Joy and happiness: a simultaneous and evolutionary concept analysis

Understanding joy amongst older people: A scoping review

To date there has been little focus on the concept of joy amongst older people in the literature. The objective of this scoping review was to understand the extent and type of evidence about joy and older people. Searches were run in ten databases in January 2022 (re-run January 2023). Eligible studies included people aged 65 and over living in their usual place of residence and described the experience or evaluation of joy. Screening was conducted independently by two reviewers and data were extracted by one reviewer and checked by a second. We included 11 papers reporting both qualitative (n = 5) and quantitative (n = 6) studies involving 1,487 participants with a mean age of 81.6 years. Seven of the studies were based in care or nursing homes with four in community settings. Five studies reported the experience of joy, three reported on the assessment of joy, and three examined the association between joy and other factors. Social connections and participation in activities that are meaningful to the individual are important sources of joy. Joy amongst older people has received little attention in the literature despite it being highlighted as being important to older people themselves in relation to their health and wellbeing.

Joyful by nature: approaches to investigate the evolution and function of joy in non-human animals

The nature and evolution of positive emotion is a major question remaining unanswered in science and philosophy. The study of feelings and emotions in humans and animals is dominated by discussion of affective states that have negative valence. Given the clinical and social significance of negative affect, such as depression, it is unsurprising that these emotions have received more attention from scientists. Compared to negative emotions, such as fear that leads to fleeing or avoidance, positive emotions are less likely to result in specific, identifiable, behaviours being expressed by an animal. This makes it particularly challenging to quantify and study positive affect. However, bursts of intense positive emotion (joy) are more likely to be accompanied by externally visible markers, like vocalisations or movement patterns, which make it more amenable to scientific study and more resilient to concerns about anthropomorphism. We define joy as intense, brief, and event-driven (i.e. a response to something), which permits investigation into how animals react to a variety of situations that would provoke joy in humans. This means that behavioural correlates of joy are measurable, either through newly discovered 'laughter' vocalisations, increases in play behaviour, or reactions to cognitive bias tests that can be used across species. There are a range of potential situations that cause joy in humans that have not been studied in other animals, such as whether animals feel joy on sunny days, when they accomplish a difficult feat, or when they are reunited with a familiar companion after a prolonged absence. Observations of species-specific calls and play behaviour can be combined with biometric markers and reactions to ambiguous stimuli in order to enable comparisons of affect between phylogenetically distant taxonomic groups. Identifying positive affect is also important for animal welfare because knowledge of positive emotional states would allow us to monitor animal well-being better. Additionally, measuring if phylogenetically and ecologically distant animals play more, laugh more, or act more optimistically after certain kinds of experiences will also provide insight into the mechanisms underlying the evolution of joy and other positive emotions, and potentially even into the evolution of consciousness.

Reasoning like a doctor or like a nurse? A systematic integrative review

When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published doi: 10.1136/bmjopen-2021-049862. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions.

New Zealand emergency nurses' perspectives and experiences of professional joy in clinical practice: An exploratory qualitative study

BACKGROUND

Nursing is becoming an increasingly stressful occupation, identified by high rates of burnout, compounded by a worldwide nursing shortage. Differing solutions to combat burnout have not provided long-term positive outcomes. This research explored emergency nurses' perspectives and experiences of one potential solution, known as joy in work, or professional joy.

METHODS

A qualitative, descriptive design was used to conduct semi-structured interviews with six registered nurses from two New Zealand emergency departments. Thematic analysis techniques were used.

FINDINGS

Professional joy was frequently experienced, despite the difficulties faced in the emergency environment. Joy was identified as being like a spark which provided an uplift. The experience of joy positively impacted the nurse, and beyond, and potentially provided a buffer that assisted with mitigating the daily challenges. Recalling or sharing experiences of joy evoked a sense of wellbeing in the nurse, which in turn provided motivation to keep on nursing. This research identified a link between nurse wellbeing, joy and the importance of a healthy work environment.

CONCLUSION

While this study was relatively small, the findings highlight the significant positive impact the experience of joy had on these nurses. Further research is recommended to gain greater understanding of this important topic.

The Second Side of the Coin-Resilience, Meaningfulness and Joyful Moments in Home Health Care Workers during the COVID-19 Pandemic

Nursing literature predominantly focuses on job demands but is scarce for resources related to nurses' work. In the face of the COVID-19 pandemic, resources that can buffer the health-impairing effects of increased demands gain importance. The aim of this study is to explore resilience, meaning of work and joyful moments in home health care workers in South Germany during the pandemic. Resilience and meaning of work were measured quantitatively; moments of joy were investigated qualitatively by audio diaries and analyzed with qualitative content analysis. In all, 115 home health care workers (mean age = 47.83 ± 11.72; 81.75% female) filled in the questionnaires and 237 diary entries were made by 23 persons (mean age = 46.70 ± 10.40; 91.30% female). The mean scores of resilience (5.52 ± 1.04; 1-7) and meaning of work (4.10 ± 0.92; 1-5) showed high levels, with significantly higher values in females. Home care workers experienced joyful moments 334 times in 60 different types in the categories of social relationships, work content, work organization, work environment and self-care. A deeper understanding of resilience, meaning of work and joyful moments provides a basis for the development of worksite health promotion programs that address both demands and resources in home health care workers.

Evaluating the effects of dance on motor outcomes, non-motor outcomes, and quality of life in people living with Parkinson's: a feasibility study

Background

Community-based dance programs for people living with Parkinson’s have grown in popularity over the past two decades. Studies investigating these programs have demonstrated multidimensional benefits in motor, non-motor, and quality of life related outcomes, yet there is a need to focus on the feasibility of larger trials. The primary objective of this study was to assess the feasibility and acceptability of conducting a trial investigating dance and Parkinson’s in Northern Ireland. The secondary objectives were to conduct preliminary analyses of the classes’ effects and to assess the appropriateness of outcome measures for a randomized controlled trial.

Methods

Participants were recruited through the community, Parkinson’s UK, and university contacts to participate in a 12-week dance intervention inspired by the Dance for PD® model. Pre- and post-intervention, participants completed the following outcomes: MDS-UPDRS III, TUG, DT-TUG, Sensory Organization Test, MoCA, Trail Making Tests A&B, Digit Symbol Substitution Test, Digit Span, PDQ-39, FOG-Q, PHQ-9, FES-I, and an exit questionnaire (post-test only). Data were analyzed using paired samples t tests or Wilcoxon signed ranked test.

Results

Ten people living with Parkinson’s participated. Running a larger trial was deemed infeasible in this setting due to recruitment issues; conversely, the dance intervention was accepted by participants with all but one completing the study. Functional mobility (TUG), symptoms of depression (PHQ-9), and bodily discomfort showed improvement. All other outcomes did not. The exit questionnaire revealed that the social aspect of classes was important, and improvements in mood or mental state were cited most frequently as perceived benefits. Outcome measures were feasible, with some changes suggested for future trials.

Conclusions

This study highlighted the infeasibility of running a larger trial using this design in this setting despite demonstrating the acceptability of implementing a dance program in Northern Ireland for people living with Parkinson’s. The results support existing evidence demonstrating that dance may improve functional mobility and symptoms of depression in people living with Parkinson’s, though the study design and small sample size prevent the generalizability of results. The findings also support the idea that dancing has the potential to support several aspects of physical, emotional, mental, and social health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-00982-9.

Reasoning like a doctor or like a nurse? An integrative review protocol

INTRODUCTION

Clinical reasoning, a major competency for all health professionals, has been defined and studied 'within' each profession. We do not know if content, process and outcomes are comparable 'between' physician and nursing clinical reasoning. This paper aims to set up a protocol for an integrative review to analyse and synthesise the scientific nursing and medical clinical reasoning literature. It builds on the history of nursing and medical clinical reasoning research and aims to create a higher level of conceptual clarity of clinical reasoning, to increase mutual understanding in collaboration in patient care, education and research.

METHODS AND ANALYSIS

This integrative review follows stepwise the methods described by Whittmore and Knafl: problem identification, literature search, data evaluation, data analysis and presentation.The initial systematic and comprehensive search strategy is developed in collaboration with the clinical librarian and is performed in electronic databases, PubMed, CINAHL, PsycInfo and Web of Science from 30 March 2020 to 27 May 2020. Empirical and theoretical studies are included. This search will be accompanied by ancestry searching and purposeful sampling. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart will summarise the selection process. The quality of eligible studies will be evaluated with a checklist, suitable for diverse study methods.The data analysis is inspired by concept analysis of Walker and Avant and layered analysis of an intervention of Cianciolo and Regehr. We will extract the data of the included studies conforming these layers and features, to capture the multifaceted nature of clinical reasoning in both professions. The data will be presented in a validity matrix to facilitate comparing and contrasting.

ETHICS AND DISSEMINATION

Ethics approval is not required. The outcomes will be disseminated through conference presentations and publications.

What Is Missing for You to Be Happy? Comparison of the Pursuit of Happiness Among Cancer Patients, Informal Caregivers, and Healthy Individuals

CONTEXT

After cancer diagnosis, personal value priorities may change in a way that would transform such values and how life is perceived by cancer patients and their caregivers, including happiness and its pursuit.

OBJECTIVES

The objective of the study was to analyze and compare what cancer patients, informal caregivers, and healthy population believe that would make them happy.

METHODS

A qualitative content analysis was performed on the responses to a single question: "What is missing for you to be happy?" Narratives of cancer patients (n = 242, face-to-face interview), informal caregivers (n = 125, face-to-face interview), and healthy participants (n = 1,671, recruited through social media, online survey) were analyzed. Word clouds were created for each group of participants. Contents were identified and frequencies were compared among participants by means of chi-square and Fisher's exact tests.

RESULTS

Overall, participants were pursuing better health (n = 288, 14.1%), better interpersonal relationships (n = 456, 22.4%), money (n = 412, 20.2%), and work-related aspects (n = 481, 23.6%). Cancer patients and informal caregivers sought better health and cure more often than when compared to healthy people (P < 0.001). Among cancer patients, survivors' profile tended to be similar to that of the healthy population concerning what they need to be happy. Unexpectedly, "cure" (22.7%) was more frequent among participants with incurable cancer.

CONCLUSION

Regardless of the group they were in, participants sought happiness in what they considered to be important to their lives, but it was something they did not have at the time of the interview. Psychoeducational and cognitive-behavioral strategies focused on how to deal with life expectations among people facing cancer are awaited.

Health maintenance of Japanese rural small enterprise shopkeepers

Purpose

Though shopkeepers in small enterprises (SSEs) are pioneers in rethinking retirement, working ages and the lifestyles of an aging society, some pertinent health issues remain unexplored. Using narratives of shopkeepers in small, rural enterprises, the purpose of this paper is to investigate the ways of thinking about health maintenance.

Design/methodology/approach

This study employed an ethnographic approach. In total, 20 shopkeepers and residents in a rural shopping street in Tohoku, in northeast Japan, were interviewed between June 2016 and May 2017. These interviews were analysed inductively.

Findings

The ways shopkeepers think about health maintenance are expressed through an interaction with their personal history. Shopkeepers and customers used narratives to arrive at novel methods to re-think health maintenance. Through data analysis, the cultural theme of maintaining vitality through long-lasting self-struggle supported by cooperation and familiar membership was identified. This cultural theme was related to three sub-themes: struggle stimulated by flexibility and responsibility; cooperation by devoting personal capital; and compensation through family support.

Practical implications

There is a growing focus on the important role that SSEs play in rural health. The results of this study will enable rural nurses to approach and develop health via communal interaction. In addition, the support of the family through cooperation at home should be enhanced.

Originality/value

There exists the potential for shopkeepers to develop a care strategy for small enterprise-related work. This strategy could enhance active ageing and promote a sustainable healthy life.

A Narrative Analysis of Nurses' Experiences With Meaning and Joy in Nursing Practice

Health care transformation is guided by the triple aim of improving health, enhancing the patient experience, and reducing costs. Experts have recommended the addition of a fourth aim, improving the experience of providing care. They advise that achievement of the triple aim will only be possible if we create the conditions where health care workers can find meaning and joy in their work. Nurses' experiences with meaning and joy in their practice have not been well described. In an effort to fill this knowledge gap, nurses across the nation recently participated in a qualitative study to share their experiences with meaning and joy in their nursing practice. The study utilized a narrative inquiry approach with a lens of appreciation to elicit and interpret nurses' stories. The stories, recorded and archived in StoryCorps, provided rich insight into meaning and joy in nursing practice. The study captured contemporary themes that crossed practice settings and generations across the United States. Four themes emerged from the analysis, including: fulfilling purpose-"I am a nurse"; meaningful connection; impact-the wow factor; and the practice environment. The practice environment theme included 3 subthemes: teams work, leaders model the way, and opportunities to learn and grow. The themes are described and illustrated with participant quotes. The study findings build on published evidence related to meaning in nursing practice and our conceptual understanding of joy. Results align with recommendations for defining and focusing on the fourth aim: To improve the practice experiences of nurses so they can more fully contribute to achieving both the triple aim in health care and their own well-being. Specific implications for leaders and supportive practice environments are discussed.