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Nursing scholar develop unique measurement tool for elusive quality

By : Susan E. Barker


Sarah Gueldner, dean of the Decker School of Nursing, has helped develop a simple tool to measure an individualís sense of well-being even when he or she canít speak. Gueldner says it is especially important for caregivers to have a way to evaluate the ef
Gerontologist and dean of the Decker School of Nursing Sarah Gueldner and a team of international colleagues have developed a unique research tool they say can measure almost anyone's sense of well-being ? even those who can't talk.

The instrument, which has been refined across four countries and three continents with the help of more than 3,000 study participants, looks as if it was torn from a children?s coloring book and could be completed with a crayon.

If the tool, known as the refined Index of Field Energy (IFE-R), sounds simplistic, Gueldner is just fine with that. Prior tools to measure well-being have tended to be far more erudite and, for some populations, not worth the paper they were written on, Gueldner said.

"The usual tools that people give you to measure well-being ask questions like, Do you feel more pragmatic or visionary ... more finite or transcendent?" she said. "Can you imagine going into a nursing home and asking people that?"

"Many people, particularly in older groups, have no research voice because they can't respond to those kind of questions. But they can to mine."

Gueldner is convinced, and early studies seem to confirm, that her simple, black-and-white pictorial tool -- consisting of 10 pairs of line drawings of everyday images like butterflies, balloons, eyes, puzzle pieces and water faucets -- will help nurses and other providers learn more about the sometimes silent populations they serve.

The survey pairs oppositional images -- a sharp pencil vs. a dull pencil, a turtle vs. a butterfly, a lion vs. a mouse. In the space between the images are seven unnumbered boxes that allow participants to mark the place on the scale that best describes how they feel. Results are scored for each set from one to seven, with one being the lowest and seven the highest. Completed tests range from 10 to 70, with 70 indicating the respondent has a high sense of well-being and 10 showing a low sense.

Based on the success of trials in Africa, Taiwan and Japan and its high correlation with other measures, Gueldner is confident the tool will hold up as perhaps the first international product of its kind. Even more important is its potential to reach broad populations, including people who have poor eyesight, limited formal education or language skills, or who may be too sick or frail to respond to more complex surveys. In one field trial, children with cerebral palsy completed the survey with crayons.

Gueldner suspects the test will even give a research voice to people with mild to moderate cognitive impairment.

Well-being, Gueldner says, is recognized as "a relative sense of harmony and satisfaction in one's life."

By measuring the perceptions of a population, such as the housebound elderly, practitioners can try and then test simple interventions. For example, taking a housebound person outside for regular walks or arranging to have a friend or family member call or stop by every day may have a significant effect on their sense of well being.

"People just need to have one good friend," she said. "They can manage the losses of old age, as long as they have somebody that they can see and talk to everyday, catch a meal with or just be with. It's hard because if you live a long time, the price you pay for that is that your friends are gone."

Gueldner's broader goal is to use the index to collect research data that can help redefine societal notions of wellness and spur human service and health care policy changes that will allow people to live more enriched lives.

Her own parents set a good example, she said. By being a part of a close community they were not only able to remain at home until their deaths, but also to experience a high quality of life even when they were ill, she said.

"They lived to be 83 and 86, well beyond their life expectancies, and they did it right," Gueldner said. "They did it about as good as you can. They had awful, really major things wrong with them. But they never did lose their will to live, their will to live well."

By identifying people who have a low sense of well-being and measuring the effectiveness of simple interventions, she hopes that perfect health will no longer be the perceived requisite for living a good life.

"They say by the time we're 50 everybody has some type of chronic illness," Gueldner said. "But it usually starts sooner than that. As we add years to life expectancy, very rapidly really, we just have to think of health in a different way. We have to begin to recognize that even with serious illness, there is always the chance for well-being, for a good life. Otherwise, if the belief is that there is no longer any hope of well-being just because you have some things wrong with you, it's likely to be a really long and depressing life for many people."
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Last Updated: 10/14/08