Holding On

Crossing Borders, fabric and thread, (detail) Deidre Scherer, 1995. For archival reproductions and to see more of the artist's work: www.dscherer.com

ABSTRACT As women age, they frequently have increasing difficulties with physical functioning associated with osteoarthritis (OA). An understanding of how elderly adults care for their health is necessary to assist older women to live independently. Self-care of five community-dwelling women with OA was investigated through an interpretative descriptive study. A phenomenologic and naturalistic inquiry framework was used. Interviews were conducted using an interview guide. Deconstruction and reconstruction by constant comparison were used for analysis. Participants told stories categorized as Holding On to Present Self, Holding On to Ableness, Holding On to Being Interested and Being Interesting, Holding On By Seeking to Know, and Holding On by Purposefully Choosing and Acting. Older women with OA may have strengths of self-caring, including positive appraisal of their OA and capabilities, maintenance and development of skills, and remaining interested in the world. Health professionals can support clients by assessing strengths and difficulties and helping clients modify activities and to find resources necessary for independent living.

s the population ages, many women strive to manage physical functioning difficulties while living independently. Older women who experience increasing disability resulting from osteoarthritis (OA) face many problems, including pain and functional limitations. They commonly also have psychosocial difficulties associated with major losses and changes in lifestyle. Managing to live with physical functioning difficulties and to participate in their own care are very important health care tasks for older women. Although numerous studies have described OA, only a few published reports exist of how older women manage to live with OA. No published reports describe self-care of women with osteo-

arthritis from their personal perception. The current investigation of self-care of women with OA, from an emic or insider perspective, offers greater understanding of patterns of self-care with the physical functioning difficulties of OA. BACKGROUND AND SIGNIFICANCE Almost all adults older than 75 have radiologic evidence of OA (Felson, 1998). Adults with OA must deal with severe pain, instability of joints, limited range of motion, weakness, and fatigue (OReilly & Doherty, 1998). In addition, osteoarthritis is a major cause of disability in older adults and admission to skilled nursing facilities (Yelin, 1998). Individuals with musculoskeletal conditions

such as OA create a tremendous strain on the heath care system by making 315 million physician visits, having more than 8 million hospital admissions, and experiencing approximately 1.5 billion days of restricted activity per year (Yelin & Callahan, 1995). Osteoarthritis also causes great stress to clients because the potential for not being able to care for themselves creates a sense of an uncertain future. The unpredictability of this chronic condition requires clients to cope with the disease on a day-to-day basis. Although defined variously in literature, self-care is generally considered to be tasks performed by oneself to improve health. Self-care is considered extremely important for health. According to Lipson and Steiger (1996), the greatest potential

CAROL L. BAIRD, DNS, APRN, BC

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Self-Caring with Osteoarthritis

for improving health might be found in what individuals do, or do not do, for themselves. The concept of selfcaring is used as a more holistic expression of activities, both physical and mental, done to benefit the self. In addition to the usual mix of health promotion and maintenance activities, self-caring encompasses personal growth activities. According to Rosenbaum (1989), knowledge of self, responsibility taking, and self-valuing are all inherent in self-caring. Few recently published studies concern self-care and OA. In a study of 61 individuals having OA (mean age = 72), Hampson, Glasgow, and Zeiss (1994) found those with more symptoms and more serious symptoms reported higher levels of self-management and greater use of medical services. Research concerning self-care and rheumatoid arthritis or arthritis in general exists. Katz (1998) reported individuals with rheumatoid arthritis and more than 13 years of education were significantly more likely to perform self-care activities (e.g., using heat, making use of relaxation and stress control techniques, avoiding certain foods) than those with less education. Similar to Katz (1998), but not specific for arthritis, Lookinland and Harms (1996) found older adults who exercised were more likely to be bettereducated women with higher incomes. Other researchers reported general health perception, social support, and a sense of meaning in life were significantly related to self-care in older women (Craft & Grasser, 1998). Social support was also important for self-care in another study. In an analysis of the structure of self-care of communitydwelling Swedish older adults, Soderhamn (1998) reported older adults actualized self-care by a process of self-realization. To participate in self-care, the participants had the opportunity to act and were supported by others. Few investigators used qualitative methods to gain an understanding of the experience of living with and caring for self with OA (Downe-Wamboldt, 1991; Kee, 1998; Keysor, Sparling, & Riegger-Krugh, 1998). DowneWamboldt (1991) identified coping skills of older adults to include an awareness of the love and companionship of family, friends, and pets; using community services; an attitude of perseverance; and maintaining a sense of humor and perseverance. Kee (1998) found that men and women reported their coping methods included refusing to give in, maintaining pragmatism, remaining in charge, and tangible caring. In contrast to research with older adults, research with young and middle-aged athletic adults identified many problems including pain; fear; isolation; helplessness; and loss of function, identity, and perceived control, but did not identify strengths (Keysor et al., 1998). The purpose of this study was to understand the experience of living and caring for self with OA and physical functioning difficulties. Gaining a greater understanding of these experiences was an important first step in developing interventions to assist individuals with OA to continue living independently. The research question was, What is the meaning of self-caring for older women with physical functioning difficulties and OA? METHOD Because the research question was related to the meaning of physical functioning difficulties and self-caring, the researcher chose a qualitative approach to data collection and analysis. No a priori theory was used (i.e., the researcher did not start with preconceived notions from a theory about what the findings would be). The framework for the design of the research was guided by naturalistic inquiry as described by Guba and Lincoln (1994) and Guba (1990). Guidelines by Strauss (1987) structured analysis and analysis methodology.
Participants

Purposive sampling was used to identify women older than 70 attending activities of a senior citizen center. Purposive sampling, in this case, was a convenience sampling technique to identify older women with OA who could readily tell their stories. It was recognized that participants in older adult activities might be different from those who do not participate because those who take part in activities might have less physical functioning difficulties and more tendency toward socialization. Sampling continued until analysis revealed no new findings were forthcoming. Five women with self-reported OA and physical functioning difficulties participated. Although a sample of five is a small number, information from interviews was consistent and, therefore, no more participants were sought. The women in this study ranged in age from 72 to 91 (M = 78.2) All were single, mostly well educated, had OA symptoms of varying duration, and lived by themselves in the community (Table 1).
Procedure

The researcher conducted two to three in-depth interviews following a

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TABLE 1
PARTICIPANTS, DEMOGRAPHIC DATA, DURATION OF OSTEOARTHRITIS

Age

Marital status
Widow Widow Widow Widow Single

Education in years
13 12 9 16 11

Number of years since symptomatic

4 23 20 25 15

Number of years since diagnosed

1 to 2 23 20 15 8 Both knees Knees, spine

Joint involvement

91 74 73 81 72

Knees, spine, hips, neck, shoulders, hands Fingers, spine, shoulder; possibly hips; wrists in past Knee, right shoulder; hands in past

semi-structured interview guide developed in a pilot study (Baird, 1995). The number of interviews depended on the richness of the data or clarification needed. Audiotaped interviews were transcribed. Data were the transcribed narratives of the participants, field notes taken of observations and impressions, theoretical memos, coded units of the narratives, and categories noted. The data were compared throughout gathering and processing data.
Analysis

Analysis consisted of a process of deconstruction and reconstruction (Figure). Deconstruction was the

reduction of the narratives to the smallest section or unit, often a sentence or small paragraph, that had meaning. Reconstruction was a process of grouping similar units, coding units in the words of the participants. The continual comparison progressed with regrouping into intermediate categories, labeled with gerunds. Final grouping led to the meaning of living with OA and was labeled by the researcher as Holding On. Because the assumptions of naturalistic inquiry were different from the assumptions of the logicalpositivistic research tradition, the criteria for the quality or worth of the findings were also different. Guba and Lincoln

(1994) suggested ways to assure trustworthiness and authenticity of findings to those reading the research. The researcher supported authenticity of findings through several means, explained in Table 2. NARRATIVES AND RECONSTRUCTIONS The narratives of the participants with OA reveal they are using a complex process of Holding On as they care for their own health. The participants demonstrate four interrelated areas to which they were holding or which assist in holding. The participants are Holding On to Present Self, Holding On to Ableness, Holding On

Unit

Unit

Unit

Unit

Unit

Unit

Unit

Unit

Unit

Unit

Holding On To Present Self

Holding On To Ableness

Holding On To Being Interested And Being Interesting

Holding On By Seeking To Know

Holding On By Purposefully Choosing And Acting

HOLDING ON

Figure. Depiction of analysis.

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TABLE 2 METHODS TO ASSURE AUTHENTICITY

1. 2. The method was explained in detail so that the reader could decide whether it was adequate. Assumptions were considered, including: Osteoarthitis (OA) typifies chronic diseases affecting older women; many older women desire to remain living independently in the community; participants from senior citizen centers might have less physical functioning difficulties and be more socially active; a naturalistic interpretive study offers an understanding of how older women live with physical functioning difficulties and care for themselves. Research questions were stated. The research answered those questions. Data collection strategies, interview and observation, were the most adequate and efficient. The researcher conducted a pilot study (Baird, 1995) to clarify the most effective means to develop an understanding of living with OA. Report of findings included participants quotes to enrich and confirm constructions. The researcher included narratives and descriptions of the lived experiences in-depth in such a way as to allow the reader to recognize what that experience was and to compare with similar experiences the reader may have. The relationship between the study and previous studies was clear in the definition of phenomena and the discussion findings. The researcher considered the context in analysis of findings and development of constructions. Context was the immediate situation, the culture of older women, ageism, nursing culture, and the context of literature reviewed. A peer debriefer assisted the researcher. A debriefer supported the quality of the study (Swenson, Scott, Minke, Lion, & Bambergh, 1993). The role of the doctorally prepared nurse researcher was to independently review a percentage of the narratives, code, and compare coding with the researcher. The debriefer was to add another voice to the transcriptions, to act as a devils advocate, and to determine if the language of the researcher was easily understood. Data was preserved and made available for re-analysis.

3. 4. 5.

6. 7. 8.

9.

10. The researcher compared data from interviews and observations. Field notes and transcribed audio-taped conversations were cross referenced and compared. Consistency of what the participants said about the same thing over time was used for credibility.
(Adapted from Patton, 1990)

to Being Interested and Being Interesting, and Holding On by Purposefully Choosing and Acting.
Holding On to Present Self

The Present Self is the product of becoming. Through many years and a multitude of experiences, the participants have become and are still becoming. The participants recognize themselves as aging women with OA. The participants describe their present selves as women living with the multiple symptoms of OA. The participants explain that living with OA is living with hurting. The hurting is said to be like a boil; sometimes you think youll cry. Other words used to describe the pain are really something, hurting really bad, and hurt clear to the socket. Arthritis is with me all the time, said one participant, Every day I wake up I have pain. One of the participants tells about arising:

I dont hop out of bed. But, mainly, I dont want to get up anymore. Just as soon as I start moving...I dont want it to hurt like that! And thats maybe one reason why Im slow getting up. Im fighting it, the pain.

Besides hurting, the participants describe living with OA as a life of having difficulties. They tell stories about difficulty arising, bathing, toileting, walking in the house, gardening, housecleaning and performing home maintenance, shopping, socializing, and continuing their usual spiritual practices. Having difficulty is who they are now. This recognition allows the participants to plan changes necessary for maintaining independence. Cleanliness is extremely difficult because none of the participants use a tub for bathing. One participant said, I tell you, I dont take baths like I used to. Im afraid. Im scared of that tub. While most shower, two of the

women bathe from a basin. The women have trouble buttoning, zipping, and fastening clothing. Some cannot wear stockings or socks because it is too painful to lean over and to lift their legs. The participants do minimal housework. As one said, My apartment just got seedy. I apologize because theres stuff on my floor; I cant get stuff picked up anymore. One participant said: I cant get the dirt out from where Id like to, you know, but I can run the mop in the middle. I have to do it with a stool. I sit on the stool and do a portion. And sit on the stool and do a portion. And sit on the stool and do a portion. Thats the only way I can manage.
Holding On to Ableness

All of these partcipants desired to hold on to their ableness, their capability, and their competence in moving.

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TABLE 3 NURSING AND COLLABORATIVE INTERVENTIONS

Client Problem
Pain

Intervention
Oral analgesics Acetaminophen NSAIDS, cyclooxygenase (COX)-1 NSAIDS, COX-2 NSAIDS with mucosal protectors Opioids Intra-articular injections Corticosteroids Viscus supplementation Complementary Superficial heat Superficial icing Massage with or without topical heat-producing and analgesic medication Cognitive-behavioral techniques Reframing and other positive thinking Diversion Stretching and strengthening exercise Temporary immobilization Supportive devices, such as canes, walkers Complementary professional treatment, such as acupuncture, chiropractice, hypnotism, biofeedback Changing tasks or ways of doing things Seeking assistance from others Exercise Supportive devices, such as canes, walkers Railings on stairs, halls Grab bars in bathrooms Exercise Adequate rest Cognitive-behavioral techniques Changing tasks or ways of doing things Seeking assistance from others Cognitive behavioral techniques Social support Spiritual support

active is being healthy. Besides exercising weekly in a pool, she participates in activities at a senior citizen center. She attends plays, goes to gambling boats, and meets with a club once a week. She recently resigned a paid job as a sitter for a woman with dementia. While remarking that it would be nice to rest on her new day off, she said:
Ill have one day now and theres more to volunteer for! I called the Literacy League about tutoring. There are all kinds of ways to spend your time. A senior in this town can just be as busy as they want to be. Theres no excuse for any senior to sit back and say, I hurt and I cant do anything and I cant be of any use. Holding On to Being Interested and Being Interesting

Instability

Weakness and fatigue

Anxiety, Depression, and other Negative Emotions

Keeping physically and socially active contributes to maintaining ableness. One participant said:
Oh, walking is what Ive concentrated on. I had been in such bad shape that I couldnt even roll over in bed. It was awful! I couldnt get out of bed. So I said to myself if I start right in walking then I wont get back in this condition again. If Im going to sit back in a rocking chair and say, Oh, well, and never get up again, then Im going to be ten times worse off.

The participant with the greatest impairment with walking exercises regularly. She said:
Every morning I stretch it out. I get up and I move out. I go to the spa and I do 15 minutes of backstroke. And I swing my leg forwards and backwards 10 times.

Holding On to Ableness is also relayed by the stories of being active socially, spiritually, and intellectually. One said, I think that Im healthy because I do. Another says that being

Holding On to Being Interested is shown as a continuation in interest in learning about the world. Being interested is being curious, being vital, and being inquisitive. Participants demonstrate Being Interested by maintaining an attitude of growth. One woman participates in Toastmasters, an international organization that helps members learn by speaking to groups and working with others in a supportive environment. She said, Im working on my advance Toastmaster. It gets more fun and more stimulating. Another enjoys learning Spanish and astronomy in senior center classes. Holding On is shown further by desiring to be interesting to others. In addition to being attractive to others by having a growing intellect, the participants actively create and experience pleasure. Laughter is heard in every interview. The participants laugh at themselves and at others. They tell jokes. One said, I grew up in a very, very happy family. We would pull tricks on each other and we just had fun. Attitude is essential to the idea of being healthy. One said, when asked to visualize a healthy older woman, I think having fun. Similarly, another described an older woman as one who has a zest for living. She said:

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Keep active. Keep interested and interesting. When you keep interested in all of the things that are happening around you and you create new beginnings, you are healthy. Holding On by Seeking to Know

The participants involve themselves in a determined exploration to perform self-care and to be self-caring. The participants seek to know through print media, through experts at classes or on television, by consulting nurses, and by listening to friends so they may learn what to do. The participants actively and purposefully seek information about arthritis and their health status. One woman said, I just read, read, read. I keep in touch. I just keep myself apprised. All except one of the participants attend arthritis classes at a senior citizen center. In addition, participants seek advice related to health care and self-care from nurses, physicians, and other health professionals in clinics and physician offices. The women said they obtain the most useful information from the nurse practitioner from the senior citizen center. The participants also obtain information about arthritiswhat to do or what not to doby comparing themselves with others. One said:
I watch other people, how they do. My friend that lives down on the corner, she has pretty bad arthritis. She fell and couldnt get out. And her arthritis bothers her terribly when she walks. She doesnt get all the exercise I get. Im always going.

Holding On by Purposefully Choosing and Acting is demonstrated in the stories of the participants as maintaining control and modifying activities. Examples of maintaining control in choosing and acting on self-caring is most evident with respect to medication use. The participants control the medication they take, particularly for OA. One is eager to try the natural way. Im having better luck [with my OA]. Im using Echinacea, elderberry syrup, vitamin C. All of the participants state they do not want to take arthritis medication if at all possible. Some are concerned about hemorrhage in the stomach. All said they did not like to take medication. One said, I try not to take any more medicine than I have to. And yet, they all say they routinely take medication as ordered for their asthma, diabetes, and hypertension it is the medication for OA that they frequently do not take. They state that medication is not always effective for OA. Choosing whether to take or not allows some control over their health care. The participants change much about their daily living to exist with their physical functioning difficulties and to live healthier lives. They use a variety of self-help treatments besides medication for their arthritis. Knee wraps and splinting, altering seating arrangements, changing bathing and dressing habits, massage, and resting joints are some of the examples of selfcare activities. DISCUSSION Self-Caring is described by the participants as Holding On. Holding On is the volitional, determined, and creative endeavor to preserve self in the face of hurting and difficulty in doing what one wants to do. Holding On is not seen as desperate grasping, but a resolute embracing of the knowledge, the skillfulness, and the grace that the woman embodies. It is an active process, not passive. Holding On is an expression of the hopefulness that the participants have. The ability to main-

The participants tell about learning to live, learning to be who they are now. One said, So I think that I have had to learn to be self-confident and learned that I have to rely on myself. Another said, I just learned to do that.
Holding On by Purposefully Choosing and Acting

Purposefully Choosing is the intentional selection of self-caring activities that the participants then act on to relieve some of the pain, difficulties, and worry with which they live.

tain what they have, which is helpful, and to look forward to a future of gaining additional strengths are indications of hope. The concept, holding on, defined as the hopeful maintenance of previous physical and psychological abilities and acquisition of new strengths is found rarely in nursing and health care literature. Most of the time holding is used in nursing management literature, such as holding accountable. Perhaps the most congruent use of the term is by Daly, Jackson, and Davidson (1999). In a description of maintaining psychological strengths in surviving a myocardial infarction, they used the term holding on to mean holding on to human connectedness. The participants told stories about living with OA. Osteoarthritis was portrayed as an intruder when participants live with the hurting. Every time they moved it reminded them of what they could not do and of their concerns about the future. The intruder was a rival for their attention. When the participants wanted to attend to other things and other people, OA kept overriding their thoughts and actions. Although the participants indicated an identity of an aging woman with an intruding and ever-present OA and with a life of hurting and difficulty doing activities, they did not portray OA as an enemy. To think of OA as an enemy was to think of their own body, their own person, as an enemy. Sometimes the known was comforting. The participants knew themselves and their OA very well. In fact, being with OA allowed the participants to grow and to become experts in self-care. The positive appraisal of OA and their self-care capabilities allowed the women to use a great deal of positive coping strategies. Although Hampson, Glasgow, and Zeiss (1996) did not find a significant correlation between positive appraisal and positive, problemsolving coping, they reported that negative appraisal of OA was related to passive coping. Ableness includes the innate and learned abilities allowing the partici-

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pants to successfully live with OA. Holding On to Ableness was an expression of the older womens expertise. The narratives painted a picture of the participants as veterans of living their lives. The participants were experts in knowing OA as a presence in their lives. Being authorities enabled the participants to continue growing and to be capable individuals. Holding On to Ableness included being confident in physical and psychological abilities needed for self-caring. Some researchers have reported that arthritis self-efficacy was improved with self-care management programs (Barlow, Williams, & Wright, 1999; Lorig, Gonzalez, Laurent, Morgan, & Laris, 1998). The increase in confidence was also supported as a primary influencing factor in self-care in people with other chronic illnesses (Ludlow & Gein, 1995). Narratives demonstrated vitality and continued interest in homes, family, community, and the world. The participants wanted to be attractive in mind and appealing to others. This was an attitude of growth, shaping the participants into more attractive persons. Participants maintained that this attitude of growth and experiencing pleasure were important for self-caring. Other studies supported humor and pleasure as important in reducing anxiety and depression (Houston, McKee, Carroll, & Marsh, 1998). The importance of sustaining an interest in their world was demonstrated by the participants informationseeking. Pollack (1996) used grounded-theory methodology to develop a descriptive theory of the informationseeking behavior of hospitalized adults and reported that acceptance of the diagnosis was the key concept in the information-seeking state. The participants in the current research were definitely accepting of their diagnosis as noted by Holding On to Present Self. Friends, family, arthritis classes, and nurses and physicians were all sources of information about arthritis care. Unlike participants in other research (Neville et al, 1999), the par-

ticipants in the current study did not state physicians as the preferred source of information, but gathered information from a variety of resources. The knowledge participants gained, based on past and present experiences, was used in decision-making. This finding was similar to other research (KellyPowell, 1997). Perhaps participants ability to obtain correct information related to arthritis care was, in part, because the women in the current study were largely well-educated. Edwardson and Dean (1999) found that more educated older adults were able to evaluate symptoms and respond with appropriate self-care measures. Nurses should assess not only the education level, but also the ability of older adults to identify symptoms and communicate these symptoms to health care providers. Based on the assessments, nurses could suggest appropriate self-care methods or could develop more helpful teaching plans and use educational techniques appropriate for the client. The participants discussed deliberately choosing self-caring activities. As mentioned previously, the participants maintained much control over their health. Some researchers reported that self-care ability is explained by the ability to make changes in attitude (Soderhamn, 1998). Similarly, Spitzer, Bar-Tal, and Ziv (1996) reported that older adults take full advantage of control when compared with younger adults. What was important to the older adults was not dependence but self-sufficiency in solving health problems. IMPLICATIONS FOR NURSING Reconstruction of narratives from the participants gives powerful insight into self-care of OA and physical functioning difficulties experienced while living independently in the community. As appropriate for qualitative research, particularly from a phenomenologic perspective, no generalization of findings is possible or desirable. However, if the reader finds that interpretations are transferable to another

similar group, then cautious application may be done. Health professionals should realize that older women are, first, individuals. Stories of older women must be listened to in order to help women identify problems, as well as strengths and opportunities for growth. Specific, independent and collaborative nursing interventions suggested from this and other research is presented in Table 3. Women must be supported in developing and maintaining skills and strengths identified. Nurses can help women modify activities of daily living and independent activities of daily living to stay living independently. Resources must be located to help women continue living alone. Resources needed may include transportation, food and medicine delivery, home health care, home maintenance and housekeeping services, and available and attainable social activities and spiritual support. This study demonstrates a need of women to remain in control of their lives. By recognizing strengths and difficulties, women can make decisions pertinent to their health and wellbeing. Part of the decision-making is recognizing when to accept help. Women should be encouraged to accept help as needed, but remain in control of decisions. Additional research is necessary to determine whether women living in more restrictive environments would tell similar stories and have similar health problems and self-caring activities. Additionally, studies of women who are not as socially active must be pursued. Research concerning experiences of men with physical functioning difficulties would offer support for the concept of Holding On. The concept of Holding On may be an element of coping with a variety of other chronic health difficulties, and needs further investigation. Additional research is necessary to validate many self-care behaviors, such as massage, that the participants used frequently. Finally, research is needed to determine more effective nursing measures

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to assist women in maintaining strengths, developing new skills, and learning about self-caring activities. REFERENCES
Baird, C.L. (1995). The lived experience of health of older women with perceived functional limitations. Unpublished manuscript, Indiana University at Indianapolis. Barlow, J.H., Williams, B., & Wright, C.C. (1999). Instilling the strength to fight the pain and get on with life: Learning to become an arthritis self-manager through an adult education programme. Health Education Research, 14, 533-544. Craft, B.J., & Grasser, C. (1998). The relationship of reciprocity to self health care in older women. Journal of Women and Aging, 10(2), 35-47. Daly, H., Jackson, D., & Davidson, P.M. (1999). The experience of hope for survivors of acute myocardial infarction (AMI): A qualitative research study. Australian Journal of Advanced Nursing, 16(3), 38-44. Downe-Wamboldt, B. (1991). Stress, emotions, and coping: A study of elderly women with osteoarthritis. Health Care for Women International, 12(1), 85-98. Edwardson, S.R., & Dean, K.J. (1999). Appropriateness of self-care responses to symptoms among elders: Identifying pathways of influence. Research in Nursing & Health, 22, 329-339. Felson, D.T. (1998). Epidemiology of osteoarthritis. In K.D. Brandt, M. Doherty, & L.S. Lohmander (Eds.), Osteoarthritis (pp. 13-22). New York: Oxford University Press. Guba, E.G. (1990). The alternative paradigm dialog. In E.G. Guba (Ed.), The paradigm dialog. Newbury Park, CA: Sage. Guba, E.G., & Lincoln, Y.S. (1994). Competing paradigms in qualitative research. In N.K. Denzin & Y.S. Lincoln (Eds.), Handbook of qualitative research (pp. 105-117). Thousand Oaks, CA: Sage. Hampson, S.E., Glasgow, R.E., & Zeiss, A.M. (1994). Personal models of osteoarthritis and their relation to self-management activities and quality of life. Journal of Behavioral Medicine, 17, 143-158. Hampson, S.E., Glasgow, R.E., & Zeiss, A.M. (1996). Coping with osteoarthritis by older adults. Arthritis Care and Research, 9, 133-141. Houston, D.M., McKee, K.J., Carroll, L., & Marsh, H. (1998). Using humour to promote psychological wellbeing in residential homes for older people. Aging and Mental Health, 2, 328-332. Katz, P.P. (1998). Education and self-care activities among persons with rheumatoid arthritis. Social Science and Medicine, 46, 10571066. Kee, C.C. (1998). Living with osteoarthritis: Insiders views. Applied Nursing Research,

KEYPOINTS

OSTEOARTHRITIS AND SELF CARE

Baird, C. L. Holding On: Self-Caring with Osteoarthritis. Journal of Gerontological Nursing, 2003, 29(6): 32-39.

1 2 3

Many women with osteoarthritis (OA) may have disabling symptoms but manage to maintain a positive appraisal of OA and their capabilities in self-care. Women may successfully manage OA by learning more about their condition and possible self-care behaviors and strategies. Self-care behaviors of older adults with OA are supported by health care providers assessing individual strengths, problems, and knowledge about possible self-care interventions.

11, 19-26. Kelly-Powell, M.L. (1997). Personalizing choices: Patients experiences with making treatment decisions. Research in Nursing and Health, 20, 219-227. Keysor, J.J., Sparling, J.W., & Riegger-Krugh, C. (1998). The experience of knee arthritis in athletic young and middle-aged adults: An heuristic study. Arthritis Care and Research, 11, 261-270. Lipson, J.G., & Steiger, N.J. (1996). Self-care nursing in a multicultural context (pp. 10-15). Thousand Oaks, CA: Sage. Lookinland, S., & Harms, J. (1996). Comparison of health-promotion behaviours among seniors: Exercisers versus nonexerciser. Social Science in Health, 2, 147-161. Lorig, K., Gonzalez, V.M., Laurent, D.D., Morgan, L., & Laris, B.A. (1998). Arthritis selfmanagement program variations: Three studies. Arthritis Care and Research, 11, 448-454. Ludlow, A.P., & Gein, L. (1995). Relationships among self-care, self-efficacy and HbAlc levels in individuals with non-insulin dependent diabetes mellitus (NIDDM). Canadian Journal of Diabetes Care, 19(1), 10-15. Neville, C., Fortin, P.R., Fitzcharles, M-A., Baron, M., Abrahamowitz, M., Du Berger, R., & Esdaile, J.M. (1999). The needs of patients with arthritis: The patients perspective. Arthritis Care and Research, 12(2), 85-95. OReilly, S., & Doherty, M. (1998). Clinical features of osteoarthritis and standard approaches to the diagnosis: Signs, symptoms, and laboratory tests. In K.D. Brandt, M. Doherty, & L.S. Lohmander (Eds.), Osteoarthritis (pp. 197-217). New York: Oxford University Press. Patton, M.Q. (1990). Qualitative evaluation and research methods. Newbury Park,

CA: Sage. Pollack, L.E. (1996). Information seeking among people with manic-depressive illness. Image: Journal of Nursing Scholarship, 28, 259-265. Rosenbaum, J.N. (1989). Self-caring: Concept development for nursing. Recent Advances in Nursing, 24, 18-24. Soderhamn, O. (1998). Self-care ability in a group of elderly Swedish people: A phenomenological study. Journal of Advanced Nursing, 28, 745-753. Spitzer, A., Bar-Tal, Y., & Ziv, L. (1996). The moderating effect of age on self-care. Western Journal of Nursing Research, 18, 136-148. Strauss, A.L. (1987). Qualitative analysis for social scientists. New York: Cambridge University Press. Swenson, M.W., Scott, M.M., Minke, K., Lion, E., & Bamberg, C.W. (1993). Experiencing the peer debriefer and auditor role in dissertation research. Unpublished manuscript, Indiana University at Indianapolis. Yelin, E. (1998). The economics of osteoarthritis. In K.D. Brandt, M. Doherty, & L.S. Lohmander (Eds.), Osteoarthritis (pp. 2330). New York: Oxford University Press. Yelin, E.H., & Callahan, L.F. (1995). The economic cost and social and psychological impact of musculoskeletal conditions. National Arthritis Data Work Groups. Arthritis & Rheumatism, 38(10), 1351-1362. ABOUT THE AUTHOR

Dr. Baird is Assistant Professor, Purdue University, West Lafayette, Indiana. Address correspondence to Carol L. Baird, DNS, APRN, BC, Purdue University, 502 N. University Street, West Lafayette, IN 47907-2069.

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