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Jeg vil leve til jeg dør: Livslyst hos hjemmeboende kronisk sykeeldste eldre
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
2013 (Norwegian)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

One challenge in the Western world is the risk of functional impairmentand chronic disease accompanying older age. In Norway it is expected thatmost chronically ill older persons will continue to live at home and receivehelp from home nursing care. The inner strength of the oldest old, as seenin relation to the help that is given, and whether the help has contributed tostrengthen the will to live has been explored only to a limited extent.Meaning in life and daily routines can be related to the will to live,understood as enjoying life and having the courage to live. The aim of thisstudy is to develop knowledge in regard to chronically ill oldest olderpersons and the possibilities and limitations in their will to live when theyreceive help from home nursing care.This study uses the quantitative method (n=120, Article 1 and Article 2) todescribe the characteristics of inner strength using the questionnairesResilience Scale, Sense of Coherence Scale, Purpose in Life Test, and Self-Transcendence Scale. Inner strength was seen in relation to mental andphysical health using the questionnaire SF-36. The qualitative method wasused to illuminate how the oldest older persons experienced living at homewith chronic illness (n=13, Article 3) and receiving help from home nursingcare (n=11, Article 4). The participants in this study were 80 years old orolder, living at home with chronic illnesses, and receiving help from homenursing care. All participants were determined to have the mental capacityto take part in this study.The analysis showed in Article 1 that the oldest old had an inner strengthexpressed as ”sense of coherence” and ”purpose in life.” Their innerstrength was accompanied by the ability for self-transcendence. Mentalhealth was predicted by self-transcendence (p < 0.001) for the total sampleand for women. Physical health was predicted by self-transcendence (p <0.01) for the total sample. Low resilience contributed to vulnerability for theparticipants. They were vulnerable in terms of limited perseverance, selfreliance,and existential aloneness (Article 2). On the contrary, theyexperienced equanimity and meaning. Meaning in daily life (Article 3)sometimes meant feelings of insufficiency and dependency. In contrast,they also experienced joy in life, gratitude for living at home, and aneagerness to participate in activities that made them feel alive. Theyexperienced both good and bad days, which depended on their illness butwas also based on how their needs for help and support were met. InviiArticle 4, receiving help indicated different experiences. Being ill anddependent on help led to days with illness, treatment, and receiving care. Italso indicated they were in need of professional help. Receiving help couldmean being at the mercy of helpers, which could imply unworthy help, asthey had no influence on the help they got from incompetent nurses whofocused only on tasks, with limited flexibility in their work, using theirhomes as a working place. This situation of receiving help from busynurses caused the old person to feel inferior as a human being. Other timesit meant receiving help from nurses who took care with respect to the oldperson and confirmed him or her as a human being. The older personswanted to be seen, met, and supported to strengthen their courage to meetthe challenges of being old and ill.According to the ethics of caring, human beings are vulnerable andmutually dependent on each other. This influences the possibilities andlimitations of ”the other” in experiencing a will to live. ”Receiving theother” can contribute to the will to live, influenced by the help received inan asymmetric dependency in which the nurses are caught in the tensionbetween suffering and the will to live for the oldest older person in need ofhelp. In this tension, the will to live is dependent on help that is given in arelationship characterized by caring and responsibility for the other.

Place, publisher, year, edition, pages
Sundsvall: Mittuniversitetet , 2013. , 74 p.
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 140
Keyword [en]
Dependency, oldest old, home, home nursing care, inner strength
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-18318ISBN: 978-91-87103-56-8 (print)OAI: oai:DiVA.org:miun-18318DiVA: diva2:599884
Public defence
2013-02-21, Høgskolen i Nord-Trøndelag, Levanger, Norge, 10:00
Supervisors
Available from: 2013-01-22 Created: 2013-01-22 Last updated: 2015-06-18Bibliographically approved
List of papers
1. Inner strength in relation to perceived physical and mental health among the oldest old people with chronic illness
Open this publication in new window or tab >>Inner strength in relation to perceived physical and mental health among the oldest old people with chronic illness
2013 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 17, no 2, 189-196 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to examine inner strength, defined as connectedness, firmness, flexibility, and creativity, and its relation to mental and physical health in a sample of the oldest old chronically ill women and men living at home.

Methods: A sample of 79 older women and 41 men in the age range of 80–101 years old (mean = 87.5) participated in this study. Inner strength measured by Resilience Scale, Sense of Coherence Scale (SOC), Purpose in Life Test (PIL), and Self-Transcendence Test (STS) was viewed in relation to mental and physical health (SF-36 Health Survey).

Results: Experiencing connectedness, firmness, flexibility, and creativity were equal for women and men. SOC, PIL, and STS showed moderate inner strength. Medium and low resilience made the participants feel vulnerable. A significant correlation was observed between the variables for inner strength and mental health for women, men, and the total sample. STS was associated with mental and physical health for the total sample and for women.

Conclusions: Although the oldest old women and men were vulnerable, they had inner strength. Encouraging participation using the inner strength of the oldest old can contribute to strengthen their experiences of independence, integrity, and enjoying life.

Keyword
Aged; Chronically ill; Inner strength; Resilience
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-18199 (URN)10.1080/13607863.2012.717257 (DOI)000315677700007 ()22934801 (PubMedID)2-s2.0-84874060347 (Scopus ID)
Note

Published online: 30 Aug 2012

Aging & Mental Health 2012, 1-8 iFirst

Available from: 2013-01-09 Created: 2013-01-09 Last updated: 2017-12-06Bibliographically approved
2. A description of resilience for Norwegian home-living chronically ill oldest old persons
Open this publication in new window or tab >>A description of resilience for Norwegian home-living chronically ill oldest old persons
2013 (English)In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, 241-248 p.Article in journal (Refereed) Published
Abstract [en]

Background: Despite worsening health the chroni- cally ill oldest older persons have expressed feelings of inner strength, which can be understood as resil- ience. The objective was to describe and compare the characteristics of resilience in two different age groups of chronically ill oldest older persons living at home and who needed help from home nursing care. Design: Cross-sectional design was used to describe and com- pare the resilience qualities between the two age groups. Methods: The inclusion criteria were 80 years or old- er, living at home with chronic disease, receiving help from home nursing care, and with the capacity to be interviewed. A sample of 120 oldest older women (n = 79) and men (n = 41) separated in two age groups, aged 80 - 89 and 90+ years, participated in the study. Resil- ience characteristics were measured by Resilience Scale. Results: The whole group of oldest older people was vulnerable in relation to the characteristics of persever- ance, self-reliance, and existential aloneness. Despite reduced physical health they reported a meaningful life, and equanimity. Even if there were no significant differences between the age groups among the oldest older persons in the characteristics of Resilience Scale (RS), in the characteristic of meaning there was a ten- dency of interaction between age and how much help from home nursing care the participants received. Con- clusions: It is important to focus on the individual aging and the risk of developing illness and disabilities rather than focusing on chronologic age. Possessing meaning in life and equanimity may be strengths to meet challenges through illness and growing older.

National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-17006 (URN)
Available from: 2012-09-12 Created: 2012-09-12 Last updated: 2017-12-07Bibliographically approved
3. Daily Life for Chronically Ill Older Persons,
Open this publication in new window or tab >>Daily Life for Chronically Ill Older Persons,
2012 (English)In: Nursing Reports, ISSN 2039-4403, Vol. 1, no 2Article in journal (Refereed) Published
Abstract [en]

In the past, the study of old age often focused on the losses and problems associated with ageing. In recent times, the focus has been on the positive aspects, such as quality of life, inner strength, and enjoying life. The aims of this study were to highlight the ways in which chronically ill older persons experience the meaning of daily life and to understand what it means to live at home with chronic disease. In-depth interviews were used to illustrate individual experiences. The sample consisted of 13 chronically ill persons, aged 80 to 94 years, living at home and receiving assistance in the form of home nursing care. Data were analyzed using the phenomenological hermeneutical method. After a naïve reading and a structural analysis of the text, we identified three themes: being insufficient, becoming dependent, and enjoying life. The comprehensive understanding suggested that daily life involved bad days, described as illness with dysfunctions, limited energy, and dependency on others. Daily life also had its positive aspects, described as enjoying life. Dignity was threatened by feelings of being a burden to others and was affirmed by experiencing a will to live. It was concluded that bad days with experiences of suffering and good days that provided the older with experiences of enjoying life could help them meet adversity through qualities of resilience that gave meaning to daily life and helped them to think positively in times of greater difficulty.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-18205 (URN)10.4081/nursrep.2012.e8 (DOI)
Available from: 2013-01-09 Created: 2013-01-09 Last updated: 2016-10-17Bibliographically approved
4. The meaning of receiving help from home nursing care
Open this publication in new window or tab >>The meaning of receiving help from home nursing care
2013 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 20, no 7, 737-747 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to illuminate the meaning of receivinghelp from home nursing care for the chronically ill, elderly personsliving in their homes. The study was carried out in Norway.Data were collected by narrative interviews, analysed byphenomenological hermeneutic interpretations. Receiving help fromhome nursing care sometimes meant, “Being ill and dependent onhelp”. Other times it meant “Being at the mercy of help”. It couldalso mean, “Feeling inferior as a human being”. Sometimes help wasgiven by nurses who were respectful and proficient at caring for anelderly person, while at other times nurses seemed to be incompetentand worked with a paternalistic attitude without respect for privacy.Receiving help also meant the elderly wanted to be regarded andapproached as equal human beings, supported in the courage tomeet challenges in life.

Keyword
Autonomy; dignity; elderly persons; home nursing care; phenomenologic hermeneutic
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-18317 (URN)10.1177/0969733013478959 (DOI)23625732 (PubMedID)
Available from: 2013-01-22 Created: 2013-01-22 Last updated: 2017-12-06

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