title: A meaningful daily life in nursing homes - a place of shelter and a space of freedom: a participatory appreciative action reflection study.
abstract: BACKGROUND
  Shortcomings in elderly care have been reported in many parts of the world, including Sweden. However, national guidelines for elderly care have been introduced in Sweden, which contain core values and local guarantees of dignity. These highlight the need for dignity and well-being, and organising the older person's daily life so that they perceive it as meaningful. Therefore, the aim of the present study was to describe older persons' experience and knowledge about obstacles, opportunities and solutions to developing a meaningful daily life for those living in nursing homes.
  
  
  METHODS
  This study combined the Participatory Appreciative Action Reflection (PAAR) and hermeneutic approaches. Twenty-five older persons participated and persons with dementia or cognitive impairments were included. Repeated interviews were carried out as reflective conversations, leaving 50 interviews in total, wherein the older persons provided their analyses and reflections on a meaningful daily life. Finally, an analysis of the data was completed based on a life-world hermeneutic approach.
  
  
  RESULTS
  We identified five tentative interpretations that describe obstacles, opportunities and solutions for a meaningful daily life. Themes 2 and 4 outline obstacles for a meaningful daily life, and Themes 1, 3 and 5 describe opportunities and solutions for a meaningful daily life: (1) Having space to be yourself; (2) No space to be yourself; (3) Belonging and security; (4) A feeling of insecurity; and (5) Longing for something to happen. In the main interpretation, we found that the five tentative interpretations are related to Tuan's concepts of space and place, where place can be described as security and stableness, and space as freedom and openness.
  
  
  CONCLUSIONS
  The reciprocal relationship is a solution for a meaningful daily life and occurs in the interaction between staff and older persons in nursing homes. It is the balance of power, and constitutes a place of shelter and a space of freedom for a meaningful daily life. The older person must have balance between shelter and freedom to have a meaningful daily life.
authors: School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
authors: Inger
authors: I
authors: James
authors: School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
authors: Karin
authors: K
authors: Blomberg
authors: School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
authors: Annica
authors: A
authors: Kihlgren
keywords: Action research; Freedom; Meaningful daily life; Nursing homes; Place; Reciprocal relationship; Security; Space