Anne Valen-Sendstad Skisland

Self-care and anticipated transition into retirement and later life in a Nordic welfare context

Few studies have appeared in the health care literature on the meaning of transition into retirement and later life. However, this predictable-involuntary transition may influence personal health and well-being, and studying it from a self-care perspective could be useful. The aim of this study was to illuminate aspects of self-care in a group of middle-aged individuals in relation to their anticipated transition into retirement in the Nordic welfare context. A total of 13 individuals, aged 55 to 65 years, were randomly chosen from the total number of inhabitants in three municipalities in mid-west Sweden. Conversational interviews took place, during which the informants shared important events in their lives that had occurred from early childhood until the present time, together with thoughts about their anticipated future developmental transition into later life. The interviews were tape recorded and transcribed verbatim. After content analyses and interpretation, a comprehensive picture of the phenomenon was revealed. The results showed that there were opportunities, expectations, wishes, concerns, and worries related to the transition into retirement and old age among informants from both rural and urban municipalities. Self-care, in connection with this, depended on motivating and demotivating factors. Autonomy and mature dependence seemed to be positive driving forces for reaching a successful transition into later life. Supporting autonomy should be a way of facilitating the transition into retirement and later life.

Construction and testing of the Moral Development Scale for Professionals (MDSP)

Moral development among students is central for nursing education, because nursing is informed by moral ends, and it is essential that professional nurses have a well developed ability for moral behaviour, ethical reasoning and decision making. The aim of this study was to construct a new instrument for measuring moral development according to Kohlbergs theory of moral development among students and professionals, and initially test it for reliability and validity among students in professional education. Thirty-two items following the conventional and postconventional stages in the theory were developed. Different actions for reducing the items were implemented. The final version of the instrument with 12 items was tested for reliability and validity among 326 conveniently chosen students. A Cronbachs alpha coefficient of 0.67 and support for construct validity was obtained.

Ethical challenges in care for older patients who resist help

Background: Situations where patients resist necessary help can be professionally and ethically challenging for health professionals, and the risk of paternalism, abuse and coercion are present. Research question: The purpose of this study was to examine ethical challenges in situations where the patient resists healthcare. Research design: The method used was clinical application research. Academic staff and clinical co-researchers collaborated in a hermeneutical process to shed light on situations and create a basis for new action. Participants and research context: Four research groups were established. Each group consisted of six to eight clinical co-researchers, all employees with different health profession backgrounds and from different parts of the municipal healthcare services, and two scientific researchers. Ethical considerations: The study was conducted in compliance with ethical guidelines and principles. Participants were informed that participation was voluntary and that confidentiality would be maintained. They signed a consent form. Findings: The findings showed that the situations where patients opposed help related to personal hygiene, detention in an institution and medication associated with dental treatment. The situations were perceived as demanding and emotionally stressful for the clinicians. Discussion: The situations can be described as everyday ethics and are more characterised by moral uncertainty and moral distress than by being classic ethical dilemmas. Conclusion: Norwegian legislation governing the use of force seems to provide decision guidance with the potential to reduce uncertainty and moral stress if the clinicians’ legal competence had been greater.

Preserving dignity in end-of-life nursing home care: Some ethical challenges:

A central task in palliative care is meeting the needs of frail, dying patients in nursing homes. The aim of this study was to investigate how healthcare workers are influenced by and deal with ethical challenges in end-of-life care in nursing homes. The study was inspired by clinical application research. Researchers and clinical staff, as co-researchers, collaborated to shed light on clinical situations and create a basis for new practice. The analysis resulted in the main theme, ‘Dignity in end-of-life nursing home care’, and the sub-categories ‘Challenges regarding life-prolonging treatment’ and ‘Uncertainty regarding clarification conversations’. Our findings indicate that nursing homes do not provide necessary organizational frames for the team approach that characterizes good palliation, and therefore struggle to give dignified care. Ethical challenges experienced by healthcare workers are closely connected to inadequate organizational frames.

Construct validity of the Moral Development Scale for Professionals (MDSP).

The aim of this study was to investigate the construct validity of the Moral Development Scale for Professionals (MDSP) using structural equation modeling. The instrument is a 12-item self-report instrument, developed in the Scandinavian cultural context and based on Kohlberg’s theory. A hypothesized simplex structure model underlying the MDSP was tested through structural equation modeling. Validity was also tested as the proportion of respondents older than 20 years that reached the highest moral level, which according to the theory should be small. A convenience sample of 339 nursing students with a mean age of 25.3 years participated. Results confirmed the simplex model structure, indicating that MDSP reflects a moral construct empirically organized from low to high. A minority of respondents >20 years of age (13.5%) scored more than 80% on the highest moral level. The findings support the construct validity of the MDSP and the stages and levels in Kohlberg’s theory.

Attitudes towards the anticipated transition into retirement in the Nordic welfare context

Introduction:There may be different attitudes towards the transition into retirement and old age pensioner life among people who are relatively close to get into their third age. This phenomenon has not been widely studied in the nursing literature. Since this predictable-involuntary transition may have influences on personal health and well-being, it should be meaningful to study it in a self-care perspective. The aim of this study was to illuminate aspects of self-care in a group of middle-aged individuals in relation to their anticipated transition into retirement in the Nordic welfare context. Methods and Materials:A qualitative design was used in this study. A total number of 13 individuals, 55–65 years of age, were randomly chosen from the total number of inhabitants in three municipalities in mid-west Sweden. The interviews were tape recorded and transcribed verbatim. After content analyses and interpretation, a comprehensive understanding of the phenomenon was revealed. Results: All informants viewed their lives in retrospective with positive feelings with respect to their childhood and youth. As grown up individuals, they saw family, friends and social relations as very important. No particular differences between the informants from the different municipalities were found, nor in relation to age, sex or profession. There were opportunities, expectations, wishes, concerns and worries related to the transition into old age pensioner life among the informants from both the rural and urban municipalities. Conclusion: Autonomy and mature dependence seem to be positive driving forces for reaching a successful transition into old age. Supporting autonomy should, therefore, be a way for facilitating the predictable-involuntary transition into retirement. Further studies about the retirement transition within a self-care perspective are needed. This study indicates that motivation, autonomy and mature dependence are important issues that should be focused in such research. Gender issues and connectedness are other important areas.