Anneli Sarvimäki

Teaching of patients undergoing total hip replacement surgery

We studied the effect of patient teaching in 60 patients who underwent primary total hip replacement surgery. All the patients received an illustrated patient guide. In addition to the general patient teaching given by doctors, nurses and physiotherapists, a randomly chosen group of 27 patients received a session of intensified patient teaching. At the follow-up, 2-3 months postoperatively, 61% of patients thought that they had received the main part of their information from the physiotherapists, 9% from their doctors and 4% from the nursing staff. The importance of a well-illustrated guide was pointed out. The knowledge of potential complications, such as infection, remained poor; 37% could not name one single relevant complication. At the follow-up, the younger or better educated patients did not score any better. The experimental group who had received intensified teaching differed only slightly from the controls, but they knew significantly better when to inform their doctor of potential complications. Also, the experimental group showed greater interest in obtaining more information about their replaced hip. Patients in the experimental group showed significantly better adherence to the instructions for the postoperative rehabilitation programme.

The meaning of vulnerability to nurses caring for older people

Research concerning work on caring for older people shows that care providers experience a variety of consuming emotions and stress. They can be said to be in a vulnerable position. It is not known, however, how the care providers themselves understand vulnerability. The aim of this study was to illuminate the meaning of vulnerability to care providers caring for older people. A qualitative interpretive approach was adopted. Data were collected through tape-recorded interviews with 16 female registered and practical nurses who were experienced in caring for older people. Qualitative analysis resulted in one core theme and six themes with subthemes. The core theme showed that, for the participating nurses, vulnerability essentially meant being human. The meanings of being human were illustrated by the six themes: having feelings; experiencing moral indignation; being harmed; having courage; protecting oneself; and maturing and developing. Analysis showed that vulnerability was a resource as well as a burden.

Stress of conscience among staff caring for older persons in Finland.

Caring for older persons is both rewarding and consuming. Work with older people in Finland has been shown to be more burdensome than in the other Nordic countries. The aim of this study was to try out a Finnish version of the Stress of Conscience Questionnaire (SCQ) and explore stress of conscience in staff caring for older persons in Finland. The data were collected from the nursing staff (n = 350) working with older people in health centre wards, municipal and private nursing homes, and municipal and private dementia care units in Finland. It emerged clearly from the results that Finnish nursing staff mostly felt that they did not have enough time to provide good care to patients, and this gave them a troubled conscience. They also felt that the demanding work taxed their energy, a consequence being that they could not give their own families and loved ones the attention they would have liked.

Fear of falling from a daily life perspective: Narratives from later life

Fear of falling is a well-known condition in later life. The aim of this study was to illuminate the experiences and the meaning of fear of falling in a daily-life context. The method used was a qualitative study inspired by interpretive phenomenology. In narrative interviews, five community-dwelling women over 80 years of age told about their fear of falling from a daily-life perspective. The overall thematic analysis resulted in three main themes: the meaning of managing daily life necessities; keeping in contact with the outside; living with fear. The findings showed that to live with fear of falling was to discipline daily life, and to learn to live with the challenge of a vulnerable bodily condition and of losing control at different levels: from falling, from incontinence, from dirt and from the stigma of being in a humiliating situation. The women created a perception of independence while they were dependent on help and community care and on news from the outside. At an existential level, they coped with their fear by strengthening their will. The conclusion was that the older women studied accepted the condition of fear of falling. They shared the ability to cope in various ways with the limitations of their bodily capacity and their imbalance.

Science and tradition in the nursing discipline--a theoretical analysis.

The purpose of the article is to argue for a conception of nursing knowledge that stresses theoretical and practical knowledge as equally important, and to analyze the roles of nursing science and nursing tradition in the discipline of nursing. Nursing knowledge is characterized as involving values, sets of beliefs, and procedural knowledge. Practical nursing knowledge is viewed as an integration of values, beliefs and procedural knowledge into action, whereas theoretical knowledge is viewed as a conception of nursing. Nursing tradition is described as the main organizer of practical nursing knowledge at the collective level, and nursing science as the main organizer of collective theoretical knowledge.

Experiential Health from an Ageing and Migration Perspective: The Case of Older Finland-Swedes

Research has shown that immigrants and minority groups tend to have a lower health status compared to the majority population. The Finnish immigrants in Sweden are no exception. The Finland-Swedes, i.e., persons living in Finland who have Swedish as their mother language, seem to be an exception, however. They have been found to have better health and longer life expectancy compared to the Finnish majority. Research on health among migrated Finland-Swedes is scarce. The aim of this study was to describe and deepen the understanding of how older Finland-Swedes living as immigrants in Sweden, as well as re-migrants in Finland, experienced their health. Data was collected through 39 qualitative interviews with 29 older Finland-Swedes aged 65 or more. Data was analysed through qualitative thematic content analysis. The analysis resulted in five themes: Ageing means becoming frail and closer to death; Despite frailty and old age it is possible to feel well and experience peace; Being grateful for health as a source of life; Health comes from inner strength and external sources; Migration meant a mental and physical burden to health. Overall, both ageing and migration were experienced as jeopardising health.

Home as a health promotion setting for older adults.

Background: The number and the proportion of older persons is growing in the Nordic Countries. The growth in the older population has a clear impact on the care system for older persons. One trend is to prioritise home care instead of care in institutions. Another trend is to emphasise preventive and health promotion care. As official guidelines in the Nordic countries state that home is the best place to grow old, it is essential that older persons keep their health and functional capacity in order to be able to live at home for as long as possible. As current policy emphasises living at home, home care, preventive work and health promotion it becomes essential to study the home as a health promotion setting. Objective: The aim of this study was to reach a new understanding of home as a health promotion setting for older persons. Study design: The method used was a literature reflection and analysis with a hermeneutical approach. Results: The results show that with increasing age the home environment becomes a crucial determinant for independence. The home environment supports the self as people age; it has associations with the past, can provide proximity to family, and a sense of being a part of neighbourhood life. Conclusions: Only by taking into consideration the meaning of home and the resources of the individual older person can home function as a true health promoting setting. If health personnel focus solely on risk prevention, they can neglect the perspectives of the older person, resulting in dis-empowerment not health promotion.

The Meaning of the Future for the Oldest Old

The aim of the study was to highlight the oldest old peoples view of their future from a perspective of philosophy of life. Data was collected by means of life story interviews with 15 persons. The analysis was performed by utilizing a phenomenological hermeneutic method and the interpretation was guided by the conceptual framework of philosophy of life as designated by Jeffner (1988). The following themes emerged: future seen as everyday life; future-oriented values; and thoughts about life and death. The oldest old were found to view their future in ways that ranged from a tangible positive approach via a wait-and-see policy to a negative approach. Their perception of their future implied two different time perspectives, their immediate future and a more long-term perspective of the future. Furthermore, the future was experienced on three different levels, the individual level, the intergenerational level, and the metaphysical level.

The meaning of vulnerability to older persons

Background: Vulnerability is an important concept in nursing and nursing ethics. Vulnerability and ageing have generally been associated with frailty, which gives a limited view of both vulnerability and ageing. Objective: The aim of this study was to illuminate the meaning of vulnerability to older persons themselves. Research design: A qualitative design based on interpretive description was adopted. The data were collected by interviews that were analysed by qualitative content analysis as interplay between analysis, interpretation and meaning construction. Participants and research context: In total, 14 older persons aged 70–96 years were interviewed, 2 men and 12 women. Some of the participants lived in their own homes, some in service houses and some in nursing homes. Ethical considerations: The ethical principles of informed consent, confidentiality and non-identification were respected. Findings: The core meaning was a deeper sense of vulnerability as you grow old. This was expressed in six themes: Being easily harmed, Becoming an old person, Being an old person in society, Reactions when being violated and hurt, Protection and Vulnerability as strength. Discussion and conclusion: The themes include frailty and threats to the dignity of older persons and also capacity to feel and develop. The results showed that although the frailty perspective dominated, vulnerability also had positive meanings for the older persons.

Differences in self-rated health among older immigrants - A comparison between older Finland-Swedes and Finns in Sweden

Aims: Research has shown a tendency among immigrants and ethnic minorities to have a lower health status compared with the majority population. This applies to Finnish immigrants in Sweden. This group, however, also consists of persons who belong to a small ethnic minority in Finland, the Finland-Swedes, who speak Swedish as their mother tongue. In Finland, this minority has been shown to have better health and longer lives than the majority of Finnish-speaking people. Most of the previous research has studied the objective health of immigrants and minorities, while less is known about their subjective health. The aim of this study was to describe and compare self-rated health in older Finland-Swedes and Finns living as immigrants in Sweden. Methods: The study was carried out as a sample-based cross-sectional study. Data was collected by a postal structured questionnaire. The response rate among the Finland-Swedes was 47% (n = 169) and among the Finns was 54% (n = 643). Data was analyzed descriptively and tested with Pearson’s chi-square test. Results: The results showed significant differences between the language groups in self-rated health, age of retirement and causes for retirement. The Finland-Swede immigrants rated their health as better than the Finnish-speaking ones. They had retired at an older age and less frequently because of health problems. Conclusions: The results indicate that there may be significant differences in health, at least in subjective health, between immigrant groups. Due to the low response rate, the results cannot be generalized.