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Å fremme den eldre sykehuspasientens helse i lys av et folkehelse- og et holistisk-eksistensielt sykepleieperspektiv
Nordic Council of Ministers, Nordic School of Public Health NHV.
2007 (Norwegian)Doctoral thesis, comprehensive summary (Other academic)
Abstract [no]

Bakgrunn og hsysykelighet. Forskningsfunn indikerer at en multsykelighet, høyere funksjonsnivå. Avhandlisykehuspasiensykehuspasientens helse. Datakilder og mdelstudier. Helse gjennomført som teoretisk-begrepslig analyse og syntese av begrepene menneske, helse, sykdom og sykepleie slik de var beskrevet i tre sykepleieteorier. I delstudie 2 ble ti eldre sykehuspasienter intervjuet gjennom kvalitative forskningsintervjuer. Temaet for intervjuene var hvordan de forsto helse, og hva som skulle til for å bedre deres helse. Delstudie 3 ble gjennomført ved deltagendesamtaler med sykepleiere i en medisinsk sykehusavdeling. Delstudie 4 var en utforskende studie. Begrepene empowerment, helse og å fremme helse relatert til den eldre sykehuspasienten ble introdusert litteratur. Hensikten var å skape en felles teoretisk plattform før deres deltagelse i refleksjonsgruppedialoger. To grupper sykepleiere deltok i tre dialoger styrt av en moderator og en assistent. Dialogene ble tatt opp på bånd og transkribert. Hver dialog ble analysert med kvalitativ innholdsanalyse. Funn: Avhandlingen foreslår en stipulativ definisjon av helsefremmende sykepleie med en holistisk-eksistensiell tilnærming støttet av fem nødvendige forutsetninger. Definisjonen og forutsetningene kan danne et utgangspunkt for et teoretisk grunnlag for helsefremmende sykepleie. Helse ble av de gamle sykehuspasientene beskrevet som å være i stand til gjennom å være den personen man er, i stand til å kunne gjøre og å føle seg vel og ha krefter. Å fremme helse ble beskrevet som å bli i stand til gjennom å kjenne seg som den personen man er, å få informasjon og kunnskap og gjennom det å ha håp og motivasjon. Sykepleiernes forståelse av helse og dermed å fremme den eldre sykehuspasientens helse var preget av en veksling mellom to tilnærminger: en biomedisinsk tilnærming og en holistisk sykepleietilnærming. I sitt daglige arbeid viste sykepleierne seg som mestre i å danse på en stram line, avhengig av å ha en profesjonell de motiveres. kompetanse som gjør dem i stand til å mestre og kunne forholde seg til en dynamisk og stadig skiftende arbeidssituasjon. Refleksjonsgruppedialogene avdekket et tosidig forhold til makt og empowerment hos de deltagende sykepleierne. Sykepleierne understreket en individuell tilnærming i det å fremme den eldre pasientens helse, hvor respekt for individet og normalisering av situasjonen utheves som viktig elementer. Konklusjon: Avhandlingens foreslåtte stipulative definisjon og fem nødvendige forutsetninger kan tjene som en retning og tilnærming for en helsefremmende sykepleie til den eldre sykehuspasienten. Hvordan helse og å fremme helse forstås, er avhengig av vitenskapelig og faglig grunnlag og hvordan den enkelte opplever sine erfaringer. Både sykepleieres og eldre sykehuspasienters forståelse av å fremme helse var delvis vag og uklar, men dialoger og diskusjoner fremmer forståelsen. Empowerment er muligens en anvendbar strategi ettersom sykepleiere og eldre pasienter anerkjenner betydningen av å ha kontroll og innflytelse over egen situasjon. Uansett forutsetter empowerment en bevissthet om egen makt og maktposisjon. Ifølge de eldre sykehuspasientene i denne studien fremmes deres helse gjennom at de ses som en person, når de får adekvat informasjon og kunnskap om sin situasjon, og når Refleksjonsgruppedialogene kan være en strategi for å øke sykepleiernes bevissthet og derigjennom implementere forskningsfunn, og for å fokusere på å fremme den eldre sykehuspasientens helse.

Abstract [en]

Background and aim: The number of elderly hospital patients is increasing in line with tidisciplinary eriatric approach reduces illness, re-hospitalization and costs as well as improving dge about health and health erly hospital patients from a public health and nursing erspective. ploys a combination between different data collection methods, data urces and analytical techniques in order to investigate health and health promotion . Study three illustrated and explored the life world of empowerment, health and health promotion were introduced to nurses in the advancing age of the population. Old people are a heterogeneous group when itcomes to health status and sickness. Research findings suggest that a mulgsurvival rates and functional level. The aim of this thesis was to describe and develop knowlepromotion related to eldpData sources and methods: The thesis, which comprises four studies, has a qualitative approach that emsoamong elderly hospital patients. Study one was conducted as a theoretical conceptual analysis and synthesis of the concepts of man, health, nursing and illness/disease based on description of the concepts in three nursing theories. Study two described and explored health and health promotion from the perspectives of ten elderly hospital patients using qualitative interviewsfive nurses and their understanding of health promotive nursing related to the elderly hospital patient by means of participant observation. Study four was an explorative study. The conceptsorder to give a mutual theoretical platform before participating in reflection group dialogues. Two groups of nurses participated in three dialogues that were conducted by a moderator and an assistant. The dialogues were tape-recorded and transcribed verbatim. Each dialogue was analysed with qualitative content analysis. Findings: The thesis proposes a stipulative definition of health promotive nursing with a holistic-existential approach based on five necessary preconditions. The definition and preconditions may serve as a theoretical basis for health promotion in nursing. The elderly hospital patients reported that health was being able to be the person I am, to do what I want, to feel well and have strength. Health promotion was described as being enabled by being seen as the person I am, through information and knowledge as well as hope and motivation. The nurses’ attitude to health and health promotion was influenced by two different views; the biomedical and the holistic nursing view, between which they moved. In their work the nurses were masters at balancing on a tightrope and interacting with a professional competence that makes it possible to manage a constantly changing work situation. Reflection group dialogues revealed a dual relation among the about participating nurses to empowerment and power. The nurses highlighted the importance of using an individualised approach in order to promote the health of elderly hospital patients with focus on respect for the individual and normalization of the situation. Conclusion: The thesis proposes a stipulative definition of health promotion as well as five preconditions that may serve as guidance and offer a health promotive nursing approach for elderly hospital patients. How health promotion and health are understood depends on one’s scientific and professional background as well as the experience of caring for the individuals in one’s charge. The understanding of health promotion on the part of both nurses and elderly hospital patients was somewhat vague, but improved as a result of dialogue and discussions. Empowerment may be a suitable strategy, as it helps both nurses and elderly patients to acknowledge the necessity of controlling and influencing their situation. However, empowerment implies a consciousness of one’s own power. According to the elderly hospital patients in this study, health is promoted when they are seen as a person, when they receive adequate information and knowledge their condition and when they feel motivated. Reflection group dialogues may be a strategy to increase the professional consciousness of nurses to implement research findings and to focus on promoting the health of elderly hospital patients.

Place, publisher, year, edition, pages
Göteborg: Nordic School of Public Health NHV Göteborg, Sweden , 2007. , p. 87
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Rapport 2007:7
Keywords [en]
public health, holistic-existential approach, qualitative methods, elderly hospital patients, individual health promotive nursing and empowerment
Keywords [no]
folkehelse, holistisk-eksistensiell tiln ærming, kvalitative metoder, den eldre sykehuspasienten, individuell helsefremmende sykepleie og empowerment
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3430ISBN: 978-91-85721-25-2 (print)OAI: oai:DiVA.org:norden-3430DiVA, id: diva2:749407
Public defence
2007-12-18, Nordic School of Public Health NHV, Göteborg, Sweden, 13:57 (Norwegian)
Opponent
Supervisors
Available from: 2014-10-09 Created: 2014-09-24 Last updated: 2014-10-09Bibliographically approved
List of papers
1. A holistic approach to the promotion of older hospital patients' health.
Open this publication in new window or tab >>A holistic approach to the promotion of older hospital patients' health.
2005 (English)In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 52, no 1, p. 73-80Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To describe how nurses interpreted health promotion related to older patients in a medical hospital ward and the presuppositions for this work.

METHODS: The study had a descriptive and explorative design. Data were created through participant observation of five nurses and informal dialogues with four nurses working in an infection unit in a small hospital in Norway. The nurses where followed during a period of 6 months. The observations and dialogues were interpreted and transformed into text. This text was analysed with qualitative content analysis and interpreted hermeneutically on three levels: (1) reading the text to get an overview of the themes; (2) systematically separating central patterns; and (3) highlighting the patterns with examples.

FINDINGS: The nurses' interpretation of health promotion was closely connected to their interpretation of health and holistic nursing. Two main aspects were uncovered in the informal dialogues: a biomedically oriented nursing view and a holistically oriented nursing view. The observations showed that presuppositions, such as waiting for something or somebody, constantly changing situations, complexity and diversity in patient cases, influenced the nurses' work in general and also their focus on health promotion. The nurses balanced between the biomedical and the holistic approach. It seemed to be important for the nurses to be the masters of walking on a tightrope and to have professional clinical competence.

CONCLUSION: It was difficult to find a clear focus on health promotion. The most visible focus was on diagnosis and treatment, while the more complex and comprehensive situations related to health promotion of older patients seemed to be underprioritized. The phenomenon of 'waiting' may be an important issue for further research.

Keywords
Health Promotion, Holistic Approach, Older Hospital Patient Observation, Waiting
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3429 (URN)10.1111/j.1466-7657.2004.00264.x (DOI)15725280 (PubMedID)
Available from: 2014-09-24 Created: 2014-09-24 Last updated: 2017-12-05Bibliographically approved
2. A holistic-existential approach to health promotion.
Open this publication in new window or tab >>A holistic-existential approach to health promotion.
2003 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 4, p. 384-91Article in journal (Refereed) Published
Abstract [en]

Health promotion seems to be implicit in many nursing theories, but the theoretical and philosophical basis of health promotion in nursing is not always explicitly stated. The interpretation of health promotion is closely related to the interpretation of man, health, illness and nursing. There is a need to clarify, refine and redefine health promotion in nursing because the concept is partly nonspecific and has not been used to identify a distinctive nursing focus. The aim of this study was to formulate a stipulative definition of health promotive nursing with a holistic-existential approach. A philosophical frame of reference in combination with conceptual analysis and theoretical synthesis were used as the methodological approach. The philosophical framework served as a basis in selecting the nursing theories and influenced the analysis. Two nursing theories and one nursing model were selected due to their influence on Norwegian nursing and because of their philosophical basis. Through analysis and synthesis of the selected nursing theories, the concepts man, health, illness/disease and nursing were analysed. The paper proposes a stipulative definition of health promotion in nursing based on a holistic-existential approach, supported by five necessary conditions. The definition and conditions needs to be further investigated by both empirical studies and by comparing with other relevant nursing theories, in order to formulate theoretical statements. The proposed definition may be the first step in a process of developing a theoretical framework of health promotive nursing with a holistic-existential approach.

Keywords
Holistic-Existential Apporoach, Health Promotion, Theroretical Analysis, Nursing Therories
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3426 (URN)14629641 (PubMedID)
Available from: 2014-09-24 Created: 2014-09-23 Last updated: 2017-12-05Bibliographically approved
3. Hospitalized older peoples' views of health and health promotion.
Open this publication in new window or tab >>Hospitalized older peoples' views of health and health promotion.
2006 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 1, no 1, p. 25-33Article in journal (Refereed) Published
Abstract [en]

Older peoples' health varies considerably and the number of older people who need hospital care will increase in the future. Traditionally, the focus of nursing care in hospitals is oriented towards diagnosis and treatment of disease, although health and health promotion are inherent in theories and definitions of nursing. This is an important issue in health politics, in new laws and regulations in Norway. However, it was difficult to find research-based knowledge about how nurses work with health promotion and health related to older hospitalized patients. This study aimed at describing older hospitalized patients' experiences of health and health promotion. The study used a descriptive and explorative qualitative design, with an interpretative-phenomenological approach. Ten older hospitalized patients, recruited through purposeful sampling, were interviewed during their hospital stay. The informants described health as Being able to be the person I am, to do what I want to do, and feel well and have strength. Health promotion was described as Being enabled through being the person I am, through information and knowledge and through hope and motivation. The findings may be applied to nursing practice in order to focus on promotion of health as an individual process built upon the unique person's life and situation, supported by nursing care and medical treatment.

Keywords
Helath, Health Promotion, Interpretative-Phenomenological Approach, Nursing, Older Hopitalized Patients, Qualitative Researc
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3428 (URN)10.1111/j.1748-3743.2006.00007.x (DOI)20925725 (PubMedID)
Available from: 2014-09-24 Created: 2014-09-24 Last updated: 2017-12-05Bibliographically approved

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