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Background: Wellness is a holistic, multidimensional, and process‐oriented property on a continuum. It has been used interchangeably with and is undifferentiated from concepts such as health and well‐being without an in‐depth clarification of its theoretical foundations and a reflection on its meaning. The concept of wellness is frequently used, but its definition remains unclear. Aim: To conceptually and theoretically explore the concept of wellness to contribute to a deeper understanding in caring science. Method: Rodgers' evolutionary concept analysis was applied to the theoretical investigation of data from publications of international origins. The focus was on antecedents, attributes, consequences, surrogate and related terms, and contextual references. A literature search was performed through a manual review of reference lists and an online search in CINAHL and PubMed via EBSCO, and in ProQuest. Abstracts were examined to identify relevant studies for further review. The inclusion criteria were peer‐reviewed papers in English; papers published in scientific journals using the surrogate terms 'wellness', 'health', 'health care', and 'health care and wellness'; and papers discussing and/or defining the concept of wellness. Twenty‐six studies met the inclusion criteria. Results: Based on the findings from this concept analysis, a definition of wellness was developed: 'a holistic and multidimensional concept represented on a continuum of being well that goes beyond health'. Implications for nursing practice were correspondingly presented. Conclusion: Wellness is defined as a holistic and comprehensive multidimensional concept represented on a continuum of being well, that goes beyond health. It calls attention by applying the salutogenic perspective to health promotion in caring science. It is strongly related to individual lifestyle and health behaviour and is frequently used interchangeably with health and well‐being without an in‐depth clarification of its theoretical foundation. [ABSTRACT FROM AUTHOR]

Background: The electronic medication administration record (eMAR) is an eHealth system that has replaced the traditional paper‐based medication administration used in many healthcare settings. Research has highlighted that eHealth technologies can change working methods and professional roles in both expected and unexpected ways. To date, there is sparse research that has explored how nurses and nurse assistants (NA) in home healthcare experience eMAR in relation to their work environment. Aim: The aim was to explore how nurses and nurse assistants experienced their work environment, in terms of job‐demand, control, and support in a Swedish home healthcare setting where an electronic medication administration record had been implemented to facilitate delegation of medical administration. Method: We took a qualitative approach, where focus groups were used as data collection method. The focus groups included 16 nurses and nine NAs employed in a Swedish municipality where an eMAR had been implemented 6 months before the first focus groups were performed. The analysis adapted the job‐demand‐control‐support model, by condensing the professionals' experiences into the three categories of demand, control, and support, in alignment with the model. Results: NAs experienced high levels of job demand and low levels of job control. The use of the eMAR limited NAs' ability to control their work, in terms of priorities, content, and timing. In contrast, the nurses described demands as high but manageable, and described having a high level of control. Both professions found the eMar supportive. Conclusion: Nurses and NAs in home healthcare experienced changes in their work environment regarding demand, control, and support when an eMAR was implemented to facilitate delegation of medical administration. In general, nurses were satisfied with the eMAR. However, NAs felt that the eMAR did not cover all aspects of their daily work. Healthcare organisations should be aware of the changes that digitalisation processes entail in the work environment of nurses and NAs in home healthcare. [ABSTRACT FROM AUTHOR]

Aim: To review the evidence of the existing literature on the impact of guided self‐determination across methodologies in different healthcare settings. Methods: An integrated five‐stage review. Results: Forty‐five eligible papers were included. Guided self‐determination was applied in full‐ or small‐scale, or combined with another intervention or approach in different healthcare settings handling, for example diabetes, stroke survivorship, schizophrenia, attention‐deficit hyperactivity disorder and medical disorder, gynaecological and breast cancer, endometriosis, persons with chronic pain, persons in haemodialysis and intensive care survivors. The included studies covered 12 randomised trials, 26 qualitative and seven papers of different methodology. A statistically significant effect was found in three trials. Six main themes describe the qualitative findings across papers on patients: (1) Guided self‐determination reduces disease‐related loneliness, (2) Insight enables integration of life and disease, (3) Reflection sheets—appreciated but challenging tool to prompt insights and person‐specific knowledge, (4) New person‐specific knowledge enables person‐centred support, (5) Feeling seen and believed in a new and trusted relationship and (6) Exchange of knowledge enables the development of life skills. Four themes describe the healthcare professionals' experience: (1) Change of usual practice—a decision from above, (2) A new role—unlearning previous behaviour and need for support, (3) Reflection sheets as facilitators and barriers and (4) Discovering the benefits of changing to a person‐centred approach. Conclusion: Overall, guided self‐determination proved to have a great impact on patient important outcomes and was useful and well‐accepted by the majority of patients and healthcare professionals. Albeit guided self‐determination is not a 'one size fits all' method. Continuous training and supervision of professionals are a necessary mean when implementing guided self‐determination to enhance adoption and sustainability in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The need for dignity and compassion in healthcare is enshrined in policy, but is often difficult to enact in practice and what is precisely meant by these concepts is unclear. In this paper, we have explored theoretical underpinnings which form the basis of a lifeworld‐led approach which was used in a research study to support the humanity of service providers and users alike. Aim: In this article, we share our analysis of what we have learnt after undertaking an innovative appreciative action research project with patients and staff in a stroke ward with the aim of exploring if a novel phenomenologically driven and philosophically derived humanising framework could be applied in health care. Following the research, we wanted to develop a theoretical understanding of the processes occurring during the research in order to provide a framework and language which could be used to support practical lifeworld developments in the future. We analysed the approach through Participatory and Appreciative Action Reflection. Findings: As researchers, we found that the approach was underpinned by four key existential principles. The first principle was recognising a mutually arising reality rather than a reality 'out there'. The second was recognising a reality which was constantly changing rather than 'fixed'. The third was recognising that we needed to work from within, as part of a human living system rather than trying to control reality from the 'outside'. Finally, we recognised that this reality could only be accessed through human knowing, including embodied knowing rather than intellectual knowing alone. These principles challenged many of the usual ways of thinking and working within research and healthcare contexts. Conclusion: Understanding the processes and reality in this way gave new perspectives; enhancing our understandings and views of ourselves, what is important and most importantly what is possible in caring systems. [ABSTRACT FROM AUTHOR]

In this paper, we explore how the development of historical research methodologies during the last centuries can contribute to more diverse and interdisciplinary research in future caring science, especially towards a care focus that is more person‐centred. The adding of a historical approach by professional historians to the theory of person‐centredness and person‐centred care can develop knowledge that enables a more holistic understanding of the patient and the development of the patient perspective from the past until today. Thus, the aim was to show how developments within historical methodology can help us to understand elements of care in the past to further develop caring science in future. Historical research methodologies have advocated a "history from below" perspective, and this has enabled the evolution of systematic approaches to historical research that can be explored and critically analysed. Linked with this, the development of a more social and cultural oriented understanding of historical research has enabled historians to explore and add knowledge from a broader societal perspective. By focusing on the life of ordinary people and taking social and cultural aspects into account when trying to reconstruct the past, we can get a deeper understanding of health, care and medical development. However, an interdisciplinary research focus on person‐centredness and person‐centred care that includes professional historians can be challenging. In this paper, we argue that a historical perspective is necessary to meet the challenges we face in future delivery of health care to all people, in all parts of society in an ever more global world. [ABSTRACT FROM AUTHOR]

Background: To facilitate change for person‐centred care, there is a need to invest in measures to assess if and how healthcare systems are delivering care based on the principles of person‐centred care. This paper describes the first phase in developing an item bank to measure patients' experiences of person‐centred care. Aim: The aim was to translate, culturally adapt and evaluate candidate items to measure person‐centred care from the patient's perspective. Methods: The Centre for person‐centred care at Gothenburg university and the UK Person‐centred and coordinated care model informed our conceptual framework. The initial pool of item candidates originated from a previous systematic review where 855 items were identified. In this study, a mixed method design was used involving persons with experience as patients, caregivers, healthcare professionals and researchers in person‐centred care or questionnaire design (n = 84). The item analysis included two validation rounds using web questionnaires, a focus group and cognitive interviews. Results: From the initial pool, 155 items covering core domains and subdomains of person‐centred and coordinated care were selected for translation and qualitative item analysis. After translation, 44 items were excluded (duplicates). After the first validation round, 21 items were rephrased and 35 were excluded (due to low ratings, lack of comprehensibility, were duplicates or too specifically phrased). To reflect the ethical basis of person‐centred care, rewordings were also made to encompass the patient as an active partner in care and where communication and information goes two‐ways and care is co‐created. After the second round, 11 items were rephrased and 25 items were excluded (for being redundant/repetitive). Six new items were added (covering access to care, patient capabilities, mental well‐being and identifying goals). Conclusion: We have developed a first set of 57 items to proceed towards developing an item bank to measure the patient experiences of person‐centred care. [ABSTRACT FROM AUTHOR]

Background: Dementia presents barriers to the collaboration between individuals and the healthcare system. Caregivers perform multiple functions helping patients with basic and instrumental activities but also communicating and mediating the dyads' needs within the broader social group. Interventions focusing on caregivers show that caregiver burden can be reduced, improving patient outcomes in a cost‐effective way, but the generalisation of these findings is limited by several factors such as low participation rates of caregivers in studies. There is a global push to increase patient participation in health care, but this can be difficult for patients with dementia. Caregiver participation has arisen as a substitute, but there is a lack of standardised definitions, goals and outcome measurement tools for this participation. Methods: In 2015, the Swedish Association of Local Authorities and Regions commissioned a study on possibilities of increasing caregiver participation within the Swedish Dementia Registry (SveDem). This discussion paper updates and adapts that report, aiming to broadly summarise the caregiving phenomenon in order to provide a backdrop for clinicians seeking to understand the legal, ethical and practical considerations of caregiver participation in dementia. Relevant literature on caregiver participation is presented, and its definition, extent and practical implementation are discussed. Discussion: The Swedish legal framework compels care providers to facilitate patient and caregiver participation in dementia and provides support to caregivers through the local level of government, but further work is needed to clarify and define the extension and form that this participation must take in clinical practice. Advanced directives are one step in extending patient participation to the period of advanced dementia. Conclusion: Little research exists on caregiver participation. There is a need to develop a framework for caregiver and patient participation to determine the extent, type and form that such participation should take in health care, research and quality initiatives pertaining to persons with dementia. [ABSTRACT FROM AUTHOR]

This paper reports on the evaluation stage of an action research project on interprofessional collaboration in discharge planning. Findings from interviews with health care professionals working in the acute sector had revealed concerns about discharge planning and multidisciplinary teamwork. In the United Kingdom the National Health Service (NHS) Plan has reinforced the need for an integrated approach to health care. Effective health care integration requires effective communication, teamwork and the commitment to deliver integrated care. Integrated documentation is a key strategy for enhancing interprofessional collaboration and reducing the isolation of professionals, and has been successfully implemented in a range of health care settings. Presented with the concerns about the collaborative process in discharge planning, an action research strategy was chosen to bring about change in an orthopaedic ward in one London teaching hospital. This paper will evaluate the implementation of an integrated care pathway with fractured neck of femurs in one London teaching hospital. Care pathways facilitate the management of defined patient groups using interdisciplinary plans of care. The emphasis will be on understanding whether integrated care pathways enhance and develop interprofessional collaboration and enable effective information access and flow across the professions and the organization. The criteria for evaluation, forming the hypotheses of the study, were that interprofessional nonverbal and verbal communication would be enhanced and that interprofesisonal collaboration would increase. Methods of evaluation used were: (i) stakeholder interviews, (ii) interprofessional audit and (iii) analysis of the variances from the integrated care pathway. The evaluation revealed that although integrated care pathways led to improved outcomes for the health care trust there was little evidence to suggest that interprofessional relationships and communication were... [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2012; 26; 333-339 An essay about health professionals' attitudes to lesbian, gay, bisexual and transgender parents seeking healthcare for their children Background: This paper is a polemic essay about an important but sometimes controversial subject. Lesbian, gay, bisexual and transgender (LGBT) clients can be reluctant to reveal their sexual orientation to health professionals from whom they may be seeking health care for their children. Family-centred care (FCC), where care is planned around the whole family not just the individual child, is widely used across the world, but unless all aspects of the families who present for care are respected, care delivery is compromised. This is particularly important for minority groups and potentially vulnerable families such as LGBT. Aim: This descriptive essay discusses the use of health services by LGBT parents, how seeking health care is influenced by perceived perceptions of LGBT people held by health professionals, and examines factors affecting such seeking of health care. Discussion: We show that LGBT people may be unwilling to disclose sexual identity to health professionals when seeking health care for their children. Health professional's attitudes can be affected by factors such as gender, age, religious and political affiliations, education level and previous interactions with LGBT people. Conclusion: We conclude our argument with the assertion that all parents, including those from minority groups such as LGBT, who bring their children for health care need supportive family-centred care, and only by ensuring that the health professionals delivering care are well educated about all aspects of sexuality will care be family-centred. [ABSTRACT FROM AUTHOR]

This paper presents baseline data on attitudes towards HIV/AIDS patients and homophobic levels among nursing students in three Baltic Sea countries: Finland, Estonia and Lithuania. The aim is to describe and compare nursing students’ attitudes in these three countries and to explore how attitudes towards HIV/AIDS correlate with background variables. The total sample comprised 471 nursing students. The respondents demonstrated average attitude scores towards patients with HIV/AIDS and rather positive attitudes towards homosexually oriented patients. Significant country differences were found, with Finnish nursing students showing the most positive attitudes towards HIV/AIDS patients and homosexually oriented patients. Previous experience of HIV/AIDS patients was the single factor with the greatest positive impact on nursing students’ attitudes. Nursing students’ willingness to provide care for an HIV/AIDS patient was associated with a positive attitude towards these patients. Length of employment experience correlated negatively with general attitude, and older nursing students with more work experience showed a more negative attitude towards homosexual patients. Proper education to achieve a sound knowledge base and good nursing skills promotes a more positive attitude to HIV/AIDS. It is important that nursing students are sensitive and show respect for the patient’s human dignity. There is need for greater harmonization of education in the three countries. [ABSTRACT FROM AUTHOR]

The intertwining ideas of self-determination and well-being have received tremendous support in western bioethics. They have been used to reject medical paternalism and to justify patients’ rights to give informed consent (or refusal) and execute advanced directives. It is frequently argued that everyone is thoroughly unique, and as patients are most knowledgeable of and invested in their own interests, they should be the ones to make voluntary decisions regarding their care. Two results of the strong focus on autonomy are the rejection of the image of patients as passive care recipients and the suspicion against paternalistic influence anyone may have on patients’ decision-making process. Although the initial focus in western bioethics was on minimizing professional coercion, there has been a steady concern of family’s involvement in adult patients’ medical decision-making. Many worry that family members may have divergent values and priorities from those of the patients, such that their involvement could counter patients’ autonomy. Those who are heavily involved in competent patients’ decision-making are often met with suspicion. Patients who defer to their families are sometimes presumed to be acting out of undue pressure. This essay argues for a re-examination of the notions of autonomy and undue pressure in the contexts of patienthood and relational identity. In particular, it examines the characteristics of families and their role in adult patients’ decision-making. Building on the feminist conception of the relational self and examining the context of contemporary institutional medicine, this paper argues that family involvement and consideration of family interests can be integral in promoting patients’ overall agency. It argues that, in the absence of abuse and neglect, respect for autonomy and agency requires clinicians to abide by patients’ expressed wishes. [ABSTRACT FROM AUTHOR]

Purpose: This paper describes the process of developing an instrument to test the middle-range nursing theory for the self-care of home-dwelling elderly. Background: Instrument development is a multiphase process, during which the researcher tests the reliability and validity of the instrument with various data and modifies it based on the test results. The aim of the study was to develop an instrument to test a theory, but also to be able to use it later in clinical settings to evaluate the self-care of home-dwelling elderly and factors associated with it. Methods: The instrument development was done in four phases. At the first phase, the initial version was created on the basis of the theory. At the second phase, two home-dwelling elders were pilot-interviewed, and 20 elders completed the structured questionnaire and commented upon its ease of use. The results were used to develop the second version of the instrument. At the third phase, the second version of the instrument was used to collect data from home-dwelling elders aged 75 or more from different parts of Finland (n = 200). Face validity, exploratory factor analyses, correlation coefficients and Cronbach's alpha were used to test and further develop the instrument. At the fourth phase, the content validity of the third version was assessed by three home-dwelling elders. Results: The agreement between the elders and the researchers about the contents of the instrument was acceptable, and exploratory factor analyses verified quite well the structure of the theory. Based on the Cronbach's alpha values (0.49–0.90), the internal consistency of the instrument was fairly good. Conclusion: The results provide sufficient evidence of the validity and reliability of the final version of the instrument, which has nine background questions and 82 items to measure the self-care of home-dwelling elderly and factors associated with it. [ABSTRACT FROM AUTHOR]

Rehabilitation is a key component of nursing and allied healthcare professionals’ roles in most health and social care settings. This paper reports on stage 2 of an action research project to ascertain older adult's experience of rehabilitation. Twenty postdischarge interviews were conducted and the interview transcripts were analysed using thematic content analysis. All older adults discharged from an acute older acute rehabilitation ward to their own homes in the community were eligible to participate. The only exclusion criterion was older adults who were thought to be unable to give consent to participate by the nurse in charge and the researcher. Whilst 92 older adults were eligible to participate in this research study, only 20 were interviewed. The findings from this study suggest that older adults valued communication with health professionals but were aware of their time constraints that hindered communication. This study suggests that both nurses and allied health professionals are not actively providing rehabilitative services to promote health and well-being, which contradicts the focus of active ageing. Furthermore, there was evidence of unmet needs on discharge, and older adults unable to recall the professions that were involved in their interventions and the rationale for therapy input. It is suggested that further research is needed to explore the effectiveness of allied health rehabilitation in the acute setting. This study highlights the need for further research into older adults’ perceptions of the rehabilitation process in the acute setting. [ABSTRACT FROM AUTHOR]

Since Hildegard Peplau's interpersonal relation model for psychodynamic nursing, in the 1950s, many theories about humanity have been expanded in the discipline of nursing. For this purpose Rosemarie Rizzo Parse, for example, synthesized principles and concepts from Martha Rogers with existential phenomenology, when she introduced the idea of a simultaneity paradigm as unique for the discipline of nursing in opposition to Peplau's psychodynamic model. The aim of this paper is to discuss borrowed theories in relation to the efforts to find a unique theoretical foundation for healthcare science and practice. It is suggested that Parse's division in a totality vs. a simultaneity paradigm is an artificial distinction. The discussion is concluded with reflections about Peplau's interpersonal relation model, a patient-oriented perspective and psychodynamic theory, as example of a theory, which may help to further understand patients’ existential situation. [ABSTRACT FROM AUTHOR]

Background: The concept of respite care has been widely accepted and used throughout most developed countries, although primarily in connection with frail elderly, people with dementia, people with developmental disability or children. This paper aims at exploring older family carers’ needs for, access to and use of respite services when caring for people with a mental illness (excluding dementia) in the community. Method: Data were collected through: semi-structured interviews with 26 mental health professionals, 21 family carers aged over 55 years and 25 respite service providers; demographic questionnaires; field notes; and local area, state and national documents relating to respite care services. Demographic data were analysed using descriptive statistics. All 72 interviews, field notes and other documents were analysed using content analysis. Results: Current respite services are not adequate to meet the needs of mentally ill patients and older carers. The unique aspects of respite care for older carers of persons with mental illness are poorly understood. Conclusion: Bringing these issues to light creates the potential to address the unmet needs of older carers, improve provision of respite services, enhance quality of life of those who can benefit from respite services, and assist mental health professionals to work better with carers. [ABSTRACT FROM AUTHOR]

The aim was to develop and test a questionnaire for use in telephone interviews concerning patient evaluation of geriatric care and rehabilitation. Instrument development was performed comprising qualitative interviews, construction of items, content validation, pilot study and data collection for evaluation of care and rehabilitation, clinical utility, reliability and construct validity. Qualitative interviews were performed with 12 elderly participants. The qualitative interviews formed the basis for the construction of 45 items. An expert panel performed a content validation of the questionnaire resulting in a revised version. A pilot study comprised 29 participants recently discharged from geriatric wards and the main data collection comprised 221 participants. Inclusion criteria were being able to perform a telephone interview and willingness to participate. Clinical utility was examined through questions to the interviewers, answered in writing. Cronbach's alpha coefficient was 0.79. According to a factor analysis and the evaluation of clinical utility, the underlying dimensions of the final revised questionnaire concern ‘Respect and safety’, ‘Information and participation’ and ‘Rehabilitation interventions’, scored in 18 items. In addition, one global item concerns satisfaction with care, resulting in 19 items in total. The revised questionnaire was named PaPeR, Patient Perspective on care and Rehabilitation. The questionnaire is considered valid, reliable and judged to have good clinical utility. The time consumption for the telephone interview is about 10–20 minutes. The questionnaire is useful in defining areas for potential quality improvement in geriatric wards. [ABSTRACT FROM AUTHOR]

This study is a part of a larger project in which the aim is to illuminate the meaning of the caring relationship between patients and nurses in daily nursing practice. Empirical studies in this area inspired from the interpretive phenomenological method are not commonly used. The aim of this paper is to describe how an interpretive phenomenological method was used to illuminate the meaning of the phenomenon caring relationship in daily nursing practice. Data were collected during 16 nursing care proceedings using participant observation with field notes, and in addition to that two interviews, one patient and one nurse. The interpretation moved back and forth between the whole and the parts in a dialectic process. Initial interpretive understanding of interviews and field notes, meaning units and comprehensive understanding were presented. Themes from the patient's interviews were competence, lack of continuity, strain and vulnerability. Themes from the nurse's interviews were competence and striving. Themes from the field notes were interactions towards a goal. The use of interpretive phenomenology offered an opportunity for learning to understand the meaning of the phenomenon caring relationship in daily nursing practice with both strengths and limitations. This study gave an understanding of the phenomenon through the illumination of the patient's and the nurse's thoughts, feelings and actions in the nursing care proceedings that led to a more profound knowledge about how they together create an encounter through their unique competence. [ABSTRACT FROM AUTHOR]

Research has shown that the Swedish-speaking Finns have better health than the Finnish-speaking majority. The aim of this paper was to explore the health resources and health strategies among home-dwelling Swedish-speaking Finns aged 75 or older. The objective was to develop health-promotive nursing care for this group. Data was collected through recorded semistructured conversations with 22 older persons. The conversations were transcribed and interpreted through a hermeneutic approach. The material was read through several times and compiled into 22 narratives with relevant quotations. The narratives were subsequently summarised into one core narrative under each major category, to present the health resources and health strategies. Six categories were found: the Positive, the Social, the Active, the Adaptable, the Stubborn and the Passive. Within the Positive category, morale played an important role as a health resource and health strategy. Within the Social category, social activities were regarded as both health resources and health strategies, whereas their absence was a health obstacle. Within the Active category, a wide range of physical activities played an important role. Within the Adaptable category, contentment was a health resource. Within the Stubborn category, stubbornness itself was a health resource, whereas strong belief was a health strategy. Within the Passive category, although health obstacles permeated the life context, contentment and caution were seen as health resources. The vision of the future varied from the confidence found in the Positive category to the uncertainty prevalent in the Passive category. The main health resources and strategies used by the elderly Swedish-speaking Finns were related to social and other activities as well as to personality. Transforming health obstacles into resources could be an important health-promotive nursing strategy. [ABSTRACT FROM AUTHOR]

Nursing is frequently described as a caring practice. What this concept means may be less clear. This paper considers nursing as a caring practice in three steps. First, the concept of practice based on Taylor's and MacIntyre's philosophical definitions of the term is described. Secondly, numerous notions of caring are presented; the call from some nurse researchers for quantification of the concept and why this is problematic is discussed; and an exposition of caring from a phenomenological perspective is provided. Finally, the notions of practice and caring are joined, and the concept of a caring practice is presented. Nursing as a public caring practice is illustrated with examples from an interpretive phenomenological study. In conclusion, it is claimed that a phenomenological view of caring combined with a comprehensive definition of practice is well suited to nursing, and allows for a description of nurses’ caring practices from both a nursing and patient perspective. [ABSTRACT FROM AUTHOR]

Over recent years, an emphasis has emerged in the UK and international policy documents, over the involvement of people in the delivery of health care. However, evaluations of health services still largely rest on outcome measures that reflect professional concerns. As new health services are being developed, new patient-centred outcome measures are needed to evaluate them. This paper aims at exploring the possibility of individual quality of life as an outcome measure for health services. As a first step, it aims to elucidate the relationship of functional outcome measures to the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) in groups of people whose age or medical diagnosis serve as the basis for health service design. Its objectives are to study the relation of SEIQoL scores and life areas to functional status in an older population and in a group of people with chronic obstructive pulmonary disease (COPD). Older people selected their health most frequently as one of the most important areas in their life (9.9%, vs. 8.6% for people with COPD) and were more satisfied with it ( U = 2512, p = 0.007). People's health status did not impact on the way they defined their quality of life, but on their level of satisfaction with discrete life areas. The weights attributed to health were significantly negatively correlated to people's overall quality of life score in the overall sample ( ρ = −0.34, p < 0.001). In the light of recent national and international policy documents advocating for the development of new, more person-centred health services, our results support the proposition of the authors of SEIQoL, that individual quality of life measures have the potential to bring a significant contribution to the evaluation of health services. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2004; 18; 264–272The progression of suffering implies alleviated sufferingThere is a lack of research focusing directly on both patients’ suffering and alleviated suffering in relation to care. The aim of this paper was to investigate the progression of suffering in relation to the encounter between the suffering person and the caregiver from the perspective of an understanding of life. The progression of suffering is assumed to be an existential‘sign’ of the development of understanding of life as an ontological or spiritual entity, which demands a meaning-creating encounter between the patient and caregiver. The concept‘existential caring encounter’ was used to describe how the encounter between patient and caregiver can create meaning in communion and thereby alleviate suffering by making it bearable. The study was carried out using an interpretive, hermeneutic approach. The study as a whole comprises three parts, and these include letter-writing and interviews. The findings are described by the following main theses: (a) a darkness in life understanding is existentially experienced as unbearable suffering and requires an encounter involving attentive care and confrontation; (b) the turning point means that the struggle of suffering begins; and (c) the encounter involves being meaning-creating in a communion in the struggle of suffering. An understanding of the patterns of unbearable and bearable suffering can be of help to the caregiver in caring for the patient by serving as a basis for meaning-creation in communion. This may thereby be a way of alleviating the patient's suffering by making it bearable during the progression of suffering. [ABSTRACT FROM AUTHOR]