A B C D E F G UNIVERSITY OF OULU P.O. Box 7500 FI-90014 UNIVERSITY OF OULU FINLAND ACTA UNIVERSITATIS OULUENSIS SERIES EDITORS SCIENTIAE RERUM NATURALIUM HUMANIORA TECHNICA MEDICA SCIENTIAE RERUM SOCIALIUM SCRIPTA ACADEMICA OECONOMICA EDITOR IN CHIEF EDITORIAL SECRETARY Professor Mikko Siponen Professor Harri Mantila Professor Juha Kostamovaara Professor Olli Vuolteenaho Senior Assistant Timo Latomaa Communications Officer Elna Stjerna Senior Lecturer Seppo Eriksson Professor Olli Vuolteenaho Publications Editor Kirsti Nurkkala ISBN 978-951-42-8636-0 (Paperback) ISBN 978-951-42-8637-7 (PDF) ISSN 0355-3221 (Print) ISSN 1796-2234 (Online) UNIVERSITATIS OULUENSIS MEDICA ACTA D OULU 2007 D 954 Danica Železnik SELF-CARE OF THE HOME- DWELLING ELDERLY PEOPLE LIVING IN SLOVENIA FACULTY OF MEDICINE, DEPARTMENT OF NURSING SCIENCE AND HEALTH ADMINISTRATION, UNIVERSITY OF OULU; FACULTY OF HEALTH SCIENCES, UNIVERSITY OF MARIBOR D 954 ACTA Danica Železnik D954etukansi.kesken.fm Page 1 Wednesday, October 24, 2007 3:08 PM ACTA UNIVERSITATIS OULUENSIS D Medica 954 DANICA ŽELEZNIK SELF-CARE OF THE HOME- DWELLING ELDERLY PEOPLE LIVING IN SLOVENIA Academic dissertation to be presented, with the assent of the Faculty of Medicine of the University of Oulu, for public defence in Kajaaninsali (Auditorium L6), Linnanmaa, on November 30th, 2007, at 12 noon OULUN YLIOPISTO, OULU 2007 Copyright © 2007 Acta Univ. Oul. D 954, 2007 Supervised by Professor Helvi Kyngäs Doctor Kaisa Backman Professor Dušanka Mičetić-Turk Reviewed by Professor Emerita Maija Hentinen Docent Riitta Suhonen ISBN 978-951-42-8636-0 (Paperback) ISBN 978-951-42-8637-7 (PDF) http://herkules.oulu.fi/isbn9789514286377/ ISSN 0355-3221 (Printed) ISSN 1796-2234 (Online) http://herkules.oulu.fi/issn03553221/ Cover design Raimo Ahonen OULU UNIVERSITY PRESS OULU 2007 Železnik, Danica, Self-care of the home-dwelling elderly people living in Slovenia Faculty of Medicine, Department of Nursing Science and Health Administration, University of Oulu, P.O.Box 5000, FI-90014 University of Oulu, Finland; Faculty of Health Sciences, University of Maribor, Žitna ulica 15, SI-2000 Maribor, Slovenia Acta Univ. Oul. D 954, 2007 Oulu, Finland Abstract This study is focused on the self-care of home-dwelling elderly people living in Slovenia. The study has two phases. The purpose of the first phase is to describe the self-care of home-dwelling elderly people living in Slovenia and factors connected to self-care. The purpose of the second phase is to describe the experiences of the elderly people's ability to manage at home. The aim of this study was to produce new knowledge about the self-care of home-dwelling elderly people living in Slovenia and the factors connected with it. The knowledge will be used to develop elderly care and support eldery people who live at home. The knowledge can be also used to educate nurses to care for the elderly people. The study was both quantitative and qualitative. In the quantitative study the sample consisted of 302 home-dwelling elderly people who were clients in domiciliary care. The selection criteria was: aged 75 years or over and the ability to communicate, no hearing problems, no severe mental problem/cognitive disability and gave full consent for their participation. The whole instrument consists of 91 items. A instrument covers background data, types of self- care, self-care orientation, life satisfaction, self-esteem and functional ability. In the qualitative study, 20 interviews were carried out and a qualitative analysis obtained. Data collection methods included open-ended questions concerning the following topics: background data, types of self-care, self-care orientation, life satisfaction, self-esteem and functional ability. Based on factor analyses, four factors were found which described the self-care. All other factors describe elderly people's perceptions concerning either the past or the future. The elderly people who are able to manage their daily activities/routines have a good functional capacity, good family relations, live qualitatively, accept the future healthily and clearly and are satisfied with their life because they can take care of themselves, but their self-esteem is not so high. Those elderly people who do not take care of themselves are abandoned; they are not satisfied with their way of life and have low-esteem. The results are going to be the basis for planning care and nursing care for all caregivers, especially community nurses. On the basis of this result the model of nursing and social care for home -dwelling elderly people living in Slovenia could be planned. Keywords: aged, functional ability, home-dwelling elderly people, life satisfication, self- care, self-esteem, self-orientation 5 Acknowledgement This study was carried out at the University of Oulu, Department of Nursing in Finland. I would like to express my sincere thanks to all those who have been of special importance to me at all stages of this work. I would like to take this opportunity to extend my warmest thanks to my dean, prof. dr. h. c., dr. Dušanki Mičetić – Turk for idea that I start my PhD at University of Oulu and for all her help and support. I wish to thank prof. Dr. Arja Isola for all her warmest help and support and dr. Kaisa Backman for all help and kindly attitude at the beginning of my study. My especial thanks go to my supervisor, prof. Dr. Helvi Kyngäs, who has given me invaluable help and support. I wish my warmest thanks also to both referees prof. dr. Maija Hentinen and prof. dr. Riitta Suhonen for their comments what helped me finished this work. I am grateful to docent Päivi Voutilainen who is commited to opponent me. Especially I am very grateful to Mrs. Alenka Marsel for all her invaluable help and encouragement, without her I could not finish this work. I would like to give my special thanks to Mr. Alojz Tapajner and to librarian Mrs. Nevenka Balun and Mrs. Simona Novak. Warm thanks go to my dearest friend and colleague Mrs. Antonija Ivanuša for her warm support, empathy, personal growth and friendship. I have to thank also to my English teacher Mr. Miran Jarc. Thanks goes also to all community nurses expecialy to Mrs. Tatjana Geč. Finally, I would like to thank my family for understanding and support from the bottom of my hart, to husband Milan, daughter Polonca and son Uroš. Without them I could not make it. 6 7 Contents Abstract Acknowledgement 5 Contents 7 1 Introduction 9 1.1 Background of the present study 9 1.2 Context of the study 11 1.2.1 Principles and general rights of elderly people in the field of health care in Slovenia 12 1.3 Purpose of the study 15 2 Self-care of the elderly people 17 2.1 Definitions of self-care 17 2.2 Self-care and factors connected to it 19 2.2.1 Functional capacity 20 2.2.2 Life satisfaction 21 2.2.3 Self-esteem 22 2.2.4 Self-care and disability 23 2.2.5 Self - care of the elderly related to mental health 24 2.3 Self-care of elderly people, quality of life and well-being 25 3 Background theory of the study 29 4 Aim of the study and research problems 31 5 Methodology 33 5.1 Sampling 34 5.1.1 Phase I 34 5.1.2 Phase II 37 5.2 Data collection 38 5.2.1 Phase I 38 5.2.2 Phase II 40 5.3 Data analyses 41 5.3.1 Phase I 41 5.3.2 Phase II 42 5.4 Ethical considerations 43 6 Results 45 6.1 The self-care of home-dwelling elderly people 45 6.2 The self-care orientation 55 6.3 The self-esteem of home-dwelling elderly people 57 8 6.4 The life satisfaction of home-dwelling elderly people 58 6.5 The functional capacity of home-dwelling elderly people 58 6.6 Functional capacity, life satisfaction and self-esteem related to the self-care behavioural styles of home-dwelling elderly people 59 6.7 The experiences of the elderly people concerning their ability to manage at home 63 6.8 Main findings of the results 65 7 Discussion 67 7.1 Reliability and validity of the study 67 7.1.1 Validity and reliability of the instrument 67 7.2 Validity of qualitative study 71 7.3 Discussion about findings 72 7.3.1 Functional capacity and self-care 75 7.3.2 Life satisfaction of self-care 76 7.3.3 Self-esteem and self-care 77 7.3.4 Self-care connection to functional capacity, life satisfaction and self-esteem 77 7.4 Discussion about the possibilities for care for home-dwelling elderly people 78 7.5 Challenges for nursing practice and further research 79 8 Conclusion 81 References 83 Appendices 101 [...]... are: 1 2 3 4 5 6 What is the self-care of the home -dwelling elderly people like? What is the self-care of the home -dwelling elderly people like from the life history point of view? What is the functional capacity of the home -dwelling elderly people like? What is the life satisfaction of the home -dwelling elderly people like? What is the self-esteem of the home -dwelling elderly people like? How are functional... because it is the only one of its kind existing and appropriate to use and because there is no other kind of study concerning the self-care of home -dwelling elderly people living in Slovenia The aim of the theory developed by Backman 2001 was to develop a model to clarify the exisisting knowledge concerning the self-care of home -dwelling elderly people living in Oulu, Finland A grounded theory method... home dwelling elderly people living in Slovenia The study has two phases The purpose of the first phase is to describe the self-care of home -dwelling elderly people living in Slovenia and the factors connected to self–care The purpose of the second phase is to describe the experiences of the elderly people` s ability to manage at home The knowledge of elderly people home dwelling self-care is not clear... the two main trends of selfcare: the nature of the turning-points of life, the way to react, the resources, the meaning of self-care and the experience of ageing The individual histories of self-care were interpreted in terms of these factors, and two main trends of selfcare were recognized: internal, unambiguous self-care and external, ambiguous self-care The responsible and independent types of self-care. .. have been defined and measured in different ways Because of the lack of knowledge of the levels of self care of home -dwelling elderly people this study is based on Backman’s theory 15 1999 of the self care of home -dwelling elderly people According to Backman’s study 2003 and some other studies (Zasuszniewski 1996, Rabiner et al 1997, Blair 1999) the self-care of elderly people is found to be linked to... compliance with the projections of changing the age structure of the population in the future period, the aim of the programme of nurse education in the field of nursing and care of the elderly people in Slovenia is a complementary development of new educational forms in the field of gerontological nursing Prolongation of life period, changing of traditional family styles, homogeneity of retired families, social... worsen their health, too At the end of 1996 the total number of places in general and special institutions of social welfare in Slovenia was 13,202 Of this total number 10,763 places belonged to the institutional care of the elderly people With regard to the population of Slovenia the above facilities for elderly people would suffice for 4% of the population over 65 years of age The programme of institutional... programme of institutional care of elderly people is based on the criteria set in the draft of the National Programme of Social Welfare in Slovenia According to these criteria the institutional network of public service needs to be expanded to be able to provide for 4% of the elderly population According to the analysis of the existing capacities and the size of the population in 1996, 11,499 places, or... pushing away of the biggest growing number of the aged to the social margins; bigger social disstratification and, therewith, the need to offer a differentiated service; changes in values and views on ageing and old age and the need for using new ways of taking care of the elderly population (Toth 2004a, Toth 2004b) 1.3 Purpose of the study This study is focused on the self-care of home dwelling elderly. .. and, on the other hand, mental health problems have an effect on functional capacity and life satisfaction, as well as the quality of life At the end of theoretical framework is introduced the background theory on which this study is based 16 2 Self-care of the elderly people 2.1 Definitions of self-care Any synthesis of the self-care of the elderly people and related factors based on the existing research . The self-care of home -dwelling elderly people 45 6.2 The self-care orientation 55 6.3 The self-esteem of home -dwelling elderly people 57 8 6.4 The life satisfaction of home -dwelling. experiences of the elderly people& apos;s ability to manage at home. The aim of this study was to produce new knowledge about the self-care of home -dwelling elderly people living in Slovenia and the factors. Železnik SELF-CARE OF THE HOME- DWELLING ELDERLY PEOPLE LIVING IN SLOVENIA FACULTY OF MEDICINE, DEPARTMENT OF NURSING SCIENCE AND HEALTH ADMINISTRATION, UNIVERSITY OF OULU; FACULTY OF HEALTH