Extensive research shows nurses’ work environment to be particularly stressful. This study develops, explores, and psychometrically tests a new profession-specific questionnaire identifying generalised and specific resistance resources, that make it possible to measure resources to manage work-related stress. An exploratory study design was employed. The questionnaire development was inspired by the MEASURE approach and the salutogenic theory of health. Building on the results from a literature review of nursing research and salutogenesis, supplemented by twelve interviews with hospital nurses, an item pool was generated. The first version was pilot-tested in a group of nurses who were studying to become specialist nurses. The second version of the questionnaire was psychometrically tested on a sample of registered nurses in close patient care (n = 475), analysed using confirmatory factor analysis to test seven predefined domains of the questionnaire. The analysis revealed a first order seven-domain model of 21 items: job satisfaction, professional role, work motivation, commitment, belonging in the workplace, factors and conditions for remaining in the profession, and workload. The structure of the questionnaire indicates its usefulness in clinical practice for measuring resistance resources.

Wellness is a holistic, multidimensional, and process-oriented property on a continuum. It has been used interchangeably with and is undifferentiated from concepts such as health and well-being without an in-depth clarification of its theoretical foundations and a reflection on its meaning. The concept of wellness is frequently used, but its definition remains unclear.

Aim

To conceptually and theoretically explore the concept of wellness to contribute to a deeper understanding in caring science.

Method

Rodgers' evolutionary concept analysis was applied to the theoretical investigation of data from publications of international origins. The focus was on antecedents, attributes, consequences, surrogate and related terms, and contextual references. A literature search was performed through a manual review of reference lists and an online search in CINAHL and PubMed via EBSCO, and in ProQuest. Abstracts were examined to identify relevant studies for further review. The inclusion criteria were peer-reviewed papers in English; papers published in scientific journals using the surrogate terms ‘wellness’, ‘health’, ‘health care’, and ‘health care and wellness’; and papers discussing and/or defining the concept of wellness. Twenty-six studies met the inclusion criteria.

Results

Based on the findings from this concept analysis, a definition of wellness was developed: ‘a holistic and multidimensional concept represented on a continuum of being well that goes beyond health’. Implications for nursing practice were correspondingly presented.

Conclusion

Wellness is defined as a holistic and comprehensive multidimensional concept represented on a continuum of being well, that goes beyond health. It calls attention by applying the salutogenic perspective to health promotion in caring science. It is strongly related to individual lifestyle and health behaviour and is frequently used interchangeably with health and well-being without an in-depth clarification of its theoretical foundation.

BackgroundMidwives report a challenging work environment globally, with high levels of burnout, insufficient work resources and low job satisfaction. The primary objective of this study was to identify factors in the organisational and psychosocial work environment associated with midwives’ job satisfaction. A secondary objective was to identify differences in how midwives assess the organisational and psychosocial work environment compared to Swedish benchmarks.

MethodsThis nation-wide, cross-sectional web survey study analysed midwives’ assessment of their organisational and psychosocial work environment using the COPSOQ III instrument. A multivariable, bi-directional, stepwise linear regression was used to identify association with job satisfaction (N = 1747, 99.6% women). A conventional minimal important score difference (MID ± 5 as a noticeable difference with clinical importance) were used to compare midwives’ results with Swedish benchmarks.

ResultsA multivariable regression model with 13 scales explained the variance in job satisfaction (R2 = .65). Five scales, possibilities for development, quality of work, role conflict, burnout and recognition, explained most of the variance in midwives’ job satisfaction (R2 = .63) and had β values ranging from .23 to .10. Midwives had adverse MID compared to Swedish benchmarks with higher difference in mean values regarding quantitative demands (8.3), work pace (6.0) emotional demand (20.6), role conflicts (7.9) and burnout (8.3). In addition, lower organisational justice (-6.4), self-rated health (-8.8), influence (-13.2) and recognition at work (-5.8). However, variation and meaning of work showed a beneficial difference in mean values with 7.9 and 13.7 respectively.

ConclusionsMidwives reported high levels of meaningfulness in their work, and meaningfulness was associated with job satisfaction. However, midwives also reported adversely high demands and a lack of influence and recognition at work and in addition, high role conflict and burnout compared to Swedish benchmarks. The lack of organisational resources are modifiable factors that can be taken into account when structural changes are made regarding organisation of care, management and resource allocation. Midwives are necessary to a high quality sexual, reproductive and perinatal health care. Future studies are needed to investigate if job satisfaction can be improved through professional recognition and development, and if this can reduce turnover in midwives.

In this chapter, the authors consider the meanings of the concepts of healthy ageing, ageing well, salutogenic ageing and reciprocity between the sense of coherence (SOC) and ageing processes. They discuss how the community can provide resources to strengthen older adults’ SOC, perceived well-being and quality of life. Quoting ‘It’s not how old we are; it’s how we are old’, the authors illuminate critical differences in understanding healthy ageing by professionals, researchers and older people themselves.

Background

Salutogenesis is a resource-oriented approach that focuses on health creation. With the shift in focus from healthcare to health, there is a need to develop salutogenic inquiry and capacity of future nurses to promote good health and well-being in the community.

Objective

This study explored nursing students' perspectives on utilising the salutogenic theory in the community for health promotion, including the scope, perceived benefits, and challenges of theory application.

Design

A qualitative study using framework analysis.

Setting

A tertiary institution in Singapore.

Participants

Nursing students who were taught the salutogenic theory for ‘Healthy Community Living’ module.

Methods

Data were gathered from four focus group discussions (n = 18) and 32 students' written assignments. They were analysed based on five components of knowledge framework.

Results

Four themes were identified: re-orienting healthcare for healthy living communities; ambivalent learning experiences; attracting early adopters of salutogenic paradigm; and practices for positive health development in complex systems: future directions. Findings reflected the value, versatility, and usefulness of introducing the salutogenic paradigm into the curriculum of healthcare education. Practical know-hows of applying the theory in community practice and development of health intervention were elicited.

Conclusion

Much work is needed to future-proof the next generation of nurses in embracing and unifying the concept of salutogenic science into the existing pathogenic-driven care model. The real challenge would be the continual support of nursing education and health system to provide salutogenic care in the community.

This chapter is this handbook’s ‘grand finale’, addressing the potential of salutogenesis to nurture thriving societies. The handbook’s editors reflect on the advancement of salutogenesis concerning theory development, applying the salutogenic model in community settings and helping society tackle crises such as COVID-19.

In this chapter, measurement issues are addressed concerning Aaron Antonovsky’s original sense of coherence (SOC) questionnaires of 29 items and of 13 items, as well as several modified translations applicable to the individual, the family, the organization, and the community levels. Validity (face, construct, consensual, criterion, predictive) and reliability issues (test–retest, internal consistency) of the scales are discussed. Criticism of the original scales is deliberated.

In this chapter, the theoretical framework of the salutogenic model of health is described, with special focus on the key concepts and reflection on the ontological and epistemological background of the health model, which so far is little explored and described. Essential in the salutogenic model of health is the understanding of health as a process in a continuum, the health ease/dis-ease continuum. This is described and explained in the chapter. Some evidence of the relationship between sense of coherence (SOC) and health is presented.