The relationship of existential well - being to identity, religious coping, mental and general health among Norwegian aging women.

The aim of this study was to explore the relationship of existential spirituality to identity processing, religious coping and mental and general health among younger and older aged women in Norway. Participant's included 120 women aged 31-91 who took part in a postal survey. Results showed that both accommodative and balancing identity processes were associated with existential well -being among both the younger and older aged. Among the younger - aged, mental health was also significantly associated with existential well-being, Moreover, among the older aged, religious coping in the form of discontent, was found to be associated with existential well-being.

Validation of the WHOQOL-Bref: psychometric properties and normative data for the Norwegian general population.

BACKGROUND: The World Health Organization's Quality of Life Questionnaire (WHOQOL-Bref) is a frequently used instrument to assess the quality of life in both healthy and ill populations. Inquiries of the psychometric properties of the WHOQOL-Bref report that the validity and reliability is generally satisfactory. However, some studies fail to support a four-factor dimensionality; others report poor reliability of the social and environmental domain; and there may be some challenges of supporting construct validity across age. This paper evaluates the psychometric properties of the Norwegian WHOQOL-Bref and extends previous research by testing for measurement invariance across age, gender and education level. In addition, we provide updated normative data for the Norwegian population. METHODS: We selected a random sample of the Norwegian population (n = 654) aged 18-75 years. Participants filled out the WHOQOL-Bref, the Utrecht Work Engagement Scale and various sociodemographic variables. RESULTS: We found an acceptable convergent and discriminate validity and internal consistency of the physical, psychological and environmental domains, but a marginal reliability was found for the social domain. The factor loadings were invariant across gender, education and age. Some items had low factor loadings and explained variance, and the model fit for the age group 60-75 years were less satisfactory. CONCLUSIONS: The original four-factor dimensionality of the WHOQOL-Bref displayed a better fit to the data compared to the one-factor solution and is recommended for use in the Norwegian population. The WHOQOL-Bref is suitable to use across gender, education and age, but for assessment in the oldest age group, the WHOQOL-Old module could be a good supplementary, but further studies are needed.

Living with Chronic Kidney Disease: Illness Perceptions, Symptoms, Coping, and Quality of Life.

The purpose of this study was to explore how illness perceptions, specifically intrusiveness, impact individuals with chronic kidney disease living with dialysis therapy and kidney transplants, and to determine the relationships among illness perceptions, symptoms, coping, and quality of life (QoL). Forty-two individuals on dialysis and with renal transplants completed an online survey. We found strong relationships between illness intrusiveness, symptom scores, and QoL. Illness intrusiveness was highly disruptive to one's financial situation, health, and work. Intrusiveness was also significantly related to individual symptoms, especially tiredness, feelings of well-being, and sleep. Correlations between intrusiveness and QoL were significant. Emotion-focused coping strategies were also significantly associated with intrusiveness. Health professionals can target illness perceptions, symptom burden, and coping strategies to enhance QoL.

Opioids, Pain Management, and Palliative Care in a Norwegian Nursing Home From 2013 to 2018.

In Norway, approximately 50% of older people die in nursing homes (NH). Holistic care and pharmacological management are key factors in quality at the end of life. The purpose of this longitudinal study was to describe the use of opioids in an NH during a 5-year period. We focused on palliative care, symptoms, and suffering during the last 3 days before death. Data were collected from spring 2013 to spring 2018. We used the interRAI assessment instrument annually and when the resident died. We conducted a semi-structured interview with nurses on duty at the deathbed. At the time of death, the residents had an average age of 88.9 years and an average stay of 2.9 years (N = 100). At the first assessment, 19% of the residents used 1 or more type of opioids. On the day of death, 55% had an active prescription for opioids, mainly as subcutaneous injections. The results illustrate the different uses of opioids, including managing pain, dyspnoea, sedation, for comfort, as a prophylaxis, or a combination of reasons. Cancer- and cardiovascular diagnoses were the strongest predictor for using morphine (P < 0.05). Identification of the residents' needs for opioids is a challenge for palliative care nurses, both ethically and legally.

Translation and Adaption of Questionnaires: A Nursing Challenge.

BACKGROUND: Translation of previously developed questionnaires has often been the choice when addressing research to groups whose language is not English. In the translation of health-related questionnaires, it is highly important to assure congruency between the words and their true meaning in the language to which the questionnaire is translated. AIM: To describe the semantic problems encountered in translating a standardized questionnaire from English (the Identity and Experiences Scale) to Norwegian according to the World Health Organizations translation protocol. DESIGN: A mixed-method study was used with the formation of four focus groups and a postal survey. DATA SOURCES: Eighteen respondents from a nursing college in Oslo, an aged community in northeast Norway, and a community organization of retired persons in southeast Norway were focus group participants. In sum, 141 persons participated in the postal survey. FINDINGS: A number of semantical challenges in relation to interpretation and understanding of the meaning and use of words in the Identity and Experiences Scale were found. DISCUSSION: Words bearing emotional weight and connected to complex operational concepts were found to be problematic. Various American-English colloquial expressions also caused semantical challenges. Other problems were related to sentence structure and grammar form. CONCLUSION: Translation, adaptation, and validation of questionnaires or scales for practice and research are very time-consuming and require careful planning and the adoption of rigorous methodological approaches to derive a reliable and valid measure of the concept of interest in the target population. IMPLICATIONS FOR NURSING: Translation quality is a methodological issue that nurses need to take seriously. It is highly recommended that nurses follow and document steps in a procedure of forward translation, qualitative reviews of translated items with regard to clarity, common language and conceptual adequacy, back translation, testing on lay panels, and committee review, or a probable variation of this procedure.

Symptoms, Coping, and Quality of Life of People with Chronic Kidney Disease.

The purpose of this study was to explore how symptoms affect quality of life (QOL) for people living with chronic kidney disease (CKD) and kidney transplants, and to determine the relationship among various coping styles, symptoms, and QOL. An online survey was conducted; 42 people with CKD or a kidney transplant completed all parts of the survey. We found strong significant relationships between symptoms and QOL ratings. Problem-focused coping strategies were the most frequently employed, but there were few significant relationships between symptoms and coping, or between problem focused coping strategies and QOL. Future research should explore whether interventions to address emotion-focused coping strategies impact QOL as well as symptom burden.

Identity Processes Among Older Norwegians Living in Urban and Rural Areas.

Guided by the Identity Process Theory, we examined whether 424 Norwegians 60+ years of age would attribute their physical and mental functioning to their health (identity assimilation), to aging itself (identity accommodation), or to both (identity balance). We were also interested in the effect of these attribution styles upon depressive symptoms. Secondary data from the 2004 World Health Organization Quality of Life OLD Group Norwegian Field Study were analyzed using General Linear Model Regression and subsequent Path Analyses. Attributing physical functioning to health as opposed to aging had a negligible effect on depressive symptoms among both study groups. Attributing mental functioning to aging worsened depressive symptoms among rural participants. Attributing mental functioning to health was associated with more positive perceptions of psychosocial loss among urban participants. Positivity toward psychosocial loss lessened depressive symptoms and factors affecting those perceptions differed among rural versus urban participants. Adapting to functional changes in older age is a complex process affecting depressive symptoms.

Attitudes to ageing among older Norwegian adults living in the community.

Attitudes toward ageing have powerful influences and impact older adults' own perception of health, quality of life and utilisation of health and social care services. This study describes attitudes to ageing among 490 Norwegian older adults living in the community who responded to The Attitudes to Ageing Questionnaire. Results showed that in spite of physical changes and psychological losses, the attitudes of older adults support life acceptance with gained wisdom in feeling that there were many pleasant things about growing older and that their identity was not defined by their age. They demonstrated the ability to incorporate age-related changes within their identities and at the same time maintain a positive view of self. Although they acknowledged that old age represented a time of loss with decreasing physical independence, they meant that their lives had made a difference, they wanted to give a good example to younger persons and felt it was a privilege to grow old.

Exploring the quality of life of depressed and nondepressed, home-dwelling, Norwegian adults.

AIM: This study aims to explore how intimacy, physical and psychological health, loneliness, and attitudes to ageing at a time of loss affect the overall quality of life (QoL) of nondepressed and depressed older adults. METHOD: This was a randomised, stratified, cross-sectional study with two subsamples: depressed (n=74; mean: 77.9 years; 65% female) and nondepressed (n=356; mean: 75.0 years; 55% female), and based on the Geriatric Depression Scale-15. RESULTS: Physical health accounted for the greatest variance in overall QoL in the nondepressed group; psychological health, losses, and feelings of intimacy also made significant contributions. In the depressed group, intimacy made the strongest contribution, while psychological health came a close second. CONCLUSIONS: Physical health, psychological health, and loss were important to the QoL of nondepressed older adults, while intimacy was important for QoL in both depressed and nondepressed older adults. For those who are depressed, feelings of intimacy, in the form of having opportunities to express and receive love, are especially relevant and should be assessed by health professionals when planning interventions.

Use of instruments to measure quality of life among healthy and ill adults in community settings.

International interest in quality of life (QoL) has been affected by patients' prolonged survival, the increasingly aging population, the increase in chronic conditions and the increasing costs of health care. This has also led to the development of QoL instruments that meet the psychometric criteria necessary for reliable and valid outcome measures in research, health policy decision-making and, increasingly, in clinical practice. Despite the proliferation of QoL instruments available to inform best practice, clinicians seldom routinely apply them. One of the barriers to using QoL instruments is the unfamiliarity nurses have with existing instruments. In order to increase community health nurses' familiarity with existing QoL assessments, the aim of this paper is to describe five instruments and modules that have been developed by the World Health Organization's Quality of Life Assessment Group for the assessment of QoL among healthy and ill adults and to describe how their applicability could enhance evidence-based practice in community nursing.

Meaning given to spirituality, religiousness and personal beliefs: explored by a sample of a Norwegian population.

AIMS AND OBJECTIVES: The aim of this article is to explore the meanings given to the words 'spirituality', 'religiousness' and 'personal beliefs' by a Norwegian sample of healthy and sick individuals. BACKGROUND: Studies show that a high proportion of nurses do not identify the spiritual needs of their patients, even if the nurses are educated to give care for the whole person, including the spiritual dimension. DESIGN: This study used an exploratory qualitative design. METHODS: Qualitative data generated from six focus groups were collected in southeast Norway. The focus groups were comprised of three groups of health professionals (n = 18) and three groups of patients from different institutions (n = 15). RESULTS: The group discussions revealed that the meanings of spirituality, religiousness and personal beliefs were interwoven, and the participants had difficulty in finding a common terminology when expressing their meanings. Many of the participants described the spiritual dimension with feelings of awe and respect. They were dependent on spirituality in order to experience balance in life and cope with life crises. CONCLUSION: The themes and categories identified by the focus group discussion highlights that spirituality ought to be understood as a multilayered dimension. An appreciation of the spiritual dimension and it's implication in nursing may help to increase health and decrease suffering. RELEVANCE TO CLINICAL PRACTICE: Health professionals need to be cognizant of their own sense of spirituality to investigate the spiritual needs among their patients. This study's focus group discussions helped both patients and health professionals to improve their knowledge regarding the meanings given to the spiritual dimension.

Nurses' and caregivers' definition of spirituality from the Christian perspective: a comparative study between Malta and Norway.

AIM: The aim of this cross-sectional comparative exploratory study was to explore the term spirituality as defined by four groups of nurses and two groups of caregivers from Malta and Norway. BACKGROUND: Spirituality is a complex subjective concept which may or may not contain religiosity. Several factors may influence the individual's interpretation with implications to nursing care and nursing management. METHODS: Data were collected from six purposive samples using focus group discussions in Malta and Norway. The Taxonomy of Spirituality guided the study. RESULTS: Four themes defined the term 'spirituality'. Two differences were found between Malta and Norway. Connectedness with family and nature was emphasized more by the Maltese group while the Norwegian group identified both the positive and the negative energies of spirituality. IMPLICATIONS TO NURSING CARE AND NURSING MANAGEMENT: A clinical environment conducive to holistic care is needed. Inclusion of spirituality in the continuous professional development programmes may enhance understanding of spirituality and foster spiritual growth. CONCLUSIONS: Irrespective of differences in cultures between Malta and Norway, commonalities were found in the definition and essence of spirituality in nursing care. Trans-cultural longitudinal research is recommended to explore further the definition of spirituality.

Quality of life data in older adults: self-assessment vs interview.

BACKGROUND AND PURPOSE: There are obstacles for older people when reporting quality of life (QoL) in a survey format. The aim of this study was to explore the quality of data obtained on self-assessed QoL among older people with respect to modes of administration. METHOD AND RESULTS: Approximately half of the QoL items showed significantly higher mean values in the mail sample than in the interview sample. Data suggest that there may be more vulnerability towards offering socially desirable answers. Problems with reduced energy and loss of memory affect both modes of administration. CONCLUSIONS: This study demonstrates that investigating the mode of questionnaire administration among older people can be a valuable means by which to detect possible threats to data quality when interpreting QoL scores.

Cultural frames, qualities of life, and the aging self.

We used the Self-Concept Enhancement Tactician (SCENT) model to explore whether older Norwegians and Canadians would tactically self-enhance on qualities considered significant within their cultures in their self-perceptions of aging. Qualities were measured using the WHOQOL-BREF and WHOQOL-OLD. Self-perceptions of aging were measured by the Attitudes to Aging Questionnaire. The study is a secondary analysis of data collected in a larger study; 393 older Norwegians and 202 older Canadians were included. The Norwegian and Canadian group self-enhanced their perceptions of psychosocial loss based on harmonious social relationships and being part of a larger social group. For self-perceptions of physical change, both groups self-enhanced on being self-sufficient and being part of a larger social group. Our findings suggest that Norwegians and Canadians are not highly individualistic people and also provide evidence of a bicultural self-perception of aging. Nurses should consider how cultural and individual perspectives affect the care priorities of older people.

Spiritual coping in rehabilitation- a comparative study: part 2.

Spiritual coping, which may or may not contain religiosity, may enhance adaptation of clients with chronic illness. Part 1 of this article (Baldacchino et al, 2013) presented the research methodology of this cross-sectional comparative study, which explored the spiritual coping of clients with chronic illness receiving rehabilitation services in Malta (n=44) (lower limb amputation: n=10, chronic heart disease: n=9, osteoarthritis in an institution: n=10 and in the community: n=15) and Norway (n=16) (post-hip/shoulder surgery: n=5; chronic heart disease: n=5; chronic pain: n=6). Data were collected from seven purposive samples by focus groups. Roy's adaptation model (1984) and Neuman's Systems Model (2010) guided the study. Part2 discusses the findings, which consist of one main spiritual coping theme and three sub-themes: 'adopting religious coping strategies, relationship with God, and time for reflection and counting one's blessings'. Commonalities were found in the findings except in one dimension, which was found only in the Malta group, that is, being supported by others with a similar condition. This difference may be a result of the environment in the rehabilitation centres, cultural, and geographical differences between the two countries. While considering the limitations of this study, recommendations are proposed to the rehabilitation and education sectors and further trans-cultural comparative longitudinal research with mixed method approach on various clients with acute, chronic and life-threatening illness.

Spiritual coping in rehabilitation - a comparative study: part 1.

Chronic illness is defined as a long-term disease that challenges a person's physical, psychological and spiritual wellbeing. However, individuals may adapt to their condition by adopting spiritual coping strategies that may or may not include religiosity. Part 1 of this article presents the methodology of this cross-sectional comparative study, which explored the spiritual coping of patients with chronic illness receiving rehabilitation services in Malta (n=44: lower limb amputation n=10; chronic heart disease n=9; osteoarthritis-in an institution n=10 and in the community n=15); and in Norway (n=16: post-hip/shoulder surgery n=5; chronic heart disease n=5; chronic pain n=6). Data were collected from seven purposive samples during focus group sessions. Roy's Adaptation Model (1984) and Neuman's Systems Model (2010) guided the study. While acknowledging the limitations of this study, the findings presented in Part 2 identify commonalities in the spiritual coping of patients irrespective of cultural differences between Malta and Norway. A set of recommendations address clinical practice, education and further research.

Translation and focus group testing of the WHOQOL spirituality, religiousness, and personal beliefs module in Norway.

PURPOSE: The purpose of this study is to describe the Norwegian translation of the World Health Organization Quality of Life Spirituality, Religiousness, and Personal Beliefs module. DESIGN: This is an exploratory study using convenience sampling. METHOD: Translation has followed the World Health Organization's standardized protocol. Six focus groups were recruited from six geographical regions in southeastern Norway: three groups of health professionals (n = 18) and three groups of patients (n = 15). RESULTS: All facets and items were found to be culturally relevant. The facet awe underwent three literary changes, spiritual strength two, and meaning, inner peace, and faith underwent one change each. The facets spiritual connection, wholeness, and integration and hope and optimism did not undergo any changes. The facets spiritual connection, meaning in life, experiences of awe, and wholeness and integration displayed the strongest discriminatory power. Internal consistency reliability of the overall module tested with Cronbach's alpha was high (α = .93). CONCLUSION: Translating questionnaires and adapting them in comprehensible forms, while maintaining the meaning of the original items, is a challenge in holistic nursing. Even though certain difficulties in comprehension were revealed, the results of this study indicate that all facets and items on the Spirituality, Religiousness, and Personal Beliefs module were equally important.

Comparing the importance of different aspects of quality of life to older adults across diverse cultures.

BACKGROUND: there is limited research examining the relative importance of aspects of quality of life (QOL) to older adults across cultures. OBJECTIVE: to examine the relative importance of 31 internationally agreed areas of QOL to older adults in 22 countries in relation to health status, age and level of economic development. DESIGN: a survey quota sampling design was used to collect cross-cultural data. This study reports a secondary analysis of WHOQOL-OLD pilot study, which was collected simultaneously in 22 centres. SETTINGS: a variety of community, primary, secondary and tertiary health care settings located in Australia, France, Switzerland, England, Scotland, USA, Israel, Spain, Japan, China (mainland and Hong Kong), Turkey, Lithuania, Czech Republic, Hungary, Canada, Norway, Sweden, Denmark, Germany, Brazil and Uruguay. PARTICIPANTS: the total sample contained 7,401 people over 60 years with a mean age of 73.1 years; 57.8% were women and 70.1% considered themselves 'healthy'. RESULTS: there were significant differences in the importance given to various aspects of QOL for people living in medium and high-development countries. Culture explained 15.9% of the variance in the importance ratings of QOL. However, the interaction showed that cultural differences were reduced once health status, gender and age were taken into account. The importance of QOL to age bands in different cultures was not significantly affected by whether or not participants perceived themselves to be healthy. CONCLUSION: understanding the self-reported importance of diverse aspects of QOL for different cultures and for healthy and less healthy people may assist national and international policy makers to decide on priorities for the development of programmes for the ageing population.

Quality of life among Norwegian older adults: focus group results.

Fundamental to the nursing profession is understanding what issues are important to quality of life (QoL) for older adults. The aim of this study was to explore issues of importance to older adults and to compare findings with Lawton's theoretical QoL conceptualization. Five focus groups were conducted with healthy and hospitalized adults and health professionals. Many valued aspects of human existence were found to affect QoL, and results lend empirical support to many of the themes appearing under Lawton's four sectors. Results indicate the need for multidimensional assessments of QoL among older adults related to health, psychological, personal competency, social, environmental, and spiritual indicators. Issues related to time use, happiness, cognitive functioning, self-concept, coping with change, social functioning, self-determination, altruistic activity, living conditions, security, and technological aids should also be considered in future assessments of QoL. Research is needed to explore the relevancy of these issues in future assessments of QoL among older adults.