Meaning of wellness in caring science based on Rodgers's evolutionary concept analysis.

BACKGROUND: Wellness is a holistic, multidimensional, and process-oriented property on a continuum. It has been used interchangeably with and is undifferentiated from concepts such as health and well-being without an in-depth clarification of its theoretical foundations and a reflection on its meaning. The concept of wellness is frequently used, but its definition remains unclear. AIM: To conceptually and theoretically explore the concept of wellness to contribute to a deeper understanding in caring science. METHOD: Rodgers' evolutionary concept analysis was applied to the theoretical investigation of data from publications of international origins. The focus was on antecedents, attributes, consequences, surrogate and related terms, and contextual references. A literature search was performed through a manual review of reference lists and an online search in CINAHL and PubMed via EBSCO, and in ProQuest. Abstracts were examined to identify relevant studies for further review. The inclusion criteria were peer-reviewed papers in English; papers published in scientific journals using the surrogate terms 'wellness', 'health', 'health care', and 'health care and wellness'; and papers discussing and/or defining the concept of wellness. Twenty-six studies met the inclusion criteria. RESULTS: Based on the findings from this concept analysis, a definition of wellness was developed: 'a holistic and multidimensional concept represented on a continuum of being well that goes beyond health'. Implications for nursing practice were correspondingly presented. CONCLUSION: Wellness is defined as a holistic and comprehensive multidimensional concept represented on a continuum of being well, that goes beyond health. It calls attention by applying the salutogenic perspective to health promotion in caring science. It is strongly related to individual lifestyle and health behaviour and is frequently used interchangeably with health and well-being without an in-depth clarification of its theoretical foundation.

Experiences of a Therapeutic Equine-Assisted Group Intervention for People with Common Mental Disorders on Sick-Leave.

Common mental disorders such as anxiety, depression and stress-related disorders are increasing worldwide, resulting in long-term sick leave and lower quality of life. Traditional treatment is often insufficient to facilitate the recovery process, and the need for holistic interventions that enable successful recovery is evident. Equine-assisted interventions have shown promising results in health promotion among people with mental disorders, and further research is needed to implement them within the range of available care. The aim of the study is therefore to describe experiences of a therapeutic equine-assisted group intervention for people with common mental disorders on sick leave. The study has a descriptive qualitative design with an inductive approach. Ten participants with common mental disorders on sick leave were interviewed after participating in a 12-week equine-assisted intervention and the data were analysed with conventional content analysis. The analysis generated the overall theme "The equine-assisted group intervention facilitates recovery," which summons the four categories "The environment of the horses contributes to relaxation and an ability to be in the present," "The presence of the horses facilitates supportive relationships in the group," "Interplay with the horses entails physical activity and bodily improvements" and "Emotional interactions with the horses strengthen inner power." In conclusion, equine-assisted interventions have the potential to facilitate recovery for people with common mental disorders by providing relaxation, promoting the ability to be in the present, cultivating supportive relationships and providing physical activity and bodily improvements as well as emotional interactions that strengthen the participants' inner power.

Anxiety Communication Notes-A Tool to Facilitate Anxiety Management and Improve the Nurse-Patient Relationship in Mental Health Nursing.

Mental health care tends to be dominated by a biomedical perspective at the expense of a more recovery-oriented approach. Research on nurse-led interventions intended to strengthen the patient's ability to manage anxiety is sparse in this context. The aim of this study was to describe nurses' experiences of the use of anxiety communication notes in nursing patients experiencing anxiety in mental health inpatient care. Data were collected by interviewing twelve nurses working in two mental health inpatient care wards in southwestern Sweden. Semi-structured interviews were conducted, and qualitative content analysis was used to analyze the data. Findings showed that the use of anxiety communication notes was perceived to provide a nursing structure to foster the development and practice of adaptive anxiety management through a visual representation for mutual understanding of the patient's anxiety pattern. The nurses could also use the anxiety communication notes to support nurse-patient communication and facilitate increased participation and empowerment in the patients' anxiety management.

Relationship between Physical Activity and Health Outcomes in Persons with Psychotic Disorders after Participation in a 2-Year Individualized Lifestyle Intervention.

People with psychotic disorders have a significantly increased risk of physical diseases and excessive mortality rates. The aim of the study was to investigate relationships between changes in physical activity, levels of salutogenic health, and glycated hemoglobin among people with psychotic disorders after participation in an individualized lifestyle intervention. The results from analyses showed that self-reported increased physical activity was positively associated with the level of salutogenic health and negatively associated with the level of HbA1c on an individual level. The results indicate that coordinated, individualized, holistic and health-promoting nursing care is crucial to enabling enhanced lifestyle within this vulnerable target group.

The Role of the Horse in an Equine-Assisted Group Intervention-as Conceptualized by Persons with Psychotic Conditions.

Adopting positive health interventions is necessary to promote self-image, improve well-being, support meaningful social interaction and reduce loneliness, with benefits for psychological and physical health for persons with psychotic conditions. Raised awareness of the potential benefits of involving horses in these kinds of interventions is warranted. Thus, the aim of this study was to explore the role of the horse in equine-assisted interventions (EAI) as conceptualized among persons with psychotic conditions. Interviews were conducted with eight persons with psychotic conditions who had participated in an EAI, and data were analyzed following conventional qualitative content analysis. The results illustrate how the horse united the group and facilitated personal maturity both at a group level and at a personal level. In the group the horse facilitated interaction and became a healthy and normal topic of discussion. The interaction between the horse and others helped the participants to become aware of and reflect on behaviors of oneself and of others. At an individual level, the horse helped to develop participants' identities and growth by offer mutual friendship. With its size and calming way of being, the horse evoked a healing power among participants who identified characteristics of themselves in the horse. Through its clear body language and communication, the horse facilitated personal maturity and development among the participants that would not have occurred without the horse's presence.

Experiences of an Equine-Assisted Therapy Intervention among Children and Adolescents with Mental Illness in Sweden - A Nursing Perspective.

Mental illness among children and adolescents is increasing globally, and prescription of psychiatric drugs for children and adolescents with mental illness is increasing worldwide, including Sweden. Holistic health-promoting interventions have shown promising long-lasting significant health benefits in young individuals with mental illness, but holistic health-promoting mental health interventions are often disregarded due to a lack of systematic theory-based knowledge. Consequently, the lack of scientific knowledge thwarts implementation of equine-assisted therapy as an established intervention in mental health nursing for children and adolescents with mental illness. The purpose of the study was to better understand experiences of equine-assisted therapy among children and adolescents with mental illness. The study adopted an inductive approach and data was collected using photovoice methodology. Six young persons, 7-18 years of age, referred by a psychologist to the equine-assisted intervention due to mental health issues, were included in the study. Data was analyzed using qualitative content analysis. The results could be summarized by an overarching theme, a physical, emotional, and social milieu for growth, consisting of three subcategories: feeling relief from everyday stress and anxiety; nurturing self-esteem in a mutual friendship; and strengthening self-reliance through synchronized interplay. The results indicate that equine-assisted therapy has essential values closely related to the goals of mental health nursing. Further research should strive to attain even gender distribution in study samples and focus on how equine-assisted therapy could be thoroughly integrated into established nursing intervention for children and adolescents with mental illness.

"Waiting in the Wings"-Next-of-Kin's Experiences of Lifestyle Interventions for People with Schizophrenia.

People with schizophrenia have an increased risk of experiencing physical ill health and thus risk premature death. It is important to gain knowledge about the next-of-kin's experiences of lifestyle interventions in order to increase the understanding of the development of health promotion. This study aimed to describe the experiences of next-of-kin of lifestyle interventions for people with schizophrenia. Ten next-of-kin to people diagnosed with schizophrenia were interviewed and content analysis was used to analyze the data. Three categories emerged in the analysis: Low prioritization of physical health, Patients' needs for motivational support and Next-of-kin's' limited and distant participation. Mental health nurses need a holistic view of human beings and to include the patients' physical health and the role of the family in their responsibilities. Further studies are needed that focus on the views of the next-of-kin and the staff from the mental health services about the care and support needs for promoting physical health in this patient group.

Swedish Mental Health Nurses' Experiences of Portrayals of Mental Illness in Public Media.

News reporting about mental illness lack perspectives of the mentally ill themselves and it is almost exclusively psychiatrists who are accessed when healthcare staff is consulted. The perspective of mental health nurses might contribute to the public understanding of mental illness. The purpose of this study was to describe mental health nurses' experiences of how mental illness is portrayed in media. Eight semi-structured interviews were conducted with qualified mental health nurses. A qualitative content analysis resulted in three categories: Negative portrayals of mental illness, Inconclusive images of mental illness and Biased dissemination of different perspectives. The conclusion of this study is that mental health nurses experience media portrayals of mental illness as negative and misleading with too much emphasis on the medical perspective while a holistic mental health nursing perspective is heavily obscured. Mental health nurses need to take a more prominent role in public reporting on mental health to resolve the current lack of relevant facts regarding mental illness. Further research is needed regarding portrayals of mental illness in social media and how the current lack of perspectives affects public perceptions of mental illness. In addition, further studies regarding the viewpoints of journalists reporting on mental illness are required.

Foster homes for neglected children with severe obesity-Debated but rarely studied.

AIM: To explore current research and theoretical articles on foster home placement of children with severe obesity. METHODS: An integrative literature review. Literature searches in six electronic databases included theoretical, quantitative and qualitative articles and case reports published in English (2008-2018) on the topic of severe childhood obesity and foster home placement. RESULTS: Seventeen selected papers included six theoretical articles, nine quantitative studies, one qualitative study and one case report. Eight of the nine quantitative studies did not specify the grading of obesity in children in foster care. The case report and the qualitative study showed distinct and sustainable body mass index (BMI) reductions after a child had been placed in foster care. Five theoretical articles justified foster care placement when chronic parental neglect led to severe obesity in the child, while one article emphasised the opposite. CONCLUSION: Parental and societal neglect of children with severe obesity placed in a foster home is rarely studied or the exclusive aim of research. The views of the children themselves are lacking in research articles, as well as the child's right to health obligations concerning children with severe obesity.

Health-related lifestyle and perceived health among people with severe mental illness: Gender differences and degree of sense of coherence.

People with severe mental illness (SMI) experience an increased risk of physical ill health and premature death, which appears to be partly related to unhealthy lifestyle habits. The aim of this study was to describe the distribution of health-related lifestyle habits and perceived health among people with severe mental illness. A further aim was to explore if there were any gender differences or differences based on degree of sense of coherence. The study adopted a cross-sectional design based on data from 65 people with SMI. The results show that degree of Sense of Coherence (SOC) does have relevance for perceived health and for dimensions of Quality of Life (QOL). Furthermore, among the participants with strong SOC, there were less daily smokers and they seemed to have less sedentary leisure time than those with low SOC. Men reported more anxiety/depression than women and women ate fruit more often than men, otherwise there were no gender differences. In comparison with the general population, people with SMI show a higher Body Mass Index are more sedentary, more often daily smokers, have lower SOC and perceive a lower QOL. This emphasizes the importance of health-promotion support that focuses on lifestyle changes, and support for strengthening SOC and QOL for people with SMI.

Health Effects of an Individualized Lifestyle Intervention for People with Psychotic Disorders in Psychiatric Outpatient Services: A Two Year Follow-up.

People with psychotic disorders experience to a great extent avoidable physical illnesses and early mortality. The aim of the study was to investigate the potential effects for this group of participating in a lifestyle intervention. A multi-component nurse-led lifestyle intervention using quasi-experimental design was performed. Changes in biomedical and clinical measurements, self-reported health, symptoms of illness and health behavior were investigated. Multilevel modeling was used to statistically test differences in changes over time. Statistically significant changes were found in physical activity, HbA1c and waist circumference. A lifestyle intervention for people with severe mental illness can be beneficial for increasing physical activity.

Equine-Assisted Therapeutic Interventions Among Individuals Diagnosed With Schizophrenia. A Systematic Review.

Persons diagnosed with schizophrenia are not sufficiently offered health promotion interventions, notwithstanding their increased risk of bodily ill health. Physical activity is found to improve health and decrease psychiatric symptoms although, there is a challenge to motivate and increase physical activity in people with schizophrenia and innovative evidence-based treatment interventions are needed. The aim was to systematically review studies concerning equine assisted interventions among individuals diagnosed with schizophrenia. The findings of the six included articles indicate that therapeutic equine assisted interventions could be beneficial for individuals with severe mental illness such as schizophrenia or schizophrenia like disorders.

Health Risks among People with Severe Mental Illness in Psychiatric Outpatient Settings.

Life expectancy is greatly reduced in patients with schizophrenia, and cardiovascular diseases are a leading cause of mortality. The aim of this cross-sectional study was to investigate the prevalence of overweight, obesity, and cardiovascular disease (CVD) risk and to investigate the relationships between self-rated health, sense of coherence, CVD risk, and body mass index (BMI) among people with severe mental illness (SMI) in psychiatric outpatient settings. Nearly 50% of the participants were exposed to moderate/high risk of CVD and over 50% were obese. The results showed no statistically relationships between the subjective and objective measures (Bayes factor <1) of health. The integration of physical health into clinical psychiatric nursing practice is vital.

The Meaning of the Lived Experience of Lifestyle Changes for People with Severe Mental Illness.

The aim of this study was to elucidate the meaning of the lived experience of lifestyle changes as perceived by people with severe mental illness (SMI). People with SMI who have experience in managing lifestyle changes were interviewed (n = 10). The interviews were analyzed with a phenomenological hermeneutic approach. The findings reveal three themes: (1) struggling with inner and outer limitations, (2) on one's own but together with others and (3) longing for living a life in harmony. The meaning of lifestyle changes can be understood as a person's internal and external endeavors to make well-considered decisions about lifestyle changes. Support should focus on strengthening the person's self-efficacy and should be based on the person's experiences.

Working with Families Affected by Mental Distress: Stakeholders' Perceptions of Mental Health Nurses Educational Needs.

Family and informal caregivers provide a substantial amount of care and support to people who experience mental health problems. The aim of this study was to explore mental health nurses', students' and service users' perceptions of the knowledge, skills and attitudes that are required by mental health nurses to work with families and carers using a qualitative methodology. Three themes emerged from the data: Knowledge of the family and how mental distress affects the family; working with the family - support and education; and valuing the role of the family. The three themes demonstrate the complexity of preparing mental health nurses to work with families and carers, and the article offers recommendations about how this might be achieved.

A 2-year follow-up study of people with severe mental illness involved in psychosocial rehabilitation.

UNLABELLED: BACKGROUNDS. A focus on psychiatric rehabilitation in order to support recovery among persons with severe mental illness (SMI) has been given great attention in research and mental health policy, but less impact on clinical practice. Despite the potential impact of psychiatric rehabilitation on health and wellbeing, there is a lack of research regarding the model called the Psychiatric Rehabilitation Approach from Boston University (BPR). AIM: The aim was to investigate the outcome of the BPR intervention regarding changes in life situation, use of healthcare services, quality of life, health, psychosocial functioning and empowerment. METHODS: The study has a prospective longitudinal design and the setting was seven mental health services who worked with the BPR in the county of Halland in Sweden. In total, 71 clients completed the assessment at baseline and of these 49 completed the 2-year follow-up assessments. RESULTS: The most significant finding was an improved psychosocial functioning at the follow-up assessment. Furthermore, 65% of the clients reported that they had mainly or almost completely achieved their self-formulated rehabilitation goals at the 2-year follow-up. There were significant differences with regard to health, empowerment, quality of life and psychosocial functioning for those who reported that they had mainly/completely had achieved their self-formulated rehabilitation goals compared to those who reported that they only had to a small extent or not at all reached their goals. CONCLUSIONS: Our results indicate that the BPR approach has impact on clients' health, empowerment, quality of life and in particular concerning psychosocial functioning.

Building up bit by bit, parent's experiences of equine-assisted intervention among children and adolescents with mental illness: a grounded theory study.

BACKGROUND: Mental ill health among children and adolescents has increased worldwide. Mental health difficulties from a young age are associated with school absence and educational underachievement. A holistic perspective of treatments besides medical treatment is essential Thus, there is a need for research regarding equine-assisted intervention (EAI). PURPOSE: The present study aimed to understand the outcomes of an equine-assisted intervention for children and adolescents with mental ill health from the perspectives of parents and close relatives. METHODS: This study used a qualitative research design informed by Charmaz's Grounded Theory, with a purposive sample including six in-depth interviews. RESULTS: The theory "building up bit by bit" was constructed, explaining the recognition that their children/adolescents were built up bit by bit and created a stronger self-identity. The participants referred to changes in the child's or adolescent's way of being and emotional regulation, which constituted building blocks leading to the child's or adolescent's 1. increased Harmony. 2. enhanced Self-identity, and 3. improved Capability. CONCLUSION: Parents and close relatives experienced that their child or adolescent was built up bit by bit and gained a stronger foundation to stand on. This led to increased harmony in everyday life with stronger self-worth, better performance, and reduced school absenteeism.

Staff's experiences of a person-centered health education group intervention for people with a persistent mental illness.

Patient education in mental health care is a conventional intervention to increase patients' knowledge about their illness and treatment. A provider-centered focus in patient education may put patients in a passive role, which can counteract their processes of recovery. There is an increasing emphasis on recovery-oriented practice, an approach that is aligned with the service user perspective, but little is known about health care staff's perspectives on person-centered mental health care. A qualitative approach was used to describe staff's experiences of being group leaders in a person-centered health education intervention in municipal services for persons with a persistent mental illness. The analysis of staff experiences revealed three core categories: (1) implications of the division of responsibility among local authorities, (2) awareness of facilitating factors of growth, and (3) the meaning of dialogue. These formed the theme Preconditions for Person-Centered Care. Further research is required to explore larger economic, political, and social structures as backdrops to person-centered mental health care, from the perspective of service users, families, health professionals, and the community at large.

Relatives' experiences of an equine-assisted intervention for people with psychotic disorders.

PURPOSE: The aim of this study was to describe relatives' experiences of an equine-assisted intervention for people with psychotic disorders. METHODS: The study has a qualitative and descriptive design. Ten semi-structured interviews were performed with relatives of people with a psychotic disorder who had participated in an equine-assisted intervention. A conventional content analysis was used to analyse the data. RESULT: The overall category "Being with the horses strengthens health capabilities" summarizes the four identified subcategories "The horses contribute to a context with a common focus", "Interaction with the horses enhances self-confidence and motivation", "The interplay with the horses nurtures positive emotions" and "Being with the horses encourages physical activity". CONCLUSIONS: The result of this study contributes to the growing body of research about the potential outcomes of equine-assisted interventions. The result also indicates that equine-assisted interventions may improve health capabilities among people with psychotic disorders. The generated knowledge may be useful in mental health services when developing equine-assisted interventions.

Differences in self-reported importance of elements of health and subjectively experienced health among outpatients in community mental health services.

Positive dimensions of mental health are strong protective factors against physical and mental illness in general population. A cross-sectional study including a randomly selected sample of 141 outpatients was performed to explore differences in patients' self-reported importance of elements of health and subjective experiences of health related to sociodemographic background variables. The examination of differences in self-reported importance of elements of health showed differences regarding gender, and the analyses of subjectively experienced health showed differences regarding age and diagnosis. Clinical interventions aiming at strengthening positive dimensions of health are required in community mental health services to meet the patients' individual needs of enhanced health.