Solveig Thorbjørnsen Tomstad

• Tomstad, Solveig Thorbjørnsen; Sundsli, Kari; Sævareid, Hans Inge & Söderhamn, Ulrika (2024). Social Contact and Belonging Among Older People Receiving Home Care Nursing. Journal of Multidisciplinary Healthcare. ISSN 1178-2390. 17, s. 1189–1198. doi: 10.2147/JMDH.S452081.
• Tomstad, Solveig Thorbjørnsen; Sundsli, Kari; Sævareid, Hans Inge & Söderhamn, Ulrika (2021). Loneliness Among Older Home-Dwelling Persons: A Challenge for Home Care Nurses. Journal of Multidisciplinary Healthcare. ISSN 1178-2390. 14, s. 435–445. doi: 10.2147/JMDH.S298548. Fulltekst i vitenarkiv
• Terkelsen, Toril Borch; Nodeland, Siren Mathisen & Tomstad, Solveig Thorbjørnsen (2019). Robert Nozick and Axel Honneth: An attempt to shed light on mental health service in Norway through two diametrical philosophers. Nursing Philosophy. ISSN 1466-7681. doi: 10.1111/nup.12244. Vis sammendrag

  This article aims at giving insight into Norwegian mental health service by exploring the ideologies of two diametrical philosophers, the American Robert Nozick (1938– 2002) and the German Axel Honneth (1949‐). Nozick proposes as an ideal a minimal state in which citizens have a “negative right” to the absence of interference and to follow their own interests without restriction from the state. On the other side,Axel Honneth claims that there is no freedom without state interference. In his view, governmental involvement is understood as a prerequisite for personal freedom. We may call this state an opposite of the minimal state; a maximal state. To get a better understanding of these opposite philosophies, we use texts written from conversations with people suffering from mental health problems, nurses and other caregivers in four Norwegian municipalities. Nozick's notion of the minimal state and Honneth's political philosophy of freedom and recognition were used as analytical tools. Among patients and helpers, there were different opinions about good care and how much caregivers should intervene. Some emphasized autonomy, independency, minimal involvement in human contact by nurses and other caregivers, similar a minimal state.Others perceived good care as bonding between helpers and service‐users. They ununderlined equal and personal relationships, as well as helping with practicalities, similar a maximal state. In the discussion, we focus on how people with chronic illnesses are supposed to transform themselves into self‐cared individuals, able to manage their own condition successfully with minimal help from public welfare and at a lower cost. Finally, we express concerns about who will care for disempowered patients without family and other resources in a minimal state.

• Tomstad, Solveig Thorbjørnsen; Dale, Bjørg; Sundsli, Kari; Sævareid, Hans Inge & Söderhamn, Ulrika (2017). Who often feels lonely? A cross-sectional study about loneliness and its related factors among older home-dwelling people. International Journal of Older People Nursing. ISSN 1748-3735. 12(4). doi: 10.1111/opn.12162. Vis sammendrag

  Aim and objectives: To investigate the prevalence of individuals who often feel lonely among a sample of Norwegian older home-dwelling people aged ≥65 years old, as well as to identify any possible factors explaining their loneliness. Background: Loneliness is known to be common among older people. To identify those older adults who are lonely, and to acquire knowledge about the complexity of their loneliness, is important to provide them with adequate help and support. Design: This study employed a cross-sectional design. Method: A questionnaire was mailed to a randomised sample of 6,033 older home-dwelling persons aged ≥65 years. A total of 2,052 persons returned the questionnaire and were included in the study. The questionnaire consisted of questions asking whether the subjects often felt lonely or not, as well as health-related and background questions and instruments to measure the participants’ sense of coherence, mental problems, nutritional screening and self-care ability. The data were analysed using univariate and multivariate statistical methods. Results: A total of 11.6% of the participants reported often feeling lonely. Six factors emerged to be independently associated with often feeling lonely among the respondents: Living alone, not being satisfied with life, having mental problems, a weak sense of coherence, not having contact with neighbours and being at risk for undernutrition. Conclusions: The study shows that often feeling lonely among older home-dwelling persons is a health-related problem that includes social, psychological and physical aspects. Moreover, these persons have limited resources to overcome feelings of loneliness. Implications for practice: Lasting loneliness among older home-dwelling persons requires an overall, person-centred and time-consuming approach by nurses. Nurses with advanced knowledge on geriatric nursing may be required to offer appropriate care and support. Healthcare leaders and politicians should offer possibilities for adequate assessment, support and help.

• Tomstad, Solveig Thorbjørnsen; Söderhamn, Ulrika; Espnes, Geir Arild & Söderhamn, Olle (2013). Nutritional self-care in two older Norwegian males - A case study. Clinical Interventions in Aging. ISSN 1176-9092. 8, s. 609–620. doi: 10.2147/CIA.S45458. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: How to support nutritional self-care among older vulnerable individuals living in their own homes can be considered important knowledge for health care professionals. Aim: The aim of this case study was to evaluate the effects of a nutritional intervention by comparing self-reported perceived health, sense of coherence, self-care ability and nutritional risk in two older home-dwelling individuals before, during and after the intervention and also to describe experiences of nutritional self-care before and after the intervention. Methods: A study circle was established to support nutritional self-care in two older home-dwelling individuals (65+ years of age), who participated in three gatherings, arranged by health professionals, during a period of six months. The effects were evaluated with the instruments the Nutritional Form For the Elderly (NUFFE), the Self-care Ability Scale for the Elderly (SASE), the Appraisal of Self-care Agency (ASA) scale and the Sense of Coherence (SOC) scale and responses on a number of health related questions. Qualitative interviews were performed before and after the intervention to interpret changes that occurred during the intervention. Results: Reduced risk of undernutrition was obtained for both participants. Higher total score on SASE was obtained for one of the participants, and a slightly stronger preference to use the potential for self-care to maintain sufficient food intake and meals appeared. For the other participant, total score on SASE decreased, but SOC was stronger after the intervention. Decreased mobility was experienced, but did not influence the food intake. The study circle was an opportunity to bring in personal views and opinions about food intake and meals. Conclusion: An organized meeting place between older home-dwelling individuals and health care professionals, based upon dialogues, can stimulate the older person’s engagement, consciousness and learning about nutritional self-care, and be of importance to reduce risk of undernutrition. Key words: health, health promotion, intervention, study circle

• Tomstad, Solveig Thorbjørnsen; Söderhamn, Ulrika; Espnes, Geir Arild & Söderhamn, Olle (2012). Lived experiences of self-care among older, home-dwelling individulas identified to be at risk of undernutrition. Journal of Multidisciplinary Healthcare. ISSN 1178-2390. 5, s. 319–327. doi: 10.2147/JMDH.S38474. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: In a society where most older people live in their own homes, it may be expected of older individuals to exercise their potential to take care of themselves in daily life. Nutrition is a central aspect of self-care, and groups of older home-dwelling people are at risk of undernutrition. Aim: The aim of this study was to describe the lived experiences of self-care and features that influence health and self-care among older home-dwelling individuals identified to be at risk of undernutrition. Methods: Qualitative interviews were performed in eleven home-dwelling individuals who had been identified as being at risk of undernutrition. The interviews were recorded, transcribed verbatim and analyzed with a descriptive phenomenological method. Findings: Self-care as lived experience among older home-dwelling individuals at risk of undernutrition is to be aware of food choices, and make decisions about making healthy steps or not. When having health problems, the appetite often decreases. Being able to take care of oneself in daily life is important as well as receiving help when needing it. To work at being physically and socially active and engaged may stimulate the appetite. Having company at meals is important and missed when living alone. To be present and taking each day by day, as well as considering oneself in the light of past time and previous experiences and looking ahead, is central, even though having fears for the future and the end of life. Conclusion: Healthcare professionals should be aware of these findings in order to support self-care in older people, and they should pay attention to the social aspects at meals. Keywords: aged, health promotion, phenomenology, qualitative interviews

• Söderhamn, Ulrika; Dale, Bjørg; Sundsli, Kari; Tomstad, Solveig Thorbjørnsen & Söderhamn, Olle (2012). Psychometric testing of the Norwegian version of the Nutritional Form For the Elderly among older home-dwelling people. Journal of Multidisciplinary Healthcare. ISSN 1178-2390. 5, s. 121–128. doi: 10.2147/JMDH.S32502. Vis sammendrag

  Background: Nutritional screening instruments need to be evaluated in terms of reliability and validity and being able to demonstrate sensitivity and specificity for use in clinical practice and research. The aims of this study were to test the reliability and validity of the Norwegian version of the Nutritional Form For the Elderly (NUFFE-NO) in a sample of older home-dwelling people, and to use the short form of the Mini Nutritional Assessment (MNA-SF) as a standard. Methods: A postal questionnaire, including the two instruments, background variables, and health-related questions, was sent to 6033 home-dwelling older people (65+ years) in southern Norway. In total, 2106 persons responded and were included. Data were analyzed statistically regarding homogeneity, concurrent and construct validity, sensitivity, and specificity of NUFFE-NO. Results: A Cronbach’s alpha coefficient of 0.71 and significant item-to-total correlations were obtained as measures of homogeneity. Concurrent validity was assessed by a correlation coefficient of –0.37 (P , 0.001) between NUFFE-NO and MNA-SF. NUFFE-NO could separate known nutritional at-risk groups as a measure of construct validity. A cut-off point of ≥4 for identification of older people at nutritional risk was found for NUFFE-NO with MNA-SF as a standard. Conclusion: NUFFE-NO shows adequate psychometric properties regarding homogeneity and construct validity. MNA-SF was not found to be the most suitable standard to use, because a low correlation coefficient was obtained as a measure of concurrent validity and a lower cut-off point was found compared with another study using the Mini Nutritional Assessment (MNA®) as a standard for NUFFE-NO. The obtained cut-off point of ≥4 is not recommended for use in practice or research, because many false positive nutritional at-risk persons would then be identified. Further studies with suitable design have to be performed among older home-dwelling people using the MNA as a standard. Keywords: nutritional screening instrument, reliability, sensitivity, specificity, validity

• Tomstad, Solveig Thorbjørnsen; Söderhamn, Ulrika; Espnes, Geir Arild & Söderhamn, Olle (2012). Living alone, receiving help, helplessness, and inactivity are strongly related to risk of undernutrition among older home-dwelling people. International Journal of General Medicine. ISSN 1178-7074. 5, s. 231–240. doi: 10.2147/IJGM.S28507. Fulltekst i vitenarkiv Vis sammendrag

  Background: Being at risk of undernutrition is a global problem among older people. Undernutrition can be considered inadequate nutritional status, characterized by insufficient food intake and weight loss. There is a lack of Norwegian studies focusing on being at risk of undernutrition and self-care ability, sense of coherence, and health-related issues among older home-dwelling people. Aim: To describe the prevalence of being at risk of undernutrition among a group of older home-dwelling individuals in Norway, and to relate the results to reported self-care ability, sense of coherence, perceived health and other health-related issues. Methods: A cross-sectional design was applied. A questionnaire with instruments for nutritional screening, self-care ability, and sense of coherence, and health-related questions was sent to a randomized sample of 450 persons (aged 65+ years) in southern Norway. The study group included 158 (35.1%) participants. Data were analysed using statistical methods. Results: The results showed that 19% of the participants were at medium risk of undernutrition and 1.3% at high risk. Due to the low response rate it can be expected that the nonparticipants can be at risk of undernutrition. The nutritional at-risk group had lower self-care ability and weaker sense of coherence. Living alone, receiving help regularly to manage daily life, not being active and perceived helplessness emerged as predictors for being at risk of undernutrition. The results indicate difficulties in identifying people at nutritional risk and supporting self-care activities to maintain a good nutritional status. Conclusion: Health care professionals have to be able to identify older home-dwelling people at risk of undernutrition, support self-care activities to enable people at risk to maintain a sufficient nutritional status, and be aware that older people living alone, who receive help, feel helpless, and are inactive are especially vulnerable. Keywords: health, nutrition, self-care, sense of coherence

• Tomstad, Solveig Thorbjørnsen; Söderhamn, Ulrika; Espnes, Geir Arild & Söderhamn, Olle (2012). Testing two self-care-related instruments among older home-dwelling people in Norway. International Journal of Older People Nursing. ISSN 1748-3735. 8, s. 189–198. doi: 10.1111/j.1748-3743.2011.00307.x. Vis sammendrag

  Aim and objective. To test reliability and validity of the Norwegian versions of the two self-care-related instruments, the Self-care Ability Scale for the Elderly (SASE) and the Nutritional Form For the Elderly (NUFFE) among older home-dwelling individuals.Background. Older persons’ ability and agency for self-care is an important issue.Therefore, the development of reliable and valid instruments to measure self-care with regard to both clinical nursing practice and personal health is important for nursing research and practice. Methods. A postal questionnaire that contained these instruments, background variables, health-related questions and two other self-care-related instruments was completed by a randomised sample of 158 older persons in southern Norway. Reliability was assessed as internal consistency and validity as concurrent and construct validity. Results. SASE reached a Cronbach’s alpha coefficient of 0.85 and significant Spearman’s rank correlations for 16 of 17 items. For NUFFE, a Cronbach’s alpha coefficient of 0.64 was obtained and significant correlations for 13 of 15 items. Validity was supported for both instruments. An appropriate cut-off was found for SASE. For NUFFE, a low cut-off point was obtained. Conclusions. SASE was shown to have sufficient psychometric properties and can be used in research and clinical practice among older persons. Implications for practice. The psychometric properties of NUFFE can be assessed as sufficient, but further studies are needed regarding the cut-off point. Key words: nursing, reliability, sensitivity, specificity, undernutrition, validity

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• Tomstad, Solveig Thorbjørnsen (2019). Ensomhet blant eldre.
• Söderhamn, Ulrika; Dale, Bjørg; Sundsli, Kari & Tomstad, Solveig Thorbjørnsen (2015). Ernæring, egenomsorg og helse hos eldre.
• Tomstad, Solveig Thorbjørnsen (2014). Nutritional Self-Care in Older People: Studies Among Home-Dwelling Persons in Southern Norway. NTNU. ISSN 978-82-326-0104-2.

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