Meaning-in-life in nursing-home patients: a valuable approach for enhancing psychological and physical well-being?

Psychometric Properties of the Functional Assessment of Cancer Therapy-General for Evaluating Quality of Life in Patients With Life-Limiting Illness in the Emergency Department

Background: The Functional Assessment of Cancer Therapy-General (FACT-G) is a widely used quality-of-life measure. However, no studies have examined the FACT-G among patients with life-limiting illnesses who present to emergency departments (EDs). Objective: The goal of this study was to examine the psychometric properties of the FACT-G among patients with life-limiting illnesses who present to EDs in the United States. Methods: This cross-sectional study pooled data from 12 EDs between April 2018 and January 2020 (n = 453). Patients enrolled in the study were adults with one or more of the four life-limiting illnesses: advanced cancer, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, or End-Stage Renal Disease. We conducted item, exploratory, and confirmatory analyses (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]) to determine the psychometric properties of the FACT-G. Results: The FACT-G had good internal consistency (Cronbach's alpha α = 0.88). The simplest EFA model was a six-factor structure. The CFA supported the six-factor structure, evidenced by the adequate fit indices (comparative fit index = 0.93, Tucker-Lewis index = 0.92, root-mean-square error of approximation = 0.05; 90% confidence interval: 0.04 - 0.06). The six-factor structure comprised the physical, emotional, work and daily activities-related functional well-being, and the family and friends-related social well-being domains. Conclusions: The FACT-G is a reliable measure of health-related quality of life among patients with life-limiting illnesses who present to the ED. Clinical Trial Registration: NCT03325985.

Quality of life and nurse-patient interaction among NH residents: Loneliness is detrimental, while nurse-patient interaction is fundamental

AIMS AND OBJECTIVES

To investigate the association between perceived nurse-patient interaction and quality-of-life among nursing home residents, adjusted for loneliness, anxiety and depression.

BACKGROUND

Symptoms of anxiety and depression are known to residents of nursing homes along with cognitive impairment, physical inactivity and low quality-of-life. Anxiety, depression and loneliness are found detrimental to NH residents' quality-of-life. The nurse-patient relationship is important for patient's well-being, both in terms of illness and symptom management.

DESIGN

Cross-sectional design.

METHODS

Data were collected in 2017 and 2018 from 188 residents in 27 nursing homes resided in two large urban municipalities in Middle and Western Norway. The inclusion criteria were: (1) local authority's decision of long-term NH care; (2) residential stay 3 months or longer; (3) informed consent competency recognised by responsible doctor and nurse; (4) capable of being interviewed, and (5) aged 65 years or older. This article is executed in accordance with STROBE statement.

RESULTS

Adjusting for age, sex, anxiety, depression and loneliness, perceived nurse-patient interaction was statistically significant to quality-of-life. While anxiety and depression showed insignificant estimates, loneliness demonstrated a significant relation with quality-of-life. Nurse-patient interaction and loneliness explained together 25% of the variation in quality-of-life.

CONCLUSION

This study suggests that loneliness is frequent as well as more detrimental to quality-of-life among nursing home residents compared to anxiety and depression. Furthermore, the present results show that the nurse-patient interaction represents an essential health-promoting resource for Quality-of-life in this population.

RELEVANCE TO CLINICAL PRACTICE

Staff nurses need to exercise their awareness of loneliness to meet residents' needs. Nursing educations should provide knowledge about nurse-patient interaction, and students as well as staff nurses in NHs should be trained, for instance by simulation, to use the nurse-patient interaction as a health-promoting resource. Finally, loneliness represents a bigger challenge than depression and anxiety; accordingly, building nurses that are capable of meeting patients' needs and facilitate care that counteracts loneliness is highly warranted.

Meaning in life as a protective factor against depression

The main objective of this study was to analyze the mediating role that meaning in life has between emotion dysregulation and depressive symptomatology in Spanish university students. Five hundred and sixty-six Spanish university students participated in the study. All of them completed the Difficulties in Emotion Regulation Scale (DERS), the Patient Health Questionnaire (PHQ-9) and the Purpose in Life Test (PIL-10). A mediation model was performed to test the hypothesis that meaning in life mediates the effect of emotional dysregulation on depressive symptomatology in college students. The results show a positive, moderate, and statistically significant correlation between depression and emotional dysregulation. In addition, a negative, moderate, and statistically significant correlation was found between depression and meaning in life, and a negative, small, and statistically significant correlation between emotional dysregulation and meaning in life. Finally, the results of the mediation model evidence the role of meaning in life in different emotional dysregulation strategies and depressive symptomatology. These findings suggest the importance of incorporating the meaning in life variable in the development and implementation of prevention and treatment programs for psychological disorders.

Evaluating the Impact of Community Gardening on Sense of Purpose for Persons Living with Dementia: A Cluster-Randomized Mixed Methods Pilot Study

Background:

Gardening has been shown to have positive effects on persons living with dementia, but no studies have explored the effects of gardening on sense of purpose.

Objective:

Explore how gardening may influence sense of purpose for people with dementia.

Methods:

Ten residents with dementia diagnoses living in a skilled care facility participated in hour-long gardening sessions twice weekly at outdoor raised beds over a two-month duration. One group (n = 5) donated vegetables to a food pantry while the other (n = 5) harvested produce for personal use. Semi-structured interviews with participants and their caregivers conducted post-intervention were analyzed for themes.

Results:

Participants and caregivers reported biopsychosocial benefits of gardening, identifying four main themes: 1) Gardening outdoors provided specific physical benefits that improved quality of life; 2) Working on a project in a group setting improved mood and fostered a sense of community; 3) Gardening promoted reminiscence and reinforced a sense of self; 4) Gardening provided participants with a sense of purpose and pride.

Conclusion:

Gardening has biopsychosocial benefits for persons living with dementia, and there appears to be additive benefit linked to improved sense of purpose via charitable giving.

Despite Symptom Severity, do Nursing Home Residents Experience Joy-of-Life? The Associations Between Joy-of-Life and Symptom Severity in Norwegian Nursing Home Residents

Background: Finding new approaches to increase health and well-being among nursing home (NH) residents is highly warranted. From a holistic perspective, several Norwegian municipalities have implemented the certification scheme framed "Joy-of-Life Nursing Home" Aims: In a holistic perspective on NH care, this study investigated if NH residents despite potential symptom severity experience joy-of-life (JoL). Therefore, we examined the frequency of common symptoms and the association between common symptoms and JoL in cognitively intact NH residents. Methods: A cross-sectional design was employed. Using the QLQ-C15-PAL quality-of-life questionnaire, hospital anxiety and depression scale, and JoL scale, a total of 188 cognitively intact NH residents participated. Results: Symptom severity was high; 54% reported fatigue, 52% reported constipation, 45% reported pain, 43% reported dyspnea, 32% reported insomnia, 22% reported appetite loss, and 20% reported nausea, while 20% reported anxiety and 23% reported depressive symptoms. Nevertheless, 59% of the NH residents reported high JoL, which was significantly positively related to the quality of life and negatively associated with anxiety and depression.

Associations between nurse-patient interaction and loneliness among cognitively intact nursing home residents - a questionnaire survey

Nursing home (NH) residents risk loneliness because of many losses. Nurse-patient interaction includes core aspects contributing to thriving and well-being among long-term NH residents. We performed a cross-sectional observation study of 188 residents 65 years and older from 27 NHs with ≥3 months' residence. All had informed consent competence recognized by the responsible doctor and nurse and could converse. We asked "Do you sometimes feel lonely?" and used the Nurse-Patient Interaction Scale (NPIS) in face-to-face interviews. We identified associations between nurse-patient interaction and loneliness and investigated the prevalence of loneliness. Eighty-eight (47%) respondents reported loneliness often or sometimes and 100 (53%) rarely or never. Adjusted for sex and age, 10 of the 14 NPIS items were significantly correlated with loneliness. Loneliness is common among cognitively intact NH residents. Nurse-patient interaction associates with residents' loneliness and might be important in alleviating loneliness.

Health Promotion Among Long-Term ICU Patients and Their Families

Few patients are as helpless and totally dependent on nursing as long-term intensive care (ICU) patients. How the ICU nurse relates to the patient is crucial, both concerning the patients’ mental and physical health and well-being. Even if nurses provide evidence-based care in the form of minimum sedation, early mobilization, and attempts at spontaneous breathing during weaning, the patient may not have the strength, courage, and willpower to comply. Interestingly, several elements of human connectedness have shown a positive influence on patient outcomes. Thus, a shift from technical nursing toward an increased focus on patient understanding and greater patient and family involvement in ICU treatment and care is suggested. Accordingly, a holistic view including the lived experiences of ICU care from the perspectives of patients, family members, and ICU nurses is required in ICU care as well as research.

Considerable research has been devoted to long-term ICU patients’ experiences from their ICU stays. However, less attention has been paid to salutogenic resources which are essential in supporting long-term ICU patients’ inner strength and existential will to keep on living. A theory of salutogenic ICU nursing is highly welcome. Therefore, this chapter draws on empirical data from three large qualitative studies in the development of a tentative theory of salutogenic ICU nursing care. From the perspective of former long-term ICU patients, their family members, and ICU nurses, this chapter provides insights into how salutogenic ICU nursing care can support and facilitate ICU patients’ existential will to keep on living, and thus promoting their health, survival, and well-being. In a salutogenic perspective on health, the ICU patient pathway along the ease/dis-ease continuum reveals three stages; (1) The breaking point, (2) In between, and (3) Never in my mind to give up. The tentative theory of salutogenic long-term ICU nursing care includes five main concepts: (1) the long-term ICU patient pathway (along the salutogenic health continuum), (2) the patient’s inner strength and willpower, (3) salutogenic ICU nursing care (4), family care, and (5) pull and push. The salutogenic concepts of inner strength, meaning, connectedness, hope, willpower, and coping are of vital importance and form the essence of salutogenic long-term ICU nursing care.

Linking Service Quality Attributes to Meaning-in-Life Outcomes for Residents Who Have Transitioned to an Assisted Living Community

The growing number of persons aged 65 and older, combined with their greater reliance on care outside the family unit, has contributed to the rapid growth of older people residing in assisted living (AL) communities. Given the increased attention paid to service standards in older adults' housing models, this qualitative study was conducted in AL to generate residents' perspectives on service and meaning-in-life outcomes. Utilizing the attributes of service quality through a transition theory lens, the data revealed empathy and responsiveness as most essential to the perceptions of service and meaning-in-life among residents. Theoretical results from this study suggest that linking current service theory to meaning-in-life outcomes would be of benefit to AL service standards research. Practical application of the research outcomes revealed how appropriate personalized attention provided in a timely manner to residents is critical to their well-being, and to their successful transition to AL.

Self-transcendence among adults 65 years and older: A meta-analysis

INTRODUCTION

Self-transcendence is a human capacity for wellbeing by expanding one's personal boundaries and may act as a health-promoting resource among adults ≥65 years. Therefore, the objectives of this meta-analysis were to determine the mean score of self-transcendence based on place of residence and gender, and to evaluate the correlations of self-transcendence with meaning, sense of coherence, resilience and depression.

METHODS

Based on inclusion criteria, 13 studies were included. Orwin Safe N and Egger's test assessed publication bias. The mean score of self-transcendence and the correlation coefficients of the selected variables were estimated by random effects models.

RESULTS

The self-transcendence mean score (n = 1634) was low (M = 43.6) and a bit lower among those staying in care facilities (M = 42.8), but did not vary significantly across gender. The correlation coefficients were self-transcendence_depression (r = -0.40), self-transcendence_meaning-in-life (r = 0.53), self-transcendence_resilience (r = 0.50) and self-transcendence_sense of coherence (r = 0.28). The correlation coefficients, except for meaning-in-life, were homogeneous.

CONCLUSION

In a health-promoting perspective, the concept of self-transcendence can help to better understand wellbeing among older individuals and provide guidance for health professionals in facilitating wellbeing and health. The concept and theory of self-transcendence can inspire health professionals in realising new health-promoting approaches to support older individuals in maintaining health, wellbeing and independency.

The efficacy of group logotherapy on community-dwelling older adults with depressive symptoms: A mixed methods study

PURPOSE

This mixed-methods study evaluated a group logotherapy program's efficacy on Korean older adults with depressive symptoms.

DESIGN AND METHODS

An intervention group (n = 23) participated in eight sessions of group logotherapy; a control group (n = 21) received the usual care. Participants completed the pretest, posttest, and 4-week follow-up questionnaires. Ten participants also had focus group or individual interviews.

FINDINGS

A linear mixed model showed significant differences between groups in terms of changes in purpose in life, depression, self-esteem, and quality of life over time. These quantitative findings were supported and enriched by qualitative data.

'I used to be a gardener': Connecting aged care residents to gardening and to each other through communal garden sites

OBJECTIVE

To explore residential aged care facility (RACF) residents' use of communal garden sites as spaces for gardening and social connection.

METHODS

Phenomenological inquiry using semi-structured interviews with 13 residents, family members and staff of a rural RACF.

RESULTS

Interest, ability and willingness to engage in communal garden sites were evident but limited by multiple factors. Data highlighted the complexities of accessing gardens, gardening and other people. An enduring identity as a gardener provided a framework for maintaining a link between gardening, finding meaning and maintaining a sense of self.

CONCLUSION

Communal garden sites can improve quality of life and enable connectedness for RACF residents. However, a range of personal, attitudinal, institutional and resource-related challenges create barriers to gardening, and in the RACF isolation and inactivity persist. We conclude that these challenges might be overcome through provision of physical and emotional support for positive risk-taking, autonomy and access to the outside to continue gardening.

Balancing instrumental rationality with value rationality: towards avoiding the pitfalls of the productivist ageing policy in the EU and the UK

The current dominant approach to active ageing policy in the EU and the UK is the productivist approach. Drawing on Weber's concepts of instrumental rationality and value rationality, this article argues that this approach is principally informed by instrumental rationality and thus has the potential to instrumentalize older persons, to become an oppressive ideological narrative, and to ignore the unique developmental meanings in late life. To avoid these pitfalls, the article proposes balancing instrumental rationality with value rationality. The balancing can occur in three dimensions. First, the value of internally oriented activities for late life should be recognized. Second, the value of participatory policy development needs to be upheld. Third, the value of meaning-in-life for the well-being and growth of older adults should be validated.

Nurse-patient interaction and self-transcendence: assets for a meaningful life in nursing home residents?

Background

Due to the shift to an older population worldwide and an increased need for 24-h care, finding new and alternative approaches to increase wellbeing among nursing home (NH) residents is highly warranted. To guide clinical practice in boosting wellbeing among NH residents, knowledge about nurse-patient interaction (NPI), inter- (ST1) and intra-personal (ST2) self-transcendence and meaning-in-life (PIL) seems vital. This study tests six hypotheses of the relationships between NPI, ST1, ST2 and PIL among cognitively intact NH residents.

Methods

In a cross-sectional design, 188 (92% response rate) out of 204 long-term NH residents representing 27 NHs responded to NPI, ST, and the PIL scales. Inclusion criteria were: (1) municipality authority’s decision of long-term NH care; (2) residential time 3 months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. The hypothesized relations between the latent constructs were tested through structural equation modeling (SEM) using Stata 15.1.

Results

The SEM-model yielded a good fit (χ2 = 146.824, p = 0.021, df = 114, χ2/df = 1.29 RMSEA = 0.040, p-close 0.811, CFI = 0.97, TLI = 0.96, and SRMR = 0.063), supporting five of the six hypothesized relationships between the constructs of NPI, ST1, ST2 and PIL.

Conclusion

NPI significantly relates to both ST1, ST2 and PIL in NH residents. ST revealed a fundamental influence on perceived PIL, while NPI demonstrated a significant indirect influence on PIL, mediated by ST.

The relationship between quality of life in a nursing home and personal, organizational, activity-related factors and social satisfaction: a cross-sectional study with multiple linear regression analyses

Objectives: This study aimed to investigate quality of life in nursing home residents and the relationship with personal, organizational, activity-related factors and social satisfaction.Methods: In a cross-sectional survey study in 73 nursing homes in Flanders, Belgium, 171 cognitively healthy residents were randomly recruited (mean age 85.40 years [±5.88]; 27% men, 73% women). Quality of life, as the dependent/response variable, was measured using anamnestic comparative self-assessment (range -5 to +5). Multiple linear regression (forward stepwise selection) was used (1) to investigate which factors were significantly related to nursing home residents' quality of life and (2) to model the relationship between the variables by fitting a linear equation to the observed data.Results: Nursing home residents reported a quality of life score of 2.12 (±2.16). Mood, self-perceived health status, social satisfaction and educational level were withheld as significant predictors of the anamnestic comparative self-assessment score (p < 0.001), explaining 38.1% of the variance in quality of life.Conclusions: Results suggest that a higher quality of life in nursing homes can be pursued by strategies to prevent depression and to improve nursing home residents' subjective perception of health (e.g. offering good care) and social network. It is recommended that nursing homes prepare for future generations, who will be more educated.

Joy-of-life in cognitively intact nursing home residents: the impact of the nurse-patient interaction

BACKGROUND

The nursing-home population is at a high risk of declined well-being and quality of life. Finding approaches to increase well-being among older adults in nursing-homes is highly warranted. Responding to this need, the approach framed 'Joy-of-Life-Nursing-Homes' (JoLNH) was developed in Norway.

AIM

To investigate the association between nurse-patient interaction and joy-of-life in the nursing-home population.

METHODS

Cross-sectional data were collected in 2017 and 2018 using the Nurse-Patient Interaction Scale and the Joy-of-Life Scale. A total of 204 cognitively intact nursing-home residents met the inclusion criteria and 188 (92%) participated. A structural equation model (SEM) of the relationship between nurse-patient interaction and joy-of-life was tested by means of STATA/MP 15.1. Ethical approval was given and each participant provided voluntarily written informed consent.

RESULTS

The SEM-model yielded a good fit with the data (χ²  = 162.418, p = 0.004, df = 118, χ² /df = 1.38, RMSEA = 0.046, p-close 0.652, CFI = 0.97, TLI = 0.96, and SRMR = 0.054). As hypothesised, nurse-patient interaction related significantly with joy-of-life (γ1,1 = 0.61, t = 7.07**).

LIMITATIONS

The cross-sectional design does not allow for conclusions on causality. The fact that the researchers visited the participants to help fill in the questionnaire might have introduced some bias into the respondents' reporting.

CONCLUSION

Relational qualities of the nurse-patient interaction should be essential integral aspects of nursing-home care. Consequently, such qualities should be emphasised in clinical practice, and research and education should pay more attention to nurse-patient interaction as an important, integral part of the caring process promoting joy-of-life and thereby well-being.

Assessing quality of life in older adults: psychometric properties of the OPQoL-brief questionnaire in a nursing home population

Background

Well-adapted and validated quality-of-life measurement models for the nursing home population are scarce. Therefore, the aim of this study was to test the psychometrical properties of the OPQoL-brief questionnaire among cognitively intact nursing home residents. The research question addressed evidence related to the dimensionality, reliability and construct validity, all of which considered interrelated measurement properties.

Methods

Cross-sectional data were collected during 2017–2018, in 27 nursing homes representing four different Norwegian municipalities, located in Western and Mid-Norway. The total sample comprised 188 of 204 (92% response rate) long-term nursing home residents who met the inclusion criteria: (1) municipality authority’s decision of long-term nursing home care; (2) residential time 3 months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed.

Results

Principal component analysis and confirmative factor analyses indicated a unidimensional solution. Five of the original 13 items showed low reliability and validity; excluding these items revealed a good model fit for the one-dimensional 8-items measurement model, showing good internal consistency and validity for these 8 items.

Conclusion

Five out of the 13 original items were not high-quality indicators of quality-of-life showing low reliability and validity in this nursing home population. Significant factor loadings, goodness-of-fit indices and significant correlations in the expected directions with the selected constructs (anxiety, depression, self-transcendence, meaning-in-life, nurse-patient interaction, and joy-of-life) supported the psychometric properties of the OPQoL-brief questionnaire. Exploring the essence of quality-of-life when residing in a nursing home is highly warranted, followed by development and validation of new tools assessing quality-of-life in this population. Such knowledge and well-adapted scales for the nursing home population are beneficial and important for the further development of care quality in nursing homes, and consequently for quality-of-life and wellbeing in this population.

Qualitative analyses of nursing home residents' quality of life from multiple stakeholders' perspectives

PURPOSE

Quality of life has been defined in various ways by nursing home stakeholders over the years. As such, analyzing the levels of agreement or disagreement among these stakeholders to ascertain if staff and leadership align with resident-identified factors for "good" quality of life has become important to include in the literature. This study sought to identify contributory factors to resident quality of life, as well as analyze areas of commonality in qualitative responses.

METHODS

Semi-structured interviews were conducted at 46 Midwestern nursing homes, with residents (n = 138), nursing assistants (n = 138), social workers (n = 46), activities directors (n = 46), and administrators (n = 46), on whether each stakeholder felt residents had a good quality of life and the factors contributing to resident quality of life.

RESULTS

Overall, the majority of residents perceived their quality of life as "good," though differences were noted in their main contributing factors when compared to staff members' and management's perspectives. Findings also demonstrated that nursing assistants most closely aligned with resident perspectives.

CONCLUSIONS

Given the implications of resident satisfaction with quality of life on multiple facets of a nursing home (e.g., survey process, financial reimbursement), it remains ever critical for management to engage residents and to truly listen to resident perspectives to enhance and ensure an optimal quality of life.

"Never in my mind to give up!" A qualitative study of long-term intensive care patients' inner strength and willpower-Promoting and challenging aspects

AIMS AND OBJECTIVES

To explore aspects that promote and challenge long-term ICU patients' inner strength and willpower.

BACKGROUND

Considerable research has been devoted to ICU patients' experiences; however, research on long-term ICU patients is limited. Studies in a health-promoting perspective focusing on long-term ICU patients' inner strength and willpower are scarce.

DESIGN

A qualitative, hermeneutic-phenomenological approach, using in-depth interviews.

METHODS

Seventeen long-term Norwegian ICU patients were interviewed once, at 6-18 months after ICU discharge. The consolidated criteria for reporting qualitative research was used (Data S1).

RESULTS

The lived experience of the phenomenon "inner strength and willpower" and what promotes and challenges this phenomenon in long-term ICU patients were represented by four main themes and nine subthemes. Promoting aspects comprised of two main themes and five subthemes: (a) "No doubt about coming back to life" with subthemes; "Strong connectedness to life; feeling alive and present," "Meaning and purpose; feeling valuable to somebody." (b) "How to ignite and maintain the spark of life," with the subthemes: "Practical solutions, coping skills from previous life experiences," "Provocative and inspiring experiences" and "Vivid dream experiences that ignite the willpower." Two main categories and four subcategories represented challenging aspects: (a) Exhaustion, weakness and discomfort; subthemes; "Physical challenges" and "Mental discomfort" and (b) "Tiring delusions," subthemes; "Living in the worst horror movie" and "Feeling trapped."

CONCLUSION

This study expands on previous studies by providing insights about what promotes and challenges long-term ICU patients' inner strength and willpower during their recovery trajectory.

RELEVANCE TO CLINICAL PRACTICE

Insights into the variety of long-term ICU patients' experiences during the recovery trajectory are important for ICU nurses to support and facilitate ICU patients' inner strength and willpower.

The mediating and moderating effects of meaning in life on the relationship between depression and quality of life in patients with dysphagia

AIMS AND OBJECTIVES

To identify whether meaning in life has moderating and mediating effects on the relationship between depression and quality of life in patients with dysphagia.

BACKGROUND

Dysphagic patients typically have multidimensional problems, such as depression, which can negatively influence their quality of life. Meaning in life, therefore, can be used as a psychological resource that may enhance quality of life for these patients.

DESIGN

A descriptive cross-sectional research design was used.

METHODS

Ninety patients with dysphagia were recruited for a survey from eight general and rehabilitation hospitals in Korea. The questionnaires, which included the Korean version of the Swallowing Quality of Life scale developed by Cha, the Center for Epidemiological Studies-Depression Scale developed by Radloff, and the Purpose in Life test developed by Crumbaugh and Maholick, were used for data collection. Descriptive statistics, Hayes' PROCESS macro and Cronbach's alpha were used for data analyses.

RESULTS

Meaning in life was found to mediate the relationship between depression and quality of life in patients with dysphagia. However, the index of moderation was not statistically significant, which mean that meaning in life did not moderate the relationship between the patients' depression and quality of life.

CONCLUSIONS

Meaning in life had a mediating effect on the relationship between depression and quality of life in patients with dysphagia. Thus, to improve the quality of life of patients with dysphagia, nurses should apply interventions to help them find meaning in life.

RELEVANCE TO CLINICAL PRACTICE

Meaning in life can be used as a nursing intervention strategy to improve the quality of life for patients living with dysphagia and depression.

Meaning in life matters for older adults with Alzheimer's disease in residential care: associations with life satisfaction and depressive symptoms

ABSTRACTObjectives:To examine whether previously established associations between experiences of meaning in life on the one hand and life satisfaction and depressive symptoms on the other hand are transferable to a population of older residential care residents with Alzheimer's disease (AD).

DESIGN

Cross-sectional study using questionnaires administered in a structured interview format.

SETTING

Nine residential care settings in Flanders, Belgium.

PARTICIPANTS

Convenience sample of 138 older adults (+65) living in residential care with a diagnosis of AD.

MEASUREMENTS

Meaning in life was measured using the Presence of Meaning (PoM) subscale of the Meaning in Life Questionnaire-Short Form, life satisfaction was measured using the Satisfaction With Life Scale (SWLS), depressive symptoms were measured using a five-item short form of the Geriatric Depression Scale (GDS), and general cognitive status was measured using the Mini-Mental State Examination (MMSE).

RESULTS

Controlling for demographic variables (age, sex, and marital status) and cognitive status, meaning in life scores were positively predictive of life satisfaction scores and negatively predictive of depressive symptoms. Post-hoc analyses suggested a possible interaction between meaning in life and cognitive status in predicting both outcomes of psychological functioning (GDS and SWLS).

CONCLUSION

The presence of meaning in life is related to important well-being outcomes for older adults with AD living in residential care. More awareness for the importance of existential themes and interventions fostering meaning might be warranted for this population.

Development and psychometric properties of the Joy-of-Life Scale in cognitively intact nursing home patients

AIM

To develop and psychometrically test the Joy-of-Life Scale. The research question addressed evidence related to the dimensionality, reliability and construct validity, all of which considered inter-related measurement properties.

METHODS

Cross-sectional data were collected during 2017-2018, in 27 nursing homes representing four different Norwegian municipalities, located in Western and Mid-Norway. The total sample comprised 188 of 204 (92% response rate) long-term nursing home patients who met the inclusion criteria: (i) local authority's decision of long-term nursing home care; (ii) residential time 3 months or longer; (iii) informed consent competency recognised by responsible doctor and nurse; and (iv) capable of being interviewed.

RESULTS

Exploratory and confirmative factor analyses clearly suggested a unidimensional solution. Five of the original 18 items showed low reliability and validity; excluding these items revealed an acceptable model fit for the one-dimensional 13-item measurement model. Reliability and construct validity were acceptable, indicating good internal consistency.

CONCLUSION

Significant factor loadings, several goodness-of-fit indices and significant correlations in the expected directions with the selected constructs (anxiety, depression, self-transcendence, meaning-in-life, sense of coherence, nurse-patient interaction and quality of life) supported the psychometric properties of the Joy-of-Life Scale.

IMPACT

The 'Joy-of-Life-Nursing-Home' is a national strategy for promoting quality of life, meaning and quality of life among nursing home patients in Norway. Therefore, exploring the essence of the Joy-of-Life phenomenon and developing a measurement scale assessing joy-of-life in this population is important for the further development of care quality in nursing homes.

Nursing students' relationships among meaning in life, well-being, and positive beliefs: A cross-sectional survey study

Nursing educators have a core responsibility to develop nursing students' health promotion. The purpose of this study was to explore nursing students regarding their relationships among meaning in life, well-being, and positive beliefs. A cross-sectional survey design was adopted in this study. Purposive sampling was used. A total of 219 nursing students participated in the study. Quantitative analysis was utilized for the data analyses. The study found that nursing students had the following mean scores on the meaning in life, 4.33 (86.60%) standard deviation (SD) 0.79; well-being, 4.23 (84.60%) SD 0.78; and positive beliefs, 4.32 (86.40%) SD 0.75. The nursing students' characteristics, meaning in life, and well-being explained 79% of the variance in positive beliefs (adjusted R = 0.79, F = 114.57, P < .001). Nursing educators can promote meaning in life and well-being to nursing students as an effective way to increase their positive beliefs.

How does meaning in life predict proactive coping? The self-regulatory mechanism on emotion and cognition

OBJECTIVE

This study examined the effectiveness of a photographic intervention method on meaning in life (MIL) and further investigated the self-regulatory mechanism responsible for the effect of MIL in the promotion of proactive coping.

METHOD

Participants were 145 Chinese adults (M_age  = 27.82; 71.3% female), who were randomly assigned into one of three conditions: An intervention (taking photos and writing expressively), a taking-photos-only control, or an assessment-only control. MIL, positive affect, future temporal focus, and proactive coping were measured before and after the intervention, with follow-up assessments conducted 1 week and 1 month later. Additionally, daily assessments were conducted during the intervention week.

RESULTS

MIL improved daily in the intervention condition, an effect that was also found post-intervention and at follow-up. Significant increases in positive affect, future temporal focus, and proactive coping were also observed after the intervention. Hierarchical linear modeling demonstrated that daily MIL positively predicted daily future temporal focus and positive affect. Furthermore, longitudinal mediation analysis confirmed that future temporal focus and positive affect mediated the relationship between MIL and proactive coping.

CONCLUSIONS

MIL's self-regulatory mechanism is reflected in both cognitive (future temporal focus) and emotional (positive affect) dimensions, which promotes proactive coping with future stressors.

Joy of life in nursing homes: A qualitative study of what constitutes the essence of Joy of life in elderly individuals living in Norwegian nursing homes

BACKGROUND

Finding new approaches to increase positive health and well-being of elderly individuals living in nursing homes (NH) is highly warranted. Several Norwegian municipalities have implemented the certification scheme framed 'Joy of Life Nursing Home' (JOLNH). JOLNH is based on a health-promoting perspective directing elderly individuals' resources. Through health promotion, preventive and social activities across generations, NH care promotes respect, well-being, health and cultural experiences among elderly individuals.

AIMS

The aims of this study were to explore the phenomenon of Joy of life (JOL) among elderly individuals living in NHs and to provide a deeper understanding of which dimensions constitute JOL in this population.

METHODS

The present study explored the JOL phenomenon using qualitative methodology. Data were collected between December 2015 and May 2016 by individual qualitative research interviews of 29 elderly individuals who met the inclusion criteria. The informants were living in ten different NHs in two large municipalities in Norway. Prior approval was obtained from all regulatory institutions dealing with research issues and the management in both municipalities.

RESULTS

The results showed that (i) positive relations, (ii) a sense of belonging, (iii) sources of meaning, (iv) moments of feeling well, and (v) acceptance constituted the conceptualisation of the JOL phenomenon.

CONCLUSION

The dimensions constituting the JOL concept correspond to the concepts of well-being and flourishing. Knowledge of the JOL phenomenon may help professionals to target elderly individuals' health and well-being more precisely and thereby increase flourishing, JOL and well-being among them.

A Meaningful Life is a Healthy Life: A Conceptual Model Linking Meaning and Meaning Salience to Health

Accumulating evidence suggests that a global sense of meaning in life is related to physical health, including increased longevity and reduced morbidity. However, the mechanisms responsible for these relationships remain largely unknown and uninvestigated. Moreover, there is no unifying conceptual framework linking meaning in life to physical health. Our aims are to (a) review the literature linking meaning in life to potential mechanisms associated with better physical health; (b) offer a comprehensive conceptual framework associating meaning in life with physical health; and (c) introduce a new construct, meaning salience, as a potentially important intermediary mechanism. Specifically, we review the evidence suggesting that meaning in life is associated with reduced stress, more adaptive coping, and greater engagement in health-promoting behaviors. Our model proposes that effects of global sense of meaning are potentiated through increased meaning salience, or daily awareness of meaning in the moment, which enhances self-regulation. Suggestions are proposed for empirically examining this new model.

"Bringing the outside world in": Enriching social connection through health student placements in a teaching aged care facility

BACKGROUND

Older adults living in residential aged care facilities (RACFs) often experience limited opportunities for social connection despite close proximity to peers, which has implications for mental health and quality of life (QoL). The introduction of large-scale undergraduate health student placements in RACFs may enhance opportunities for meaningful engagement through social connection, although this remains unexplored.

OBJECTIVE

This research explores whether interpersonal encounters between health students and RACF residents influence residents' opportunities for social connection and QoL.

METHODS

A mixed methods design was employed which included questionnaire data from residents, and qualitative interview data from residents, family members and RACF staff. Data were collected during and after student placements to allow for an in-depth exploration of residents, family members and staff perspectives.

RESULTS

Forty-three participants (28 residents, 10 staff and five family members) were recruited during 2014. Overall, many residents had clinical levels of depression, mild cognitive impairment and multiple morbidities, however reported moderate-to-good QoL. Thematic analysis was undertaken on interview transcripts, and three themes emerged: (i) social isolation and loneliness fostered by residents' age-related conditions, (ii) students expand socially supportive connections beyond the RACF and (iii) meaning making by sharing health experiences, which was found to help renegotiate older adults' pervasive narrative of vulnerability.

CONCLUSION

Supported and structured health student placements in RACFs enable older adults to participate in meaningful encounters with younger people. These encounters focus on sharing health experiences and address long-standing issues of isolation and loneliness by providing opportunities for social connection.

Aging With Purpose: Systematic Search and Review of Literature Pertaining to Older Adults and Purpose

Purpose can provide a sense of intentionality, guide behavior to achieve personal aims and living objectives, and may offer insight into how and why certain people remain healthy over time. A review of the literature sought to identify contemporary research pertaining to purpose and older adults. Thirty-one studies were selected for evaluation based on inclusion criteria. Research outcomes suggest that greater reported purpose is related to a range of better health and well-being outcomes for older adults. With few exceptions, the literature demonstrates that purpose declines with age. Nevertheless, the potential to experience purpose persists across the life span, by providing opportunities for older adults to continue contributing roles, participate in meaningful activities, and sustain their social value and sense of relevance. Further research could explore how purpose is experienced by the oldest-old age-group, those living within noncommunity settings, and people with age-related cognitive impairment such as dementia.

Development of the Chinese version of Meaning in Life Scale for cancer patients and psychometric evaluation

AIMS AND OBJECTIVES

To develop a Meaning in Life Scale for cancer patients in Chinese version and to test the validity and reliability.

BACKGROUND

Meaning in life is a protective factor of psychological well-being and is negatively related to depression and demoralisation among cancer patients. The existing scales measuring meaning in life are mostly designed in English and there is no scale designed for Chinese cancer patients based on Chinese cultural background.

DESIGN

Process of instrument development and psychometric evaluation were used.

METHODS

Items were generated from literature review and a focus group interview. Delphi technique was used to test the content validity. Item analysis and exploratory factor analysis were performed with data from 251 cancer patients. The internal consistency of the scale was tested by Cronbach's alpha.

RESULTS

A 25-item Meaning in Life Scale in Chinese version with five domains was developed. The five factors explained 62·686% of the variance. The Cronbach's alpha for the total scale was 0·897.

CONCLUSIONS

The Meaning in Life Scale in Chinese version has acceptable internal consistency reliability and good content validity and acceptable construct validity. The content of the scale reflected the attitudes of cancer patients towards meaning in life based on Chinese cultural background.

RELEVANCE TO CLINICAL PRACTICE

The Chinese version of Meaning in Life Scale for Cancer Patients appears to be a new scale to assess meaning in life among Chinese cancer patients exactly and the concept of meaning in life presented in this scale provides new ideas of meaning intervention in routine clinical practice.

Active ageing within the nursing home: a study in Flanders, Belgium

Nursing homes should support residents' quality of life (QoL). It remains vague, however, how these facilities can create a QoL enhancing environment. Active ageing (AA) is a useful framework in this context, since it provides a multidimensional set of determinants that enhance QoL. This study examined the current status of AA in nursing homes in Flanders, Belgium. A sample of 383 randomly recruited residents was surveyed on the subjective importance and experienced reality of the AA determinants as well as on QoL. Based on descriptive analyses, residents appeared to have a positive QoL and a moderately positive appraisal of the extent to which nursing homes provide a multidimensional environment to enhance their QoL. Multivariate analyses showed that residents' nursing home active ageing (NHAA) experience was positively related to their QoL and explained 20 % of its variance. Specifically, psychological factors and participation related positively to QoL. Demographic variables showed no relationships with QoL, while educational level related negatively to the NHAA experience. Currently, in Flanders, nursing homes are on their way to working according to the AA vision, but further efforts are still needed.

Psychometric properties of the Orientation to Life Questionnaire in nursing home residents

AIM

Older residents of nursing homes have several illnesses and face various challenges regarding losses of physical and mental functioning. Thus, coping and the quality of life are vital aspects in long-term care. Sense of coherence is considered an important resource for coping and the quality of life, and sense of coherence therefore needs to be validly and reliably measured in this population. We investigated the dimensionality, reliability and construct validity of the Orientation to Life Questionnaire in assessing sense of coherence among cognitively intact nursing home (NH) residents.

METHODS

We collected cross-sectional data from 227 cognitively intact NH residents (30 NHs) with one-on-one interviews. We performed confirmative factor analysis and correlations with the selected construct.

RESULTS AND CONCLUSION

In accordance with the salutogenic theory of sense of coherence, the three-factor model revealed the best fit to our data. In particular, item OLQ2, defined as 'concerns the experience of being surprised by the behaviour of people whom you know well', seemed troublesome. Removing this item resulted in good fit to the present data. Rewording or deleting item OLQ2 seems needed to get a reliable instrument measuring sense of coherence among nursing home residents.

A meaningful daily life in nursing homes - a place of shelter and a space of freedom: a participatory appreciative action reflection study

Background

Shortcomings in elderly care have been reported in many parts of the world, including Sweden. However, national guidelines for elderly care have been introduced in Sweden, which contain core values and local guarantees of dignity. These highlight the need for dignity and well-being, and organising the older person’s daily life so that they perceive it as meaningful. Therefore, the aim of the present study was to describe older persons’ experience and knowledge about obstacles, opportunities and solutions to developing a meaningful daily life for those living in nursing homes.

Methods

This study combined the Participatory Appreciative Action Reflection (PAAR) and hermeneutic approaches. Twenty-five older persons participated and persons with dementia or cognitive impairments were included. Repeated interviews were carried out as reflective conversations, leaving 50 interviews in total, wherein the older persons provided their analyses and reflections on a meaningful daily life. Finally, an analysis of the data was completed based on a life-world hermeneutic approach.

Results

We identified five tentative interpretations that describe obstacles, opportunities and solutions for a meaningful daily life. Themes 2 and 4 outline obstacles for a meaningful daily life, and Themes 1, 3 and 5 describe opportunities and solutions for a meaningful daily life: (1) Having space to be yourself; (2) No space to be yourself; (3) Belonging and security; (4) A feeling of insecurity; and (5) Longing for something to happen. In the main interpretation, we found that the five tentative interpretations are related to Tuan’s concepts of space and place, where place can be described as security and stableness, and space as freedom and openness.

Conclusions

The reciprocal relationship is a solution for a meaningful daily life and occurs in the interaction between staff and older persons in nursing homes. It is the balance of power, and constitutes a place of shelter and a space of freedom for a meaningful daily life. The older person must have balance between shelter and freedom to have a meaningful daily life.