D 954 ACTA Danica Železnik D954etukansi.kesken.fm Page 1 Wednesday, October 24, 2007 3:08 PM OULU 2007 D 954 UNIVERS ITY OF OULU P .O . Box 7500 F I -90014 UNIVERS ITY OF OULU F INLAND U N I V E R S I TAT I S O U L U E N S I S A C T A U N I V E R S I T A T I S O U L U E N S I S ACTA D S E R I E S E D I T O R S MEDICA Danica Železnik ASCIENTIAE RERUM NATURALIUM Profesor Mikko Siponen SELF-CARE OF THE HOME- BHUMANIORA DWELLING ELDERLY PEOPLE Professor Harri Mantila LIVING IN SLOVENIA CTECHNICA Professor Juha Kostamovaara DMEDICA Professor Olli Vuolteenaho ESCIENTIAE RERUM SOCIALIUM Senior Assistant Timo Latomaa FSCRIPTA ACADEMICA Communications Officer Elna Stjerna GOECONOMICA Senior Lecturer Seppo Eriksson EDITOR IN CHIEF Professor Olli Vuolteenaho EDITORIAL SECRETARY Publications Editor Kirsti Nurkkala FACULTY OF MEDICINE, DEPARTMENT OF NURSING SCIENCE AND HEALTH ADMINISTRATION, UNIVERSITY OF OULU; ISBN 978-951-42-8636-0 (Paperback) FACULTY OF HEALTH SCIENCES, ISBN 978-951-42-8637-7 (PDF) UNIVERSITY OF MARIBOR ISSN 0355-3221 (Print) ISSN 1796-2234 (Online) A C T A U N I V E R S I T A T I S O U L U E N S I S D M e d i c a 9 5 4 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 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. 5 6 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 7 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 8