The evolving concept of health in nursing research: 1988-1998

Positioning Psychiatric and Mental Health Nursing as a Transformative Force in Health Care

From the perspective of psychiatric and mental health nurses in Sweden, this discussion paper aims to position psychiatric and mental health nursing as a transformative force contributing to enforcing person-centered values and practices in health care. We argue the potential impact of psychiatric and mental health nursing on service user health and recovery, nursing student education and values, and the organization and management of health care. Psychiatric and mental health nursing is discussed as a caring, reflective, and therapeutic practice that promotes recovery and health. Implications for nursing education, research, management, and practice are outlined.

The evolution of social health research topics: A data-driven analysis

The realm of social health has not yet been properly established in terms of fixed definitions, concepts, and research areas. This study attempts to define social health using macro and micro perspectives and explores trends in social health research by mapping their topics and fields. We used Latent Dirichlet allocation (LDA) topic modeling, which allows the extraction of key terms and topics derived from a large volume of literature. We traced the evolution of research topics from past (the literature that "present" articles cited), present (existing journal articles on social health), to future (the literature which cited the articles) studies based on connections between citations. The datasets were collected by the query terms "social health" in the Scopus database, including title, abstract, and keywords of journal articles. We collected a total of 443 articles from recent social health literature, 6588 articles from past literature that the recent articles on social health cited, and 2680 articles from future literature in which recent social health articles were cited. We defined social health as positive interaction that increases individual engagement in social life at the micro level, and the high degree of social integration that deals with collective problems in society at the macro level. The results of LDA showed that social health research has developed into seven fields: Health Care Delivery; Vulnerable Groups; Measurement; Health Inequality; Social Network and Empowerment; Clinical/Physical Health; and Mental/Behavioral Health. Based on citation relationships, topics grounded in an individual/micro perspective have grown increasingly specialized and productive, while topics grounded in a social/macro perspective have stagnated or was underexplored. Our findings imply that social health studies should follow a more interdisciplinary approach to integrate current health models of individual-centered treatments with social science concerns on building collective capacity for social well-being.

The impact of shareholding networks for facilitating care in rural Thailand

This study explored the existential meaning of being a participant in shareholding networks for the care of older people in Thailand. Ten older persons were interviewed about their experiences of participating in the networks. A reflective lifeworld perspective based on phenomenological philosophy was used. The findings show that participating in shareholding network activities entails an always-present existence of aging intertwined with life. Its constituents further describe the essential meaning of the phenomenon: "experience of improved self-management", "feeling of increased self-esteem", and "bridging a gap in the care of older people". Participation in shareholding network activities means keeping contact with oneself and being able to have a life that corresponds to how one perceives oneself to be and must therefore be understood from a holistic perspective. The present study recommends that older persons' need for support include places where safe and profound reflection on existential issues.

Standardised assessment of functioning in ADHD: consensus on the ICF Core Sets for ADHD

Attention-deficit/hyperactivity disorder (ADHD) is associated with significant impairments in social, educational, and occupational functioning, as well as specific strengths. Currently, there is no internationally accepted standard to assess the functioning of individuals with ADHD. WHO's International Classification of Functioning, Disability and Health-child and youth version (ICF) can serve as a conceptual basis for such a standard. The objective of this study is to develop a comprehensive, a common brief, and three age-appropriate brief ICF Core Sets for ADHD. Using a standardised methodology, four international preparatory studies generated 132 second-level ICF candidate categories that served as the basis for developing ADHD Core Sets. Using these categories and following an iterative consensus process, 20 ADHD experts from nine professional disciplines and representing all six WHO regions selected the most relevant categories to constitute the ADHD Core Sets. The consensus process resulted in 72 second-level ICF categories forming the comprehensive ICF Core Set-these represented 8 body functions, 35 activities and participation, and 29 environmental categories. A Common Brief Core Set that included 38 categories was also defined. Age-specific brief Core Sets included a 47 category preschool version for 0-5 years old, a 55 category school-age version for 6-16 years old, and a 52 category version for older adolescents and adults 17 years old and above. The ICF Core Sets for ADHD mark a milestone toward an internationally standardised functional assessment of ADHD across the lifespan, and across educational, administrative, clinical, and research settings.

The Gestalt of functioning in autism spectrum disorder: Results of the international conference to develop final consensus International Classification of Functioning, Disability and Health core sets

Autism spectrum disorder is associated with diverse social, educational, and occupational challenges. To date, no standardized, internationally accepted tools exist to assess autism spectrum disorder–related functioning. World Health Organization’s International Classification of Functioning, Disability and Health can serve as foundation for developing such tools. This study aimed to identify a comprehensive, a common brief, and three age-appropriate brief autism spectrum disorder Core Sets. Four international preparatory studies yielded in total 164 second-level International Classification of Functioning, Disability and Health candidate categories. Based on this evidence, 20 international autism spectrum disorder experts applied an established iterative decision-making consensus process to select from the candidate categories the most relevant ones to constitute the autism spectrum disorder Core Sets. The consensus process generated 111 second-level International Classification of Functioning, Disability and Health categories in the Comprehensive Core Set for autism spectrum disorder—one body structure, 20 body functions, 59 activities and participation categories, and 31 environmental factors. The Common Brief Core Set comprised 60 categories, while the age-appropriate core sets included 73 categories in the preschool version (0- to 5-year-old children), 81 in the school-age version (6- to 16-year-old children and adolescents), and 79 in the older adolescent and adult version (⩾17-year-old individuals). The autism spectrum disorder Core Sets mark a milestone toward the standardized assessment of autism spectrum disorder–related functioning in educational, administrative, clinical, and research settings.

Health: A Developing Concept in Nursing

PURPOSE

The purpose of this paper is to evaluate the level of maturity of the concept of health in the nursing discipline.

METHOD

The four principles of Morse and colleagues were used to evaluate the level of maturity of the health concept-epistemological, logical, pragmatical, and linguistical.

FINDINGS

This evaluation suggests that the concept of health in nursing is immature, defined inconsistently, and with different instruments.

CONCLUSION

Health is a central concept for nursing. Additional concept development and clarification are needed.

PRACTICE IMPLICATIONS

For the concept of health to be conceptualized, it is important that nurses have consensus regarding the definition of health. The nursing discipline should define health in a manner that is consistent with its philosophical presuppositions. Further, it should be measurable, empirically based, and capture the outcomes that are sensitive to the nursing interventions.

Supporting positive dimensions of health, challenges in mental health care

This paper will explore two contrasting paradigms in mental health care and their relationship to evidence-based practice. The biomedical perspective of pathogenesis and the health perspective of salotogenesis are two major diverse views in mental health care. Positive dimensions of health are traditionally viewed as software not suitable for statistical analysis, while absence of symptoms of disease are regarded as measurable and suitable for statistical analysis and appropriate as a foundation of evidence-based practice. If the main goal of mental health care is to enhance subjectively experienced health among patients, it will not be sufficient to evaluate absence of symptoms of disease as a measure of quality of care. The discussion focuses on the paradox of evidence-based absence of illness and disease versus subjectively experienced health and well-being as criterions of quality of care in mental health care.

Construct validity of a health questionnaire intended to measure the subjective experience of health among patients in mental health services

Mental health services have been lacking systematic health-promoting activities, and health is often perceived as the absence of disease from a biomedical perspective. It is vital to develop methods to assess perceived health among patients in a broader perspective. The aim of the study was to investigate construct validity of a newly developed health questionnaire intended to measure subjectively experienced health among patients in mental health services. A cross-sectional study, including a randomly selected sample of 139 outpatients in contact with the mental health services, was performed in order to explore the relationship between perceived health and self-reported levels of self-esteem, symptoms, empowerment, quality of life and experiences of stigmatization. Self-esteem, symptoms, empowerment and quality of life altogether accounted for 70% of the variation in overall perceived health. Overall perceived health showed positive associations to self-esteem, empowerment and quality of life and negative associations to psychiatric symptoms, discrimination and rejection experiences. The findings suggest that perceived health as measured by the health questionnaire can be a meaningful and valid construct that may be useful for measuring health in clinical mental healthcare practice and in mental health services research.

Dimensions and reliability of a questionnaire for the evaluation of subjective experiences of health among patients in mental health services

Even though the concept of health and its importance has been widely discussed in health care during recent decades, mental health services have been criticised for adopting a biomedical perspective, which does not sufficiently consider the concept of health. The aim of the present study was to investigate the psychometric properties of the Health Questionnaire, a newly developed questionnaire to measure patients' subjective experience of health in mental health services. A cross sectional study was performed using a sample of 139 outpatients in mental health services. A principal component analysis with varimax rotation was used to test the factor structure of the questionnaire. Cronbach's alpha was employed to test internal consistency and Cohen's Kappa assessed test-retest reliability. The final scale, which contained 22 items, derived from three factors (autonomy, social involvement, and comprehensibility) and showed a good reliability in terms of internal consistency. Test-retest reliability was moderate or better for 17 out of 22 items. The Health Questionnaire may enable further empirical studies on subjectively experienced health in mental health services and serve as a measure of outcome and to monitor quality of care.

Perceptions of the concept of health among nurses working in mental health services: a phenomenographic study

A new understanding of the concept of health is needed to meet the goal of mental health nursing, which besides reducing disease is to strengthen the patient's health. The aim of the present study was to describe perceptions of the concept of health among nurses working in mental health services. Twelve Swedish nurses working in mental health services were interviewed and data were analysed with a phenomenographic approach. The nurses expressed 10 perceptions, which constituted three description categories: autonomy, process, and participation. The result showed that health was more than absence of disease. Simultaneously, perceptions were expressed indicating that health was viewed as absence of disease, which implies that the concept is not sufficiently defined. The result emphasizes the need to clarify the concept of health if it is to be used as a goal in mental health nursing and to integrate a clarified definition of health at all hierarchical levels in mental health care services.

A nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis: A qualitative study

The aim of this study was to describe a nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic, inflammatory disease that attacks many joints, causing considerable functional restrictions for patients. Consequently, these patients are dependent on a wide variety of health-care services. A descriptive, qualitative design inspired by phenomenography was chosen. The conceptions were collected through interviews with 16 strategically selected patients with RA. Three descriptive categories comprising eight conceptions emerged: teaching (gaining insight and receiving information), regular review (receiving security, realizing regularity, and achieving accessibility), and attention (getting a holistic assessment, receiving coordinated care, and getting sufficient time). A nurse-led rheumatology clinic can be a source for empowering patients with RA to adopt new stances to alternative actions and achieve a higher level of faith in their own abilities.

Integrating Swedish massage therapy with primary health care initiatives as part of a holistic nursing approach

Nursing has long embraced a holistic approach to health care. Providing such an approach is also a goal embodied within many complementary therapy (CT) practices, such as Swedish massage therapy (SMT). Primary health care (PHC) reform initiatives as well often support a holistic approach to patient/client management. Presently, amongst the practices of nursing, a potential synergy between CTs and PHC domains has not as yet been adequately explored within the humanities and social/scientific literature. The purpose of this review is to address the potential of such a collaboration, as made feasible by incorporating an integrative medicine approach to enhance comprehensiveness of care, and in turn, holistic nursing.

Perceptions of the concept of health among patients in mental health nursing

Health has been a central concept in nursing science since the 18th century but the holistic concept of health that includes both the body and the soul, still has to be clarified. The concept of health is often unclear and represents an unreachable ideal state that can be hard to use as a realistic goal in nursing care. The aim of this study was to describe how the patient perceives the concept of health in mental health nursing. Twelve patients with experience of mental health nursing were interviewed and the data were analyzed with a phenomenographic approach. The patients described nine different perceptions that were divided into three descriptive categories: autonomy, meaningfulness, and community. All of these are important to achieve health. There is ambiguity about the possibility to influence the concept of health. Health is described, on the one, hand as a prerequisite to experiencing freedom and finding meaning in life and, on the other hand, it is believed that the search for meaning and the courage to fight and try in spite of the disease is what leads to health. The patients' descriptions are mostly about things that they need in the present time to achieve health, but health as a process with growth and potential for development does not appear that clearly. One conclusion is that mental health nursing must deliver a more process-focused nursing care where the concept of health is visibly used as a goal for all nursing interventions.

The biopsychosocial model in medical research: the evolution of the health concept over the last two decades

The object of this study was to assess the change towards a biopsychosocial health concept among medical researchers in the last two decades, after the explicit criticism of the biomedical model in the late 1970s because of its somatic reductionism. The concepts of 'health' or 'healthy status of an individual' as reported as variable in empirical articles published in the journal The Lancet over the years 1978-1982 (period a) and 1996-2000 (period b) were searched by means of Medline and compared for their definition of these variables. None of the 52 examined papers set out a positive and replicable definition of 'health' (seven papers) or 'healthy status' (45). No difference was found between the two periods studied except for the failure of reports to describe 'healthy status' at all (65.5% in a, 19% in b). Most articles do it in an indirect way, namely through exclusion conditions of subjects taking part in treatment or control groups. Only three studies include psychological dimensions in their measures of 'healthy status' (two in a, one in b). Concerning 'health', all seven examined papers include psychological or both psychological and social dimensions. Although a change towards a more holistic concept of health has occurred in academic and institutional contexts over the last few decades, there does not appear to have been a parallel change in the practical domains of medicine. Possible reasons are discussed, specially the difficulty of applying the biopsychosocial model in medical care and the difficulty of competing with the traditional biomedical concept of health, which has proved fruitful and dominant in medicine over the past three centuries.

Caregivers of frail rural older adults. Effects of an advanced practice nursing intervention

Informal caregivers are responsible for providing the majority of post-discharge care for many frail older adults in rural settings. The purpose of this study was to investigate whether an advanced practice nurse (APN) intervention would promote more positive physical and emotional outcomes in caregivers of rural older adults who are frail and were recently discharged from urban-based hospitals. Thirty-two caregivers of frail rural elderly individuals were randomly assigned to treatment (APN intervention) and control groups (no APN intervention). Assessments of caregiver outcomes were collected via telephone interviews at 48-hour, 2-week, and 4-week intervals after hospital discharge of the frail rural older adults. Outcomes were operationalized as caregiver physical health and well being, and stress and burden. The former was measured using the Health and Daily Living form (HDL) and the latter by the Thoughts and Feeling and Time and Energy subscales of the Caregiver Burden Inventory (CBI). Additional information on caregiver problems and APN visit time was collected by the APN using the Omaha Classification System. Caregivers in the treatment group experienced significantly more positive physical and emotional health outcomes. The caregivers who received the APN intervention had higher self-rated emotional health scores, fewer emotional symptoms at Week 4, fewer depressive symptoms at Week 2 and 4, and lower Thoughts and Feelings stress scores at 48 hours than the control group. Findings support the importance of addressing the needs of caregivers post-discharge and the ability of APNs to improve post-discharge outcomes for home health care recipients and their caregivers.

The concept of health scale: developed for Chinese people with chronic illness

BACKGROUND

As the concept of health in Chinese people with chronic illness had not been previously explored, a scale to measure this concept in this client group was developed.

OBJECTIVE

To develop and test the psychometric integrity of the Concept of Health Scale (CHS) for use with Chinese people.

METHODS

Previous nursing experience and a literature review were used to inform the initial development of the CHS. It was revised following scrutiny by a panel of experts. Two studies tested the psychometric integrity of the scale. In Study One the data gathered from 80 Chinese people with a chronic illness were subjected to item analysis and exploratory factor analysis. In Study Two, with a convenience sample of 372 chronically ill Chinese people, confirmatory factor analysis was conducted.

RESULTS

Instrument analysis in Study One resulted in a 34-item scale with a Cronbach alpha of 0.94. The results of an exploratory factor analysis showed that physical, psychosocial, and spiritual factors were represented by the CHS. The hypothesized model of the CHS was tested in Study Two using confirmatory factor analyses. The results of this study indicated that the concept of health was comprised of six first-order and three second-order factors.

CONCLUSION

The results of this study demonstrated that Chinese people with chronic illness held a broad frame of reference in gauging the concept of health. The development of the CHS brings us one step closer to understanding how Chinese people with chronic illness regard the concept of health.