Department of Nursing
Umeå University Medical Dissertations, New Series No 2135
“Life is for living”
Exploring thriving for older people
living in nursing homes
Rebecca Baxter
Akademisk avhandling
som med vederbörligt tillstånd av Rektor vid Umeå universitet för
avläggande av filosofie/medicine doktorsexamen framläggs till
offentligt försvar i Aula Biologica, Biologihuset, torsdagen den 3:e
juni, kl. 09:00. Avhandlingen kommer att försvaras på engelska.
Fakultetsopponent: Professor Lisbeth Fagerström
Hälsovetenskaper, Fakulteten för pedagogik och välfärdsstudier
Åbo Akademi, Finland
Organization
Document type
Umeå University Doctoral thesis
Date of publication
12 May 2021 Department of NursingAuthor
Rebecca Baxter
Title
“Life is for living” - Exploring thriving for older people living in nursing homes.
Abstract
Background: Demand for formal care in nursing homes has steadily increased in recent decades, prompting calls for exploration of health-promoting and salutogenic concepts that support people not only to survive in older age, but to thrive. The concept of thriving has been described as a holistic experience of place-related well-being resulting from interactions between the person and their lived-environment. However, detailed understandings of thriving among nursing home residents and staff are lacking, and little is known about the variables that influence thriving, how thriving is understood outside of Scandinavia, or the extent to which thriving may change over time.
Aim: The overall aim of this thesis was to explore meanings, expressions, measurements, and associations for thriving in nursing homes.
Methods: For studies I and II data were collected in the form of qualitative interviews with Australian nursing home residents (N=21; study I) and staff (N=14; study II). Qualitative data were analysed using phenomenological hermeneutical analysis and qualitative content analysis respectively. For studies III and IV cross-sectional baseline (i.e., 2013/2014) and follow up (i.e., 2018/2019) data were collected from a nationally representative sample of Swedish nursing homes. The baseline sample consisted of 4,831 rated resident surveys from 35 municipalities (study III) and the follow-up sample consisted of 3,894 proxy-rated resident surveys from 43 municipalities (study IV). Quantitative data were analysed using descriptive statistics, validity testing, item response theory-based analysis, and simple linear regression.
Results: The meanings of thriving for nursing home residents were understood as encompassing elements of acceptance, balance, and contentment in relation to the person’s living situation, as well as their social and physical environment (study I). These meanings were interpreted as having options and choices, and the agency to make decisions where possible, in relation to the care and living environment. Nursing home staff were found to recognise expressions of thriving through a combination of understanding, observing, and sensing (study II). Staff described recognising thriving through reflective assessment processes that involved comparing and contrasting their personal and professional interpretations of thriving with their overall sense of the resident. Psychometric testing of the 32-item and short-form versions of the TOPAS showed good validity and reliability to measure thriving among nursing home residents (study III). Population characteristics were relatively consistent between the baseline and follow-up samples (study IV). A sub-sample of nursing homes that participated in both baseline and follow-up data collections reported a statistically significant increase for thriving and a decrease in the prevalence of neuropsychiatric symptoms; however, the overall clinical effect of these changes require further consideration. Higher and lower thriving was associated with several specific neuropsychiatric symptoms.
Conclusions: Thriving appeared to be a relevant and meaningful phenomenon with shared understandings among nursing home residents and staff, providing valuable support for the ongoing assessment and application of thriving in international and cross-cultural nursing home settings. The TOPAS appeared valid and reliable to facilitate proxy-rated measurement of thriving among nursing home residents, and the short-form TOPAS could have enhanced use for assessment of thriving in research and practice. Changes to overall thriving scores between baseline and follow-up provides important information that may be used as a reference point for future measurements and comparisons of thriving and its associated variables over time. This thesis highlights the importance of considering the various experiences, perceptions, and interpretations of thriving if such a concept is to be effectively embedded in person-centred care, policy, and practice. Keywords
Thriving, well-being, nursing home, older people, nursing, phenomenological hermeneutics, psychometric evaluation, cross-sectional, longitudinal, person-centred care
