The aim of this study was to develop a model to clarify the existing knowledge concerning the self-care of home-dwelling elderly people. The data were collected in Oulu, a medium-sized city in northern Finland, by interviewing 40 home-dwelling elderly persons aged 75 or more. Data were analysed using the constant comparative method of the grounded theory approach. The model consists of four modes of self-care with different conditions for action and different meanings: responsible self-care consists of responsible activity by the elderly person based on a positive orientation towards the future and a positive experience of ageing. The meaning of responsible self-care is a desire to continue living as an active agent. Formally guided self-care consists of uncritical observance of instructions and routine performance of daily tasks. This approach is based on life experiences of taking care of others and realistic awareness of the effects of old age. The meaning of formally guided self-care is a tendency to accept life as it comes. Independent self-care is based on the person's desire to listen to his/her own internal voice. These persons aim to manage in life independently and deny the prospect of growing old. The meaning of independent self-care is an attempt to maintain the constancy of life. Abandoned self-care is characterized by helplessness and lack of responsibility. It involves bitterness and a negative attitude towards ageing. The meaning of abandonment is a desire to 'give up'. According to this study, self-care is not a separate part of old men's or women's lives, it is associated closely with their past life and with the future. As an activity, self-care is not just a rational way to maintain health. It also reflects the person's overall attitude towards health care, illnesses and manner of living.

The grounded theory approach has been used in nursing research since 1970. The latest methodological books describe the research process in detail. However, there are many problems involved in the grounded theory approach, which especially need to be considered by a novice researcher. One of these problems is the question of how deeply and widely the researcher should familiarize her- or himself with the research topic before the empirical study. The problems also include the need to focus the research problem and to choose the sampling method. Data analysis is a multistage process, which demands from the researcher both sensitivity and time to work out the findings which emerge from the data. In this paper, the grounded theory approach is described as a process undertaken by the novice researcher. The purpose of this paper is to discuss the challenges of the grounded theory approach and the problems encountered by a researcher using the method for the first time.

The quality of institutional geriatric care is a topical issue in Finland. The study to be described here is part of a Finnish project on the quality assessment and development of long-term geriatric care provided by the City of Helsinki. The health care division of the City of Helsinki authorized an outside survey of long-term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of geriatric care were issued. In the years 1999-2000, a further education programme was arranged for ward nurses, chief nurses and heads of profit centres concerning leadership in long-term geriatric nursing. A re-survey was conducted in 2001, using the same criteria of quality assessment. The purpose of this paper is to report on the quality of institutional geriatric nursing as evaluated by family members in 2001 and to compare the responses to those obtained in 1998. The results are presented as frequency and percentage distributions, means and medians and cross-tabulations. The responding family members were generally content with the care of their elderly relatives: 92% said they were very satisfied or satisfied with the care, and the average of the marks given for geriatric care was 8.3 (range 4-10). Family members were more content now than in 1998, when the corresponding figures were 86% and 7.3 (range 4-10). Nevertheless, the results still highlight certain aspects that should be improved and developed.

The purpose of this study was to examine how functional capacity, activities of daily living (ADL), instrumental activities of daily living (IADL), life satisfaction and self-esteem are related to the self-care behaviour styles of home-dwelling elderly persons. Data were collected by qualitative interviews (self-care) and structured interviews (functional capacity, life satisfaction and self-esteem) from home-dwelling elderly persons (n=40) aged 75 or more. The persons were living in a medium-sized city in northern Finland. The qualitative data were analysed using deductive content analysis. The classification frame consisted of a theoretical classification developed in an earlier study. The categories were quantified and the relationship between the variables analysed by cross-tabulation. The persons whose self-care behaviour style was responsible, formally guided or independent carried out their daily activities without assistance from others, while those who showed abandoned self-care did not manage their daily activities without help. Life satisfaction was the highest among the formally guided persons and self-esteem among the responsible ones. Poor life satisfaction and self-esteem correlated with abandoned self-care behaviour.