2. Residents’ Descriptions of Meaningful Events in Nursing Homes Plan for Proposed Study N. Reimer, MS, Ph.D. candidate. Purpose Design and Sample Results Conclusions Conceptual Definitions Implications for Practice Background Text Box font 66 pt UPPER CASE TEXT BOX font 66 pt Bold Text Box font 66 pt Black outline Text Box font 66 pt While a focus on individualizing care for residents in nursing homes is now recognized, a lack of understanding exists about what events make meaning for residents in nursing homes. By year 2040, the age 65 or older portion of the global population is predicted to increase from 7% to 14%. Approximately 4% of all persons who are 65 and older or 1.5 million Americans reside in nursing homes. Investigations in care of residents in nursing homes reveal a serious need for improvement. In order to improve care, exploring patient-centered care in nursing homes has emerged with a focus on changing the culture in nursing homes. Operationalizing a culture that embraces person-centered care has been slow to develop in nursing homes. Only 5% of nursing home directors stated that their nursing home had completely transformed their nursing home cultures to include person- centered care. In order to implement person-centered care, practitioners need to understand what is meaningful for residents. There is a lack of research that targets residents‘ descriptions of meaningful events in nursing homes. Embracing the uniqueness of each resident by including meaning-making strategies may enhance person-centered in nursing homes. The primary purposes of this qualitative study are to: 1. describe meaningful events for residents in the long- term care section of nursing homes. 2. describe what meaningful events for residents could be integrated into care of residents in nursing homes. 3. reveal residents‘ descriptions of events that are not meaningful for them in nursing homes. Qualitative Descriptive Design A qualitative description is inclined to: 1. draw from the ideas of naturalistic inquiry where something is studied in a natural state s 2. generate findings close to the data and requires the researcher to draw inferences with rigor by moving the data toward some new idea or concept Sampling Method Purposive sampling of participants who reside in the long- term care sections of three mid-west nursing homes. 1. A total sample size of 15 is proposed. 2. Interviews will be conducted with eligible participants and a $25.00 gift certificate will be presented at the end of the interviews as a token of appreciation. Eligibility criteria: 1. Age 65 and older. 2. Reside in the long-term care section of nursing homes. 3. Complete the Montreal Cognitive Assessment (MOCA) with a score of 18-26 (mild-cognitive impairment) or 26 and higher (normal cognitive status). Exclusion criteria: 1. Receiving short-term care in the nursing home (< 100 days stay). 2. Score < 18 on the MOCA cognitive assessment. Sandelowski, M. (2010). What’s in a name? Qualitative Description Revisited. Research in Nursing and Health, 31(1), 77-84. Long-term care: Residents who reside in nursing homes for longer than 100 days are considered to be receiving long-term care (Centers for Medicare & Medicaid Services, 2010). Residents: Persons who reside in nursing homes for long-term or short-term care. Long-term residents have various care needs that vary from a limited scope of care to total care of their daily activities and live in nursing homes with the intention of staying more than 100 days (Centers for Medicare and Medicaid Services, 2010). Person-centered care : specific to care in nursing homes, person centered care integrates the uniqueness of the resident with elements of fostering consistent and trusting relationships, emphasizing freedom of choice, and promoting individuality (Talerico, 2003). Meaning : Occurs through self-transcendence where the person becomes open to existence and relates to something beyond the self (Frankyl, 1978). Personal Meaning : Results from a person's understanding about interactions in life. Occurs with attaining purpose and reason for existence in life, possessing a sense of direction and order, and establishing social consciousness in finding personal meaning (Reker & Wong, 1988). Meaning in life : Reflects a positive life focus where a person believes that life is fulfilled and understood within the person's highly-valued life goals (Battista & Almond, 1973). Meaning- making : Encompasses accomplishment of restoring meaning derived from the individual's shared life experiences and learned lessons when a stressful life event has been experienced (Park, 2010). Theory of Health Expanding Conciousness (HEC ): The underpinnings of HEC Theory guides nurses to establish presence with clients in authentic ways that promote clients to transform to a higher organized state of conciousness. When clients expand their conciousness, they can interact with increased complex patterns of nature such as illness or disability. Health is synonymous with expanding conciousness (Newman, 1994). Battista, J. & Almond, R. (1973). The development of meaning in life. Psychiatry, 36(4), 409-427. Centers for Medicare & Medicaid Services. (2010). Category definitions: National health expenditures. Retrieved from http://www.cms.gov/NationalHealthExpendData/downloads/quickref.pdf Frankyl, V. (1978). The unheard cry for meaning. New York, NY: Simon and Schuster. Newman, M. (1994). Health as expanding consciousness (2nd ed.). New York, NY: National League for Nursing Press. Park, C. (2010). Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin, 136(2), 257-301. Reker, G. & Wong, P. (1988). Aging as an individual process: Toward a theory of personal meaning. In Birren, J. & Bengtson, V. (Eds.), Emergent theories of aging (pp. 214-246). New York, NY: Springer Publishing Company. Talerico, K., O’Brien, J., & Swafford, K. (2003). Person-centered care: An important approach for 21 st century health care. Journal of Psychosocial Nursing & Mental Health Services, 41(11), 12-16. This tentatively proposed study will describe events that make meaning for residents and may lead nursing home caregivers to: change their practice of care in nursing homes. expand on current initiatives, such as person-centered care, for improving quality of care in nursing homes. serve as the basis for developing educational tools aimed at improving gerontological care in nursing homes. These tools could enhance nursing education for nursing home staff and nursing students. LOGO Qualitative Descriptive Method Iterative approach where sampling, data collection, analysis, and interpretation occur together Semi-structured, face to face interviews Content analysis will be used to move the data, yet keep it near to the actual findings Respondent validation, peer debriefing, expert review, reliability coding, reflexive accounting, and audit trail will be used to optimize validity. Reanalyze the data, look for informational redundancy, retain parallel categores to promote intra-rater reliability Natural unfolding of the data used to describe events that make meaning for residents