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Purpose: Developed simultaneously in English and Swedish, the Patient Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) assesses patients’ perceived difficulty managing life with long-term health conditions. This study assessed the comparability of the PRISM-CC across sociodemographic groups, number of health conditions and language (English and Swedish).

Methods: Differential item functioning (DIF) and differential test functioning (DTF) were analysed by age, gender, education level, and number of conditions using independent English and Swedish datasets. Language-based DIF and DTF were examined using pooled data. An iterative hybrid ordinal logistic regression approach was applied to identify potential DIF across the PRISM-CC’s seven domains. The impact of flagged items on total scores (DTF) was evaluated by comparing test characteristic curves.

Results: Few items were flagged for potential DIF in the English, Swedish or pooled data, and only at low cutoff values. The impact of items with potential DIF on DTF was negligible.

Conclusion: The absence of meaningful DIF and DTF in either the English or Swedish version of the PRISM-CC or between English and Swedish versions provides further support for the PRISM-CC as a valuable tool for assessing self-management ease and difficulty. These results also demonstrate the value of simultaneous development of instruments in two languages. Further evaluation of DIF is necessary in populations with greater self-management challenges, such as among people with severe disease burden.

Aim: To explore how staff promote resident thriving in an Australian nursing home.

Design: Qualitative research design using content analysis.

Methods: Interviews were held with 14 nursing staff working in an Australian nursing home in March/April 2018. Data were analysed using qualitative content analysis.

Results: Four themes were revealed: promoting personalized care; promoting opportunities for autonomy; promoting connection and meaning; and promoting a curated environment.

Conclusions: Staff promoted resident thriving in relation to everyday care, activities, capabilities, relationships and the lived environment. Interventions that were perceived to promote thriving were described relative to the nurse, the resident, the care team and the wider nursing home context.

Background: The ethical climate in healthcare is part of the work environment and a basis for professional nursing practice. The ethical climate is crucial as it is closely associated with staff job satisfaction, the quality-of-care provision, and nurses’ intention to stay in their current occupation and position. Even though several instruments assessing ethical climate in healthcare have been developed over the years, their psychometric properties have not been systematically reviewed.

Objectives: This study was conducted to identify and critically appraise the psychometric properties of instruments used to measure the ethical climate among healthcare professionals in care settings prior to the COVID-19 pandemic.

Methods: A systematic review was performed, covering papers published between 1994 and 2019, excluding grey literature sources. The literature search was performed in October 2019 in Cinahl, PsychINFO, PubMed, and SocIndex. Empirical studies were included describing the psychometric properties of instruments measuring the ethical climate among healthcare professionals in healthcare settings. Data on psychometric properties were extracted and a quality assessment was performed following the quality criteria for measurement properties proposed by Terwee et al. criteria 2007.

Result: Our search yielded 15,150 publications. After title and abstract screening, 611 studies were retained for full-text analysis, of which eight studies describing five instruments were included (five instrument development studies and three translation studies). Four studies concerned the Hospital Environment Climate Scale (HECS). All instruments had been assessed for content validity and internal consistency. Information concerning criterion validity, construct validity, and reproducibility was lacking or intermediate. No information concerning floor/ceiling effect or interpretability was reported in most cases. One study reported having performed a test-retest analysis. None of the included studies fulfilled all the Terwee et al. criteria.

Conclusion: Five instruments were identified as having undergone psychometric testing; however, none fulfilled all the criteria outlined by Terwee et al. Also, only one of the instruments had been subjected to the well-established test-retest analysis. This highlights a need for further well-structured validation studies of instruments assessing the ethical climate among healthcare professionals in care settings.

Objective: This study describes patterns of self-management ease and difficulty among older adults with long-term health conditions and the associations with gender, level of education, number of conditions, depression and/or health status.

Materials and methods: Cross-sectional data were collected between 2021–2022 in a municipality in northern Sweden. The survey included demographic and health-related questions. To assess self-management ease or difficulty and symptoms of depression, the Patient Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) and the Geriatric Depression Scale were used. 516 older adults between 72–73 years of age with long-term health conditions were included. Descriptive statistics and logistic regression were used to describe patterns of self-management ease and difficulty and to examine which factors were associated with self-management difficulty.

Results: Most older adults did not experience self-management difficulty. There were, however, differences between the seven PRISM-CC domains. The Internal domain (managing negative emotions and stress) had the highest percentage (25.39%) of older adults with self-management difficulty. In all domains, there was also a subgroup of individuals (n = 26) that had noticeably lower PRISM-CC scores (more difficulty). A strong association between having depressive symptoms or having poor health status and self-management difficulty was found.

Conclusion: This study highlights the need for regular mental health screenings and individualized self-management support for older adults. Future research should explore intervention strategies that integrate mental health support into self-management programs for individuals with long-term health conditions.

Background: Self-management is internationally recognized as important to maintain independence, quality of life and to minimize the risk of poor health outcomes, especially among persons with multi-morbidity. Self-management can be especially challenging for older adults, who have higher rates of multi-morbidity and experience diverse impacts of long-term health conditions on everyday life. Good measures of self-management are currently lacking. The Patient Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) is a new, generic, multidimensional measure of self-perceived ease or difficulty with self-management, that overcomes many of the limitations of existing measures.

Objectives: To test the structural validity and test-retest reliability of the Swedish version of the PRISM-CC among seventy-year-olds with long-term health conditions.

Methods: Translation of PRISM-CC items into Swedish followed the Patient-Reported Outcome (PRO) Consortium process. Survey data (n = 516 Swedish seventy-year-olds with ≥1 long-term health condition) was used to assess structural validity of the 36-item PRISM-CC using multidimensional item response theory (IRT) models. Test-retest reliability was assessed on a subsample of 58 individuals using intra-class correlation coefficient (ICC) and Bland-Altman Plots.

Results: The Swedish PRISM-CC demonstrated good internal consistency with Cronbach’s alpha >0.8 for all domains, and good fit to a graded response IRT model (RMSEA 0.034, SRMSR 0.050, CFI 0.952 and TLI 0.945). All 36 items had standardized loadings >0.7. ICC showed moderate to good test-retest reliability for all seven domains. The Bland-Altman plots showed minimal bias and good test-retest agreement for all domains.

Conclusion: The Swedish PRISM-CC showed good structural validity and test-retest reliability in this sample of relatively healthy seventy-year-olds with long-term health condition(s). Further validation in a population with more severe health issues is needed.

Persons with severe mental ill-health die early from preventable physical ill-health. Registered nurses in psychiatric outpatient care play a key role in improving persons’ physical health, and it is important to examine how they view their responsibility, their experiences of care, and the obstacles they meet in providing person-centred care. The purpose of this study was to explore registered nurses’ experiences of caring for persons with mental ill-health and somatic comorbidity in psychiatric outpatient care, using qualitative content analysis to analyze data from semi-structured interviews. The results show that these nurses monitored the person’s right to equal care, embraced the whole of the persons suffering, and dealt with unclear boundaries in care. This highlights the unique role that registered nurses play in psychiatric outpatient care via their ability to interpret symptoms and find ways to adapt care based on persons’ needs. Registered nurses consider physical health in all care and provide a link between psychiatric and somatic care. Together with mental health nurses at primary health care centers, they are key in reducing persons’ suffering. There is a need for structural and functional changes in line with person-centred care including collaboration both within and outside healthcare organizations.

ObjectiveThis study aimed to explore changes to resident thriving in Swedish nursing homes over a 5-year period and describe changes in associated factors.

MethodsCross-sectional data were collected from a randomised sample of Swedish nursing homes in 2013/2014 (baseline) and 2018/2019 (follow-up). Descriptive statistics, independent samples t-tests, and chi squared tests were used to statistically evaluate differences between the samples. Simple and multiple linear regression analyses were used to explore associations between thriving and the study variables.

ResultsResident characteristics were relatively consistent between the full baseline (N = 4831) and follow-up (N = 3894) samples. Within a sub-sample of nursing homes that participated in both data collections mean thriving scores were found to have increased from 152.9 to 155.2 (p ≤ 0.003; d =0.09) and overall neuropsychiatric index scores had decreased from 16.0 to 14.3 (p ≤ 0.004; d =0.09), as had the prevalence of several neuropsychiatric symptoms. Thriving was found to have a positive association with the neuropsychiatric symptom of elation/euphoria, and negative associations with the symptoms of aggression/agitation, depression/dysphoria, apathy, and irritability.

ConclusionsThe results show an increase in overall thriving scores and a decrease in overall neuropsychiatric scores between baseline and follow-up. This study confirmed associations between thriving and certain neuropsychiatric symptoms and established comparative knowledge regarding changes in resident thriving, characteristics, and symptom prevalence. These findings could inform future care and organisational policies to support thriving in nursing homes, particularly among residents at risk of lower thriving due to cognitive impairment or neuropsychiatric symptoms.

Background: Physical inactivity and low muscle mass are risk factors for falls, fractures and overall poor health. However, physical activity is reduced with increased age and only a fraction of older adults engages in resistance training (RT). Thus, strategies that facilitate RT among older adults are needed. The aim of the present study was to evaluate the effectiveness and user experience, and explore barriers and motivators toward an online delivered, home-based RT program in older adults with low muscle mass.

Methods: Thirty men and women, 70–71 years of age with low muscle mass were assigned home-based RT with online exercise videos (3 times/week, 45 min/session for 10 weeks) accompanied with an initial supervised try-out session. Quantitative outcome measures included changes in lean body mass and physical function. Semi structured one-to-one interviews with a subset of the participants (n = 8) were also conducted to generate a greater understanding of the participants experience of the digitally supported RT. The material was transcribed and analyzed with qualitative content analysis.

Results: Twenty-seven participants (90%) completed the trial. Lean body mass increased by 0.39 kg (95% CI: 0.06–0.72, p < 0.05) and chair stand time improved by 1.6 s (95% CI: 0.8–2.3, p < 0.001). No significant improvements were seen for balance or gait speed. The theme “Engaging in Digital Resistance Training with Personal Adaptation Leads to a Sense of Strength and Vitality” captured the participants experience of the intervention, where a sense of how the body was changing toward a more active lifestyle was described. Instructions, feedback, and intrinsic motivation were identified as key elements for compliance. 

Conclusion: The online delivered RT program for older adults with low muscle mass was feasible based on high compliance, user satisfaction, increased lean mass and improved chair-stand time. The participant experiences may explain the high compliance to the intervention and effects on outcomes. Based on these results, online delivered RT could be an accessible exercise routine for older adults with low muscle mass. More research is needed to verify the present findings and assess changes in a long-term perspective.

Aim: To explore contributors for thriving in nursing homes by evaluating, analysing and synthesizing peer‐reviewed qualitative literature on the topic.

Background: Thriving is a positive life‐world concept that has been explored by several qualitative studies; however, descriptions of thriving and contributors to thriving have not been compared or contrasted among different studies and contexts, nor have they been reviewed and synthesized.

Design: Qualitative meta‐ethnography.

Data sources: Four electronic databases were searched in October 2019, with sources published between 2000 and 2019 included.

Review methods: Sources of peer‐reviewed literature that employed qualitative methods to explore thriving in nursing homes were evaluated. In total, 1,017 sources were screened at title‐level, 95 advanced to abstract‐level review and 11 were assessed at full‐text level. Each source was evaluated by two researchers independently in relation to methodological quality and relevance to the study aim. Themes pertaining to thriving in nursing homes were extracted, interpreted and synthesized.

Results: In total, seven sources of peer‐reviewed literature were included. Two main themes illustrating the contributors to thriving were identified: ingredients for thriving (subthemes: personal contributors and social contributors) and environment for thriving (subthemes: spacial contributors and societal contributors).

Conclusion:Contributors to thriving in nursing homes include personal attributes, relationships with others, the lived environment and societal structures. Thriving for older people could thereby be defined as a holistic concept denoting lived experiences of situated contentment. Future studies should explore different temporal facets of thriving in the nursing home setting.

Impact: This meta‐synthesis proposes a ‘recipe’ for thriving as comprising the right ingredients and the right environment, determined by the preferred ‘taste’ of the individual person. The proposed definition and contributors illuminate thriving as a positive life‐world concept that is based on one's lived experiences and context.

BACKGROUND: Thriving has emerged as a contemporary and health-promoting concept for older people living in nursing homes; however, there has been limited research to explore how nursing home staff identify thriving in their everyday practice. The aim of this study was to explore how staff recognize expressions of thriving among persons living in nursing homes.

METHODS: Semi-structured interviews were conducted with 14 nurses working at a nursing home in Victoria, Australia. The interviews were audio-recorded, transcribed and analyzed using qualitative content analysis.

RESULTS: The analysis resulted in six sub-categories and three main categories. Expressions of thriving were recognized in relation to how staff understood thriving, observed thriving and sensed thriving. Staff described comparing and contrasting clinical assessment indicators with their own personal and professional understandings of thriving, as well as their overall sense of the individual person within the wider situational and environmental context.

CONCLUSIONS: Our results illuminate how staff recognize everyday expressions of thriving for people living in nursing homes and emphasizes the importance of utilizing person-centred care principles in clinical assessments. These findings have practical implications with regards to how thriving is identified and assessed in long-term care, and could be used to inform and guide staff education, person-centred care strategies, and organizational policies to better support and promote thriving in nursing homes.