Hospitalized older peoples' views of health and health promotion.

Older peoples' health varies considerably and the number of older people who need hospital care will increase in the future. Traditionally, the focus of nursing care in hospitals is oriented towards diagnosis and treatment of disease, although health and health promotion are inherent in theories and definitions of nursing. This is an important issue in health politics, in new laws and regulations in Norway. However, it was difficult to find research-based knowledge about how nurses work with health promotion and health related to older hospitalized patients. This study aimed at describing older hospitalized patients' experiences of health and health promotion. The study used a descriptive and explorative qualitative design, with an interpretative-phenomenological approach. Ten older hospitalized patients, recruited through purposeful sampling, were interviewed during their hospital stay. The informants described health as Being able to be the person I am, to do what I want to do, and feel well and have strength. Health promotion was described as Being enabled through being the person I am, through information and knowledge and through hope and motivation. The findings may be applied to nursing practice in order to focus on promotion of health as an individual process built upon the unique person's life and situation, supported by nursing care and medical treatment.

A holistic approach to the promotion of older hospital patients' health.

PURPOSE: To describe how nurses interpreted health promotion related to older patients in a medical hospital ward and the presuppositions for this work. METHODS: The study had a descriptive and explorative design. Data were created through participant observation of five nurses and informal dialogues with four nurses working in an infection unit in a small hospital in Norway. The nurses where followed during a period of 6 months. The observations and dialogues were interpreted and transformed into text. This text was analysed with qualitative content analysis and interpreted hermeneutically on three levels: (1) reading the text to get an overview of the themes; (2) systematically separating central patterns; and (3) highlighting the patterns with examples. FINDINGS: The nurses' interpretation of health promotion was closely connected to their interpretation of health and holistic nursing. Two main aspects were uncovered in the informal dialogues: a biomedically oriented nursing view and a holistically oriented nursing view. The observations showed that presuppositions, such as waiting for something or somebody, constantly changing situations, complexity and diversity in patient cases, influenced the nurses' work in general and also their focus on health promotion. The nurses balanced between the biomedical and the holistic approach. It seemed to be important for the nurses to be the masters of walking on a tightrope and to have professional clinical competence. CONCLUSION: It was difficult to find a clear focus on health promotion. The most visible focus was on diagnosis and treatment, while the more complex and comprehensive situations related to health promotion of older patients seemed to be underprioritized. The phenomenon of 'waiting' may be an important issue for further research.

Values and evaluation in health care.

The purpose of this paper is to broaden the view of evaluation in health care by 'problemizing' the concepts of quality and evaluation and relating them to a more general discussion of values. The discussion of the concept of quality shows that the concept of quality is often vague or contradictory and that the relationship between quality and costs is problematic. The discussion is broadened by studying quality and evaluation from the viewpoint of four categories of values: scientific values, aesthetic values, ethical values and economic values. The authors also show that values, in addition to constituting the basis for evaluation, actually guide the whole process of care. Values are explicit and implicit elements of the care culture and the individual's action system. The authors conclude that the four value categories could be used to study which values actually guide the care process in real situations.

Quality of life in old age described as a sense of well-being, meaning and value.

The purpose of the study was to present a model of quality of life and related factors, to study quality of life in a group of elderly subjects, and to do preliminary testing of the model. Quality of life was defined as a sense of well-being, meaning and value. The model includes health, functional capacity, and coping mechanisms as intra-individual conditions for quality of life, while factors in the biophysical and sociocultural environment are described as external conditions. The study sample consisted of 300 subjects, aged 75 or older and living in Finland. Data were gathered by means of structured personal interviews. The participants' quality of life was generally quite good. The correlations among the variables related to quality of life were significant, but the results of the regression analyses showed that the individual aspects of quality of life did not have identical explanatory models. The internal consistency of the instruments was good. The results give preliminary support to the model, but in future studies more attention must be paid to the conceptual and theoretical validity. In order to achieve results that can be applied in gerontological nursing practice, different groups and contexts must be investigated.

Feeling old: being in a phase of transition in later life.

The aim of the study was to illuminate very old persons' experiences of feeling old in order to get a nuanced understanding of the ageing process in later life. Fifteen persons 85-96 years of age, living in their own homes, were interviewed in-depth. Data were analysed utilising a phenomenological-hermeneutic approach. Eight persons reported that they felt old. The experience of feeling old entailed four characteristics: being able to date the beginning of feeling old, fear of helplessness and of being unable to manage one's life situation, not recognising one's former self, and feeling different from others. These characteristics corresponded to the main properties of a transition process. The comprehensive understanding was that the very old persons who also felt old were in a phase of transition. The distinguishing qualities of those that felt old were also found to be in line with the dystonic dominance in the ninth stage designated by Joan Erikson of the previously described life cycle. Knowledge about transition processes and sensitivity to very old people's experiences of feeling old are of great importance to nursing in order to provide adequate health care services and prevent unhealthy transitions.

Answering philosophical questions facing contemporary nursing practice.

The purpose of the article is to point out the relevance of asking and answering philosophical questions in nursing. The author characterizes philosophical questions as higher order questions that cannot be answered by empirical observations alone. Questions about the nature of nursing reality, about the nature of nursing knowledge, and about the validity of ethical principles are mentioned as examples of such questions. The means for dealing with philosophical questions in nursing range from formal, logical analysis to philosophical poems.

Caring culture. A study of Swedish geriatric nursing personnel utilizing the Nurse Self-Description Form.

This study is part of main investigation entitled 'The Efficiency of Care. The Importance of Work Environment and Climate', the purpose of which is an examination of the relationships between culture, climate and experiences of care providers and patients in different settings. The purpose of the present study was to investigate the perception care personnel had of themselves as reported on the Nurse Self-Description Form (NSFD). Olsson and Gullberg have added two items to the original 19-item form in the Swedish version. The research was conducted in all six wards of a geriatric hospital in Sweden, and the sample consisted of 67 head nurses, registered nurses, practical nurses and nursing assistants. It was assumed that a similar structure of factor dimensions would appear as in previous studies with the NSFD. The resulting three-factor Varimax solution explained 63% of the variation. A different factor content emerged, however, which required factor names to be provisionally renamed Intuitive-Resourceful Nurse, Ambitious-Knowledgeable Nurse, and Reliable-Considerate Nurse.

Tension neck and evaluation of a physical training course among office workers in a bank corporation.

The purpose of this study was to investigate the effects of a physical training course in a group of patients (n = 74) suffering from chronic tension neck. All participants in the course were employed by a bank corporation in Helsinki, Finland. A comparable control group (n = 77) consisted of office workers with tension neck from the same bank corporation who did not attend any training course. The outcome was analysed 6 months after the course. Pain and disability in the neck and shoulder region did not vary significantly between the group which participated in the training course and the control group. The experimental group had increased the amount of physical workout compared to the control group (83.7% vs 69.0%, P = 0.0448). Also, regarding the frequency of relaxation and stretching exercises the two groups differed significantly: the experimental group had continued to perform exercises more often (P = 0.0434). The frequency of sick leave days did not significantly differ between the groups, but the office workers in the experimental group had more periods of extended sick leave (> 10 days) and the controls had more frequent short sick leaves. The experimental group did increase their physical workout significantly compared with the controls, but no differences were detected regarding pain and disability. In order to gain more benefit more attention should be paid to the educational part of the training courses in order to enhance the patients' self-care abilities. Also, strategies to alleviate psychosocial problems and organized relaxation exercises could decrease muscle tension in the neck in office workers.

Intuition--a problematic form of knowledge in nursing.

The purpose of this article is to discuss the concept and phenomenon of intuition in nursing. With an overview of theories of intuition in philosophy and empirical research as the starting point, the authors discuss the conceptualization of intuition in nursing. Concept analyses, intuition as phenomenological nursing knowledge, intuition as clinical knowledge and intuition as spiritual connection are discussed. The authors conclude that the conceptions of intuition in nursing differ with respect to their philosophical underpinnings and that it can be questioned whether 'intuition' is always a proper term for the kind of knowledge investigated. Intuition is seen as an important concept in nursing, but there are still philosophical as well as empirical and practical problems to investigate.

Aspects of moral knowledge in nursing.

The purpose of the article is to identify and clarify different aspects of moral knowledge in nursing and to discuss the relevance of these aspects to nursing practice, nursing ethics, and education. Moral action knowledge, theoretical-ethical, personal, and situational moral knowledge are identified as different aspects of moral knowledge in nursing. Moral integration refers to the coordination of the four aspects. Some controversies in contemporary nursing ethics are discussed in the light of the proposed notion of moral knowledge. The ethics of caring is discussed as a form of personal and situational moral knowledge. The notion of moral integration requires knowledge of abstract principles as well as virtue and caring as the foundation of nursing ethics.

Teaching of patients undergoing total hip replacement surgery.

We studied the effect of patient teaching in 60 patients who underwent primary total hip replacement surgery. All the patients received an illustrated patient guide. In addition to the general patient teaching given by doctors, nurses and physiotherapists, a randomly chosen group of 27 patients received a session of intensified patient teaching. At the follow-up, 2-3 months postoperatively, 61% of patients thought that they had received the main part of their information from the physiotherapists, 9% from their doctors and 4% from the nursing staff. The importance of a well-illustrated guide was pointed out. The knowledge of potential complications, such as infection, remained poor; 37% could not name one single relevant complication. At the follow-up, the younger or better educated patients did not score any better. The experimental group who had received intensified teaching differed only slightly from the controls, but they knew significantly better when to inform their doctor of potential complications. Also, the experimental group showed greater interest in obtaining more information about their replaced hip. Patients in the experimental group showed significantly better adherence to the instructions for the postoperative rehabilitation programme.

Science and tradition in the nursing discipline--a theoretical analysis.

The purpose of the article is to argue for a conception of nursing knowledge that stresses theoretical and practical knowledge as equally important, and to analyze the roles of nursing science and nursing tradition in the discipline of nursing. Nursing knowledge is characterized as involving values, sets of beliefs, and procedural knowledge. Practical nursing knowledge is viewed as an integration of values, beliefs and procedural knowledge into action, whereas theoretical knowledge is viewed as a conception of nursing. Nursing tradition is described as the main organizer of practical nursing knowledge at the collective level, and nursing science as the main organizer of collective theoretical knowledge.

[The need for social support of relatives of elderly persons in hospital. A comparison of relatives' and caregivers' perception]. / Behovet av socialt stöd hos anhoriga till åldringar (förbättring av årldingar) på sjukhus. En Jämförelse av anhörigas och värdares uppfattingar.

The purpose of this study was to examine the support provided to the relatives of aged people in hospitals by different sources, the demand for support among them and the role of nursing personnel in providing support. The study was conducted in April 1990. Questionnaires were completed by 96 relatives and 82 members of nursing personnel on nine wards. Both emotionally and informatively, the relatives were provided better support by unofficial than by official auxiliaries. The discontent concerned mainly informative support. The relatives felt that the nursing personnel had provided them less support than the personnel believed to have given. What was required was more information of the condition and the treatment of the aged person as well as general discussion with the personnel. The preparedness of the nursing personnel to provide support to relatives was considered better by relatives than by the personnel themselves.

Nursing care as a moral, practical, communicative and creative activity.

In this paper nursing care is studied by philosophical inquiry. According to the outlined philosophical theory, nursing can be conceived as a moral, practical, communicative and creative activity. This means that nursing care is viewed as a manifestation of a conception of the good life, that it is related to some kind of changes or non-changes with respect to the patient, that it is oriented towards reaching understanding and that something new, unpredictable and meaningful is created in the nursing interaction. The theory is defended by scientific, moral and practical arguments. Habermas' theory of communicative action plays a central part in the outlined theory of nursing care.