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Aims and Objectives: To investigate the association between perceived nurse-patient interaction and quality-of-life among nursing home residents, adjusted for loneliness, anxiety and depression., Background: Symptoms of anxiety and depression are known to residents of nursing homes along with cognitive impairment, physical inactivity and low quality-of-life. Anxiety, depression and loneliness are found detrimental to NH residents' quality-of-life. The nurse-patient relationship is important for patient's well-being, both in terms of illness and symptom management., Design: Cross-sectional design., Methods: Data were collected in 2017 and 2018 from 188 residents in 27 nursing homes resided in two large urban municipalities in Middle and Western Norway. The inclusion criteria were: (1) local authority's decision of long-term NH care; (2) residential stay 3 months or longer; (3) informed consent competency recognised by responsible doctor and nurse; (4) capable of being interviewed, and (5) aged 65 years or older. This article is executed in accordance with STROBE statement., Results: Adjusting for age, sex, anxiety, depression and loneliness, perceived nurse-patient interaction was statistically significant to quality-of-life. While anxiety and depression showed insignificant estimates, loneliness demonstrated a significant relation with quality-of-life. Nurse-patient interaction and loneliness explained together 25% of the variation in quality-of-life., Conclusion: This study suggests that loneliness is frequent as well as more detrimental to quality-of-life among nursing home residents compared to anxiety and depression. Furthermore, the present results show that the nurse-patient interaction represents an essential health-promoting resource for Quality-of-life in this population., Relevance to Clinical Practice: Staff nurses need to exercise their awareness of loneliness to meet residents' needs. Nursing educations should provide knowledge about nurse-patient interaction, and students as well as staff nurses in NHs should be trained, for instance by simulation, to use the nurse-patient interaction as a health-promoting resource. Finally, loneliness represents a bigger challenge than depression and anxiety; accordingly, building nurses that are capable of meeting patients' needs and facilitate care that counteracts loneliness is highly warranted., (© 2023 John Wiley & Sons Ltd.)

Aims and Objectives: To provide insights into what promotes and challenges inner strength and willpower in formerly critically ill patients back home after a long-term ICU stay., Background: Critically ill patients demand great resources during an ICU stay, some experience great challenges after discharge from hospital. Knowledge about how health professionals can promote former long-term critically ill patients' inner strength and willpower after discharge is essential, but still missing., Design: A qualitative, hermeneutic-phenomenological approach using in-depth interviews with former long-term ICU patients., Methods: Seventeen long-term ICU patients were interviewed 6-20 months after ICU discharge. The consolidated criteria for reporting qualitative research was used (COREQ,2007)., Results: Back home after hospital discharge, some former patients coped well while others suffered heavy burdens mentally and physically, along with economic problems. They handled their challenges differently: some found comfort and insight by reading their diary written by their ICU nurses, while several were struggling alone experiencing a lonesome silent suffering; these called for a follow-up support by the healthcare system., Conclusion: Long-term ICU patients' inner strength and willpower are vital salutogenic resources supporting the fight back to one's former independent life. However, physical, mental and economic challenges drain their inner strength to go on and succeed. Several long-term ICU patients need health-promoting follow-up support after hospital discharge., Relevance to Clinical Practice: This study disclosed a lonely and silent suffering indicating a need for development of systematical health-promoting follow-up programmes including salutogenic components such as health-promoting conversations, diaries and web-based recovery programme along with a cell phone app., (© 2021 John Wiley & Sons Ltd.)

Aims and Objectives: To explore how the presence of family and health professionals influences long-term critically ill patients' inner strength and willpower as an incitement to keep fighting for recovery., Background: This study reports long-term critically ill patients' experiences of family and health professionals as health-promoting resources in terms of significance for their inner strength and willpower. Earlier research on this topic is scarce., Design: A qualitative, hermeneutic-phenomenological approach, within the context of Antonovsky's salutogenic theory., Methods: Seventeen long-term critically ill patients were interviewed once, at 6-18 months after ICU discharge. The consolidated criteria for reporting qualitative research (COREQ) were used (Supplementary File 1)., Results: Four main themes identified how family and staff promoted and challenged the patient's inner strength and willpower: (a) the importance of family and friends; my family was surrounding me, (b) staff contributions, (c) challenges to inner strength and willpower in relation to family and (d) loneliness and indifferent care., Conclusion: This study brings new knowledge from the long-term critically ill patient's view about the impact of family, friends and nurses on the patient's inner strength and willpower. All impact is experienced positively and negatively., Relevance to Clinical Practice: Knowledge from the long-term critically ill patient's view is vital in nurse-patient interactions to facilitate liberation of inner strength and willpower., (© 2020 John Wiley & Sons Ltd.)

Aims and Objectives: To explore aspects that promote and challenge long-term ICU patients' inner strength and willpower., Background: Considerable research has been devoted to ICU patients' experiences; however, research on long-term ICU patients is limited. Studies in a health-promoting perspective focusing on long-term ICU patients' inner strength and willpower are scarce., Design: A qualitative, hermeneutic-phenomenological approach, using in-depth interviews., Methods: Seventeen long-term Norwegian ICU patients were interviewed once, at 6-18 months after ICU discharge. The consolidated criteria for reporting qualitative research was used (Data S1)., Results: The lived experience of the phenomenon "inner strength and willpower" and what promotes and challenges this phenomenon in long-term ICU patients were represented by four main themes and nine subthemes. Promoting aspects comprised of two main themes and five subthemes: (a) "No doubt about coming back to life" with subthemes; "Strong connectedness to life; feeling alive and present," "Meaning and purpose; feeling valuable to somebody." (b) "How to ignite and maintain the spark of life," with the subthemes: "Practical solutions, coping skills from previous life experiences," "Provocative and inspiring experiences" and "Vivid dream experiences that ignite the willpower." Two main categories and four subcategories represented challenging aspects: (a) Exhaustion, weakness and discomfort; subthemes; "Physical challenges" and "Mental discomfort" and (b) "Tiring delusions," subthemes; "Living in the worst horror movie" and "Feeling trapped.", Conclusion: This study expands on previous studies by providing insights about what promotes and challenges long-term ICU patients' inner strength and willpower during their recovery trajectory., Relevance to Clinical Practice: Insights into the variety of long-term ICU patients' experiences during the recovery trajectory are important for ICU nurses to support and facilitate ICU patients' inner strength and willpower., (© 2019 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.)

Aims and Objectives: To explore family members' experiences of long-term intensive care unit (ICU) patients' pathways towards survival and to highlight family members' efforts to promote the patient's health during the ICU stay., Background: Although considerable research has been devoted to the substantial burden of long-term ICU patients, less attention has been paid to health-promoting factors that facilitate patients' health and survival during ICU stays. Support from family members can improve patient outcome. However, there is little knowledge of the specific contributions provided by family members., Design: A hermeneutic phenomenological approach, within the context of Antonovsky's salutogenic theory and Merleau-Ponty's phenomenology of the body, involving the body as the fundament of experience and understanding., Methods: In-depth qualitative interviews. Thirteen family members of long-term ICU patients were interviewed once, at six to 18 months after ICU discharge. The consolidated criteria for reporting qualitative research were used., Results: Three themes were identified: (i) A body at a breaking point; (ii) family members' presence; and (iii) breaking through. In the perspective of the family members, their beloved ones were at a breaking point between life and death. The family's presence was significantly health promoting, demonstrating and communicating love and sensitivity. Moreover, family members' understanding of the patient's unique characteristics and personality was crucial to the patient's experience of being understood, recognised and acknowledged. Inner strength represented a life force capable of moving the patient from the breaking point towards a breakthrough towards life. Family members purposely used their knowledge about the patient to trigger, nurture and release the patient's inner strength., Conclusions: Family presence helps to trigger, arouse and release a patient's inner strength, representing important health-promoting factors facilitating patients' health and survival during an ICU stay., Relevance to Clinical Practice: Insights into the unique and vital health-promoting influence of family participation indicate the responsibility of the ICU team to provide support for families., (© 2018 John Wiley & Sons Ltd.)

Aims and Objectives: To investigate the associations between meaning-in-life and physical, emotional, functional and social well-being in a cognitively intact nursing-home population., Background: Meaning-in-life is understood as an influential psychological variable that promotes health and well-being; meaning-in-life has been found to be a mediating variable in both psychological and physical health., Design and Methods: The study employed a cross-sectional design. Data were collected in 2008 and 2009 using the purpose-in-life test and the FACT-G quality-of-life questionnaire. A total of 250 cognitively intact nursing-home patients who met the inclusion criteria were approached and 202 attended. The hypothesised relationships between meaning and multidimensional well-being were tested by means of structural equation modelling., Results: The structural equation modelling model fit well with the present data, showing significant direct relationships between meaning-in-life and emotional and functional well-being, and a significant mediated influence of meaning on social and physical well-being., Conclusion: Meaning-in-life is associated with all dimensions of well-being and likely plays an important role in both emotional and physical well-being., Relevance to Clinical Practice: Facilitating patients' perceived meaning-in-life might help ease emotional distress and physical symptoms, thus fostering well-being in cognitively intact nursing-home patients. Therefore, advancing staff nurses' competence in facilitating meaningful involvement, connectedness, nurse-patient interaction and symptom management is important for care quality and global well-being in nursing homes., (© 2013 John Wiley & Sons Ltd.)

Aims and Objectives: To investigate the prevalence of physical and emotional symptoms and the associations between symptoms and meaning-in-life in a cognitively intact nursing-home population., Background: Meaning has been found to be a strong individual predictor of successful ageing and life satisfaction as well as an important psychological variable that promotes well-being. Meaning serves as a mediating variable in both psychological and physical health., Design and Methods: The study employed a cross-sectional design. Data were collected in 2008 and 2009 using the QLQ-C15-PAL quality-of-life questionnaire, the purpose-in-life test and the Hospital Anxiety and Depression Scale. A total of 250 cognitively intact nursing-home patients who met the inclusion criteria were approached and 202 attended., Results: The prevalence of symptoms was fairly high, with fatigue (57%), pain (49%), constipation (43%) and dyspnoea (41%) as the most frequent physical symptoms, while 30% were depressed and 12% had anxiety. Significant correlations between meaning-in-life and symptom severity were displayed., Conclusions: The level of symptom severity among cognitively intact nursing-home patients is high, requiring highly competent staff nurses. Meaning-in-life might be an important resource in relation to a patient's physical and emotional health and global well-being., Relevance to Clinical Practice: Facilitating patients' meaning-in-life might help reducing symptom severity and fostering quality of life in cognitively intact nursing-home patients. However, advancing staff nurses' competence in palliative care, symptom management and nurse-patient interaction is important for care quality and quality if life in nursing homes., (© 2013 John Wiley & Sons Ltd.)

Aims and Objectives: To test the effects of nurse-patient interaction on anxiety and depression among cognitively intact nursing home patients., Background: Depression is considered the most frequent mental disorder among the older population. Specifically, the depression rate among nursing home patients is three to four times higher than among community-dwelling older people, and a large overlap of anxiety is found. Therefore, identifying nursing strategies to prevent and decrease anxiety and depression is of great importance for nursing home patients' well-being. Nurse-patient interaction is described as a fundamental resource for meaning in life, dignity and thriving among nursing home patients., Design: The study employed a cross-sectional design. The data were collected in 2008 and 2009 in 44 different nursing homes from 250 nursing home patients who met the inclusion criteria., Methods: A sample of 202 cognitively intact nursing home patients responded to the Nurse-Patient Interaction Scale and the Hospital Anxiety and Depression Scale. A structural equation model of the hypothesised relationships was tested by means of Lisrel 8.8 (Scientific Software International Inc., Lincolnwood, IL, USA)., Results: The SEM model tested demonstrated significant direct relationships and total effects of nurse-patient interaction on depression and a mediated influence on anxiety., Conclusion: Nurse-patient interaction influences depression, as well as anxiety, mediated by depression. Hence, nurse-patient interaction might be an important resource in relation to patients' mental health., Relevance to Clinical Practice: Nurse-patient interaction is an essential factor of quality of care, perceived by long-term nursing home patients. Facilitating nurses' communicating and interactive skills and competence might prevent and decrease depression and anxiety among cognitively intact nursing home patients., (© 2013 Blackwell Publishing Ltd.)

Aims and Objectives: The aim of this study was to test whether nurse-patient interaction affects cognitively intact nursing home patients' interpersonal and intrapersonal self-transcendence, as well as testing the psychometric properties of the Nurse-Patient Interaction Scale (NPIS)., Background: Self-transcendence is considered a spiritual developmental process of maturity in adulthood, and a vital resource of well-being at the end of life. The concept of self-transcendence has previously been explored in various populations, yet the nurse-patient interactions' potential influence on self-transcendence in nursing home patients has not been published previously., Design and Methods: A cross-sectional design employing the Self-Transcendence Scale and the NPIS was adopted. A sample of 202 cognitively well-functioning nursing home patients in Norway was selected. The statistical analyses were carried out using lisrel 8.8 and structural equation modelling., Results: Structural equation modelling-analysis indicates statistical significant effect of nurse-patient interaction on the patients' self-transcendence. Direct influence on the intrapersonal and indirect influence on the interpersonal self-transcendence aspects was disclosed., Conclusion: Nurse-patient interaction significantly affected both interpersonal and intrapersonal self-transcendence among cognitively intact nursing home patients. Hence, facilitating caring interventions can be significantly beneficial to older patients' self-transcendence and thereby well-being, both emotional and physical., Relevance to Clinical Practice: Caring behaviour signifies the vital and ultimate qualitative nursing behaviour, which promotes self-transcendence and thereby well-being. These findings are important for clinical nursing that intends to increase patients' well-being., (© 2012 Blackwell Publishing Ltd.)