assignment 3

By Vernon Williams,2014-03-30 19:42
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assignment 3


    Loneliness and the Quality of Life

    Every individual would experience loneliness and sometimes difficult to cope with it. Loneliness was a sense of bad feelings and sensed by an individual once without others‟ supports and misunderstanding. Indeed, loneliness was

    psychological discomfort and helpless feelings, which could not be solved by friends surrounded. Many psychiatric patients lived with other co-patients in 24 hours during admission in hospital. They reported lonely but difficult to elaborate it during counseling, particularly for those depressed adults and old aged. Besides, for those Schizophrenic elderly, they reported that they were lonely as well. It seemed that loneliness was a common phenomenon for both Schizophrenic and

    non-Schizophrenic elderly and it gave negative impacts to the quality of life.

    In the past few decades, the quality of life was proved to be influenced by various aspect of life. Quality of life as a health-orientated measure, it included disease manifestation and multi-axial functioning. Measurement items included happiness, fulfillment, „normality‟, mental capacity, attachment, rationality, independence, role performance, autonomy, physical ability, and pain absence. Based on the measured items of the quality of life, loneliness definitely showed adverse effects toward to



    happiness, fulfillment and most probably made an individual to have the sense of pain. On the other hand, schizophrenia caused impairments in many aspects of life, including: physical and cognitive functioning, mood state, social and occupational roles, and economic stability. Moreover, the subjective quality of life of schizophrenic individuals living in the community was shown to be lower than in the general population. (Fitzpatrick, Fletcher & Gore, 1992; Kaasa & Loge, 2003; Hansson & Tops,1999; Akdede, Akvardar, Alptekin, Dumlu, Isik, Kitis, Pirincci & Yahssin, 2005). Therefore, loneliness was adversely affected an individual‟s mental

    health and the quality of life but the nature of how Schizophrenic elderly felt about loneliness and the meaning of it were still unclear. It was worth exploring more in these aspects.

    Parses human becoming theory in studying loneliness of schizophrenic elderly.

Concerning a nursing theory explored the meaning of loneliness, Parses human

    becoming theory would be adopted in this study. In Parses human becoming theory,

    it elicited the meaning of universal human experiences. It also mentioned that individual, a combination of bio-psycho-social-spirituals aspects, was surrounded by



    both internal and external environment. Therefore, individuals had their unique perspectives about their meanings of the quality of life, which guided decisions about health. Moreover, individuals interacted and adapted with their own environments to maintain equilibrium in order to achieve goals and experience the quality of life. With the purpose of helping patient to achieve their health goals, nurses hypothesized to help in maintaining the equilibrium of patients and concerned with giving advices and opinions. Nurses would be „being with‟ an

    individual throughout the period of illness (Parse, 1998, 1992).

    Loneliness was a kind of human experiences but it varied of how individuals interpreted and perceived of loneliness. However, it was sure that the quality of life on individual was affected by the sense of loneliness in certain level. Thus, this study was done by a Giorgis descriptive phenomenological research method

    approach based on Parses thinking to expand understanding of the loneliness in schizophrenic elderly.

Literature reviews on loneliness

    Loneliness, a complex and powerful feelings, ruined the quality of life and



    implied poor prolongsis in the old age. People experienced loneliness involved both emotional and social loneliness. Emotional loneliness included feeling of loss or absent of confiding in an imitating attachment to a special and beloved person; and sensation of separation, anxiety, restlessness and emptiness. On the other hand, social loneliness corresponded to the absence of a meaningful friendship. Loneliness was different from living alone and social isolation as living alone was a simple concept which could be measured by household size while social isolation associated with the number of contacts and integration of an individual into the surrounding social environment. In additions, loneliness was a subjective feelings and the amount of it could only be illustrated by an individual, an individual‟s

    experience of loneliness in various types of isolation, an isolation of both inner and outer nature. Thus, people might suffer from loneliness even an individual was surrounded by many people (Cattan & White, 2003; Jolkkonen, Pitkala, Strandberg & Tilvis, 2000; Naden, Nilsson & Lindstrom, 2006; Weiss, 1973).

For the elderly, the most common subjectives of loneliness were caused by ones

    own illnesses; death of spouses; and lost of friends. It was stated that people suffered from Schizophrenia, a serious and persistent mental illness, was found lonelier than non-Schizophrenia but it was not specific for the elderly. Although ageing process



    alone was not responsible for causing of loneliness, ageing process interacted with loneliness that would cause psychological disturbances (Bond, Bowling, Scambler & Victor, 2000; Cacioppo & Ernst, 1999; Pitkala, Savikko, Strandberg, Routasalo & Tilvis, 2005). From De-Jong, Feskens, Gierveld and Tijhuis (1999) report, it supported that loneliness increased with aged and it also made a positive relationship with depression. Thus, elderly, both Schizophrenia and non-Schizophrenia, would experience loneliness inevitably when their ages increased but not implied to those over 90 years of age. Other than psychological distress, physiological health was also influenced by loneliness.

    Loneliness was estimated as an important factor in the development of medical dysfunctions, such as psychosomatic disorders, breast cancer and cardiovascular dysfunctions in adults. Various studies supported that the loneliness showed adverse effects in elderly. It showed a strong relationship with depressive symptoms: increased in using of health services and raised the risk of mortality. It also associated with poor subjective health and predicted cognitive decline as well. In some studies, it stated that loneliness could predict early institutionalization and cognitive decline (Cole, Page & Wrye, 1986; Jolkkonen et al., 2000; Ellaway, Macintyre & Wood, 1999; Geller, Janson, McGovern & Valdinin, 1999).



    From the mentioned literature reviews, it did not provide a deeper description of how phenomenon of loneliness was, beyond the fact that the experience of loneliness was related to distress of an individual‟s life experience. Besides,

    loneliness as a theme for research was not a long history. In the Nordic countries and the USA, research groups and individual researchers emerged in the late 1970s and studied loneliness first as sub-themes and as the subject for independent studies eventually. Moreover, in nursing studies, there were few studies that mentioned about the specific significance of loneliness in terms of psychological dysfunction. (Naden, Nilsson, Lindstrom & 2006). Because of limited literatures to study loneliness and using in qualitative approach, this study was important in exploring the meaning of the loneliness of Schizophrenic elderly.

Research question and methodology

    In order to understand the meaning and structure of loneliness in Schizophrenic elderly phenomenon, Giorgis descriptive phenomenological research method would

    be adopted in this study.



    Giorgis descriptive phenomenological research method aimed at uncovering meaning of human experiences. It focused on inquiring the meaning of the phenomenon rather than solved the problem. Moreover, it assumed that the knowledge of human experience was expanded by allowing essences of phenomena which described from lived experiences. In the data processing of this method, researchers initially studied the descriptions again and again, clarified on ambiguous areas of description by returning to participants for elaboration. Next, identified and separated it

    into meaning units which were written in the participants own words. Subsequently, the meaning units were brought up to focal meanings level that were written in the researchers language and followed by a synthesis into a structural description for every participant. Lastly, the structural descriptions were synthesized into one general structural description for all participants (Van, 1990; Parse, 2001; Spiegelberg, 1976; Giogi, 1975; Giorgi & Giorgi, 2003).

    Therefore, in this study, the essence of the meaning of loneliness in Schizophrenia would be explored by following the Giorgis descriptive phenomenological research

    method as mentioned which included: dwelling reflectively with the descriptions in loneliness; returning to participants (Schizophrenic elderly) for elaboration on ambiguous areas of description; identifying the meaning units and the focal meaning of



    loneliness in Schizophrenic elderly; synthesizing a situated structural description; and

    then synthesizing a general structural description about the loneliness of Schizophrenic elderly eventually. The research questions of this study would be What is the

    loneliness experience of Schizophrenic elderly?

Recruitment of participants

    Twelve participants would be recruited in this study by purposive sampling method; 4 from living in post-admission ward in hospitals, 4 from living in hostel and 4 from living alone in home. These participants would be living in their current living settings for at least 2 years and no longer than 2 and a half year. The inclusion criteria of these 12 participants were all above or equal to 65 years of age at the point of interview. All were diagnosed Schizophrenia over 10 years, they spoke and understood in Cantonese, no hearing or speech deficits. The exclusion criteria were those suffered from any types of dementia and daily living were dependent. The living alone participants, they would be recruited from a community old aged center and for the post-admission ward and hostel participants would be recruited in hospital and a government-fund old aged home, respectively. With the purpose to know the meaning and more about any differences between different living settings of Schizophrenic



    elderlys meaning of loneliness, 3 different living settings of Schizophrenic elderly would be recruited in this study.

    All participants would have a face-to-face interview in an interview room. Participants will be interviewed in their own settings that meant living in a hostel Schizophrenic elderly would be interviewed together in the hostel, living alone in the community Schizophrenic elderly would be interviewed together in the community center, and living in post admission ward Schizophrenic elderly would be interviewed together in hospital, respectively. Researcher would ask the question Tell me your experience of lonely and how is it? and let them share their point of

    views. Researchers would return to participants for elaboration on ambiguous areas of descriptions during or after the interview. All dialogues would be audio-taped recorded for analyzing as it was a verbal interaction between the researchers and participants to acquire valid and reliable research questions, which related to research questions. After finishing the interviews, all descriptions would be read repeatedly until identifying the meaning units and the focal meaning of loneliness. Subsequently, synthesizing the situated structural description and concluding a general structural description of loneliness of these Schizophrenic elderly (Armayor, Mcqueen, Vivar & Whyte, 2007; Giorgi & Giorgi, 2003).



Ethical aspects

    Scientific merit, protection of participants, and integrity were three major areas in ethical dimension. Scientific merit was responsiveness; coherence; and pragmatics, which also reflected in the logical coherence of the entire research process as well. Moreover, protections of participants included preserving in confidentiality; anonymity; safety; and withdraw rights whereas integrity was the consistent adherence to a set of ethical principles which were not false reporting of research findings, duplicating publications and plagiarism but ensured the clarity, accuracy and truthfulness all over the study (Parse, 2001).

    Thus, the study would begin after approved by the hospital review board and ethical committee board for the protection of human subjects. Before commencing the first interview, the informed consent would be given after signed and explained. Informed consent would be written in Chinese, participants would be informed the nature of the study; confidentiality; the required time commitment; the involved manner; withdrawal rights within the study; and the risks and benefits of the study. For those illiteracy participants, this information would be told by researchers before


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