"Thesis--University of Southern California. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

"Thesis--University of Southern California. / Includes bibliographical references.

One challenge in the Western world is the risk of functional impairmentand chronic disease accompanying older age. In Norway it is expected thatmost chronically ill older persons will continue to live at home and receivehelp from home nursing care. The inner strength of the oldest old, as seenin relation to the help that is given, and whether the help has contributed tostrengthen the will to live has been explored only to a limited extent.Meaning in life and daily routines can be related to the will to live,understood as enjoying life and having the courage to live. The aim of thisstudy is to develop knowledge in regard to chronically ill oldest olderpersons and the possibilities and limitations in their will to live when theyreceive help from home nursing care.This study uses the quantitative method (n=120, Article 1 and Article 2) todescribe the characteristics of inner strength using the questionnairesResilience Scale, Sense of Coherence Scale, Purpose in Life Test, and Self-Transcendence Scale. Inner strength was seen in relation to mental andphysical health using the questionnaire SF-36. The qualitative method wasused to illuminate how the oldest older persons experienced living at homewith chronic illness (n=13, Article 3) and receiving help from home nursingcare (n=11, Article 4). The participants in this study were 80 years old orolder, living at home with chronic illnesses, and receiving help from homenursing care. All participants were determined to have the mental capacityto take part in this study.The analysis showed in Article 1 that the oldest old had an inner strengthexpressed as ”sense of coherence” and ”purpose in life.” Their innerstrength was accompanied by the ability for self-transcendence. Mentalhealth was predicted by self-transcendence (p < 0.001) for the total sampleand for women. Physical health was predicted by self-transcendence (p <0.01) for the total sample. Low resilience contributed to vulnerability for theparticipants. They were vulnerable in terms of limited perseverance, selfreliance,and existential aloneness (Article 2). On the contrary, theyexperienced equanimity and meaning. Meaning in daily life (Article 3)sometimes meant feelings of insufficiency and dependency. In contrast,they also experienced joy in life, gratitude for living at home, and aneagerness to participate in activities that made them feel alive. Theyexperienced both good and bad days, which depended on their illness butwas also based on how their needs for help and support were met. InviiArticle 4, receiving help indicated different experiences. Being ill anddependent on help led to days with illness, treatment, and receiving care. Italso indicated they were in need of professional help. Receiving help couldmean being at the mercy of helpers, which could imply unworthy help, asthey had no influence on the help they got from incompetent nurses whofocused only on tasks, with limited flexibility in their work, using theirhomes as a working place. This situation of receiving help from busynurses caused the old person to feel inferior as a human being. Other timesit meant receiving help from nurses who took care with respect to the oldperson and confirmed him or her as a human being. The older personswanted to be seen, met, and supported to strengthen their courage to meetthe challenges of being old and ill.According to the ethics of caring, human beings are vulnerable andmutually dependent on each other. This influences the possibilities andlimitations of ”the other” in experiencing a will to live. ”Receiving theother” can contribute to the will to live, influenced by the help received inan asymmetric dependency in which the nurses are caught in the tensionbetween suffering and the will to live for the oldest older person in need ofhelp. In this tension, the will to live is dependent on help that is given in arelationship characterized by caring and responsibility for the other.

The aim of this thesis is to inform in detail about the latest clinical and nursing practice trends concerning the needs of patients in vegetative state and their carers. It also deals with relations in the system of long-term nursing care, providing medical and social services and rehabilitation. It also tries to point out the most pressing problems of the current situation of patients in vegetative state and their families, especially in terms of patient discharge to home care and availability of services specified for this target group. The latest findings and proven methods will be summarized in a simple and understandable form, which will serve as a guide both for health professionals and caregivers.For this thesis the Review and synthesis method will be used. The overview of current knowledge and studies in the field of care for patients in vegetative state will be synthesized and focused on home care with recommendations for practice and indications of weak spots.Long-term follow-up nursing and rehabilitative care is necessary for these patients. A special chapter is focused on the specific needs of patients in vegetative state and appropriate nursing care, rehabilitation and release issues. The fundamental part is the consistency of formal and informal care, caregiver preparation for their future role and related socio-economic issues. In conclusion the legal and ethical aspects of the whole field are mentioned regarding medical and nursing care of patients in vegetative state.In line with the objective of this thesis a manual will be created for potential informal carers on how to care for their loved ones, where to go in the case of emergency and what steps to take during the intermediate stage of institutional and home care. The results can be used for further exploration and as an additional source of information for health professionals.