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Abstract: Background: The prevalence of dementia, a progressive and incurable condition that affects memory and daily function, is increasing worldwide. The perspective of people with dementia can be captured to better understand which factors impact quality of life for this particular population. Such factors can then be used to guide future research to improve quality of life for people with dementia, even as troubling symptoms like memory loss progress. Purpose: The purpose of this dissertation is to identify factors that influence quality of life from the perspective of people with dementia. Methods: The dissertation consists of four related and sequential papers: (1) a conceptual paper to assess the extent to which the perspective of people with dementia has been included to assess and conceptualize quality of life in the quantitative dementia-specific literature, (2) a systematic literature review and metasynthesis of qualitative evidence to identify factors that influence quality of life according to people with dementia, (3) a methods paper describing how metasyntheses findings were applied to design a quantitative study, and (4) a cross-sectional, quantitative, correlational study to test the association between perceived conflict and sadness (a proposed influencing factor and outcome of poor quality of life, respectively). Findings and Conclusions: Two important limitations of previous research to understand quality of life from the perspective of people with dementia were identified. First, existing quantitative literature was inconsistent with a subjective definition of quality of life because researchers neglected to conceptualize quality of life from the perspective of people with dementia. Second, the body of existing qualitative research had not been considered collectively, nor had it informed quantitative research. In this dissertation, these limitations were addressed by applying knowledge from the body of qualitative research as a whole to design a quantitative study that was consistent with a subjective definition of quality of life. The findings demonstrated that people with dementia could contribute meaningfully to advance knowledge about factors that impact quality of life in this population. The four factors that influenced quality of life from the perspective of people with dementia included Relationships, Sense of Place, Wellness Perspective, and Agency in Life Today. Further exploration of the Relationships factor generated evidence in support of the proposed association between conflict and sadness, and highlighted that conflict with family and friends may have a particularly negative impact on people with moderate and severe dementia living in long-term care. The factors identified in this dissertation were each complex, but potentially modifiable and useful to generate further research questions and hypotheses that reflect the priorities of people with dementia. Given these four factors, the roles and responsibilities of health care providers may need to be re-considered in order to optimize quality of life for people with dementia.

Abstract: Work engagement in nursing practice is critically important to consider in addressing key challenges of health systems, including the global nursing shortage, pressures to reduce health care spending, and increasing demands for quality care and positive outcomes for patients. There is a significant and growing body of research in other disciplines that demonstrates relationships between work engagement of employees and positive organizational outcomes. Recent interest in the work engagement of nurses has primarily been motivated by the desire to realize these documented positive organizational outcomes. However, research on work engagement in nursing practice has not yet been synthesized and therefore, there is not an accessible foundation of knowledge to guide practice and further research. Additionally, the ethical foundation of professional nursing demands attention to the ethical importance of work engagement, which has not previously been examined. The overall aim of this master’s thesis was to examine the importance of work engagement in nursing practice from an ethical perspective and to determine what is currently known about the antecedents and outcomes of work engagement in nursing practice. This master’s thesis is comprised of two papers, one theoretical, ethical paper, and one systematic review paper. In the first paper, I use a relational ethics perspective to examine the ethical importance of work engagement and I argue that work engagement is essential for ethical nursing practice and the subsequent provision of ethical nursing care. The second paper is a systematic review of studies in nursing that examine the relationship between work engagement and it’s antecedents and outcomes. The findings of the systematic review indicate that a wide range of antecedents, at multiple levels, are related to nurses’ work engagement and that the outcomes of work engagement also occur at multiple levels. Based on the results, I developed an adapted Job Demands-Resources (JD-R) model for work engagement in nursing practice, which offers a valuable framework to understand the current evidence on work engagement in nursing practice and can be used to guide practice, policy, and further research on the topic. Key findings are highlighted in the adapted model, including the role of the organizational climate, addition of professional resources, and expansion of outcomes to include personal and professional outcomes. The combined findings of the two papers demonstrate the importance of work engagement in nursing practice, from both an ethical and organizational perspective. However, significant gaps in research on work engagement in nursing remain. Greater theorization is needed to further understand the mechanisms and manifestations of work engagement in nursing practice. A concept analysis that explores all concepts, constructs, and labels that could be the same as, similar to, or distinctly different from work engagement would offer immense value to this field of research. Future research should also test the adapted JD-R model using longitudinal designs and multivariate analysis across more diverse samples of nurses. I recommend that future research include objective measurement of antecedents and outcomes, further qualitative exploration, and intervention-based studies.