Academic journal article Journal of Nursing Measurement

The Herth Hope Index-A Psychometric Study among Cognitively Intact Nursing Home Patients

Academic journal article Journal of Nursing Measurement

The Herth Hope Index-A Psychometric Study among Cognitively Intact Nursing Home Patients

Article excerpt

Background and Purpose: Hope is seen as the act by which the temptation of despair is actively overcome and has thus been interpreted as an inner strength and an available resource for living in the present. An understanding of hope and its meaning in the lives of institutionalized older adults may aid in developing interventions to enhance hope and well-being in the nursing home setting. This study aimed to investigate the psychometric properties of the Norwegian version of the Herth Hope Index among cognitively intact nursing home patients. Methods: Cross-sectional data was obtained in 2008 and 2009 from 202 of 250 patients who met the inclusion criteria in 44 different nursing homes. Results: Exploratory factor analysis revealed 3 internal consistent dimensions of hope, explaining 51.2% of the variance. The 1-factor, 2-factor, and the originally 3-factor solutions of the Herth Hope Index were tested by means of confirmatory factor analysis. A 2-factor construct comprising 11 items came out with the best model fit. Conclusions: The Herth Hope Index was found to be a reliable and valid instrument for assessing hope in nursing home patients. The 2-factor structure was psychometrically superior the original 3-factor construct of hope in this particular sample. The Herth Hope Index might be used to assess hope and changes in the hope process during long-term nursing home care. An enhanced understanding of hope in this population might contribute to increased quality of nursing home care.

Keywords: confirmatory factor analysis; Herth Hope Index; nursing home; psychometric properties

With advances in medical technology and improvement in the living standard globally, the life expectancy of the population is increasing worldwide. A huge shift to an older population and its consequences is highlighted, and people more than 80 years old is the most rapidly growing segment (U.S. Census Bureau, 2009). By 2050, the percentage of those 80 years and older would be 31%, up from 18% in 1988 (Organisation for Economic Co-operation and Development [OECD], 1988). These perspectives have given rise to the notions of the "third age" (65-80 years old) and the "fourth age" (older than 80 years old) in the life span developmental literature (Baltes & Smith, 2003), which are also referred to as the "young old" and the "old old" (Kirkevold, 2010).

Aging as a biological process has been extensively studied, but less attention has been paid to the study of aging as a spiritual process, especially among nursing-home (NH) patients. Moving to an NH results from numerous losses, illnesses, disabilities, loss of functions and social relations, and approaching mortality, all of which increases individual's vulnerability and distress. The NH life is institutionalized, representing loss of social relationships, privacy, self-determination, and connectedness. Thus, NH patients are more likely to feel hopeless and to become depressed. Significantly more hopelessness, helplessness, and depression are found among patients in NHs compared to those living in the community (Ron, 2004); Jongenelis and colleagues (2004) found three to four times higher depression in NH patients than in community-dwelling adults. Hence, meeting their spiritual needs for hope might be a greater challenge for NH patients than for healthier, more functional, and community-dwelling older people. Previous studies on hope, quality of life (QoL; Duggleby et al., 2007; Hodge & Horvath, 2011; Hodge, Horvath, Larkin, & Curl, 2012), and spiritual well-being (Bredle, Salsman, Debb, Arnold, & Cella, 2011; Burack, Weiner, Reinhardt, & Annunziato, 2012; Gibson, 2000) have shown a strong positive relationship between these concepts. Hence, by increasing hope nurses may be able to contribute to patients' QoL (Herth, 2000), which is a main goal in NH care (Drageset et al., 2009).

BACKGROUND AND CONCEPTUAL FRAMEWORK

The hope dimension has been largely described in nursing theories (Kylmä & Vehviläinen-Julkunen, 1997; Miller, 2007). …

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