Satu Elo

The qualitative content analysis process.

AIM This paper is a description of inductive and deductive content analysis. BACKGROUND Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method. DISCUSSION When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge. CONCLUSION Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.

Testing and verifying nursing theory by confirmatory factor analysis

AIM This paper presents a discussion of the use of confirmatory factor analysis to test nursing theory. BACKGROUND Theory testing is an important phase in nursing theory development. Testing of theory is intended to give more information about concepts and their usefulness in nursing practice. Confirmatory factor analysis is commonly used in instrument development in nursing science studies, but also in theory testing. However, there has been little discussion of its use in theory testing in nursing science research. DATA SOURCES Multidisciplinary methodological and research publications from 1990 to 2009 were used. DISCUSSION The aim of confirmatory factor analysis is to test nursing theory that has already been established, i.e. researchers have an a priori hypothesis based on theoretical knowledge or empirical indications. Analysis is represented as three phases: preparation, model testing and reporting the results. Preparation involves data screening and preliminary analyses. Model testing is divided into model specification, model identification, model estimation, model evaluation and model modification. The results are reported with standardized regression coefficients of the items related to the latent variables, squared multiple correlations (R²) related to error terms and the models goodness of fit indexes. Implications for nursing. Testing of theory is intended to give more valid information about the concepts and their usefulness in nursing practice. CONCLUSION Confirmatory factor analysis is a good method to test the structure of theory, for example to test the concepts built by concept synthesis or analysis. Tested theories are needed to develop nursing science itself.

The physical, social and symbolic environment supporting the well-being of home-dwelling elderly people

Objectives. The purpose of this study was to construct a theory on an environment that would support the well-being of home-dwelling elderly people in northern Finland. Study design. The study was carried out according to the phases of theory formulation using both qualitative and quantitative methods. Methods. The data of the first phase consisted of focused interviews (n=39) with home-dwelling elderly people over the age of 65 years. Judgement-based snowball sampling was used. By means of inductive concept synthesis, hypothetical models were constructed of a physical, social and symbolic environment that would support the well-being of the elderly. In order to verify the concepts of the hypothetical model, an instrument was constructed in the second phase of the study and its reliability was evaluated by a panel of experts consisting of nurses (n=15), through expert evaluations (n=3) and by postal questionnaire. The final phase of the study (n=328) also targeted home-dwelling elderly people living in northern Finland. The sampling method used was a stratified random sampling. The data of (n=328) were analysed by principal component analysis (PCA) and confirmatory factor analysis (CFA). Results. The physical environment that supports the well-being of the elderly includes a northern environment, an environment that enables safe activity and a pleasant physical environment. The social environment that supports well-being enables the elderly to receive help, allows them to keep in contact with family members and friends as providers of support to their well-being and offers a pleasant living community. The symbolic environment that supports well-being consists of the ideal attributes of well-being, spirituality, the normative attribute of well-being and a sense of history. Conclusions. Even though the environment is artificially divided into separate areas in the theory, in putting the results into practice, it needs to be taken into account that observing separate areas of the environment does not provide a comprehensive view on the connection between environment and well-being.

Challenges for institutional elder care in Slovenian nursing homes.

AIMS AND OBJECTIVES To investigate deficiencies in the institutional elder care that is being offered to residents of nursing homes in Slovenia. BACKGROUND Public criticism of the provision of elder care in nursing homes is growing all over the world, including in Slovenia. Many studies on this issue have been conducted, but seldom have assessed different viewpoints simultaneously. DESIGN A qualitative research design that involved individual unstructured interviews was used in 2007. The participants (n=48) comprised 16 residents, 16 relatives and 16 members of the nursing staff from four nursing homes in Slovenia. METHODS The data generated were subjected to qualitative content analysis. RESULTS The major themes that emerged from this analysis were neglect, unprofessional communication, uncomfortable physical environment and inadequate administration. CONCLUSIONS The participants of the study identified issues in institutional elder care in Slovenia that have also been highlighted by international research. Due to staff shortages, low motivation, insufficient communication skills and inexperience, members of the nursing staff reported that they were not in a position to offer the best possible quality of care. RELEVANCE TO CLINICAL PRACTICE To improve the living environment in nursing homes, it is important to consider the opinions of all those who are involved closely in institutional elder care. Correction of deficiencies should be a priority and should result in more engagement with residents.

Developing and Testing a Middle-Range Theory of the Well-Being Supportive Physical Environment of Home-Dwelling Elderly

The aim is to describe the development of a middle-range theory by using an inductive-deductive approach. A theory of well-being supporting physical environment of home-dwelling elderly is used as an example. The inductive-deductive theory development process is described through four different phases: (1) the creations of concepts were described inductively through concept synthesis, (2) relationships between the concepts were examined to set up a hypothetical model, (3) hypotheses were set up to verify the concepts and to test hypothetical models, and (4) the verification and presentation of the theory.

Social Environment of Older People during the First Year in Senior Housing and Its Association with Physical Performance

Increasing numbers of older people relocate into senior housing when their physical performance declines. The change in social environment is known to affect their wellbeing, providing both challenges and opportunities, but more information on the relations between social and physical parameters is required. Thus, we elicited perceptions of the social environment of 81 older people (aged 59–93 years, living in northern Finland) and changes in it 3 and 12 months after relocation to senior housing. We also measured their physical performance, then analysed associations between the social and physical variables. Participants reported that they had freedom to do whatever they liked and generally had enough contact with close people (which have recognized importance for older people’s wellbeing), but changes in their physical condition limited their social activity. Moreover, their usual walking speed, dominant hand’s grip strength and instrumental activities of daily living (IADL) significantly decreased. The pleasantness of the residential community, peer support, constraints on social activity imposed by changes in physical condition, meaningful activity at home and meeting close people all affected these physical performance parameters. Clearly, in addition to assessing physical performance and encouraging regular exercise, the complex interactions among social factors, physical performance and wellbeing should be considered when addressing individuals’ needs.

Frequent attenders in primary health care: A concept analysis

OBJECTIVES Frequent attendance is a well-known phenomenon in health care systems. A small proportion of patients make a high rate of visits to primary health care physicians. However, due to the diversity of this phenomenon, there is no generally accepted definition of the frequent attender. The aim of this analysis was to define the concept of the frequent attender in primary health care. DESIGN A concept analysis. DATA SOURCES The literature was searched using electronic databases (MEDLINE, CINAHL, and Scopus) and a manual search was performed for studies published from 2000 to 2016. The inclusion criteria covered frequent attenders in primary health care examined by quantitative or qualitative studies published in English or Finnish. REVIEW METHODS Walker and Avants (2010) strategy for concept analysis was used. Uses of the concept were studied, and attributes, antecedents, and consequences of the concepts were defined. RESULTS A total of 59 articles provided data for this concept analysis. Four defining attributes of frequent attenders were identified: the feelings of symptoms, perceived poor health status, lower quality of life and frequent visits to a primary health care provider. Antecedents included the patients individual characteristics, the primary health care system, and the patient-physician relationship. Consequences were divided into two categories: those for frequent attenders and those for society. Consequences for frequent attenders included: follow-up investigations and visits, social disadvantages, and economic costs. Consequences for society included: the costs to the national economy and the consumption of health care resources. CONCLUSION A theoretical definition and a conceptual model of the frequent attender were developed. The definition and the proposed empirical referents of all four attributes can be used to validate the presence of frequent attenders and to develop theory-based applications. Future research on frequent attenders is needed to develop and assess possible interventions.

Care practices of older people with dementia in the surgical ward: A questionnaire survey:

Objectives: The objective of this study was to describe the care practices of nursing staff caring older people with dementia in a surgical ward. Methods: The data were collected from nursing staff (n = 191) working in surgical wards in one district area in Finland during October to November 2015. Data were collected using a structured questionnaire and analyzed statistically. The instrument consists of a total number of 141 items and four dimensions. The dimensions were as follows: background information (12 of items), specific characteristics of older people with dementia in a surgical ward (24 of items), specific characteristics of their care in a surgical ward (66 of items) and use of physical restraints and alternative models for use of restraints for people with dementia (39 of items). Results: The questions which measure the nursing staff’s own assessment of care practices when caring for people with dementia in surgical wards were selected: counseling people with dementia, reaction when a surgical patient with dementia displays challenging behavior and use of alternative approach instead of physical restraints. Most commonly the nursing staff pay attention to patient’s state of alertness before counseling older people with dementia. Instead of using restraints, nursing staff gave painkillers for the patient and tried to draw patients’ attention elsewhere. The nursing staff with longer work experience estimate that they can handle the patients’ challenging behavior. They react by doing nothing more often than others. They pretend not to hear, see or notice anything. Conclusion: The findings of this study can be applied in nursing practice and in future studies focusing on the care practices among older people with dementia in acute care environment. The results can be used while developing patient treatments process in surgical ward to meet future needs.

Perceived loneliness among home-dwelling older adults with and without memory disorder: A population-based study

The aim of this population-based cross-sectional study was to describe and compare the prevalence and features of perceived loneliness among home-dwelling older adults with (n = 129) and without (n = 244) memory disorder. The latter group was randomly resampled from 789 respondents stratified by age to obtain a standardized control group. Loneliness was assessed using the six-item De Jong Gierveld Loneliness Scale, and perceived stress using Cohen, Kamarck and Mermelstein’s 10-item Perceived Stress Scale. Results show that severe loneliness was common among the home-dwelling older adults, especially those with memory disorder, who also perceived stress more frequently than those without memory disorder. Both groups, but again more frequently those with memory disorder, were more likely to be emotionally than socially lonely. Thus, when planning social and healthcare services and interventions to mitigate loneliness among older adults living at home, memory problems and emotional loneliness require particular consideration.

Mental Well-Being of Older People in Finland during the First Year in Senior Housing and Its Association with Physical Performance

Growing numbers of older people relocate to senior housing, when their physical or mental performance declines. The relocation is known to be one of the most stressful events in the life of older people and affect their mental and physical well-being. More information about the relationships between mental and physical parameters is required. We examined self-reported mental well-being of 81 older people (aged 59–93, living in northern Finland), and changes in it 3 and 12 months after relocation to senior housing. The first measurement was 3 months and the second measurement 12 months after relocation. Most participants were female (70%). Their physical performance was also measured, and associations between these two were analyzed. After 12 months, mental capability was very good or quite good in 38% of participants, however 22% of participants felt depressive symptoms daily or weekly. Moreover, 39% of participants reported daily or weekly loneliness. After 12 months participants reported a significant increase in forgetting appointments, losing items and difficulties in learn new things. They felt that opportunities to make decisions concerning their own life significantly decreased. Furthermore, their instrumental activities of daily living (IADL), dominant hand’s grip strength and walking speed decreased significantly. Opportunities to make decisions concerning their life, feeling safe, loneliness, sleeping problems, negative thoughts as well as fear of falling or having an accident outdoors were associated with these physical parameters. In addition to assessing physical performance and regular exercise, the various components of mental well-being and their interactions with physical performance should be considered during adjustment to senior housing.