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PhD project – Connect 1.0

Conceptualizing Health Assets in a Nursing Context: Synthesis of Findings from Multiple Perspectives

Health assets, or peoples’ capacities and strengths, have been recognized by the World Health Organization (WHO) as being necessary to strengthen and maintain health and wellness. However, the concept of health assets has not been well defined in recent years and there is little consensus. The purpose of this doctoral dissertation was to synthesize findings about health assets based on conceptualization and knowledge from various perspectives: literature, patients and nurses, and the nursing terminology system International Classification for Nursing Practice (ICNP).

First, a concept analysis was conducted to examine the meaning of the concept, its underlying attributes, antecedents and consequences, and its uses in health care. A definition of health assets and a descriptive model of its components and possible relationships were proposed. Health assets were defined as the “repertoire of potentials—internal and external strength qualities in the individual, both innate and acquired—that mobilize positive health behaviors and optimal health/wellness outcomes” (Study I). Five strength dimensions were uncovered: relational, motivational, volitional, protective strengths, and mobilization. To further explore and describe the concept empirically, focus group interviews with 26 cancer patients and cancer survivors who were members of patient support groups (Study II), and 26 nurses experienced in cancer care were conducted (Study III). Patients reported a rich repertoire of personal strengths they used or wished for during their illness and recovery, resulting in seven themes and 12 subthemes of health assets. Most striking was their experience that care providers did not ask for, discuss, or build on patients’ own strengths. Patients wanted to be involved, and they possessed a considerable number of potential strengths that they wished could have been mobilized with the help of care providers. Patients preferred a more active role in their care than they actually had or were invited to take.

Nurses in the focus groups were not very familiar with the concept of health assets, and realized that they did not focus much on patients’ strengths in their care. The discussions and reflections on health assets directed their attention to the patient as an active agent contributing to his or her own health rather than a passive recipient of care. Three additional dimensions of health assets appeared from the nurses’ focus groups: cognitive, emotional, and physical strength. Additionally, various themes and subthemes related to health assets were elicited. Furthermore, it became apparent that health assets were not static, but may fluctuate between more or less of the same asset and/or between two or more health assets. Contextual and individual circumstances also affected what constitutes a health asset.

The findings of these studies suggest a need for a greater focus on patients’ health assets; patients want their strengths to be utilized and to contribute to their own care. However, nurses do not fully utilize patients’ strengths, but realize their importance when made aware of them and aspire to become more aware of this aspect of care.

This dissertation provides an improved understanding of health assets, particularly within cancer care, and contributes to knowledge about health assets from several perspectives. A synthesis of the findings from the five studies resulted in a refinement of the definition and conceptual model for health assets. However, further studies are needed to substantiate the model and test its suitability for research and teaching, and to develop support systems for patients and nurses that foster the use of health assets. Knowledge gained from this work can assist nurses in balancing the traditional problem-oriented approach with a health assets approach. In this manner, nursing care can help patients move from being passive recipients of care to becoming active agents of wellness and health, sharing power, and having more control over their illness.

I Rotegård, A. K, Moore, S., Fagermoen, M. S., & Ruland, C. M. (2010). Health assets: a concept analysis. International Journal of Nursing Studies, 47(4), 513–525. DOI: 10.1016/j.ijnurstu.2009.09.005

II Rotegård, A. K, Fagermoen, M. S., & Ruland, C. M. (2011). Cancer patients’ experiences of their personal strengths through illness and recovery. Cancer Nursing, May 9. DOI: 10.1097/NCC.0b013e3182116497

III Rotegård, A. K., Ruland, C. M., & Fagermoen, M. S. (2011) Nurse perceptions and experiences of patient health assets in oncology care: a qualitative study. Research and Theory for Nursing Practice, (Accepted). Res Theory Nurs Pract. 25(4):284-301 DOI: 10.1891/1541-6577.25.4.284

IV Rotegård, A. K., & Ruland, C. M. (2010). Patient centeredness in terminologies: coverage of health assets concepts in the International Classification for Nursing Practice. Journal of Biomedical Informatics, 43(5), 805–811.DOI: 10.1016/j.jbi.2010.04.010

V Rotegård A. K. Health assets in nursing documentation of cancer care. Studies of Health Technology and Informatics (Submitted to International Medical Informatics Association, NI2012, The 11’th Nursing Informatics Conference).