The effect of long-term life dissatisfaction on health-related quality of life among general population subjects.

The aim of this population-based study (n = 329) was to explore how long-term life dissatisfaction (LS burden) and concurrent life dissatisfaction are associated with the concurrent health-related quality of life (HRQL) (RAND-36), and how long-term life dissatisfaction predicts HRQL in the general population. The sum of the life satisfaction scores in 1998, 1999, 2001 (LS burden) and the concurrent life satisfaction score (LS) in 2005 were used to categorize the study participants into satisfied, intermediate and dissatisfied groups. Differences in RAND-36 dimensions in 2005 were investigated with respect to the LS burden and concurrent life dissatisfaction. The predictive power of the LS burden for HRQL dimensions was assessed with logistic regression models. Both a high LS burden and concurrent life dissatisfaction were strongly associated with HRQL and were risk factors for poor HRQL, regardless of its dimensions. The LS burden predicted all of the RAND-36 dimensions, except for physical functioning. Screening of life dissatisfaction can be used to identify service users whose HRQL should be further investigated. Assessment of HRQL provides information on the domains and factors that require mental health nursing intervention. This knowledge could assist mental health nurses in both the alleviation of disease consequences and promotion of well-being of service users.

Clinical decision making involved in secluding and restraining an adult psychiatric patient: an integrative literature review.

The purpose of this integrative literature review was to describe different factors involved in the decision-making process of using seclusion or restraint, and to discuss the process in practice. The data used in this review were systematically retrieved from the following databases: CINAHL, Medline and PsycINFO. Manual data retrieval was conducted from the reference lists of the papers that came up in the original database search. A total of 32 studies were selected. Results suggest that the situations that lead to the use of seclusion or restraint are always dynamic and circumstantial. During the decision-making process staff observe a patient's behaviour, assesses risk and chooses and uses interventions that aim to de-escalate the situation. This process is affected by the previous experiences and history of staff as well as the behaviour and previous experience of the patient.

Health-related quality of life among subjects with long-term mental symptoms in a population-based sample.

Women have shown to have poorer health-related quality of life (HRQL) than men. The purpose of this study was to examine HRQL, its gender differences and correlates among subjects (n = 158) with long-term mental symptoms in a population-based sample. HRQL was assessed with the eight dimensions and the Physical (PCS) and Mental Component Summary (MCS) scales of RAND-36. Sociodemographic and lifestyle factors were recorded and psychometric scales were administered. Psychiatric diagnoses were confirmed with the Structured Clinical Interview for DSM-IV. HRQL was quite poor in all dimensions of RAND-36 regardless of gender. Men and women had similarly poor scores for PCS and MCS. Mental health-related factors were main correlates of HRQL and this knowledge could be used in nursing practice and in health promotion.

Parental conceptions of self-mutilation among Finnish adolescents.

The purpose of this paper is to describe self-mutilation from the viewpoint of parents of self-mutilating Finnish adolescents. Four parents of self-mutilating adolescents were interviewed in depth. Qualitative content analysis was applied. Four main categories emerged: the phenomenon of self-mutilation, factors contributing to self-mutilation, the purposes of self-mutilation and sequels of self-mutilation. Factors contributing to self-mutilation could be divided into those relating to the adolescent and those relating to the family, especially the mother. The purposes of self-mutilation were purposes relating to the adolescent and those relating to others, while sequels of self-mutilation could be divided into sequels for the adolescent and those for the parents. Sequels of self-mutilation for the adolescent could be further divided into sequels for the adolescent herself and for the relationship with significant others, including parents, siblings and peers, and sequels in relation to healthcare staff. While knowledge of self-mutilation is inadequate among parents, it evokes strong negative emotions when it occurs in their own family. Self-mutilation should be raised by healthcare professionals and discussed in health promotion or in parents' meetings at schools.

Hope and schizophrenia: an integrative review.

The purpose of this article is to describe the current status of research on hope and schizophrenia. The CINAHL database was used to identify the articles that met the criteria. The searches were conducted using the terms 'hope', 'hope instillation (IOWA NIC)', 'hope (IOWA NOC)', 'schizophrenia' and their combinations. The findings were limited to research articles. In addition, Pub Medical database was used by searching the words 'hope' and 'schizophrenia' from the fields 'title' or 'abstract'. Four new articles were found. The data consist of 17 articles on hope and schizophrenia published in peer-reviewed journals, which were analysed using content analysis. Existing research has focused on people with schizophrenia (n = 8), significant others (n = 4), staff (n = 2), hope-engendering interventions (n = 2) and treatment evaluation related to hope (n = 2) in the care of people with schizophrenia. Different data collection methods have been used in these studies. The most common method was interview (n = 9), followed by questionnaires (n = 8) and observation (n = 1). Most studies used quantitative methods (n = 9). Hope is considered a positive factor in the life of a person living with schizophrenia, in significant others as well as in staff members. Existing research provides evidence of the following themes: factors associated with hope and factors contributing to hope in people with schizophrenia; hope from the perspective of significant others of people with schizophrenia; staff hopefulness and factors contributing to their hope, hope-engendering interventions and treatment evaluation in regard to hope. Based on this review, research evidence of hope in the context of schizophrenia is quite scant and limited, even though the importance of hope in schizophrenia has been underlined in research reports and the literature. It is clear that hope is important to people with schizophrenia, their significant others and the healthcare personnel caring for them. It is therefore also important to study hope among these people.

Life events are important in the course of hopelessness-a 2-year follow-up study in a general population.

BACKGROUND: The association between life events and hopelessness in a general population is unknown. AIM: The aim of this study was to examine the course of hopelessness and how positive and negative life events are associated with it. METHOD: This was a 2- year follow-up study among general population adults, excluding any with a mental disorder. The impact of 15 occasional life events during the follow-up was assessed and the course of hopelessness measured with the Beck Hopelessness Scale (HS). RESULTS: Four percent of the study subjects with no hopelessness at baseline and 56% of those with hopelessness at baseline reported hopelessness on follow-up. In multiple logistic regression analyses, a notable worsening of the subjective financial situation was revealed as the most important life event, both in becoming hopeless during the follow-up (OR 5.07; 95% CI 2.20-11.7) and in continued hopelessness (OR 7.51, 95% CI 2.19-25.8). Moreover, considerable interpersonal conflicts at work (OR 3.29, 95% CI 1.17-9.27) were associated with becoming hopeless. However, a notable positive change in common living conditions (OR 0.16, 95% CI 0.04-0.74) was found to be a protective factor against becoming hopeless. All these variables remained significant even when adjusted for change in depression scores (BDI). CONCLUSION: Hopelessness may be persistent in a general population. The impact of life events, especially a notable worsening of the subjective financial situation, is important in becoming or remaining hopeless.

Gender differences in the association of adult hopelessness with adverse childhood experiences.

BACKGROUND: The impact of childhood traumatic events on long-term psychological development has been widely studied. Nevertheless, little research has been carried out on possible associations between adverse childhood experiences (ACEs) and hopelessness in adulthood, and whether any gender differences exist. AIM: The aim of this study was to examine the association between ACEs (poor relationship between parents, unhappiness of childhood home, hard parenting, physical punishment, domestic violence, alcohol abuse in primary family) and current hopelessness without any mental disorder in a general population sample. METHOD: 1598 adults (43 % were men), aged 25-64 years, completed self-report measures to assess ACEs and hopelessness by means of the Beck Hopelessness Scale (HS). Logistic regression was used to adjust for the effects of sociodemographic factors on the association between the cumulative number of ACEs and hopelessness. RESULTS: Whereas several bivariate associations were found between ACEs and hopelessness, none of them remained significant in multivariate analysis. However, men who reported three or more ACEs were 2.79 times (95 % CI 1.17-6.63) and women 2.19 times (95 % CI 1.04-4.65) more likely to be hopeless compared with those without any ACEs. In women (OR 2.25, 95 % CI 1.01-5.00), but not in men, this relationship remained significant after adjusting for several current covariates. CONCLUSION: Clustering of ACEs may have long-lasting effects by increasing the risk of hopelessness in adulthood, especially in women. Increased awareness of the frequency of ACEs and their subsequent consequences, such as hopelessness, may encourage health care professionals to undertake preventive work in primary and mental health care.

Voluntary caregivers' observations on the dynamics of hope across the continuum of HIV/AIDS: a focus group study.

The purpose of this study was to describe voluntary caregivers' observations on the dynamics of hope across the continuum of HIV/AIDS. Three focus group interview sessions were conducted with 10 voluntary caregivers in 1998. The data were analyzed using the grounded theory method described originally by Glaser and Strauss. Closing and opening emerged as the core categories in the dynamics of hope. Closing means closing down in despair and to the process of life, whereas opening means opening up to hope and the process of life. Nursing interventions that prevent closing and enable opening are helpful for these people. Conceptual clarification and the differentiation between the concepts of hope, wish, despair, and hopelessness presented in this study require further elaboration. Further research on the dynamics of hope in fearing HIV/AIDS or living with HIV/AIDS and being a significant other to a person with HIV/AIDS from different perspectives is also needed.

Hope, despair and hopelessness in living with HIV/AIDS: a grounded theory study.

BACKGROUND: Hope, despair or hopelessness have been detected in several research reports as important elements of the lives of persons living with human immunodeficiency virus (HIV) (PLWH) or acquired immunodeficiency syndrome (AIDS) (PLWA). However, there is an obvious gap in the literature suggesting a need to study the overall dynamics of hope (including both hope and despair or hopelessness) along the HIV spectrum from PLWHs' and PLWAs' perspective. AIM: The purpose of this study was to describe the dynamics of hope in living with HIV/AIDS. METHODS: The data were collected through interviewing 10 PLWHs/PLWAs and analysed using a grounded theory method. FINDINGS: The dynamics of hope is a multifaceted and complex combination of 'hope', 'despair' and 'hopelessness'. It comprises balancing between 'believing life to be worth living at the present and in the future', 'losing one's grip and sinking into narrowing existence vs. fighting against sinking' and 'giving up in the face of belief in nonexisting future'. A dynamic alternation between hope, despair and hopelessness takes place in the presence of factors that contribute to the 'folding' and 'unfolding' possibilities in everyday life. Factors contributing to the folding possibilities include 'losing', 'fear', 'uncertainty', 'problems in care', 'HIV/AIDS in close ones', 'difficulties in relationships' and 'negative public images and attitudes concerning HIV'. Factors contributing to the unfolding possibilities are 'constructive life experiences', 'wishing not to have HIV while uncertain', 'constructive relationships', 'ability to control one's life', 'finding the meaning of life and zest for life', 'caring', 'noticing one's improved health and the continuance of life', 'increasingly positive attitudes concerning HIV-positive people' and 'protection by law'. CONCLUSIONS: The dynamics of hope discovered in this study present new conceptualization, where hope, despair and hopelessness are viewed in relation to each other. The emerged definitions may be used in clinical practice to identify these phenomena in individuals with HIV/AIDS. The discovered factors contributing to the folding and unfolding possibilities can be used in clinical practice to help the individuals along the dynamics of hope.

Dynamically fluctuating hope, despair and hopelessness along the HIV/AIDS continuum as described by caregivers in voluntary organizations in Finland.

The purpose of this study was to describe the dynamics of hope in a) people fearing a diagnosis of HIV or living with HIV/AIDS and b) their significant others, from the perspective of caregivers working in voluntary organizations in Finland. Individual interviews with eight caregivers were analysed using the grounded theory method. Living with the fluctuating waves of hope, despair, and hopelessness based on factors constructing them emerged as the core category describing the dynamics of hope in a person fearing a diagnosis of HIV, becoming aware of HIV contagion, and living with HIV/AIDS. Mirroring the fluctuating waves of hope, despair, and hopelessness based on factors constructing them emerged as the core category describing the dynamics of hope in a significant other of a person fearing a diagnosis of HIV, or living with HIV/AIDS. It is important to take into consideration the dynamics of hope in taking care of people fearing a diagnosis of HIV or living with HIV/AIDS and their significant others.

Ethical considerations in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others.

The purpose of this article is to describe and reflect ethical challenges in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others. It concentrates on the justification of a research problem, sensitive research and the relationship between the researcher and the participants in data collection. The basis of ethically sound nursing research on the dynamics of hope in these two vulnerable groups lies in the relationship between the researchers and the participant. However, it is also obvious that the content, the process, the methods used and the ethics of the study cannot be divorced from this relationship. In conducting grounded theory research on the dynamics of hope in this research population, the researcher has to consider the surrounding world, that is, the reality in which these people live in hope or despair.

[The dynamics of hope described by elderly people aged 70 and over living at home]. / Toivon dynamiikka yli 70 vuotiaiden kotona asuvien vanhusten kuvaamana.

In previous nursing studies hope and hopelessness have been described mostly in sick middle-aged people. The study designs have been mainly cross-sectional. The dynamics of hope in elderly people has received little attention in nursing research. The purpose of this study was to describe the meanings elderly people aged 70 and over attach to the dynamics of hope. The study was based on phenomenological philosophy and method. The data were collected in spring 1997 by interviewing four over 70 years old women who lived at home. The data were analysed using the Giorgi method. According to the results hope and hopelessness are normal elements of every human life. They coexist side by side, but are opposite phenomena. Hope is a will to try in the limits of one's own possibilities. It helps at the present but directs also to the future. It is based on something in past, present and future that helps an aged person to manage in his or her life. Hopelessness is uncertainty of and fear for one's future. It is also a hard and difficult feeling. Hopelessness does not mean solely a negative experience. It can produce the wisdom of life in the future. Elderly person's own and other people's diseases and their consequences may produce hopelessness.

Hope in nursing research: a meta-analysis of the ontological and epistemological foundations of research on hope.

The purpose of this study is to describe the ontological basis of hope and the epistemological solutions adopted in research on hope by reviewing research articles concerned with the subject in the field of nursing science. The material consisted of 46 articles published between 1975 and 1993, and the examination was based on the meta-analysis method. References to the ontology of hope were inductively clustered according to the principle of continuous comparison. For the analysis of epistemological solutions, the purpose of the study, population/respondents, and methods of data collection and analysis were identified. The articles reviewed focus on the essence and distinctive characteristics of hope. Although rich in detail and quite vivid, there is a certain lack of precision about the descriptions. Hope may be described as an emotion, an experience or need. A distinction is made between generalized and particularized hope. There is a clear emphasis on the necessity and the dynamism of hope. As far as its dynamics are concerned, the most important dimension is the dialectic between hope and despair. An affective, functional, contextual and temporal as well as relational dimension are distinguished in the process of hope. Research on hope consists in the main part of descriptive cross-sectional research that focuses on individuals who are unwell. The most common method of data collection is the questionnaire, while the analyses are typically based on quantitative methods. There is need for further work to clarify the concept of hope. In the field of nursing research, there is obvious need to carry out more qualitative longitudinal research. More attention should be paid to healthy individuals and families at different stages of their life cycle.

[Nursing research on the dynamics of hope in the elderly--a review]. / Vanhuksen toivon dynamiikkaan kohdistunut hoitotieteellinen tutkimus--kirjallisuuskatsaus.

The dynamics of hope--the dialectics between hope and hopelessness--is a central dimension in the essence of human being, in health and illness, as well as in nursing. In this paper nursing research on hope and hopelessness in elderly people is described. CINAHL- and MEDLINE EXPRESS-database were used as sources of research material. The purposes, the target populations, the methods of data collection and the central results from 10 research articles were analyzed using the method of content analysis. In addition qualitative content analysis was used to illustrate the dynamics of hope. The research on the dynamics of hope in nursing science has mostly focused on young adults, and less on elderly people. Most of the studies on hope and hopelessness in elderly people were descriptive, cross-sectional research based on quantitative assumptions. The dynamics of hope was described as the dynamics of life and death in which elderly people's significant relationships, feelings and the ability to act were central elements. Qualitative, longitudinal designs are needed in nursing science in order to capture the essence of the dynamics of hope in elderly human beings.