'Meaning in life? Make it as bearable, enjoyable and good as possible!': A qualitative study among community-dwelling aged adults who receive home nursing in the Netherlands.

The population of adults ageing in place and using home-care services is growing rapidly worldwide. Meaning in life (MiL) of this group of clients is relevant for healthcare and social workers. MiL is associated with many positive outcomes, but can be challenging for aged persons. Objective of this study was to explore MiL in daily life of community-dwelling aged persons who receive homecare. A hermeneutic phenomenological approach was followed. Three waves of semi-structured interviews took place among 24 clients of a home-care organisation in the Netherlands between November 2015 and July 2018. Photo-elicitation was part of the interview procedure. Interpretative Phenomenological Analysis and dialogues enhanced understanding. Findings show that participants derived meaning from self, others, environment and living. The process of retaining MiL involved maintaining, adapting and discovering. We conclude that community-dwelling aged adults can draw MiL from many sources. Retaining MiL is interwoven in everyday life and requires continuous adaptation to ever-changing life conditions during later life. Although relevant general themes were sketched in this paper, the importance of each, and the connections between them, vary and come to light at the individual level. The themes in this paper and the cases in the appendices provide insights that may help professionals recognise MiL in their work. Besides listening to the stories of aged adults, person-centred interventions should support aged adult's strategy to retain MiL.

Nurse's attunement to patient's meaning in life - a qualitative study of experiences of Dutch adults ageing in place.

BACKGROUND: Meaning in life (MiL) is considered to be an important part of health and is associated with many positive outcomes in older adults, such as quality of life and longevity. As health promotors, nurses may take patients' MiL into account in the care process. There is a knowledge gap in terms of what constitutes good care in relation to older patients' MiL, and what the benefits may be for patients when nursing is attuned to this aspect. The purpose of this study was to explore the experiences of home nursing older adults in relation to nurses' attunement to MiL. METHODS: Gadamerian hermeneutic phenomenological design with semi-structured interviews. Participants were 24 aged home nursing patients. A framework of care ethical evaluation was used in the analysis. Multiple dialogues enhanced understanding. RESULTS: Patients did not expect nurses' regard for their MiL. They rather expected 'normal contact' and adequate physical care. Nurses showed that they were open to patients' MiL by being interested in the patient as a person and by being attentive to specific and hidden needs. Participants explained that the nurse's behaviour upon arrival set the tone: they knew immediately if there was room for MiL or not. All participants had positive and negative experiences with nurses' behaviour in relation to MiL. Valued nursing care included maintaining a long, kind and reciprocal relationship; doing what was needed; and skilled personalised care. Participants mentioned 'special ones': nurses who attuned to them in a special way and did more than expected. Benefits of care that was attuned to patients' MiL were: experiencing a cheerful moment, feeling secure, feeling like a valuable person and having a good day. Older adults also stressed that consideration for MiL helps identify what is important in healthcare. CONCLUSION: Aged homecare patients value nurses' attunement to their MiL positively. Although patients regard MiL mostly as their own quest, nurses play a modest yet important role. Managers and educators should support nurses' investment in reciprocal nurse-patient relationships.

Meaning in life of older adults in daily care: A qualitative analysis of participant observations of home nursing visits.

AIM: To explore situations in daily home nursing regarding meaning in life of older adults. DESIGN: Qualitative research design. METHODS: In total, 197 participant observations were conducted during home nursing visits between September 2015-May 2018. Descriptions were thematically analysed. The themes of this analysis were subsequently linked to dimensions of meaning in life. Dialogue in research groups expanded understanding. RESULTS/FINDINGS: Four main themes were found namely: being in a private environment; nurse-patient encounter embedded in a relationship; personal care; and conversation. CONCLUSION: Meaning in life of older adults may come to light in every situation during daily care. Hence there are many opportunities for nurses to attune their work to patients' meaning in life. Nurse education and health management should enable them to do so.

Meaning in life of older persons: An integrative literature review.

BACKGROUND:: Meaning in life of older persons is related to well-being, health, quality of life, and "good life." However, the topic is scarcely covered in nursing literature. OBJECTIVE:: The aim of this integrative review for nurses is to synthesize knowledge from scholarly literature to provide insight into how older persons find meaning in life, what are influencing circumstances, and what are their sources of meaning. The review serves as a starting point for including meaning in life of older persons as a major concern for nurses in their role as health promoters. METHOD:: An integrative review was performed including empirical research literature and texts on theoretical perspectives. ETHICAL CONSIDERATION:: Researches agree with ethical codes for research of universities in the Netherlands. For literature reviews no additional procedures are necessary according to Dutch law. FINDINGS:: A total of 44 heterogeneous texts were included in this review. Finding meaning in life is challenging for older persons. Older persons find meaning through a developmental process, by creating and discovering. Meaning in life is found in connection with self and others. Health, living together, high socio-economic status, social relations, activities, and religion are associated with experiencing meaning in later life. The main source of meaning in life of older persons is human relationships. Other sources of meaning in life vary by age and culture. DISCUSSION:: The review provides insight into meaning in life of older persons. There are several gaps in knowledge: literature is culturally biased, research on discovery of meaning and daily meaning is limited, and research from a nursing perspective is lacking. In practice, nurses have many opportunities to attune to meaning in life of patients. Further development of competence and training are needed. CONCLUSION:: Older persons find meaning in life through different processes. Meaning in life is associated with the circumstances old persons live in. Human relationship is the major source of meaning. The knowledge from this review is a necessary knowledge base for nurses to include meaning in life of older patients in care. Further research is needed to explore the role of nurses.

Implementation of complementary interventions in the Netherlands: experiences of pioneers.

OBJECTIVE: Although many Dutch patients desire integration of complementary interventions in conventional healthcare, implementation is in its infancy in the Netherlands. The objective of this study was to describe the implementation process of complementary interventions in Dutch healthcare organizations. METHODS: Data in this qualitative study were collected in two steps: by questionnaires and by interviews. In five organizations the project leader and a professional who provides the interventions participated in the study. RESULTS: Main facilitators for implementation are: enthusiasm and support of colleagues; appreciation of patients; effectiveness of the interventions; positive publications in media; possibility to link the project to objectives of the organization; and accessibility of the interventions. Main barriers for implementation are: ignorance and skepticism of professionals; lack of research; lack of budget; lack of integration of the interventions in daily practice. Participants developed strategies to overcome barriers and to exploit facilitators. CONCLUSION: Professionals play a leading role in the implementation of complementary interventions in Dutch healthcare organizations. They use several methods to deal with facilitators and barriers. PRACTICE IMPLICATIONS: Organizations and professionals that aim to implement complementary interventions in their service may learn from experiences of pioneer organizations.