Older people's experience of participating in a reminiscence group with a gerotranscendental perspective: reminiscence group with a gerotranscendental perspective in practice

Tornstam's theory of gerotranscendence provides the theoretical underpinning for two small reminiscence groups that met for eight weekly sessions in a Swedish daycentre. Tornstams's theoretical perspective provides a developmental model for understanding positive progressive changes in values, attitudes and behaviour in the second half of life. Practical guidelines derived from this theory informed the group-work approach used. Participants' opinions about their reminiscence experience were analysed to determine the relevance of gerotranscendental theory as a basis for understanding older people's use of reminiscence in the ageing process. The study aimed at investigating older peoples' experiences of participating in a reminiscence group with a gerotranscendental perspective. The study used a qualitative approach. Older people were invited to participate in reminiscence group sessions arranged at a daycentre. When the sessions were finished, participants were interviewed about their experience of the reminiscence group. Data were analysed and categorized by using qualitative methods. The participants were satisfied with the arrangement of the group sessions. All participants believed they had reminisced and thought much more about their childhood and also recalled other memories from their lives during the period. Three quite different views emerged of the recall experience and effects of participating in the reminiscence group: 'An activity like any other; an activity that led to thoughts about memories from life or an activity that influenced my thoughts about life.' Findings suggest that it is possible to arrange reminiscence groups from a gerotranscendental perspective that serve as an intervention in gerontological nursing. This paper provides some guidance concerning how this type of group may be arranged and the various categories of participant response that may be expected.     

Theory-driven guidelines for practical care of older people,based on the theory of gerotranscendence

INTRODUCTION: The theory of gerotranscendence states that human development is a process extending into old age. When optimized, this process ends in a new perspective. The developmental process towards gerotranscendence can be obstructed or accelerated by life crises and grief, but elements in the culture can also facilitate or impede the process. Similarly, the caring climate can obstruct or accelerate the process toward gerotranscendence. The view introduced by the theory may have several consequences for staff treatment of and actions towards older people, as it offers a new understanding of living into old age. AIM: The aim of the present study was to derive guidelines for practical use in the care of older people. The guidelines should be used to promote a development toward gerotranscendence and should also be of value for people who already have attained a state of gerotranscendence. METHODS: The method of deriving guidelines from the theory was focus group interviews. The theory of gerotranscendence was used as a foundation for stimulating the discussions in the focus groups as well as for organizing the proposals that emerged. FINDINGS: Concrete guidelines at three levels, focusing on the individual, activity and organization, were derived. The guidelines describe different ways to support older people in their process towards gerotranscendence. CONCLUSION: These guidelines could support staff in their practical care of older people and could be used as a supplement to enrich the present care.     

Adoption of an innovation based on the theory of gerotranscendence by staff in a Nursing home - Part III

This article presents an intervention involving introduction of the theory of gerotranscendence and practical guidelines derived from the theory. A qualitative method was used with triangulation of methods in data collection and analysis. Both the theory of gerotranscendence and the theory of innovation were used as frameworks in the analysis. Introducing this new perspective constituted an abstract intervention. It involved nursing staff changing their interpretations and values with respect to ageing and their treatment of older people in ways not compatible with extant values. The 'early adopters' were staff members who felt acquainted with the essential ideas of the theory because they perceived in themselves a personal developmental process in line with the theory. The innovation attributes, described in the innovation theory, explained some of the problems associated with adopting the guidelines.     

The theory of gerotranscendence in practice: guidelines for nursing - Part II

Aim.  The aims of this article were to describe both how guidelines were derived from the theory of gerotranscendence and the actual guidelines. It also discusses the relevance of guidelines to practice.
Background.  This article describes how guidelines were derived from the theory of gerotranscendence as well as the content of the guidelines and how they could be used. The view of ageing introduced by the theory may have several consequences for nursing staff members' attitudes and treatment of older people, as it offers a new understanding of living in old age.
Resultant guidelines.  Concrete guidelines at three levels – focusing on the individual, activity and organization – were derived using focus groups. The guidelines describe different ways to support older people in their process towards gerotranscendence.
Conclusion.  The theory of gerotranscendence and the guidelines could help support nursing staff in their attitude towards older people and could be used as a supplement to enrich the present care.     

South Africans' experiences of being old and of care and caring in a transitional period

This focused ethnographic study aimed to illuminate a group of South Africans' experiences of being old and of care and caring in a transitional period. With a growing number of older people in Africa, studies on the individual experiences may help to develop care which is more sensitively based on the needs for older people in a changing Southern Africa context. Data were collected through group and individual in-depth interviews and participant observations which involved 16 individuals, aged 52-76. Data were analysed using a qualitative content analysis. The study showed two interrelated themes reflections on life and ubuntu - an orientation towards others. Findings were discussed from the viewpoint of the theory of gerotranscendence, showing similarities as well as differences, possibly due to societal and cultural differences. Shortage of formal care for older people living in poor conditions in Southern Africa, gave rise to the discussion for the need of a contextualized development of gerontological care. To enhance knowledge on the theory of gerotranscendence and develop guidelines for nursing in home-based care/community-based care in a South African context may be a first step to support older people in their process towards gerotranscendence.     

An analysis of psychosocial theories of ageing and their relevance to practical gerontological nursing in Sweden

BACKGROUND: Theories exist to challenge current practice, create new approaches to practice and remodel the structure of rules and principles. One question is whether nurses could find in psychosocial theories of ageing a theoretical foundation on which to base support of older people in their ageing process. AIM: The aim of the present paper was to analyse five psychosocial theories of ageing and to discover what they could mean for gerontological nursing in Sweden. METHOD: A literature search was conducted to find original works. Research questions inspired by Fawcett's framework guided the analysis. FINDINGS: Psychosocial theories of ageing cover different aspects of the ageing process, but do not address crucial issues regarding the attitudes and structure of good nursing care. These theories provide no clear guidance on how to care for older people and how to support them in their ageing process. However, the analysis did show that the theories contain underlying values that influence society and staff as regards their views on the ageing process and how care of older people should be carried out. Nursing interventions to support ageing will be quite different depending on the theoretical perspective taken by nurses. CONCLUSIONS: There is a need to translate the ageing theories into guidelines, so that staff in gerontological care will have tools to use in practice irrespective of which theoretical perspective they choose to use in care. This could also promote care that is tailored to each individual older person.     

Applying to a nursing home is a way to maintain control of life—Experiences from Swedish nursing home applicants

Background

Swedish social policy enables ageing in place with support from home-based care services despite high age and/or declining health.

Aim

This study aims to describe the daily life experiences behind the decision to apply for a nursing home placement in older adults ageing in place.

Materials and Methods

A qualitative design was chosen, and 11 semi-structured interviews were conducted and analysed using inductive qualitative content analysis.

Results

The participants described a feeling of dependence in which they had to ignore their personal privacy when receiving home-based care. They reached a turning point when ageing in place was, for several reasons, no longer considered an acceptable option. This influenced their choice to apply to a nursing home where they expected that they could maintain control over their lives.

Discussion and Conclusion

The results indicate that when enhancing ageing in place it is important to enable older adults to receive support to maintain autonomy in daily activities and to have the opportunity to age in the right place.     

Attitudes towards hospitalized older adults

BACKGROUND: A number of studies have explored nurses' attitudes toward older people. However many of those have produced inconclusive results. Moreover dated attitudinal measures have been used to answer a broad range of questions relating to older people. AIM: The aim of this paper is to report a study examining whether negative attitudes and beliefs toward older adults persist. METHODS: Focus group interviews were used identifying factors which may influence attitudes and beliefs both negatively and positively. Nine Registered Nurses from care of older adult areas, four from acute areas, six nurse teachers, and 17 nursing students participated in the study. Ten themes were identified from the findings. FINDINGS: The findings show that the student nurses had varying experiences in older adult settings. Some of which had the effect of turning them away from the specialty. However, nurses who worked with older adults were very positive about their work and the nursing opportunities they had to offer student nurses. They were rather critical of the content of the pre-registration curriculum, which they perceived to over-rely teaching the negative aspects of ageing, and there was also criticism of the currency of teachers' knowledge. Nurses who worked in acute settings also did not escape criticism, in that they were identified as attributing a lack of sense of humour to older adults. The limitations include the small sample size although it is congruent with qualitative research. CONCLUSIONS: All nursing staff need to be more aware of their influence on the attitudes of student nurses toward older people. Good practice includes the ability to demonstrate that older people in hospital settings are valued. Nurse teachers need to review the way they prepare students for this specialist work in order to avoid inadvertently conveying negative attitudes.     

Living with chronic heart failure: a review of qualitative studies of older people

Title. Living with chronic heart failure: a review of qualitative studies of older people Aim. This paper is a report of a systematic review of qualitative studies of how older people live with chronic heart failure. Background. Chronic heart failure is a global epidemic mainly affecting an ageing population. Understanding how older people live with this disease is important to help promote their adjustment to the distressing illness experience. Data sources. Eligible studies published in 1997–2007 were identified from several databases (Medline, CINAHL, PsycINFO and Sociological Abstracts). A manual search was conducted of bibliographies of the identified studies and relevant journals. Review methods. Two researchers independently reviewed the studies and extracted the data. Key concepts from the papers were compared for similarities and differences. The transactional model of stress was used to guide data synthesis. Findings. Fourteen qualitative studies were identified. Most described the illness experiences of older people with chronic heart failure and associated coping strategies. There was some emerging work exploring the adjustment process. The findings indicated that living with chronic heart failure was characterized by distressing symptoms, compromised physical functioning, feelings of powerlessness and hopelessness, and social and role dysfunction. There were gender differences in the way the disease was conceived. Adjustment required patients to make sense of the illness experience, accept the prognosis, and get on with living with the condition. Conclusion. Empowering older people to manage chronic heart failure, instilling hope and bolstering support system are means of promoting successful adjustment to the disease. Further research needs to explore the cultural differences in the adjustment process.     

Social support and networks in health promotion of older people: a case study in Brazil

Aim.  This research aimed at identifying social support for older people and their families.
Background.  The Brazilian National Policy for Older People's Health, created in 1998, is based on the promotion of healthy ageing, aiming at encouraging older people to remain in their environment and independently exert their functions in society. Nursing has engaged in this process, seeking to provide integrated care to the older person and family.
Method.  A case study with multiple participants was carried out. The inclusion criteria were families of older people over 70 years old who attended a Family Health Unit in the interior of the State of Minas Gerais, Brazil. Data were collected between April and June, 2007. In-depth interviews, genograms and ecomaps were used to collect data, which were categorized by thematic content analysis.
Results.  Three families participated in this study, totalling seven participants.
Conclusions.  The older people's families depend on institutional networks for their health maintenance. Spirituality and religion are mixed and are very expressive sources of support.
Relevance to clinical practice.  Assessing social support and networks can favour nursing interventions in order to intensify social interactions, promote leisure and help the families of older people to cope with life changes.     

The use of drama to support reflection and understanding of the residents’ situation in dementia care: a pilot study

Background. One key aspect of person‐centredness is striving to understand both the patients’ experiences and behaviours from their perspective. These aspects are precisely those that staff in dementia care highlight as causing them most difficulty because the people in their care have major problems expressing themselves. There is thus a need to develop a method to help the staff to achieve interpretation through reflection. Aim. The aim of this study was to explore the use of drama as a tool to support reflection among staff working in the residential care of people with dementia. Design. A qualitative evaluation of a programme consisting of three drama sessions with staff working in residential care (n = 10 nurse assistants). Methods. Data comprised observations and tape recordings of the sessions, the researchers’ reflections after each session and a focus‐group interview with the participants. The texts were analysed using qualitative content analysis. Results. The analysis showed that: (i) the exercises stimulate reflection about daily caring practice; (ii) the participants must receive extensive information about the purpose of the sessions; (iii) the research team must secure the defined frames and conditions and have practical knowledge about caring for people with dementia and (iv) the management needs to be stable, committed and supportive. Conclusion. Drama seems to be a valid tool to aid reflection, but several adjustments are needed concerning both the content of the sessions and the methodology. When designing a larger intervention study, it would be preferable to the sessions to be combined with staff support to effect changes in care provision resulting from their increased awareness of the residents’ situation and experience. Implications for practice. Our results showed that drama can be a means to enhance reflection among staff in residential care for people with dementia. Further research is however needed concerning the effects for the staff's situation and nursing care quality.     

Pilot testing the effectiveness of the Healthy Ageing Supported by Internet and Community programme for promoting healthy lifestyles for people over 65 years of age

Active ageing is associated with physical, social and mental wellbeing, as well as the participation and integration of older people in society. Currently, demographic changes represent a major challenge while reinforcing the need to improve our current understanding of active ageing and promote appropriate interventions suitable for older people. The aim of this pilot study was to evaluate the impact of the Healthy Ageing Supported by Internet and Community training programme for acquiring the knowledge and skills necessary for adopting a healthy lifestyle in community-dwelling adults over 65 years of age. This study was conducted between 2015 and 2016 and was based on a convenience sample of individuals who responded to questionnaires. The study participants comprised all those who were included in the training programme (n = 71, 47 mentors and 24 participants in peer groups). The statistical analysis demonstrated the effectiveness of the programme regarding feasibility and expected results (p < 0.05 for most items, individually, as well as for the total scores of each test dimension). The programme was based on peer group training and the use of information and communication technologies and proved to be effective for acquiring the knowledge and skills necessary for adopting a healthy lifestyle. Furthermore, increased health scores were obtained in the physical, mental and social domains. It could also be beneficial for other groups of older people in order to support their integration into society, enhance their social skills and decrease any feelings of loneliness and rejection.