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Balancing on a knife-edge: Experiences of older patients with acquired deafblindness when receiving existential care
Abstract
Introduction: The population of older persons with acquired deafblindness increases rapidly, but individuals with the disability are often not identified by healthcare services. Becoming deafblind is associated with profound existential challenges as social isolation, loneliness, depression, vulnerability for harm and abuse, and a lack of self-value. Additionally, when growing older, persons with deafblindness must cope with ordinary challenges such as frailty, illness, and an increasing probability of dying, which makes these individuals particularly vulnerable to existential crises. Aim: The aim of this study is to explore the lived experiences of older patients with acquired deafblindness when receiving existential care. Method: A qualitative design with open individual narrative interviews of four older patients with acquired deafblindness was chosen. The interview texts were analyzed using Lindseth & Norberg's phenomenological hermeneutical method for researching lived experience. Findings: The patients experienced existential care when they felt acknowledged and empowered without being labeled as persons with a disability. Being challenged to do things they had stopped doing due to deafblindness could help them become independent and self-reliant. The patients wished to be supported to participate in society. They felt that their abilities often were misjudged by others, which could entail a feeling of being patronized. This could lead to social isolation and loneliness. The patients also experienced existential care when they were supported to connect with faith. Conclusion and clinical implications: Older patients with acquired deafblindness experience existential care when they feel empowered to gain independence and participation and when they are supported to find faith. The patients are highly exposed to the caregivers' power and way of connecting with them. The patients can experience empowerment through the maintenance of trust and communion. However, if met with an overprotecting or neglecting attitude, older patients with acquired deafblindness can feel disempowered.
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Introduction
Experiencing deafblindness is frequently accompanied by existential struggles. The number of older people with acquired deafblindness is fast increasing, and older persons’ health-related burdens are particularly associated with existential challenges. Hence, older persons with acquired deafblindness are explicitly exposed to existential struggles. Chaplains have a vital role in providing existential care. They do this both in congregational as well as health and social care contexts and are confronted with older persons’ religious, spiritual, and secular concerns.
Aim
The aim of this study is to explore chaplains’ lived experiences with providing existential care to older persons with acquired deafblindness.
Materials and Methods
Individual open narrative interviews were conducted with five chaplains. The interview texts were analyzed by using Lindseth and Norberg’s phenomenological hermeneutical method for researching lived experience based on Ricoeur’s interpretation theory.
Findings
The chaplains are direct and immediate during their encounters with older persons with acquired deafblindness. They can experience personal limitations when they try to alleviate the older persons’ burdens. Establishing trust and confidentiality appears to be a prerequisite for conversations about the older peoples’ existential struggles. The chaplains emphasize the importance of acknowledging the persons’ negative feelings and addressing new perspectives to a life with deafblindness. In this way, the older persons can experience reconciliation with their lives. The chaplains struggle with creating inclusive fellowships, but show high commitment trying to make that possible.
Conclusion and Implications for Health and Social Care
Chaplains can contribute to the existential well-being of older persons with acquired deafblindness through their presence in times of existential struggle. They provide existential care in a highly compassionate way, but can also experience the support they offer as insufficient. The implementation of a systematically organized service for existential care to older persons with acquired deafblindness could be worthwhile. Discourse about different ways of using (sign) language and other possibilities for the inclusion of older persons with acquired deafblindness in the Deaf Church and other communities is recommended.
Introduction
The proportion of older adults with combined acquired vision and hearing impairments (referred to as Dual Sensory Impairment/DSI) is growing, and their unique care needs are beginning to receive increased attention. Considering the age-related demographic shift, one million older adults in Canada are expected to experience DSI by 2036, and evidence suggests that DSI is associated with communication difficulties, cognitive decline, depression, functional decline, and participation challenges. Given that the goal of sensory rehabilitation is to improve participation, the study explored perceived contextual barriers and facilitators of social participation among older adults with DSI to better understand their lived experience.
Methods
The International Classification of Functioning, Disability and Health (ICF) was used as a framework to identify and describe the contextual factors (environmental and personal) that influence the social participation of older adults with DSI. Sixteen older adults with DSI (mean age = 86 years, SD = 7; 9 female; registered with an urban sensory rehabilitation organization) were interviewed using a semi-structured qualitative interview guide. Interviews were audio-recorded, transcribed, and then analyzed using a content analysis approach.
Results
Environmental factors, such as societal attitudes toward disability, access to technology aids, and availability of transportation services emerged as the most important factors influencing participation. The onset and type of the impairments and attitude toward one’s disability were important personal factors affecting the participation. The availability of social support and the use of assistive devices (e.g., magnifiers, glasses, and hearing aids) were reported to be facilitators. In contrast, the inaccessibility of the built environment and the cost and limited availability of accessible transportation were key barriers to their social participation.
Discussion
Our study indicated that assistive devices facilitate older adults with DSI in their day-to-day functioning and improve social participation, while expensive and inadequate transportation services may deter their participation. For rehabilitation professionals working with older adults with DSI, it is crucial to consider the barriers to and facilitators of social participation when designing interventions. Future research is warranted to investigate the role of assistive devices and transportation in improving the social participation of older adults with DSI.
Background
Spirituality has always been present in the history of nursing and continues to be a topic of nursing interest. Spirituality has ancient roots. The term ‘spirituality’ is interpreted as spirit and is translated as breath and soul, whereas spirituality (immateriality) is spiritual nature. Historically, the term spirituality is associated with the term religiosity, a definition that persists today, and often the two terms are used interchangeably. In the healthcare context, the construct is still.
Objective
To clarify the concept of spirituality in nursing.
Research design
In this article spirituality was explored using Rodgers' evolutionary and inductive method of concept analysis.
Participants and research context
For this analysis, a sample of 71 articles published in English, from 2008 to 2018 from PubMed/Medline, CINAHL Plus with full text, PsycINFO, SciELO databases were retrieved. It was also accomplished an empirical search of dictionaries and e-books.
Ethical considerations
This study was conducted according to good scientific practice.
Findings
It emerged that “spirituality” is a dynamic process and has a range of attributes. The cultural dimensions, the religious and spiritual traditions, the ethnic diversity and the influence of the historical and social contexts represent the societal and historical conditions ingrained in the Western thought that influence the emergence of spirituality as a concept. Antecedents, attributes and onsequences appeared to inform and strengthen one another over time. Spirituality is a significant concept for the discipline of nursing with profound consequences for caring patients and for work organizations.
In this analysis of data from the Canadian Longitudinal Study on Aging, vision loss (in men) and dual sensory loss (in 65- to 85-year-olds) were independently associated with low social network diversity. Vision loss and dual sensory loss (in 65- to 85-year-olds) were independently associated with low social participation. Hearing, vision,
and dual sensory losses were each independently associated with loneliness and reduced availability of social support, respectively. These findings are concerning because social support facilitates positive coping mechanisms that mitigate the effects of sensory loss and other chronic disabling conditions. Living with a chronic
health condition often entails relying on others for help with instrumental tasks and emotional support. Unfortunately, individuals with clinically diagnosed sensory loss typically receive little, if any, relationship and communication counseling.
Background
Spiritual distress is prevalent in advanced disease, but often neglected, resulting in unnecessary suffering. Evidence to inform spiritual care practices in palliative care is limited.
Aim
To explore spiritual care needs, experiences, preferences and research priorities in an international sample of patients with life-limiting disease and family caregivers.
Design
Focus group study.
Setting/participants
Separate patient and caregiver focus groups were conducted at 11 sites in South Africa, Kenya, South Korea, the United States, Canada, the United Kingdom, Belgium, Finland and Poland. Discussions were transcribed, translated into English and analysed thematically.
Results
A total of 74 patients participated: median age 62 years; 53 had cancer; 48 were women. In total, 71 caregivers participated: median age 61 years; 56 were women. Two-thirds of participants were Christian. Five themes are described: patients’ and caregivers’ spiritual concerns, understanding of spirituality and its role in illness, views and experiences of spiritual care, preferences regarding spiritual care, and research priorities. Participants reported wide-ranging spiritual concerns spanning existential, psychological, religious and social domains. Spirituality supported coping, but could also result in framing illness as punishment. Participants emphasised the need for staff competence in spiritual care. Spiritual care was reportedly lacking, primarily due to staff members’ de-prioritisation and lack of time. Patients’ research priorities included understanding the qualities of human connectedness and fostering these skills in staff. Caregivers’ priorities included staff training, assessment, studying impact, and caregiver’s spiritual care needs.
Conclusion
To meet patient and caregiver preferences, healthcare providers should be able to address their spiritual concerns. Findings should inform patient- and caregiver-centred spiritual care provision, education and research.
Objectives
To gain insights into the process of nurses’ changing perceptions when trained to implement a self-management programme for dual sensory impaired older adults in long-term care, and into the factors that contributed to these changes in their perceptions.
Design
Qualitative study alongside a cluster randomised controlled trial.
Setting
17 long-term care homes spread across the Netherlands.
Participants
34 licensed practical nurses supporting 54 dual sensory impaired older adults.
Intervention
A 5-month training programme designed to enable nurses to support the self-management of dual sensory impaired older adults in long-term care.
Primary outcomes
Nurses’ perceptions on relevance and feasibility of the self-management programme collected from nurses’ semistructured coaching diaries over the 5-month training and intervention period, as well as from trainers’ reports.
Results
Nurses’ initial negative perceptions on relevance and feasibility of the intervention changed to positive as nurses better understood the concept of autonomy. Through interactions with older adults and by self-evaluations of the effect of their behaviour, nurses discovered that their usual care conflicted with client autonomy. From that moment, nurses felt encouraged to adapt their behaviour to the older adults’ autonomy needs. However, nurses’ initial unfamiliarity with conversation techniques required a longer exploration period than planned. Once client autonomy was understood, nurses recommended expanding the intervention as a generic approach to all their clients, whether dual sensory impaired or not.
Conclusions
Longitudinal data collection enabled exploration of nurses’ changes in perceptions when moving towards self-management support. The training programme stimulated nurses to go beyond ‘protocol thinking’, discovering client autonomy and exploring the need for their own behavioural adaptations. Educational programmes for practical nurses should offer more longitudinal coaching of autonomy supportive conversational skills. Intervention programming should acknowledge that change is a process rather than an event, and should include self-evaluations of professional behaviours over a period of time.
Trial registration number
NCT01217502, Post-results.
Sample sizes must be ascertained in qualitative studies like in quantitative studies but not by the same means. The prevailing concept for sample size in qualitative studies is “saturation.” Saturation is closely tied to a specific methodology, and the term is inconsistently applied. We propose the concept “information power” to guide adequate sample size for qualitative studies. Information power indicates that the more information the sample holds, relevant for the actual study, the lower amount of participants is needed. We suggest that the size of a sample with sufficient information power depends on (a) the aim of the study, (b) sample specificity, (c) use of established theory, (d) quality of dialogue, and (e) analysis strategy. We present a model where these elements of information and their relevant dimensions are related to information power. Application of this model in the planning and during data collection of a qualitative study is discussed.
Patient participation benefits the patient and is a core concept of patient-centred care. Patients believe in their ability to prevent errors; thus, they may play a vital role in combating adverse event rates in hospitals.
To explore hospitalised medical patients' perceptions of participating in nursing care, including the barriers and facilitators for this activity.
This interpretive study was conducted on four medical wards, in two hospitals. Purposeful maximum variation sampling was operationalised to recruit patients that differed in areas such as age, gender and mobility status. In-depth semi-structured audiotaped interviews were undertaken and analysed using inductive content analysis.
Twenty patients participated in the study. Four categories were uncovered in the data. First, valuing participation showed patients' willingness to participate, viewing it as a worthwhile task. Second, exchanging intelligence was a way of participating where patients' knowledge was built and shared with health professionals. Third, on the lookout was a type of participation where patients monitored their care, showing an attentive approach towards their own safety. Fourth, power imbalance was characterised by patients feeling their opportunities for participation were restricted.
Patients were motivated to participate and valued participation. Cultivating this motivation may be crucial to patient empowerment and practices of safety monitoring, a fundamental strategy to addressing patient safety issues in hospitals. Engaging nurse-patient relationships, inclusive of knowledge sharing, is required in practice to empower patients to participate. Educating patients on the consequences of non-participation may motivate them, while nurses may benefit from training on patient-centred approaches. Future research should address ways to increase patient motivation and opportunities to participate.
© 2015 Nordic College of Caring Science.
Purpose of the study:
To examine the documentation of sensory impairment in the electronic medical records (EMRs) of Veterans with both hearing and vision losses (dual sensory impairment [DSI]).
Design and methods:
A retrospective chart review of the EMRs of 20 patients with DSI was conducted. Providers' documentation of the presence of sensory impairment, the use of assistive technology during clinical appointments, and the content of notes mentioning communication issues were extracted from each chart note in the EMR for the prior 6 years.
Results:
Primary care providers documented DSI in 50% of EMRs, vision loss alone in 40%, and hearing loss alone in 10% of EMRs. Audiologists documented vision loss in 50% of cases, whereas ophthalmologists/optometrists documented hearing loss in 15% of cases. Examination of two selected cases illustrates that care can be compromised when providers do not take note of sensory impairments during planning and provision of clinical care.
Implications:
Sensory impairment is poorly documented by most providers in EMRs. This is alarming because vision and hearing affect patient-physician communication and the use of medical interventions. The results of this study raise awareness about the need to document the presence of sensory impairments and use the information when planning treatment for individuals with DSI.
This paper discusses issues related to communication, independence, and isolation for an understudied group of deaf people
who also have visual impairments. The discussion is based on the experiences of 28 deafblind people in 6 different countries,
obtained from interviews that were carried out as part of a larger research project on travel issues. However, the similarities
in experiences between countries were stronger than the differences. In particular, barriers to communication and inadequate
support, with resulting problems of isolation and depression, were found in all the countries. Equally, deafblind people in
all the countries were interested in being involved in and contributing to society and supporting other people, particularly
through organizations of blind and deafblind people. This runs counter to the tendency to present deafblind and other disabled
people purely as recipients of support rather than also as active participants in society. However, there were some differences
in the support available in the different countries.
The purpose of the study was to describe the prevalence of hearing difficulties, vision difficulties and dual sensory difficulties in 11 European countries, and to study whether sensory difficulties are associated with social inactivity in older Europeans. This cross-sectional study is based on the 2004 data collection of the Survey of Health, Ageing and Retirement in Europe comprising 27,536 men and women aged 50 years and older. Hearing and vision difficulties, as well as participation in seven different social activities were assessed using a structured computer-assisted personal interview. Logistic regression models were used for analyses. Altogether, 5.9 % of the participants reported both hearing and vision difficulties (dual sensory loss), 10.2 % vision difficulties only, and 13.5 % hearing difficulties only. More than two-thirds (68.6 %) of the participants with dual sensory loss were socially inactive compared to half of those who reported no sensory difficulties. The participants who reported dual sensory loss had 2.18 (95 % CI 1.83-2.59) times higher odds for social inactivity compared to persons without hearing or vision difficulties. In a model adjusted for age, gender, mobility, depressive symptoms, cognition, education and wealth the corresponding odds ratio was 1.21 (95 % CI 1.00-1.47). According to our results, sensory difficulties were associated with social inactivity, but the higher likelihood for social inactivity among persons with sensory difficulties was attenuated by other health and socio-economic indicators. Our results suggest that various preventive and rehabilitative actions targeting older persons' sensory functions may enhance their social activity.
Introduction
The purpose of this study was to identify the needs and challenges of seniors with dual sensory loss (combined hearing and vision loss) and to determine priorities for training family members, community service providers, and professionals who work with them.
Methods
Individuals (N = 131) with dual sensory loss between the ages of 55 and 99 years participated in a survey designed to collect information about their most important needs, challenges encountered associated with sensory losses, and the training requirements of the people who interact with them. Results were analyzed with descriptive statistics, and comparisons were made between persons with early and late onset of sensory loss.
Results
The most commonly identified needs were transportation, technology training, assistance with errands, and improved communication. Medical providers were identified as the service providers who most need training about dual sensory loss. A majority of respondents thought their local community members, friends, and family also need education. Some differences were noted based on age of onset of sensory losses.
Discussion
Needs differed by age of onset group: needs of participants with early onset of one or both sensory losses focused on transportation and training to use technology, while needs for those with later onset focused on information about devices to improve hearing or vision and better ability to communicate with family.
Implications for practitioners
Training to use technology is an important area of need that may not always be addressed for this population by service providers, but it may contribute to overall improved quality of life, since it has the potential to improve communication options and reduce feelings of isolation. Health care providers are an important group to target for education regarding how to interact with people with dual sensory loss.
The vulnerability of deafblind people is considered axiomatic; they are seen not only as a vulnerable group but also as one of the most vulnerable. This paper aims to synthesise existing knowledge to determine what is known about such vulnerability. A comprehensive literature search was undertaken between April 2013 and May 2014. The review method was informed by systematic review principles. An approach based on a ‘hierarchy of evidence’ would have reduced the amount of literature reviewed significantly, to the point where synthesis would not be possible. Included material was appraised and an interpretative rather than aggregative approach to synthesis adopted. Drawing on principles of critical interpretive synthesis, rather than being a determiner of whether material should be included or excluded, a critique of the literature is offered within the synthesis. Twenty-eight references were identified for inclusion, originating from the UK, USA, Australia, Continental Europe and the Nordic Countries. No empirical studies specifically examining the experience of vulnerability of deafblind people were found. However, deafblind people describe feelings of vulnerability in studies exploring their experiences more generally, and in personal accounts of living with the impairment. Literature produced by practitioners and specialist organisations also explores the topic. Deafblind people are identified as a population ‘at risk’ of various adverse outcomes, particularly when compared to the non-deafblind majority, and deafblind people describe being and feeling vulnerable in various situations. The literature largely relates to negative outcomes and includes significantly less exploration of positive risk taking, coping capacity and resilience. Deafblind people do not appear to describe themselves as being vulnerable as a permanent state, suggesting a need for greater exploration of the experience among all sections of this heterogeneous population, with consideration of the concepts of resilience and coping capacity.
Cover Blurb: Researching Lived Experience introduces an approach to qualitative research methodology in education and related fields that is distinct from traditional approaches derived from the behavioral or natural sciences—an approach rooted in the “everyday lived experience” of human beings in educational situations. Rather than relying on abstract generalizations and theories, van Manen offers an alternative that taps the unique nature of each human situation.
The book offers detailed methodological explications and practical examples of hermeneutic-phenomenological inquiry. It shows how to orient oneself to human experience in education and how to construct a textual question which evokes a fundamental sense of wonder, and it provides a broad and systematic set of approaches for gaining experiential material that forms the basis for textual reflections.
Van Manen also discusses the part played by language in educational research, and the importance of pursuing human science research critically as a semiotic writing practice. He focuses on the methodological function of anecdotal narrative in human science research, and offers methods for structuring the research text in relation to the particular kinds of questions being studied. Finally, van Manen argues that the choice of research method is itself a pedagogic commitment and that it shows how one stands in life as an educator.
Background:
Deafblindness or dual sensory loss is a rare condition among young people, but more frequent among older people. Deafblindness is a heterogeneous condition that varies with regard to time of onset and degree of vision and hearing impairment, as well as communication mode, medical aetiology, and number and severity of co-morbidity.
Method:
We conducted a comprehensive review of public health issues related to deafblindness.
Results:
Deafblindness often lead to barriers in language and communication, access to information and social interaction, which can lead to a number of health-related difficulties. Some of the reported consequences are a higher risk of depression, cognitive decline, developmental disorder in children and psychological distress.
Conclusions:
Deafblindness is associated with a number of health-related issues and more knowledge is needed about the impact of dual sensory loss to be able to offer the best support.
In order to compile knowledge on deafblindness (DB) and congenital deafblindness (CDB), one important factor is comparison of results between different scientific studies. In an attempt to do a systematic review of the literature on cognitive assessment and CDB, considerable difficulties in determining eligibility of the studies were encountered due to heterogeneity in definitions and inclusion criteria used in the articles. The present systematic review aims to provide both an overview of this terminological and methodological heterogeneity and suggestions for better future research practices. A systematic review of definitions used in (N=30) studies employing psychological assessment of people with CDB served as a sample of the scientific literature on DB and CDB. Absent or heterogeneous definitions and inclusion criteria regarding both DB and CDB are evident in the sample. Fifty percent of the studies reported no definition of DB and 76.7% reported no definition of CDB. Main discrepancies are: (1) medical/functional versus ability/functioning definitions regarding DB; and (2) different criteria for onset of DB in the case of defining CDB (e.g. age versus developmental level). The results of this study call attention to a scientifically inadequate approach to the study of DB and CDB. Findings indicate that clear guidelines for sample descriptions of the DB and/or CDB populations are needed. It is suggested that studies including DB and CDB participants provide the following information: definitions of DB and CDB used; severity of sensory impairments; level of sensory ability in relation to mobility, access to information, and communication; age at onset of DB; and communication as well as language ability at onset of DB.
The article presents a portrait and analysis of the existential-psychocultural situation in postmodern Sweden. Drawing from recent research exploring psychology of religion and existential worldviews, and the Swedish findings from the international World Values Survey, an argument is made for thinking about existential function and dysfunction as public health issues. This is portrayed against the background of Sweden as one of the most secularized countries and simultaneously a country with one of the most encompassing welfare systems. Psychology of religion's updated role here would be to take responsibility for identifying and assessing the categories of function and dysfunction for an existential public health system. This role would also include the planning of policy for societal existential wellbeing, as well as planning prevention and intervention efforts for avoiding existential epidemiology. This new role fits well with public health's third revolution agenda focusing on health, wellbeing and quality of life.
Context:
Spirituality may promote psychosocial adjustment to illness, and this may be a mechanism by which patients with greater existential well-being (EWB) experience better health-related quality of life (HRQL) in the context of life-limiting illness.
Objectives:
This study explored the relationship between psychosocial adjustment to illness, EWB, and HRQL in patients with advanced chronic kidney disease and sought to determine whether adjustment to illness mediates the relationship between EWB and HRQL.
Methods:
This was a cohort study of 253 prevalent Stage 4 or 5 chronic kidney disease and dialysis patients. Participants completed the Spiritual Well-Being Scale, the Psychological Adjustment to Illness Scale (PAIS)-Self-Report, and the Kidney Dialysis Quality of Life Short Form.
Results:
Psychosocial adjustment to illness was highly correlated with HRQL, accounting for 29% and 27% of the variance in physical and mental HRQL scores, respectively. Although PAIS domains were associated with EWB, EWB remained a significant predictor of HRQL after all PAIS domains were considered. Adjustment in the domains of psychological distress and extended family relationships did appear to mediate some of the relationship between EWB and HRQL.
Conclusion:
Adjustment in the domains of psychological distress and extended family relationships appears to mediate some of the beneficial effect of EWB on HRQL. Spirituality, however, provides unique variance in patients' HRQL, independent of their psychosocial adjustment. This study testifies to the importance of targeting both psychosocial adjustment to illness and spirituality as ways to preserve or enhance HRQL of predialysis and dialysis patients.
This study describes a phenomenological hermeneutical method for interpreting interview texts inspired by the theory of interpretation presented by Paul Ricoeur. Narrative interviews are transcribed. A naïve understanding of the text is formulated from an initial reading. The text is then divided into meaning units that are condensed and abstracted to form sub-themes, themes and possibly main themes, which are compared with the naïve understanding for validation. Lastly the text is again read as a whole, the naïve understanding and the themes are reflected on in relation to the literature about the meaning of lived experience and a comprehensive understanding is formulated. The comprehensive understanding discloses new possibilities for being in the world. This world can be described as the prefigured life world of the interviewees as configured in the interview and refigured first in the researcher's interpretation and second in the interpretation of the readers of the research report. This may help the readers refigure their own life.
This article proposes a framework of concepts for the field of existential meaning-making in secular cultures such as those of Northern Europe. Seeking an operational approach, we have narrowed the field's components down to a number of basic domains and dimensions that provide a more authentic cultural basis for research in secular society. Reviewing the literature, three main domains of existential meaning-making emerge: Secular, spiritual, and religious. In reconfirming these three domains, we propose to couple them with the three dimensions of cognition (knowing), practice (doing), and importance (being), resulting in a conceptual framework that can serve as a fundamental heuristic and methodological research tool for mapping the field of existential meaning-making and health. The proposed grid might contribute to clearer understanding of the multidimensional nature of existential meaning-making and as a guide for posing adequate research and clinical questions in the field.
The purpose of this study was to identify risk factors that are associated with depression among older adults with dual sensory loss, evaluating variables typically associated with depression in an elderly population and variables related to sensory loss.
Survey data was collected from a sample of 203 adults aged 55 years and older with significant hearing and vision loss. Independent variables included demographics (as control variables), sensory loss-related factors, activity factors, and social factors. Correlation and hierarchical linear regression were used to analyze the data.
A large proportion of participants experienced depression. Risk factors typically associated with depression in the elderly were also significant for this group, with the exception of functional disability, but only one variable directly related to sensory loss was significant in the final model. The block of variables with the greatest relationship to depression was the social factor.
Receipt of rehabilitation services and use of assistive devices are two strategies that could be used to address the issue of depression with this population. Interventions could target some of the variables found to be associated with depression in this study: communication problems, loss of activity, and physical activity.
The concept of human dignity is a term commonly used in professional codes and standards for biomedical healthcare disciplines and professional nursing practice. What is the definition of this ethical concept? This column offers a unique definition from a nursing disciplinary perspective. Common straight thinking or ethical questions emerging with the application of the concept in practice are offered along with a discussion of misunderstandings regarding the use of the concept in nursing practice and in professional healthcare arenas.
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Se och hör mig: Personer med förvärvad dövblindhets erfarenheter av delaktighet rehabilitering och medborgerligt liv [See and hear me: Experiences of persons with deafblindness with participation rehabilitation and civic life
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