Health promotion- Worthwhile? Work package 3: Health promotion factors in Joy of Life Nursing Homes

The PhD project was a part of the project Health Promotion Worthwhile? Reorienting the community health care services which was founded by the Research Council of Norway (grant number 238331). The overall aim of the project was to reorient the community health care services in a health promoting direction by providing knowledge for three areas representing different phases in human life. This project is a part of the third work package and focuses on health promotion in Nursing home (NH) residents and to be more specific the Joy of Life ( JoL) among NH residents. Finding new approaches to increase positive health and well-being of elderly individuals living in nursing homes (NH) is highly warranted. Several Norwegian municipalities have implemented the certification scheme framed Joy of Life Nursing Home (JOLNH). JOLNH is based on a health-promoting perspective directing elderly individuals resources. Through health promotion, preventive and social activities across generations, NH care promotes respect, well-being, health and cultural experiences among elderly individuals. The aims of the first part of the study were to explore the phenomenon of Joy of life (JOL) among elderly individuals living in NHs and to provide a deeper understanding of which dimensions constitute JOL in this population. The present study explored the JOL phenomenon using qualitative methodology. Data were collected between December 2015 and May 2016 by individual qualitative research interviews of 29 elderly individuals who met the inclusion criteria. The informants were living in ten different NHs in two large municipalities in Norway. Prior approval was obtained from all regulatory institutions dealing with research issues and the management in both municipalities.The results showed five salutogenic dimensions contributing to JOL: (i) positive relations, (ii) belongingness, (iii) sources of meaning, (iv) moments of feeling well, and (v) acceptance. Based on this study, a measurement model of JOL (the Joy Of Life Scale) was developed and psychometrically tested among 200 elderly individuals in NH in Norway. In the second part of this study we examined the frequency of common symptoms and the association between common symptoms and JoL in cognitively intact NH residents. A cross-sectional design was employed. Using the QLQ-C15?PAL quality-of-life questionnaire, hospital anxiety and depression scale, and JoL scale, a total of 188 cognitively intact NH residents participated. The results showed that symptom severity was high; 54% reported fatigue, 52% reported constipation, 45% reported pain, 43% reported dyspnea, 32% reported insomnia, 22% reported appetite loss, and 20% reported nausea, while 20% reported anxiety and 23% reported depressive symptoms. Nevertheless, 59% of the NH residents reported high JoL, which was significantly positively related to the quality of life and negatively associated with anxiety and depression.This study shows that symptom severity is high among NH residents. JoL was shown to be strongly positively associated with several aspects of health-related QoL, and strongly negatively associated with anxiety and depression. Despite low physical and emotional functioning and a high symptom burden, we found that largely, NH residents reported to be happy, experienced enjoyable social activities, and positive contact with friends and family, and were grateful for how their life had become, and accepted the person they had been in life. This indicates that NH residents accept and adapt to their life situation as well as adjusting their orientation to life in their late years. The aim of the third study was two-fold: (1) to investigate factors influencing JoL in cognitively intact NH residents, and (2) to investigate a possible impact of the JoLNH concept on JoL in cognitively intact NH residents. A cross-sectional design was employed using the QLQ-C15?PAL quality-of-life questionnaire, hospital anxiety and depression scale, the Self- Transcendence Scale (STS), The Nurse-Patient Interaction Scale (NPIS) and the JoL scale. A total of 188 cognitively intact NH residents participated. This study is not published yet, but the results indicate that important factors for explaining the variation in JoL in NH residents are their emotional functioning, the interaction between the health professionals and the residents ( NPIS) , how resources of wellbeing are supported among the NH residents (ST) and depression ( HADS) . The PhD project contributes with knowledge to the importance of health promotion focus in NH residents by identify: a) the main factors constituting JoL in NH residents b) the frequency of common symptoms and the association between common symptoms and JoL in cognitively intact NH residents and c) important factors explaining the variation of JoL. With this knowledge Health professionals might approach NH residents in a health promoting way increasing their JoL and wellbeing.

Doktorgradsprosjektet bidrar med kunnskap om hvor viktig et helsefremmende fokus til sykehjemspasienter er ved å : - identifisere de viktigste faktorene som definerer livsglede for sykehjemspasienter, - identifisere hyppigheten og forekomsten av vanlige symptomer og sammenhengen mellom vanlige symptomer og livsglede for kognitivt friske pasienter i sykehjem - identifisere viktige faktorer som forklarer variasjon av livsglede hos sykehjemspasienter. Med mer kunnskap om dette kan helsepersonell bidra med en helsefremmende tilnærming til sykehjemspasienter, øke deres livsglede og livskvalitet, gjøre helsepersonell oppmerksom på viktigheten av god smertebehandling og lindring og redusere depresjon. I tillegg ble det gjennom dette prosjektet utviklet og validert en skala for å måle nivået av Livsglede.

Trondheim kommune er partner i et større forskningsprosjekt i samarbeid med Høgskolen i Sør- Trøndelag (HiST). Prosjektet «Health Promotion Worthwhile Reorienting the community health care services» er tildelt strategiske høgskoleprosjektmidler (SHP-midler) fra Norges Forskningsråd, med oppstart 01.01.15. Prosjektets hovedformål er å bidra til å reorientere Trondheim kommunes helsetjenester (Arbeidspakke 1: Skolehelsetjenesten; Arbeidspakke 2: Frisklivssentraler; Arbeidspakke 3; Sykehjemsomsorgen) i en mer helsefremmende retning. Følgelig er Trondheim kommune en sentral part i prosjektet, og har forpliktet seg til å bidra med en av de i alt 6 PhD-stipendiatene (2 i hver arbeidspakke) som skal tilsettes i forskningsprosjektet. Trondheim kommunes stipendiat knyttes til Arbeidspakke 3 med fokus på «Helsefremmende faktorer i Livsgledesykehjem». Prosjektets forskningsgruppe tilhører Senter for helsefremmende forskning, Høgskolen i Sør- Trøndelag (HiST) og ledes av Professor Toril Rannestad HiST og Professor Geir Arild Espnes, NTNU og HiST. Prosjektets tilnærming er svært relevant for helsetjenestene i Trondheim kommune og godt forankret i kommunens strategiske satsninger på Tidlig innsats og Helsefremmende arbeid. Disse strategiene er gjennomgripende i alt planarbeid som Trondheim kommune har gjennomført de siste årene. Kommunen har forpliktet seg til å bidra som partner, tilrettelegger og arena mht gjennomføringen av prosjektet. Målet er på sikt at dette prosjektet sammen med andre tilsvarende, skal bidra til å utvikle Trondheim kommune til en Universitetskommune tilsvarende spesialisthelsetjenestens ordning med Universitetssykehus. «Livsgledesykehjem» fokuserer på det friske. på den enkeltes ressurser og har et helsefremmende perspektiv og tilnærming til pleie og omsorg for mennesker i sykehjem. Det er et norsk sykehjemskonsept utviklet i Trondheim av Stiftelsen Livsglede for eldre (LFE). Filosofien er basert i St.meldingene nr. 25 Mestring, muligheter og mening.