols and rituals. The study also portrays how religious support may foster dignity, especially near the end of life, and experiences and opinions regarding support from nursing personnel. The study concludes that religiousness cannot be separated from spirituality, and that nurses should be able to provide spiritual care to a certain extent. Spiritual care including religious support according to patients’ desires may foster health and preserve human dignity.     

Autonomy of the elderly

If individuals cannot change life events, at least they can change their attitude towards them. To do so, older people need autonomy; that is, the freedom and independence to accept what they cannot change. How to master life and enjoy the remaining years, and how to replace negative forces by positive ones are explored here with caring and sensitivity. Readers are challenged to accept death as well as life, and that happiness in the later years is embodied in one's capacity to embrace health or sickness as a powerful lesson. By living fully into old age, we can attain peace, serenity and joy.     

Developing leadership in nurse managers: the British Columbia Nursing Leadership Institute

The British Columbia Nursing Administrative Leadership Institute for First Line Nurse Leaders (BC NLI) is a collaborative partnership among British Columbia's Chief Nursing Officers, the Ministry of Health Nursing Directorate and the University of British Columbia School of Nursing. This initiative consists of a four-day residential program and a year-long leadership project between BC NLI participants and their organizational mentors. The evidence-based curriculum covers universal leadership and management concepts, but it also addresses leadership issues of relevance to nurse leaders in today's complex healthcare environments. The BC NLI is part of a provincial health human resources endeavour to ensure sufficient nursing leaders - for now and in the future. This paper will discuss the development, implementation and evaluation of the BC NLI. Unique aspects of the program, such as its online networking component, will be described, and its role in nursing leadership research will be briefly examined.     

Participatory action research and photovoice in a psychiatric nursing/clubhouse collaboration exploring recovery narrative

ACCESSIBLE SUMMARY: ? Personal stories about recovery in mental health are important sources of knowledge. ? Research methods are needed for exploring personal stories of recovery which honour and empower the authors of recovery stories. ? The Clubhouse of Winnipeg and an assistant professor in psychiatric nursing piloted a research project using photography in order to explore, document and share Clubhouse Member stories of recovery. ABSTRACT: The Clubhouse of Winnipeg (a community psychosocial rehabilitation centre) collaborated with a psychiatric nursing assistant professor on a participatory action research (PAR) project exploring the concept of recovery using a using a research method called photovoice. The collaborative project -Our Photos Our Voices- demonstrates how PAR and photovoice are well suited for collaborative research in mental health which honours principles underlying consumer empowerment and recovery. The foundation of empowerment is the power to act on one's behalf; PAR and photovoice support the full participation of concerned individuals in all aspects of research with the ultimate goal of action to solve problems or to meet goals identified by those individuals. Empowerment is also the ability to lay claim to one's own truth. At the core of the recovery model is the principle that recovery is defined by the individual and based on individual determinations of meaningful goals and a meaningful life. The Our Photos Our Voices project uses PAR and photovoice to effectively access, explore, document and share personal, local knowledge about recovery grounded in the personal experience of the Clubhouse researchers.     

Intercultural caring-an abductive model

The aim of this study was to increase the understanding of caring from a transcultural perspective and to develop the first outline of a theory. The theoretical perspective includes Eriksson's theory of caritative caring. Texts on caring by the transcultural theorists, including Campinha-Bacote, Kim-Godwin, Leininger and Ray, are analysed using content analysis. The overall theme that resulted from this analysis was that caring is a complex whole. Three main categories of caring emerged: inner caring, outer caring and the goal of caring. Inner caring consists of caring is a relationship, and caring and culture are seen in different dimensions. Outer caring refers to caring affected by educational, administrative and social and other structures. The goal of caring consists of caring leading to change towards health and well-being. The main categories include categories and subcategories that are compared with Eriksson's theory of caritative caring.
A model for intercultural caring is generated abductively. Caring and culture appear in three dimensions: caring as ontology independent of context; caring as a phenomenon emphasised differently in different cultures; caring as nursing care activities is unique. Caring alleviates suffering and leads to health and well-being. This model describes caring from an intercultural perspective as a mutual but asymmetric relationship between the nurse and the patient, including the patient's family and community. The patient's cultural background and acculturation influence caring. The cultural background, cultural competence and organisation of the nurse also influence caring. Caring is seen as a complex whole. This study integrates Campinha-Bacote's, Kim-Godwin's, Leininger's and Ray's views of caring with Eriksson's caritative caring and presents caring from a transcultural perspective in a new way as a model for intercultural caring, which can benefit nursing care, education, research and administration.