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.

Space and place for health and care.

Purpose: This discussion paper aims to contribute to a greater understanding of the state of the art of research engaged with conceptual matters of space and place for health and care. Method: The authors, who represent a variety of academic disciplines, discuss and demonstrate the conceptual recognition of space and place in research in health and caring sciences building upon own work and experience. Results: To explore the concepts of space and place for health and care is a research pursuit of utmost importance, and should be made through transdisciplinary research collaborations, whereby spatial theories from various disciplines could be communicated to cultivate truly novel and well-informed research. Furthermore, engaging with relational and topological perceptions of space and place poses methodological challenges to overcome in future research on health and care. Conclusions: We argue that there is a need for accelerating spatially informed research on health and care that is informed by current theories and perspectives on space and place, and transdisciplinary research collaborations are a means to achieving this.

Conceptions of Healthy Aging Held by Relatives of Older Persons in Isan-Thai Culture: A Phenomenographic Study.

In Thailand, family nurses are expected to provide support for older persons and their family members to promote healthy aging. Family bonds are strong, and relatives are expected to take care of their older family members. However, there is limited research on how older persons' family members perceive healthy aging. This study aimed to describe the conceptions of healthy aging held by the children and grandchildren of older persons in northeast Thailand. In a phenomenographic study, 14 interviews were performed to qualitatively analyze different conceptions of healthy aging. Four descriptive categories emerged: being independent, not being afflicted by diseases or illnesses, being a giver and a receiver, and being wise. The conceptions of healthy aging entail both autonomy and interdependence. The relative's perspective needs to be considered when policies relating to healthy aging are implemented in the community and when family nurses provide support to families to promote healthy aging.

"Don't stop believing!" From health religiosity to an equality-enhancing hermeneutic of health promotion.

PURPOSE: Health beliefs are usually regarded as subjective understandings of one's health. They can, however, be re-interpreted by drawing on the understanding that the structural features of the health discourse resemble the characteristics of a religion and on the spiritual dimension of health with its possibly salutogenic influence. The applicability of the notion of "health religiosity" and its consequences for individual health promotion are explored. METHOD: Data consist of already existent semi-structured interviews. These have been reanalyzed in a deductive-hermeneutical way by using a five-dimensional concept of religiosity as deductive template. RESULTS: The concept of religiosity proved to be productive and revealed that all health dimensions in the case are infused with spiritually ennobled ideas. CONCLUSION: We conclude that, irrespective of their factual accuracy, the salutogenic potential of ennobled ideas may best be utilized by understanding them hermeneutically. An exploration of a narrative hermeneutic approach to individual health promotion is suggested as the merging of meaning horizons in a hermeneutic dialogue is expected to increase awareness of spiritualized aspects of health beliefs. This may mitigate healthism and health disparities. Moreover, three challenges for individual health promotion are anticipated: realizing the situation, recognizing its complexity and resisting a simplistic practical approach.

Community Nurses' Experiences Regarding the Meaning and Promotion of Healthy Aging in Northeastern Thailand.

PURPOSE: Describe community nurses' experiences regarding the meaning and promotion of healthy aging in northeastern Thailand. METHOD: Data were collected through five focus group interviews with 36 community nurses in northeastern Thailand. Latent content analysis was conducted to analyze the data. FINDINGS: Healthy aging was characterized by the interconnection of older persons, older persons' family members, and the community. Healthy aging was associated with two themes: "being strong" and "being a supporter and feeling supported." The nurses' experiences in promoting healthy aging were described by the themes "providing health assessment," "sharing knowledge," and "having limited resources." CONCLUSIONS: The findings of this study provide a deeper understanding of the meaning of healthy aging from a holistic viewpoint. Community nurses must pay attention to older persons and their surroundings when planning how to promote healthy aging. Person-centeredness should be applied in practice to promote healthy aging. The current findings contribute useful information that should help policy makers develop healthy aging strategies in Thailand.

Factors Associated with Healthy Aging among Older Persons in Northeastern Thailand.

The aim of this study was to describe factors associated with perceived health and healthy aging among older people in northeastern Thailand. Thailand's aging population is growing and facing an increasing old-age dependency ratio. Northeastern Thailand, known as Isan, is a region in which the number of older residents is projected to grow rapidly. Older people in this region are likely to confront great threats to their health and well-being. These issues require appropriate attention and actions to promote healthy aging. However, healthy aging in this region has not been studied. A cross-sectional study was conducted on a sample of 453 older people, aged 60 years or older. Participants completed the Healthy Aging Instrument (HAI) and provided relevant demographic characteristics. Mann-Whitney U tests, Kruskal-Wallis tests and multiple regression models were used to analyze the data. Through comparative analyses, significant differences in HAI scores were observed for the following factors: marital status, residential area, disability, income level, and perceived meaningfulness in life. In the multiple regression models, residential area, disability, and marital status explained 24.30 % of the variance in HAI scores. Health promotion strategies and future targeted intervention programs should consider the importance of these factors.

Healthy ageing in Isan-Thai culture--A phenomenographic study based on older persons' lived experiences.

Healthy ageing is a concept that concerns older persons' quality of life and is a key factor in promoting well-being. The older population in Thailand is growing. Isan (a region of north-eastern Thailand) has been reported as having one of the most rapidly increasing older populations in the country. In order to care for and promote the health of older people, healthcare providers should understand how healthy ageing is perceived by this target group. Although healthy ageing has been studied in different contexts as well as perspectives, no studies have previously focused on older persons' experiences of healthy ageing from a lifeworld perspective in Isan-Thai. Therefore, the aim of this study is to describe older persons' qualitatively different conceptions of healthy ageing in Isan-Thai culture. A phenomenographic approach with an epistemological base in lifeworld theory was used to disclose the various ways to conceptualize healthy ageing. Individual, qualitative interviews were conducted with 17 people aged 60 and above who live in Isan-Thai. The findings of this study revealed three categories of descriptions: "being independent in dependence," "being at peace," and "being a valuable person." This study also found family members, friends, healthcare providers, and religion important to healthy ageing in the Isan-Thai culture. Understanding how older people conceptualize healthy ageing is valuable for healthcare providers. They can apply these findings regarding healthy ageing in their fieldwork when caring for older people.

The pendulum time of life: the experience of time, when living with severe incurable disease--a phenomenological and philosophical study.

The aim of this study was to gain a deeper understanding of the experience of time when living with severe incurable disease. A phenomenological and philosophical approach of description and deciphering were used. In our modern health care system there is an on-going focus on utilizing and recording the use of time, but less focus on the patient's experience of time, which highlights the need to explore the patients' experiences, particularly when life is vulnerable and time is limited. The empirical data consisted of 26 open-ended interviews with 23 participants receiving palliative care at home, in hospital or in a nursing home in Norway. The theoretical frameworks used are mainly based upon K. Martinsens philosophy of care, K. E. Løgstrup phenomenological philosophy, in addition to C. Saunders' hospice philosophy, L. Feigenberg's thanatology and U. Qvarnström's research exploring patient's reactions to impending death. Experience of time is described as being a movement that moves the individual towards death in the field of opposites, and deciphered to be a universal, but a typical and unique experience emerging through three integrated levels: Sense of time; where time is described as a movement that is proceeding at varying speeds. Relate to time; where the awareness of limited life changes the understanding of time to be more existential. Being in time; where limited time seems to clarify the basic living conditions and phenomena of life. The existence of life when the prospect of death is present is characterized by emotional swings that move within polarizing dimensions which is reflected in the experience of time illustrated as the moves of the pendulum in a grandfather clock. The diversity of the experience of time is oscillating between going fast or slow, being busy or calm, being unpredictable but predictable, safe or unsafe and between being good or bad, depending on the embodied situation of the individual.

The 2004 Indian Ocean tsunami catastrophe, its survivors, job and the universal features of suffering: a theoretical study.

The purpose of this theoretical article is to discuss the existential and universal feature of suffering--as illustrated by Job's suffering in the Book of Job in the Bible and by the survivors of the 2004 Asian tsunami catastrophe--and to highlight its significance for health care. Further, the study is aiming at contributing to health professionals' understanding of patients' suffering. The sources are narratives, comprising Job's book, TV interviews 1 year after the tsunami catastrophe and the survivors' autobiographies. The methodological approach is a philosophical analysis. The existential, universal, ontological and epistemological aspects of suffering are carefully scrutinized to unveil the universal and existential versus culture-specific features of suffering. Based on the results, the authors' recommendations are (1) a holistic concept of the patient and health care has to seriously consider suffering in all its complexity because when a person is in pain, it is not his/her body but the whole person as a unity of body, psyche and spirit that suffers and (2) suffering should be seen as the most central concept of health care, which should provide treatment for physical pain and all dimensions of suffering: physical, social, mental and spiritual aspects.

Being in transit and in transition: the experience of time at the place, when living with severe incurable disease--a phenomenological study.

The aim of this study is to describe the experience of time as it presents itself at the place being situated when living with severe incurable disease and receiving palliative care. The empirical data consist of 26 open-ended interviews with 23 patients receiving palliative care at home, at a palliative day care, in a palliative bed unit in hospital or in a nursing home in Norway. A common meaning of a shifting space for living emerged from the analysis and was revealed through three different aspects: (i) Transition from a predictable to an unpredictable time: To live with severe incurable disease marks a transition to a changed life involving an ongoing weakened and altered body with bothersome symptoms making experience of time different and unpredictable. (ii) Transition between a safe and unsafe time: When time is unpredictable, feeling safe is revealed as essential to how time is experienced at the place being situated. (iii) To be in transition from a homely to a homeless existence: In a time of increased bodily weakness, unpredictable ailments and displacements, the sense of belonging to the place is revealed as significant to the experience of time. Not knowing where to be in a time of change is like an existential cry of distress where the foothold in existence is lost. The findings are discussed and interpreted as an embodied experience originating from the passage of time continually affecting life sometimes so fundamentally that it marks a transition to a changed space of life that is reflected in the experience of time.

Entering a world with no future: a phenomenological study describing the embodied experience of time when living with severe incurable disease.

This article presents findings from a phenomenological study exploring experience of time by patients living close to death. The empirical data consist of 26 open-ended interviews from 23 patients living with severe incurable disease receiving palliative care in Norway. Three aspects of experience of time were revealed as prominent: (i) Entering a world with no future; living close to death alters perception of and relationship to time. (ii) Listening to the rhythm of my body, not looking at the clock; embodied with severe illness, it is the body not the clock that structures and controls the activities of the day. (iii). Receiving time, taking time; being offered - not asked for - help is like receiving time that confirms humanity, in contrast to having to ask for help which is like taking others time and thereby revealing own helplessness. Experience of time close to death is discussed as an embodied experience of inner, contextual, relational dimensions in harmony and disharmony with the rhythm of nature, environment and others. Rhythms in harmony provide relief, while rhythms in disharmony confer weakness and limit time.

Where can I find consolation? A theoretical analysis of the meaning of consolation as experienced by job in the Book of Job in the Hebrew Bible.

The aim of the study was to explore the meaning of consolation as experienced by Job in the Book of Job and as presented in literature and how consolation relates to suffering and care. The study's theoretical design applied Ricoeur's view on phenomenology and hermeneutics. The resulting themes were as follows: consolation that is present, that originates in confrontation, that keeps suffering at a distance, that does not alleviate suffering, that originates in experience from giving comfort, and that facilitates a change of perspective. The authentic and caring consolation accepts the sufferer's incomprehensible "otherness" but however provides no answers about how to console.

Guilt and shame--a semantic concept analysis of two concepts related to palliative care.

BACKGROUND: The theoretical viewpoint of the study was based on the fundamental motive in caring science, the suffering person and his/her health and life situation, which according to the philosophy of palliative care also includes the next of kin. The latter often wish to participate in the care of their loved ones and it is thus important for them to be able to make decisions that can generate a meaningful participation. Unfulfilled obligations or wrong decisions, concerning their dying relative, can result in experiences of guilt and shame in relation to the care of the loved one. A semantic concept analysis can provide a deeper understanding of these concepts and create a deeper insight into what the concepts mean for the individual. AIM: The aim of the study was to elucidate the meaning of and the distinction between the concepts of guilt and shame. METHODS: Semantic concept analysis based on Koort and Eriksson. FINDINGS: The findings show that guilt and shame are two separate concepts. Guilt contains meaning dimensions of being the cause of and sin. Shame contains meaning dimensions of something that gives rise to shame and ability to experience shame. The synonyms for each concept do not overlap each other. CONCLUSION: The semantic analysis creates an understanding of the concepts ontologically and provides a basis for theoretical, contextual and clinical understanding and development.

Psychometric evaluation of 'The 25-item Sex after MI Knowledge Test' in a Swedish context.

The patients' sexual life after a myocardial infarction is important for his/her quality of life. In spite of this, many patients are in doubt regarding their sex life after a myocardial infarction (MI) and the sexual information received, and counselling from health care providers has been seen to be insufficient. The purpose of this study was to evaluate the psychometric properties of 'The 25-item Sex after MI Knowledge Test' in a Swedish context. A convenience sample was recruited. The scale was translated into Swedish and completed by 79 former patients from The Heart and Lung Patients' National Association on two occasions, with an interval of 2 weeks. The scale was tested for face and content validity, internal consistency and test-retest reliability. The result in this study indicates that the instrument has good face and content validity and displayed a moderate internal consistency (alpha 0.61). The instrument showed some level of instability in test-retest reliability with 60% of the items presenting moderate or strong agreement between the test and retest. Further studies that use this instrument in larger and more diverse samples are thus needed.

Out of the wave: The meaning of suffering and relief from suffering as described in autobiographies by survivors of the 2004 Indian Ocean tsunami.

The aim of this study was to explore the meaning of suffering and relief from suffering as described in autobiographies by tourists who experienced the tsunami on 26 December 2004 and lost loved ones. A lifeworld approach, inspired by the French philosopher Merleau-Ponty's phenomenology of perception, was chosen for the theoretical framework. This catastrophe totally changed the survivors' world within a moment. In this new world, there were three main phases: the power of remaining focused, a life of despair, and the unbearable becoming bearable. Life turns into a matter of making the unbearable bearable. Such challenging experiences are discussed in terms of the philosophy of Weil, Jaspers, and Merleau-Ponty. The survivors of the tsunami catastrophe were facing a boundary situation and "le malheur," the unthinkable misfortune. Even at this lowest level of misfortune, joy is possible to experience. This is part of the survivors' ambivalent experiences of their lifeworld. In this world of the uttermost despair there are also rays of hope, joy, and new life possibilities.

Community nurses' experiences of ethical dilemmas in palliative care: a Swedish study.

AIM: The aim of this study was to highlight community nurses' experiences of ethical dilemmas in palliative care. BACKGROUND: There are many studies on palliative care but research on how community nurses experience ethical dilemmas in palliative home care is lacking. The ethical dilemmas to which these nurses are exposed seriously challenge their ethical competence. METHOD: Seven community nurses described their experiences of ethical dilemmas in palliative home care. The data was analysed by means of qualitative content analysis. FINDINGS: The core themes that emerged were: powerlessness, frustration, and concern in relation to ethical dilemmas in palliative care. The nurses were motivated and felt responsibility for their patients' end of life, and their relatives, and took their duties seriously. They wanted to satisfy all parties; the patient, the relatives and other palliative care professionals. CONCLUSION: The study confirms the need for knowledge about how community nurses experience dilemmas in ethical decision-making. They have the freedom to act and the willingness to make decisions, but they lack competence and knowledge about how their colleagues' experience and deal with such issues.

Out of the wave: the meaning of suffering and relieved suffering for survivors of the tsunami catastrophe. An hermeneutic-phenomenological study of TV-interviews one year after the tsunami catastrophe, 2004.

The tsunami catastrophe, 26th December 2004, is one of a number of catastrophes that has stricken mankind. Climate reports forecast that natural disasters will increase in number in the future. Research on human suffering after a major catastrophe, using a caring science perspective, is scarce. The aim of the study was to explore the meaning of suffering and relieved suffering of survivors of the tsunami catastrophe, 26th December 2004. An explorative study design, inspired by the French philosopher Paul Ricoeur's hermeneutic-phenomenology, was used. Interviews made by the Swedish Television (SVT) in connection with the 1 year anniversary were carried out on site in the disaster area and in Sweden. The text analysis revealed four main themes: 'An incomprehensible event', 'A heavy burden', 'Help that helps', and to 'Being changed in a changed life situation'. The findings were mainly interpreted in light of Paul Ricoeur's thinking on suffering, quilt, forgiveness, time and narrative. The first year after the loss of loved ones in the tsunami catastrophe, 2004, was like starting an inner as well as an outer journey. This journey was experienced as living with the heavy burden of an incomprehensible event. Help that helped was mediated by consolers who endured the suffering of the other. An 'enduring courage' is a key moral virtue to encounter the alienation of the sufferer and how it in turn alienates from the sufferer. It is also important to recognize that the complexity of the world of those who have lost loved ones in major catastrophes includes possibilities for reconciliation with the loss. The reconciliation creates hope that opens up for being changed in a changed life situation.

Validity and reliability of a Swedish version of the Relationship Assessment Scale (RAS): a pilot study.

BACKGROUND: There is a need for a short and easily administered scale, in the Swedish language, for assessing partner relationships in the health care of persons with cardiac disease. PURPOSE: To establish the reliability and validity of the Swedish version of the Relationship Assessment Scale (RAS). DESIGN: The present pilot study has a methodological design. FINDINGS: Content validity has been tested for relevance, clarity and readability. The scale was tested for construct validity with explorative factor analysis. The reliability was tested by internal consistency and test-retest analysis. The result showed a two-factor solution, which does not correspond to the original proposed one-factor solution. The factor analyses revealed two quite distinct factors of RAS, labelled "Relationship built on expectations and satisfaction of needs" and "Relationship built on love and devotion". CONCLUSIONS: The scale has satisfactory psychometric properties in terms of content validity, construct validity, homogeneity and stability in a population of persons with cardiac disease. Wider evaluations of the RAS for other populations and settings are recommended.

Existential and spiritual needs in mental health care: an ethical and holistic perspective.

This study illuminates how existential needs and spiritual needs are connected with health care ethics and individuals' mental health and well-being. The term existential needs is defined as the necessity of experiencing life as meaningful, whereas the term spiritual needs is defined as the need of deliverance from despair, guilt and/or sin, and of pastoral care. It discusses whether or not patients' needs are holistically addressed in Western health care systems that neglect patients' existential and spiritual needs, because of their biomedical view of Man which recognizes only patients' physical needs. It excludes a holistic health care which considers all needs, expressed by patients in treatment of mental illness. Addressing all needs is important for patients' improvement and recovery. For some patients, this is the only way to regain their mental health and well-being.

The meaning of consolation as experienced by nurses in a home-care setting.

AIMS AND OBJECTIVE: The aim of this study was to illuminate nurses' experiences of consolation and how these experiences relate to suffering and care. BACKGROUND: Consolation is commonly associated with the relief of suffering. The question of consolation in terms of its definition and relevance for care has, however, been a matter of discussion among nurse researchers. The question raised concerns about the nature of consolation, its place and its role in relation to care and the caring sciences. DESIGN: An explorative qualitative interview study with 12 participants, six registered and six enrolled nurses, was carried out in a home-care context. METHODS: A phenomenological-hermeneutic method inspired by the French philosopher Paul Ricoeur was used for the text analysis. Results. Two main aspects of consolation appeared: 'the present consolation', which is flexible, sustaining and opening and 'the absent consolation', which conceals the suffering and is incapable of consoling. The result was interpreted from a philosophical-ethical perspective, based on the works of Levinas and Lögstrup. CONCLUSIONS: Consolation appears as a complex phenomenon, both in terms of its existence and its absence consolation, constituting a caring and non-caring consolation. A caring consolation entails meeting the other as different and being present in a way that gives the other space to be the one he or she really is. It requires acceptance, accepting the sufferer and his/her way of suffering as unique. Relevance to clinical practice. The clinical nurse is involved in complex care situations, which entails both reflecting upon and using intuition when consoling. A caring consolation is a contradictory phenomenon that requires a nurse to be capable of both reflecting upon and acting intuitively on the unique suffering of the other.