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BACKGROUND: The World Health Organization's Quality of Life Questionnaire (WHOQOL-Bref) is a frequently used instrument to assess the quality of life in both healthy and ill populations. Inquiries of the psychometric properties of the WHOQOL-Bref report that the validity and reliability is generally satisfactory. However, some studies fail to support a four-factor dimensionality; others report poor reliability of the social and environmental domain; and there may be some challenges of supporting construct validity across age. This paper evaluates the psychometric properties of the Norwegian WHOQOL-Bref and extends previous research by testing for measurement invariance across age, gender and education level. In addition, we provide updated normative data for the Norwegian population. METHODS: We selected a random sample of the Norwegian population (n = 654) aged 18-75 years. Participants filled out the WHOQOL-Bref, the Utrecht Work Engagement Scale and various sociodemographic variables. RESULTS: We found an acceptable convergent and discriminate validity and internal consistency of the physical, psychological and environmental domains, but a marginal reliability was found for the social domain. The factor loadings were invariant across gender, education and age. Some items had low factor loadings and explained variance, and the model fit for the age group 60-75 years were less satisfactory. CONCLUSIONS: The original four-factor dimensionality of the WHOQOL-Bref displayed a better fit to the data compared to the one-factor solution and is recommended for use in the Norwegian population. The WHOQOL-Bref is suitable to use across gender, education and age, but for assessment in the oldest age group, the WHOQOL-Old module could be a good supplementary, but further studies are needed.

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In Norway, approximately 50% of older people die in nursing homes (NH). Holistic care and pharmacological management are key factors in quality at the end of life. The purpose of this longitudinal study was to describe the use of opioids in an NH during a 5-year period. We focused on palliative care, symptoms, and suffering during the last 3 days before death. Data were collected from spring 2013 to spring 2018. We used the interRAI assessment instrument annually and when the resident died. We conducted a semi-structured interview with nurses on duty at the deathbed. At the time of death, the residents had an average age of 88.9 years and an average stay of 2.9 years (N = 100). At the first assessment, 19% of the residents used 1 or more type of opioids. On the day of death, 55% had an active prescription for opioids, mainly as subcutaneous injections. The results illustrate the different uses of opioids, including managing pain, dyspnoea, sedation, for comfort, as a prophylaxis, or a combination of reasons. Cancer- and cardiovascular diagnoses were the strongest predictor for using morphine (P < 0.05). Identification of the residents' needs for opioids is a challenge for palliative care nurses, both ethically and legally.

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Guided by the Identity Process Theory, we examined whether 424 Norwegians 60+ years of age would attribute their physical and mental functioning to their health (identity assimilation), to aging itself (identity accommodation), or to both (identity balance). We were also interested in the effect of these attribution styles upon depressive symptoms. Secondary data from the 2004 World Health Organization Quality of Life OLD Group Norwegian Field Study were analyzed using General Linear Model Regression and subsequent Path Analyses. Attributing physical functioning to health as opposed to aging had a negligible effect on depressive symptoms among both study groups. Attributing mental functioning to aging worsened depressive symptoms among rural participants. Attributing mental functioning to health was associated with more positive perceptions of psychosocial loss among urban participants. Positivity toward psychosocial loss lessened depressive symptoms and factors affecting those perceptions differed among rural versus urban participants. Adapting to functional changes in older age is a complex process affecting depressive symptoms.

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Attitudes toward ageing have powerful influences and impact older adults' own perception of health, quality of life and utilisation of health and social care services. This study describes attitudes to ageing among 490 Norwegian older adults living in the community who responded to The Attitudes to Ageing Questionnaire. Results showed that in spite of physical changes and psychological losses, the attitudes of older adults support life acceptance with gained wisdom in feeling that there were many pleasant things about growing older and that their identity was not defined by their age. They demonstrated the ability to incorporate age-related changes within their identities and at the same time maintain a positive view of self. Although they acknowledged that old age represented a time of loss with decreasing physical independence, they meant that their lives had made a difference, they wanted to give a good example to younger persons and felt it was a privilege to grow old.

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AIMS AND OBJECTIVES: The aim of this article is to explore the meanings given to the words 'spirituality', 'religiousness' and 'personal beliefs' by a Norwegian sample of healthy and sick individuals. BACKGROUND: Studies show that a high proportion of nurses do not identify the spiritual needs of their patients, even if the nurses are educated to give care for the whole person, including the spiritual dimension. DESIGN: This study used an exploratory qualitative design. METHODS: Qualitative data generated from six focus groups were collected in southeast Norway. The focus groups were comprised of three groups of health professionals (n = 18) and three groups of patients from different institutions (n = 15). RESULTS: The group discussions revealed that the meanings of spirituality, religiousness and personal beliefs were interwoven, and the participants had difficulty in finding a common terminology when expressing their meanings. Many of the participants described the spiritual dimension with feelings of awe and respect. They were dependent on spirituality in order to experience balance in life and cope with life crises. CONCLUSION: The themes and categories identified by the focus group discussion highlights that spirituality ought to be understood as a multilayered dimension. An appreciation of the spiritual dimension and it's implication in nursing may help to increase health and decrease suffering. RELEVANCE TO CLINICAL PRACTICE: Health professionals need to be cognizant of their own sense of spirituality to investigate the spiritual needs among their patients. This study's focus group discussions helped both patients and health professionals to improve their knowledge regarding the meanings given to the spiritual dimension.

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PURPOSE: The purpose of this study is to describe the Norwegian translation of the World Health Organization Quality of Life Spirituality, Religiousness, and Personal Beliefs module. DESIGN: This is an exploratory study using convenience sampling. METHOD: Translation has followed the World Health Organization's standardized protocol. Six focus groups were recruited from six geographical regions in southeastern Norway: three groups of health professionals (n = 18) and three groups of patients (n = 15). RESULTS: All facets and items were found to be culturally relevant. The facet awe underwent three literary changes, spiritual strength two, and meaning, inner peace, and faith underwent one change each. The facets spiritual connection, wholeness, and integration and hope and optimism did not undergo any changes. The facets spiritual connection, meaning in life, experiences of awe, and wholeness and integration displayed the strongest discriminatory power. Internal consistency reliability of the overall module tested with Cronbach's alpha was high (α = .93). CONCLUSION: Translating questionnaires and adapting them in comprehensible forms, while maintaining the meaning of the original items, is a challenge in holistic nursing. Even though certain difficulties in comprehension were revealed, the results of this study indicate that all facets and items on the Spirituality, Religiousness, and Personal Beliefs module were equally important.

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The quality of life of cancer relatives should influence the justification, selection, and modification of nursing interventions in the cancer patient-family dyad. To justify these interventions, relevant, valid, and reliable quality of life assessments are needed. The purpose of this study was to examine the relevancy, validity, and reliability of the World Health Organization Quality of Life Instrument-BREF in a sample of 435 Norwegian cancer relatives. The World Health Organization Quality of Life Instrument-Short Form is a multidimensional, generic instrument designed for the assessment of quality of life cross-culturally. Cronbach alpha ranged from .59 in the social domain to .86 in the psychological domain. Correlational analysis confirmed the relevancy of the items and domains and lent partial support to the construct validity of the scale. Multivariate analyses showed that all domains were significant explanatory variables for overall quality of life and health satisfaction with the exception of the environmental domain. Subgroups effects were best shown by the physical domain. Factor analysis resulted in a 4-factor solution, with 24 items explaining 57% of the cumulative variance in this sample. Results of a confirmatory factor analyses showed reasonably good fit indices, although several covariates between the residuals had to be added, and the covariates between the factors were high. The World Health Organization Quality of Life Instrument-BREF has been translated into 40 languages. It is hoped that cancer nurses will continue to test the instrument in various groups of relatives so that scale validity and conceptual clarity can be improved and subgroup interactions confirmed.

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The aim of this study was to examine the validity and reliability of the WHOQOL-BREF, a generic quality of life scale, among older people in Canada and Norway. Very similar data from the Canadian and Norwegian Field Trial data (Canada n = 192; Norway, n = 469) were analyzed and compared. Higher negatively skewed mean scores were found for all WHOQOL-BREF domains in Canada. For both study samples, missing values were highest for the sex item from the social domain. Ceiling effects were found (Canada n = 21; Norway n = 11) primarily among items in the physical and environmental domains. In both study samples, a multitrait multimethod procedure indicated items correlated most strongly with their parent domains; however, equally appreciable correlations were observed between physical, psychological, and environmental items (r = 0.33-0.64; p < 0.01). The social domain had the lowest internal consistency (α = 0.67 Canada, α = 0.55 Norway). Confirmatory factor analyses (CFA) yielded marginal goodness-of-fit between the hypothesized WHOQOL-BREF measurement model and the sample data as well as differing patterns of domain misspecification. Patterns of correlations (p < 0.01) of WHOQOL-BREF domains with WHOQOL-OLD facets, a global QOL item, the SF-12, and the geriatric depression scale provided evidence of convergent and divergent validity. Domain scores also significantly discriminated between health and unhealthy populations and presence of morbidity. Empirical support was found, in part, for the construct validity of the WHOQOL-BREF in older adults. Despite some different patterns found in the CFA, possibly due to cultural or sampling differences, it appears that the instrument is reliable, valid, and facilitates cross-cultural comparisons.

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The purpose of this paper was to describe quality of life (QoL) following an acute exacerbation of chronic obstructive pulmonary disease (COPD), and to examine possible relationships between QoL, health status, psychological distress and QoL. This prospective longitudinal study examined data from hospitalization and two subsequent phases, collected over a 9-month period. The sample consisted of 51 COPD patients aged 48-87 years. Health status was assessed with the St George's Respiratory Questionnaire (SGRQ); psychological distress with the Hopkins Symptom Checklist (HSCL); and quality of life using the World Health Organization Quality of Life - Bref (WHOQOL - Bref). Health status improved significantly over the 9 months; from 65.95 to 59.40 (p = 0.001) in the SGRQ total score. Psychological distress improved significantly from hospitalization to the 1-month assessment (T2) (p = 0.001). QoL remained stable except for a significant increase in the physical domain from hospitalization to T2, and in the environmental domain from hospitalization to T2 and T3. Test-retest correlations of the WHOQOL - Bref were high. The results suggest an improvement in the health status over a 9-month period from being discharged after an exacerbation of COPD in spite of high levels of psychological distress and reduced QoL.

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BACKGROUND: Previous studies have emphasized the importance of coping in patients with chronic obstructive pulmonary disease (COPD). In other medical conditions, inadequate coping is associated with higher levels of psychological distress. Therefore, the types of coping strategies that patients use may also influence the distress that accompanies an acute exacerbation of COPD. OBJECTIVES: The objective was to examine the prevalence of psychological distress in patients hospitalized for an acute exacerbation COPD, assess how they appraise and cope with the recent stressful event, and examine the relationships among coping, appraisal, and psychological distress. THEORETIC FRAMEWORK: Lazarus and Folkman's cognitive-motivational-relational meta-theory guided this study. METHODS: A descriptive, cross-sectional design was used to analyze baseline data from 92 participants of a longitudinal study of patients hospitalized with an acute exacerbation of COPD and followed for up to 9 months after discharge. The baseline interview included an assessment of demographic and clinical characteristics, coping, appraisal, and psychological distress. RESULTS: The majority of patients demonstrated psychological distress (64%), identified their current breathing problem as their stressful event (68.5%), and appraised the mean intensity of the event at 5.57+/-1.55 (scale range: 1, not stressful to 7, most stressful). Approximately half of the respondents (51%) characterized the stressful event as representing a threat, 26% as harmful, 7.6% as a loss, 4.3% as a challenge, and 11% chose other terms to characterize the stressful event. The majority of patients (61%) reported that the stressful event was something they had to accept, 21.7% thought they could change or do something about it, and the remainder needed more information. There were no significant differences between patients with and without psychological distress with regard to demographic characteristics, disease severity (forced expiratory volume in 1 second), types of stressful event, stress intensity, primary or secondary appraisal, or number of coping strategies used. However, problem-solving coping strategies were inversely related to psychological distress. CONCLUSIONS: Timely identification and use of problem-solving coping strategies may help reduce the psychological distress experienced during acute hospitalizations for COPD.

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OBJECTIVES: To investigate the prevalence of psychological distress in hospitalized patients with chronic obstructive pulmonary disease (COPD), and to examine possible associations between psychological distress and several sociodemographic variables. METHODS: The Hopkins Symptom Checklist was used to gather data from 92 hospitalized COPD patients. These data were compared with 3,319 respondents aged 45 or over drawn from the 1998 Norwegian Statistics Health Survey. The latter were divided into four groups: respondents with COPD, respondents with other respiratory diseases, respondents with mixed chronic diseases, and a healthy group. RESULTS: The prevalence of psychological distress was found to be 58.7% in the hospitalized COPD patients and 42.9% in the community-based COPD sample. After controlling for sociodemographic variables and current smoking, the results showed a higher risk of psychological distress among hospitalized COPD patients (OR = 23.69; 95% CI: 13.37-41.98) and the community-based COPD sample (OR = 18.16; 95% CI: 8.31-39.68), and with sub-samples with other respiratory diseases (OR = 5.87; 95% CI: 3.82-9.02), and mixed chronic diseases (OR = 3.51; 95% CI: 2.39-5.18). CONCLUSIONS: COPD is associated with a high prevalence of psychological distress in both hospital and community settings. Furthermore, it appears that age, gender, education, marital status, and current smoking status do not substantially mediate the association between the severity of psychological distress and COPD status. The results provide additional evidence of the importance of screening for psychological distress symptoms in both hospitalized and community-based patients with COPD.

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BACKGROUND: Knowledge of what may influence patients' perceptions of quality of life is essential for improving nursing interventions, but there has been little research on the influence of psychological distress on health status and quality of life among patients with chronic obstructive pulmonary disease. AIM: This paper reports a study whose aim was to examine how disease factors and health status affect psychological distress and subjectively perceived quality of life in patients admitted for an acute exacerbation of chronic obstructive pulmonary disease. METHOD: A convenience sample of 92 inpatients (mean age 69 years) were interviewed using the St George's Respiratory Questionnaire, Hopkins Symptoms Check List (23 item version), and World Health Organization Quality of Life Assessment. Disease variables (disease duration and pulmonary function) and health status were entered in blockwise multivariate regression analyses to examine the relationships between disease variables, psychological distress, and a single item assessment of overall quality of life. RESULTS: The St George's Respiratory Questionnaire Total and Impact subscores showed statistically significant associations with psychological distress. Pulmonary function showed a moderately significant association with subjective perceived quality of life. Pulmonary function and disease duration explained a minor part of the variance in quality of life. Psychological distress had a statistically significant association with quality of life and accounted for 34% of the total 39% variance explained by our model. CONCLUSIONS: The influence of psychological distress on quality of life implies that bringing about change in psychological distress factors may have important consequences for quality of life. The findings should be taken seriously in developing future nursing interventions for this group of patients.

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