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  • 1.
    Boman, Erika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Faculty of Nursing, Åland University of Applied Sciences, Mariehamn, Finland.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Häggblom, Anette
    Faculty of Nursing, Åland University of Applied Sciences, Mariehamn, Finland.
    Santamäki Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Faculty of Nursing, Åland University of Applied Sciences, Mariehamn, Finland.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Inner strength: associated with reduced prevalence of depression among older women2015Inngår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 19, nr 12, s. 1078-1083Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: The aim of this study was to explore if inner strength is independently associated with a reduced prevalence of depression after controlling for other known risk factors associated with depression.

    Methods: A population-based cross-sectional study was performed, where all women living in Åland, a Finnish self-govern island community in the Baltic Sea, aged 65 years or older were sent a questionnaire including the Geriatric Depression Scale and the Inner Strength Scale along with several other questions related to depression. Factors associated with depression were analyzed by means of multivariate logistic regression.

    Results: The results showed that 11.2% of the studied women (n = 1452) were depressed and that the prevalence increased with age and was as high as 20% in the oldest age group. Non-depressed women were more likely to never or seldom feel lonely, have a strong inner strength, take fewer prescription drugs, feeling needed, being able to engage in meaningful leisure activities, as well as cohabit.

    Conclusion: Our results showed an association between stronger inner strength and being non-depressed. This can be interpreted to mean that inner strength might have a protective effect against depression. These findings are interesting from a health-promotion perspective, yet to verify these results, further longitudinal studies are required.

  • 2.
    Boman, Erika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Åland University of Applied Sciences, Mariehamn, Finland.
    Haggblom, Anette
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Santamäki Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Åland University of Applied Sciences, Mariehamn, Finland.
    Inner Strength as Identified in Narratives of Elderly Women A Focus Group Interview Study2015Inngår i: Advances in Nursing Science, ISSN 0161-9268, E-ISSN 1550-5014, Vol. 38, nr 1, s. 7-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    By identifying sources of inner strength, health care personnel can be given valuable information about elderly people's capacities regardless of frailty. The focus of this interview-based study was to explore how inner strength and its dimensions can be identified in narratives of elderly women. The analysis was based on a theoretical model where inner strength is composed of 4 interacting dimensions of connectedness, creativity, firmness, and flexibility. Our findings add nuance to the notion of inner strength and deepen empirical knowledge about the concept.

  • 3.
    Boman, Erika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Nursing, Åland University of Applied Sciences, Finland.
    Häggblom, Anette
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Santamäki Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Nursing, Åland University of Applied Sciences, Finland.
    Identifying variables in relation to health-related quality of life among community-dwelling older women: knowledgebase for health-promoting activities2016Inngår i: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 36, nr 1, s. 20-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of the present study was to explore health-related quality of life (HRQoL) and associated variables among all community-dwelling older women (565 years) (n¼2724) on A ° land, a Finnish self-governing island community. A total of 1023 women participated (mean age 72.96.8 years). Absence of depression, absence of diagnosed disease(s), having the opportunity to engage in meaningful leisure activities, and never or seldom feeling lonely explained, together with socioeconomic control variables (i.e. age, education and economic situation), 34.4% of the variation in physical health. Absence of depression, strong inner strength, and never or seldom feeling lonely explained, together with socio-economic control variables, 27.7% of the variation in mental health. HRQoL was rated as relatively good, although special attention should be paid to women aged 80þ years. To promote HRQoL, interventions aimed at preventing, detecting and treating depression should be prioritised. In addition, interventions aimed at reducing feelings of loneliness are also recommended in order to enhance overall HRQoL.

  • 4.
    Boman, Erika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, B
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Årestedt, K
    Santamäki Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Inner strength and its relationship to healththreats in ageing – a cross-sectional studyamong community-dwelling older womenManuskript (preprint) (Annet vitenskapelig)
  • 5. Boman, Erika
    et al.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Årestedt, Kristofer
    Santamäki Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland.
    Inner strength and its relationship to health threats in ageing: a cross-sectional study among community-dwelling older women2017Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, nr 11, s. 2720-2729Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To explore the relationship between inner strength and health threats among community-dwelling older women. Background: Inner strength is described as a resource that promotes experiences of health, despite adversities. Inner strength and its dimensions (i.e. connectedness, creativity, firmness and flexibility) can be assessed using the Inner Strength Scale (ISS). Exploring attributes of weaker inner strength may yield valuable information about areas to focus on in enhancing a person's inner strength and may ultimately lead to the perception of better health. Design: Cross-sectional questionnaire survey. Methods: The study is based on responses from 1270 community-dwelling older women aged 65 years and older; these were collected in the year 2010 and describe the situation that still exists today for older women. The questionnaire included the ISS, background characteristics and explanatory variables known to be health threats in ageing. Data were analysed using descriptive and inferential statistics. Results: Poorer mental health was related to weaker inner strength in total and in all the dimensions. Symptoms of depressive disorders and feeling lonely were related to three of the dimensions, except firmness and creativity respectively. Furthermore, poor physical health was associated with the dimensions firmness and flexibility. Other health threats were significantly related to only one of the dimensions, or not associated at all. Conclusion: Mental ill health has overall the strongest association with weaker inner strength. Longitudinal studies are recommended to confirm the results. However, the ISS does not only estimate inner strength but can also be a tool for discovering where (i.e. dimension) interventions may be most profitable.

  • 6.
    Choowattanapakorn, Tassana
    et al.
    Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Resilience among women and men aged 60 years and over in Sweden and in Thailand2010Inngår i: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 12, nr 3, s. 329-335Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to compare the level of resilience of people aged > or = 60 years in Sweden and Thailand. In a randomized sample of 422 people in Sweden and a convenience sample of 200 people in Thailand, the level of resilience was measured by using the Resilience Scale. A chi(2)-analysis was used for the differences between proportions. The relationships between the background variables and the resilience scores were analyzed by using stepwise multiple linear regression. The mean scores of resilience were 144 for the Swedish participants and 146 for the Thai participants. The two samples differed in their background characteristics. The Thai participants were more likely to be women, to be widowed, and to have more children, while among the Swedish participants, more women were married and more participants were aged > or = 80 years. Despite different background characteristics, the Swedish and the Thai participants' scores were almost the same on the Resilience Scale. More studies are necessary to address aspects of gender and ethnicity in relation to resilience.

  • 7.
    Isaksson, Ulf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Santamäki-Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Åström, Sture
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Supporting the oldest old when completing a questionnaire: risking bias or gaining reliable results?2007Inngår i: Research on aging, Vol. 29, nr 6, s. 576-89Artikkel i tidsskrift (Fagfellevurdert)
  • 8.
    Jonsén, Elisabeth
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Fagerström, Lisbeth
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Vähäkangas, Magdalena
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Psychometric properties of the Swedish version of the purpose in life scale (PIL)2010Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, nr 1, s. 41-48Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to test the theoretical assumptions beyond the Purpose in Life (PIL) scale, and to elucidate the underlying structure of the Swedish version of the PIL. The PIL, originally created by Crumbaugh and Maholick, is a 20-item scale of the Lickert type with possible scores ranges from 20 to 140, the higher score, the stronger PIL. The analysis was based on 449 participants, 62% of whom were women, from five different samples, ranging from 19 to 103 years old. An exploratory factor analysis restricted to three factors was performed. The factors were labelled meaning in existence, freedom to create meaning in daily life, and will to find meaning in future challenges. These factors reflected the three dimensions described by Frankl. Cronbach's alpha coefficient for the total scale was 0.83 and varied between 0.54 and 0.83 in the three factors. We concluded that the Swedish version of the PIL scale seems to have construct validity and reliability. Our results give support to the fact that the PIL scale captures and confirms the theoretical assumptions of Frankl's existential theory. We consider the PIL scale to be both feasible and appropriate for use in nursing research.

  • 9.
    Lundman, Berit
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsén, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Fischer, Regina Santamäki
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Inner strength in relation to functional status, disease, living arrangements, and social relationships among people aged 85 years and older2012Inngår i: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 33, nr 3, s. 167-176Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Inner strength is described as an important resource that promotes well-being. We used data from a sample of 185 people in the Umeå 85+ cohort study to relate inner strength and its attributes to objective health variables. The Resilience, Sense of Coherence, Purpose in Life, and Self-Transcendence scales were used to assess aspects of inner strength, and strong correlations between the scales were found. Prevalence of heart failure, chronic obstructive pulmonary disorder, osteoporosis, or diagnosed depression was associated with low inner strength. Significant relationships were also found between high inner strength and various measures of social relationships. Participants with a higher degree of inner strength had better physical health and more satisfying social relationships. The promotion of inner strength should be a major aim of geriatric nursing.

  • 10.
    Lundman, Berit
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsén, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Santamäki Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Inner strength-A theoretical analysis of salutogenic concepts.2010Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, International journal of nursing studies, ISSN 1873-491X, Vol. 47, nr 2, s. 251-260Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Theoretical and empirical overlaps between the concepts of resilience, sense of coherence, hardiness, purpose in life, and self-transcendence have earlier been described as some kind of inner strength, but no studies have been found that focus on what attributes these concepts have in common. OBJECTIVES: The objective of this study was to perform a theoretical analysis of the concepts of resilience, sense of coherence, hardiness, purpose in life, and self-transcendence, in order to identify their core dimensions in an attempt to get an overarching understanding of inner strength. PRINT METHOD: An analysis inspired by the procedure of meta-theory construction was performed. The main questions underlying the development of the concepts, the major paradigms and the most prominent assumptions, the critical attributes and the characteristics of the various concepts were identified. RESULTS: The analysis resulted in the identification of four core dimensions of inner strength and the understanding that inner strength relies on the interaction of these dimensions: connectedness, firmness, flexibility, and creativity. These dimensions were validated through comparison with the original descriptions of the concepts. CONCLUSION: An overarching understanding of inner strength is that it means both to stand steady, to be firm, with both feet on the ground and to be connected to; family, friends, society, nature and spiritual dimensions and to be able to transcend. Having inner strength is to be creative and stretchable, which is to believe in own possibilities to act and to make choices and influence life's trajectory in a perceived meaningful direction. Inner strength is to shoulder responsibility for oneself and others, to endure and deal with difficulties and adversities. This knowledge about inner strength will raise the awareness of the concept and, in turn, hopefully increase our potential to support people's inner strength.

  • 11.
    Lundman, Berit
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Viglund, Kerstin
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsén, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Fischer, Regina Santamäki
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Development and psychometric properties of the Inner Strength Scale.2011Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 48, nr 10, s. 1266-1274Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Four dimensions of inner strength were previously identified in a meta-theoretical analysis: firmness, creativity, connectedness, and flexibility.

    OBJECTIVE: The aim of this study was to develop an Inner Strength Scale (ISS) based on those four dimensions and to evaluate its psychometric properties.

    METHOD: An initial version of ISS was distributed for validation purpose with the Rosenberg Self-Esteem Scale, the resilience scale, and the sense of Coherence Scale. A convenience sample of 391 adults, aged 19-90 years participated. Principal component analysis (PCA) and confirmatory factor analysis (CFA) were used in the process of exploring, evaluating, and reducing the 63-item ISS to the 20-item ISS. Cronbach's alpha and test-retest were used to measure reliability.

    RESULTS: CFA showed satisfactory goodness-of-fit for the 20-item ISS. The analysis supported a fourfactor solution explaining 51% of the variance. Cronbach's alpha on the 20-item ISS was 0.86, and the test-retest showed stability over time (r=0.79).

    CONCLUSION: The ISS was found to be a valid and reliable instrument for capturing a multifaceted understanding of inner strength. Further tests of psychometric properties of the ISS will be performed in forthcoming studies.

  • 12. Lövheim, Hugo
    et al.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Absolute reliability of the Resilience Scale2012Inngår i: Journal of Nursing Measurement, ISSN 1061-3749, E-ISSN 1945-7049, Vol. 20, nr 3, s. 258-260Artikkel i tidsskrift (Fagfellevurdert)
  • 13. Melder, Cecilia
    et al.
    Santamäki Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Åbo Akad Univ, Turku, Finland.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    DeMarinis, Valerie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Validating WHOQOL-SRPB in Sweden: instrument adaption for measuring existential aspects of health-related quality of life [HRQL] in secular contexts2016Konferansepaper (Fagfellevurdert)
  • 14.
    Niklasson, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Conradsson, Mia
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Hörnsten, Carl
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nyqvist, Fredrica
    Umeå universitet, Samhällsvetenskapliga fakulteten, Centrum för befolkningsstudier (CBS).
    Padyab, Mojgan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Olofsson, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lövheim, Hugo
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Psychometric properties and feasibility of the Swedish version of the Philadelphia Geriatric Center Morale Scale2015Inngår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 24, nr 11, s. 2795-2805Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Morale is related to psychological well-being and quality of life in older people. The Philadelphia Geriatric Center Morale Scale (PGCMS) is widely used to assess morale. The purpose of this study was to evaluate the psychometric properties and feasibility of the Swedish version of the 17-item PGCMS among very old people.

    METHODS: The Umea 85+/GERDA study included Swedish-speaking people aged 85, 90 and 95 years and older, from Sweden and Finland. Participants were interviewed in their own homes using a predefined set of questions. In the main sample, 493 individuals answered all 17 PGCMS items (aged 89.0 +/- 4.3 years). Another 105 answered between 1 and 16 questions (aged 89.6 +/- 4.4 years). A convenience sample was also collected, and 54 individuals answered all 17 PGCMS items twice (aged 84.7 +/- 6.7 years). The same assessor restated the questions within 1 week.

    RESULTS: Cronbach's alpha was 0.74 among those who answered all 17 questions in the main sample. Confirmatory factor analysis was used to test the construct validity of the most widely used version of the PGCMS, with 17 items and three factors, and showed a generally good fit. Among those answering between 1 and 17 PGCMS questions, 92.6 % (554/598) answered 16 or 17. The convenience sample was used for intra-rater test-retesting, and the intraclass correlation coefficient (ICC) was 0.89. The least significant change between two assessments, with 95 % confidence interval, was 3.53 PGCMS points.

    CONCLUSION: The Swedish version of the PGCMS seems to have satisfactory psychometric properties and feasibility among very old people.

  • 15.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Inner strength among the oldest old: a good aging2006Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The overall purpose of this thesis is to describe, explore and illuminate inner strength among the oldest old. The thesis has a salutogenic perspective where strengths and health are in the foreground instead of weakness and ill health. The thesis is part of The Umeå 85+ study and comprises four studies with both quantitative and qualitative data.

    The aim of Study I was to test reliability and validity of the Swedish language version of the Resilience Scale (RS) in regard to its stability, internal consistency and validity. A convenience sample of 142 participants aged 19 to 85 years answered the questionnaires the first time and 126 on the retest. In Study II scales aimed to measure phenomena related to inner strength, health and development were used. The aim was to describe resilience, sense of coherence, purpose in life, and self-transcendence in relation to perceived physical and mental health in a sample of 125 participants aged 85 to 103 years. Study III aimed to give a more extensive knowledge of resilience among the oldest old. The relationship between resilience and physical health factors, psychological health factors, diseases and social relations were examined among a sample of 192 persons aged 85 to 103 years. In order to deepen the knowledge about inner strength from a life world perspective the aim of study IV was to illuminate the meaning of inner strength as narrated by women and men 85 and 90 years old. The sample consisted of those 18 participants that scored the highest on the scales aimed at measure phenomena related to inner strength.

    The findings in study I showed that the Swedish version of the RS was both valid and reliable. Construct validity was established by satisfactory correlations coefficient values between the RS and the Sense of Coherence Scale and the Rosenberg Self Esteem Scale. A principal component analysis corresponded well to the original version of the RS. Reliability was assured with both satisfactory internal consistency as well as test-retest reliability. The findings in study II showed significant correlations between the scales aimed to measure resilience, sense of coherence, purpose in life and self-transcendence which indicates that the scales reflect some kind of common core, which was interpreted as inner strength. The oldest old scored high on all scales, this indicating that strength can be preserved or perhaps even increased in old age. The finding also showed lack of significant correlations between the scales and perceived physical health but significant correlations between these scales and perceived mental health among the women but not for the men. No significant correlation was found between physical and mental health. In study III a regression analysis showed that a strong resilience among the oldest old was found to be associated with health, mainly represented by absence of depressed mood but also by not being on medication and by the absence of psychological symptoms, but also that raising children in the past gave a meaning to the present by having a family and this produced feelings of feeling safe and secure in facing the inevitable future; that is, being resilient means living in connectedness with one’s past, present, and future. In study IV a phenomenological hermeneutic approach to the interview text disclosed a meaning of inner strength as Life goes on –living it all, meaning that inner strength still makes it possible to live, handle and being open to ones life in many of its potentials. Inner strength means that one can chose to stand up and fight as well as living in reconciliation, a possibility to work hard as well as feeling relaxed, inner strength means having tasks to accomplish as well as feeling content and proud over ones life as well as life itself, it means relying in oneself as well as having faith in others and God (for some), knowing that you as a person is the same as well as accepting and adjusting to changes. It means that one can chose aloneness and still be connected, it is to be living in the present as well as in one’s past and in the future. That is, living in wholeness.

    The findings of the studies are discussed in relation to personal strengths and a good aging.

  • 16.
    Nygren, Björn
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsén, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health among the oldest old.2005Inngår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 9, nr 4, s. 354-362Artikkel i tidsskrift (Fagfellevurdert)
  • 17.
    Nygren, Björn
    et al.
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Inner strength as disclosed in narratives of the oldest old.2007Inngår i: Qualitative Health Research, ISSN 1049-7323, Vol. 17, nr 8, s. 1060-73Artikkel i tidsskrift (Fagfellevurdert)
  • 18.
    Nygren, Björn
    et al.
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Randström, Kerstin Björkman
    Lejonklou, Anna K
    Lundman, Beril
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Reliability and validity of a Swedish language version of the Resilience Scale.2004Inngår i: Journal of Nursing Measurement, ISSN 1061-3749, E-ISSN 1945-7049, Vol. 12, nr 3, s. 169-178Artikkel i tidsskrift (Fagfellevurdert)
  • 19.
    Santamäki-Fischer, Regina
    et al.
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Living amidst consolation in the presence of God: Perceptions of consolation among the oldest old.2007Inngår i: Journal of Religion Spirituality and Aging, ISSN 1552-8049, Vol. 19, nr 3, s. 3-20Artikkel i tidsskrift (Fagfellevurdert)
  • 20.
    Viglund, Kerstin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Aléx, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsén, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden.
    Santamäki Fischer, Regina
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Nursing Education, University of Applied Sciences, Mariehamn, Åland, Finland.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Psychometric properties of the Swedish version of the selection, optimization, compensation questionnaire2013Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, nr 2, s. 460-467Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The model of selection, optimization and compensation has been proposed as a model of adaptive management strategies throughout the lifespan.

    Aim: The aim of this study was to test the psychometric properties of a translated Swedish version of the 12-item selection, optimization, and compensation (SOC) questionnaire.

    Method: The 12-item SOC questionnaire is composed of four subscales: elective selection (ES), loss-based selection, optimization and compensation. A convenience sample of 122 Swedish-speaking people, aged 19-85, participated in a study of the validity and reliability of the SOC questionnaire. Cronbach's alpha coefficient, corrected item-total correlation and Cronbach's alpha if item deleted were used for reliability testing. Two other scales, the ways of coping questionnaire and Rosenberg's self-esteem scale, were used to test convergent validity, and the geriatric depression scale was used to test discriminant validity. Stability over time was evaluated using a test-retest model with a 2-week interval.

    Results: The 12-item SOC questionnaire showed a Cronbach's alpha value of 0.50, and the subscales ranged from α=0.16 to α=0.64. Two items in the ES subscale had negative values on the corrected item-total correlation and showed substantial improvement (>0.05) in Cronbach's alpha when item deleted. When these two items that influenced internal consistency were deleted, Cronbach's alpha rose to 0.68.

    Conclusion: The Swedish version of the 12-item SOC questionnaire showed deficiencies in a test of internal consistency because of two items in the ES subscale, and these two items were deleted. A consequence of the reduction is a weakening of the ES subscale and thereby to some extent the SOC questionnaire in total. Further testing is advisable. However, the 10-item SOC questionnaire was acceptable in a test of validity and reliability.

  • 21.
    Viglund, Kerstin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsén, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Inner strength among old people who have experienced a crisis in lifeManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Inner strength is a resource associated with health and disease management. Our objective was to elucidate inner strength in the narratives of people 65 years and older who had experienced a crisis in life associated with a disease. They had self-rated their inner strength as high, and qualitative content analysis was used in the interpretation of the narratives (n = 12). In the narratives, we found that inner strength comprised feelings of being connected and finding life worth living. Having faith in oneself and one’s possibilities and facing and taking an active part in the situation were also expressed. Finally, coming back and finding ways to go forward in life were found to be essential aspects of inner strength.

  • 22.
    Viglund, Kerstin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsén, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Inner strength in relation to age, gender and culture among old people: a cross-sectional population study in two Nordic countries.2013Inngår i: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 17, nr 8, s. 1016-1022Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: The theoretical framework for the study was the Model of Inner Strength, and the Inner Strength Scale (ISS)developed based on the Model was used. The aim was to examine inner strength in relation to age, gender and culture among old people in Sweden and Finland.

    Method: This study forms part of the GErontological Regional DAtabase (GERDA)-Botnia project that investigates healthy ageing with focus on the dignity, social participation and health of old people. The participants (N = 6119) were 65-, 70-, 75- and 80-year old and living in two counties in Sweden or Finland. The ISS consists of 20 items relating to four interrelated dimensions of inner strength, according to the Model of Inner Strength. The range of possible ISS scores is 20-120, a higher score denoting higher inner strength.

    Result: The result showed that the 65-year-old participants had the highest mean ISS score, with a decrease in score for every subsequent age. The lowest score was achieved by the 80-year-old participants. Women had slightly but significantly higher mean ISS scores than men. Only small differences were found between the counties.

    Conclusion: The study population came from Sweden and Finland; still, despite the different backgrounds, patterns in the distribution of inner strength were largely similar. The present study provides basic and essential information about inner strength in a population of old people.

  • 23.
    Viglund, Kerstin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsén, Elisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Inner strength as a mediator of the relationship between disease and self-rated health among old people2014Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 70, nr 1, s. 144-152Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To explore inner strength as a mediator of the relationship between disease and self-rated health among older people.

    BACKGROUND: Qualitative research has indicated that inner strength is an essential resource for an individual affected by disease. A hypothesis of inner strength as a mediator of the relationship between disease and self-rated health was proposed. The theoretical framework of inner strength was based on the Model of Inner Strength.

    DESIGN: A cross-sectional design was used.

    METHOD: The sample included 6119 participants from Finland and Sweden, in the ages of 65, 70, 75 and 80 years. The GERDA-Botnia questionnaire, which included the Inner Strength Scale and items related to diseases and self-rated health, was sent out between October and December 2010. Structural equation modelling was used to test a hypothesized model.

    RESULTS: The result indicated that having a disease was associated with poorer self-rated health and a lower degree of inner strength and a higher degree of inner strength was associated with better self-rated health. The result supported the hypothesis by indicating that inner strength partially mediated the relationship between disease and self-rated health.

    CONCLUSION: This large cross-sectional study with participants from 65 to 80 years of age from Finland and Sweden showed that inner strength can be a resource for older people affected by disease. Increasing inner strength in older people affected by disease may be one intervention to support experiences of health despite disease.

  • 24.
    Viglund, Kerstin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Jonsén, Ellisabeth
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Strandberg, Gunilla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sources and expressions of inner strength among old people who have experienced a crisis in life associated with a disease2017Inngår i: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 37, nr 1, s. 20-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Inner strength is reported as an important resource associated with aging, health, and disease management. The aim was toexplore inner strength in people (n ¼ 12) aged 65 years and older, who had experienced a crisis in life associated with a disease. The participants had self-rated their inner strength as high. We found that sources of inner strength were mutual love and support, and the fact that tough times have been managed before. Expressions of inner strength comprised focusing on possibilities instead of brooding, facing and take an active part in care and treatment, and being able to confront reality and pick yourself up again. Inner strength is a complex phenomenon. Increased knowledge of inner strength can serve as an aid inefforts to identify the need to promote inner strength.

  • 25.
    von Heideken Wågert, Petra
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Gustavsson, Janna Mc
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Kallin, Kristina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Gustafson, Yngve
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Health status in the oldest old: Age and sex differences in the Umeå 85+ Study.2006Inngår i: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 18, nr 2, s. 116-126Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND AIMS: With an increasing population aged 85 years and over, the aim of this study was to describe health status and living conditions in the oldest old and to estimate age and sex differences in a Northern European population. METHODS: A population-based cross-sectional study, The Umeå 85+ Study, was carried out in the municipality of Umeå in northern Sweden. Out of 319 eligible participants aged 85, 90 and 95 years and over, 253 participated. Structured interviews and assessments were conducted with the participants in their homes, and data were also collected from relatives, caregivers and medical charts. Cognition was screened with the Mini-Mental State Examination (MMSE), depressive symptoms with the Geriatric Depression Scale-15 (GDS-15) and nutritional status with the Mini Nutritional Assessment (MNA). Activities of daily living (ADL) were assessed applying the Staircase of ADL (including Katz' Index of ADL) and morale with the Philadelphia Geriatric Center Morale Scale (PGCMS). Participants also rated their own health. RESULTS: Over half of the participants had hypertension, one out of four was depressed, and the same proportion had had a hip fracture; the mean number of drugs taken was 6.4+/-4.0. Younger participants had lower rates of diagnoses and prescribed drugs, and were less dependent in ADL and other functional variables; men had lower rates of diagnoses and reported symptoms. The majority of participants rated their general health and morale as good. CONCLUSIONS: There were large variations in social, medical and functional variables within and between age and sex groups. This northern population of the oldest old seems to have a very high prevalence of hypertension, depression, hip fractures, and many prescribed drugs.

  • 26.
    von Heideken Wågert, Petra
    et al.
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Rönnmark, Birgitta
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Rosendahl, Erik
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Lundin-Olsson, Lillemor
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering.
    Gustavsson, Janna M C
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Nygren, Björn
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Norberg, Astrid
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Gustafson, Yngve
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Geriatrik.
    Morale in the oldest old: the Umeå 85+ study2005Inngår i: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 34, nr 3, s. 249-255Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: to describe morale among the oldest old, and to investigate which social, functional and medical factors are associated with morale in this population. DESIGN: a cross-sectional study. SETTING: a population-based study in the municipality of Umeå, a city in Northern Sweden. SUBJECTS: half of the 85-year-old population, and the total population of 90-year-olds and > or = 95-year-olds (95-103) were asked to participate (n = 319) and 238 were interviewed. METHODS: structured interviews and assessments during home visits, interviews with relatives and caregivers and review of medical charts. The 17-item Philadelphia Geriatric Center Morale Scale (PGCMS) was used to measure morale. Participants were assessed with the Barthel Activities of Daily Living (ADL) Index, Geriatric Depression Scale (GDS-15), Mini-Mental State Examination (MMSE), Mini Nutritional Assessment (MNA), and a symptom questionnaire. Multiple regression analyses were conducted to find independent factors to explain the variation in the PGCMS score. RESULTS: eighty-four per cent (n = 199) of those interviewed answered the PGCMS. Three-quarters had middle range or high morale. GDS score, type of housing, previous stroke, loneliness and number of symptoms, adjusted for age group and sex, explained 49.3% of the variance of total PGCMS score. CONCLUSIONS: a large proportion of the oldest old had high morale. The most important factors for high morale were the absence of depressive symptoms, living in ordinary housing, having previously had a stroke and yet still living in ordinary housing, not feeling lonely and low number of symptoms. The PGCMS seems applicable in the evaluation of morale among the oldest old.

  • 27.
    Wijk, Helle
    et al.
    Göteborgs universitet.
    Öhlén, Joakim
    Göteborgs universitet.
    Lidén, Eva
    Göteborgs universitet.
    German Millberg, Lena
    Karlstads universitet.
    Jacobsson, Catrine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Söderberg, Siv
    Luleå Tekniska Universitet.
    Berg, Linda
    Göteborgs universitet.
    Engström, Åsa
    Luleå Tekniska Universitet.
    Höglund, Ingela
    Borås Högskola.
    Lepp, Margret
    Göteborgs universitet och Borås Högskola.
    Lindström, Irma
    Göteborgs universitet.
    Nygren, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Persson, Cathrin
    Umeå universitet.
    Petzäll, Kerstin
    Karlstads universitet.
    Skär, Lisa
    Luleå Tekniska Universitet.
    Suserud, Björn-Ove
    Borås Högskola.
    Söderlund, Maud
    Luleå Tekniska Universitet.
    Verksamhetsförlagd utbildning på avancerad nivå: ny utmaning för specialistutbildningar för sjuksköterskor2009Inngår i: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 29, nr 4, s. 41-43Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    The aim of this article is to discuss challenges in the development of Specialist Nursing Educations as a result of the 2007 Swedish Higher EducationReform: the implementation of the so-called Bologna process. Certain challenges follow this reform, particularly since the specialist nursingprogrammes will be part of the second cycle of the higher education system, and it will be possible to combine the professional degree witha masters degree (one year). Possible strategies in four areas related to the Specialist Nursing Education are discussed: integration of researchbasedknowledge, experienced-based knowledge, improvement knowledge, and strategies for collaboration between university institutions andclinics. Specific didactical issues are raised.

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