The number of older adults living in continuing care retirement communities is increasing with each passing year (Horvitz, 1997). While people may choose to leave their own homes to reduce the daily demands of cooking, cleaning, and yard work, there may be some concern regarding how they will spend the increased leisure time the move will create. For nurses committed to maintaining older adults' quality of life in their new community, assisting them to find meaning in their newly acquired leisure time is fundamental (Fine, 1996).
Leisure is a relatively new concept in the domain of nursing. In 1980, the fourth North American Nursing Diagnosis Association (NANDA) conference accepted the first leisure-related diagnosis for clinical testing - the nursing diagnosis of diversional activity deficit (Kim & Moritz, 1982). In 1988, the eighth NANDA conference defined the diagnosis (Carroll-Johnson, 1989), and that definition currently remains the same. Diversional activity deficit is defined as "the state in which an individual experiences decreased stimulation from (or interest in engagement in) recreational or leisure activities" (NANDA, 1996, p. 60).
Clinical testing of this definition is not evident in the literature. Because NANDA is using the concept of leisure interchangeably with diversion and recreation, the meaning of these concepts needs to be clarified. Research in other disciplines to clarify the meaning of leisure has yielded ambiguous results (Crandall, 1980; Cutler & Hendricks, 1990; Lawton, 1985; MacNeil, 1988; Meyersohn, 1969; Neulinger, 1981; Shaw, 1985). Thus, the purpose of this study was to conceptualize the meaning of leisure for older adults living in a continuing care retirement community to provide a database for gerontological nursing research and practice from their perspectives.
Both theoretical and empirical leisure literature were reviewed to obtain a sense of prevailing meanings. In the theoretical literature, the concept of leisure has been viewed historically in three ways: as experience, activity, or time (Kelly, 1982). Leisure as experience is the classical view, dating back to ancient Greece. Aristotle defined the concept as a "state of being or mind free from the necessity to labor, a state in which an activity was performed for its own sake or as its own end" (deGrazia, cited in Iso-Ahola, 1980, pp. 28-29). This classical view corresponds closely with the traditional psychological, subjective view of leisure as a condition or state of mind (Neulinger, 1981). By contrast, concepts of leisure as activity or time emerged from the traditional, sociological, objective view (Kelly, 1982). The view of leisure as activity refers to nonwork activities people engage in during free time, while the view of leisure as time alludes to residual (i.e., surplus), quantitative (i.e., amount), or discretionary (i.e., optional) time remaining after people complete work and self-maintenance activities.
Furthermore, two central defining conditions have emerged over time for the concept of leisure to include the "dimensions of freedom and intrinsic satisfaction" (Kelly, 1982, p. 31). Freedom refers to the idea of choice, and intrinsic satisfaction refers to the meaning of an activity for participants.
In the empirical literature on leisure, the concept typically has not been studied in terms of meaning but in terms of participation. Leisure participation studies focus on the quantity or objective aspect of leisure (e.g., time, cost, barriers, activities, frequencies) (Beard & Ragheb, 1980; Gunter, 1987; Howe, 1987; Shaw, 1986). Conversely, leisure meaning studies address the quality or subjective aspect of leisure in three primary ways. The first way is to address the satisfaction gained from engaging in a specific favorite activity. In one early study incorporating leisure, Donald and Havighurst (1959) asked 234 adults age 40 to 70 to name their favorite leisure activities and identify 3 meaning or satisfaction statements of the 12 provided that related best to their first-choice and second-choice activities. Of the 12 statements, both men and women ranked "just for the pleasure of it" highest.
Hawes (1978) refined the Donald and Havighurst (1959) study with further development of satisfaction statements. In a study of 1,115 adults, men ranked "peace of mind" and "chance to get the most out of life while I can still enjoy it" as most important, and women ranked "peace of mind" and "chance to learn about new things" as most important.
A second way to study leisure meaning is to address the satisfaction gained from engaging in leisure activities in general. Beard and Ragheb (1980) developed a Leisure Satisfaction Scale (LSS) consisting of six subscales:
Several researchers (Foret, 1986; Ragheb & Griffith, 1982; Russell, 1987; Sneegas, 1986) have used this instrument to measure leisure satisfaction with older people. Among other findings, these researchers found support for the hypothesis that the greater the leisure satisfaction, the greater the life satisfaction. Thus, the more satisfied subjects were with how they spent their leisure time, the more satisfied they were with their lives in general.
A final way to study leisure meaning is to address the psychological needs satisfied from engaging in specific leisure activities. Tinsley, Teaff, Colbs, and Kaufman (1985) used their Paragraphs About Leisure Form E (PAL-E) to ask 1,649 people, age 55 and older, to describe one leisure activity and relate it to the PAL-E. The leisure activities then were clustered according to the psychological benefits. Four of the six clusters that emerged were consistent with Donald and Havighurst's (1959) meaning statements. For example:
* Companionship (i.e., contact with friends).
* Temporary disengagement (i.e., passing the time).
* Compensation (i.e., change from work, newness of the experience).
* Expressive solitude (i.e., chance to be creative, to achieve something).
The other two clusters were comfortable solitude and expressive service.
Two qualitative studies also were found that defined the meaning of leisure. In the first study, Shaw (1985) explored the meaning of leisure for married couples. Themes that emerged to differentiate leisure from nonleisure included: enjoyment; relaxation; lack of evaluation by self and others; freedom of choice; and intrinsic motivation. Second, Chin-Sang and Allen (1991) explored the meaning of leisure for older Black women. The major theme that emerged was "making it through the day." Four subcategories included loneliness; church, worship, and duty; affiliative activities; and solitary activities.
The present study extended previous qualitative work, focusing on conceptualizing the meaning of leisure for older adults living in a continuing care retirement community. The research questions were:
* How do older adults define leisure?
*What is the meaning of leisure activity to older adults?
Grounded theory method (Chenitz & Swanson, 1986; Glaser, 1978; Glaser & Strauss, 1967) guided this study. This method is rooted in symbolic interactionism (Blumer, 1969; Mead, 1934) which emphasizes that meaning guides behavior. The purpose of this method is to generate theory from the data that explains basic social and psychological phenomena, such as leisure.
Setting and Sample
The setting chosen for this study was a not-for-profit, 326-unit retirement home in a continuing care retirement community in the suburban midwestern United States. All subjects were White, Protestant, and Dutch. Dutch individuals were studied because ethnic leisure studies of this group are practically nonexistent (Allison, 1988; Hutchinson, 1988; MacNeil, 1988), and the author was interested in expanding a previous leisure study with this population (Roelofs, 1981). Subjects ranged in age from 66 to 94, with a mean age of 81. The majority of the sample was older than age 75, female, widowed, a resident in the home for 4 years or less, and educated through the seventh or eighth grade. A majority also rated their health and financial situation as good or excellent. All subjects gave verbal informed consent to participate, and the study was approved by a university institutional review board and the retirement home administrative team.
Data collection involved an initial period of 32 hours of participant observation, followed by intensive interviewing during a 3-month period. All participant observation experiences were recorded in field notes that were used for contextual purposes (Knafl & Breitmeyer, 1989). As such, they provided the background to enhance understanding of the formal interviews.
After the initial observation, 40 intensive interviews were conducted using an author-designed interview guide based on the literature review and further developed during the early interviews. Subjects were selected by theoretical sampling, which maximized collection of theoretically relevant data to reach theoretical saturation of categories. Therefore, sampling was based on data needed to develop emerging categories. To generate as many categories as possible, comparison groups were selected from four subgroups within the larger social system of the retirement home. These four groups included:
* Age (i.e., older and younger residents).
* Gender (i.e., women and men).
* State of health (i.e., healthy or unhealthy, according to nursing staff descriptions).
* Room location (i.e., various wings and floors).
The average length of the audiotaped interview was 70 minutes.
Data analysis was concurrent with data collection, using the constant comparative method (Stern, 1980; Wilson, 1977). First, line-byline coding of tne transcribed interviews was conducted, yielding substantive or "in vivo" codes (Glaser & Strauss, 1967, p. 40). These codes capture what actually is ocurring in the subjects' Uves and are often the exact words of the subjects. Second, these codes were compared across and within matrixes (Miles & Huberman, 1984, 1994) and clustered into categories. Third, the related categories were clustered together, yielding theoretical codes. For example, substantive codes of "using your noodle" and "matching wits" generated the theoretical codes of "educating" and "competing," respectively. The use of theoretical "memoing" (Miles & Huberman, 1994, p. 72), or writing notes containing inferences about the data and emerging categories, assisted this analysis process. Finally, constant comparison of all possible relationships of categories enabled identification of the core category or the essence of the phenomenon that was studied (Sandelowski, Davis, & Harris, 1989).
Trustworthiness efforts to limit potential bias included member checks and peer review (Lincoln & Guba, 1985). Subjects and peers agreed the resulting conceptualization of the meaning of leisure was accurate.
The inductive analysis of data yielded a conceptual model of leisure that describes the meaning of leisure for Dutch older adults living in a continuing care retirement community. The model consists of the core category of authoring leisure that highlights subjects' definition of leisure, strategies used to author leisure, and the consequence of authoring leisure. In this model, the term "authoring" refers to an active process of creating leisure experiences, while the term "leisure" refers to non work activities.
The process was named "authoring" because it was clear that most of the retirement home residents created their leisure experiences by actively choosing their leisure activities rather than being directed by others, and personally initiating their leisure activities instead of relying on home-initiated activities. In other words, subjects actively selected and initiated leisure activities. Consequently, the process of authoring leisure is defined as a dynamic process in which older adults actively initiate activities of their choice. Choice included not only selecting leisure activities but also the time and duration of participation in those activities.
DEFINITION OF LEISURE THEMES WITH EXAMPLES FROM SUBJECTS
Moreover, the term authoring was selected from an in vivo code (Glaser & Strauss, 1967) used by one of the residents. In viewing himself as the author of leisure, this 84-year-old man expressed his notion of freedom and choice of activities by declaring:
I am the author of [leisure] time, you might as well say. I don't know how to express it really. But I am not under somebody... you are free from work.. .you are your own boss.
Definition of Leisure
Most residents viewed leisure positively, conveying an independent spirit of doing what they wanted to do, when they wanted to do it, and for as long as they wanted. Their definitions contained the themes of:
* Nonwork time.
Themes were included if expressed by at least 20 (50%) subjects. Examples of these themes from the subjects are found in Table 1.
The first theme, nonwork time, consisted of free time or spare time that remained after obligations were completed at work, home, and in the community, especially in church. The second theme, relaxation, encompassed a variety of restful responses (e.g., relaxing, unwinding, taking it easy, having no cares). The third theme, choice, entailed selecting not only the leisure activities but also the time and duration of participation in those activities. The fourth and final theme, enjoyment, encompassed a variety of joyful responses (e.g., fun, pleasure, enjoyment, happiness, satisfaction). A definition that contains all the themes is "leisure is nonwork time that I may choose to spend in a relaxing and enjoyable way."
STRATEGIES OF AUTHORING LEISURE WITH EXAMPLES FROM SUBJECTS
Strategies Used to Author Leisure
The six strategies that residents used to author leisure were found within their responses to a question of how they selected specific activities as favorites. The strategies include:
Strategies were included in the analysis if expressed by a minimum of 10 (25%) subjects. These strategies of authoring leisure are presented in Table 2 with examples from the subjects. The strategies are not mutually exclusive to any activity. More than one strategy can address the same activity, and one strategy can address different activities.
Educating. The first strategy of authoring leisure, educating, involved both thinking and learning. Thinking entailed keeping the mind busy. The residents believed their intellectual demands were decreasing and, therefore, sought out activities in which they could exercise their minds, such as working crossword and word search puzzles. On the other hand, learning involved keeping informed about the outside world. This enabled residents to not only feel less isolated but also to discuss new information with others. Being able to discuss world events was salient particularly when major events were occurring. Several residents were avid readers and watchers of news, including news shows on late-night television. It gave them a sense of pride that they could still learn and be involved in the world around them.
Continuing. The second strategy, continuing, was expressed primarily as statements that residents selected the leisure activities because they always had liked them or always done them. These responses were constant, regardless of additional probing by the author. One woman even said, jokingly, that she was not a psychologist, so she really did not know any other reason why she chose a certain activity. Childhood, more than adulthood, experiences greatly influenced residents' choices. Residents recalled interests that began early in life while at play, in elementary school, or in their homes with family.
Contributing. The third strategy of authoring leisure, contributing, involved service activities such as helping other people, being a friend to others, and donating time or talent to worthy causes. Helping other people entailed running errands and doing odd jobs. Men, especially, enjoyed using their tools to help women with such things as hanging shades or pictures or repairing electrical appliances. Being a friend to others involved showing interest in other residents and their families, including visiting lonely residents in a nearby nursing home. Donating one's time or talent included such things as giving away handmade items like afghans and blankets, and helping the retirement home's Activity Department with projects like stuffing pillows and cutting postage stamps.
SELECTED RESEARCH SUPPORT FOR STRATEGIES
Competing. The fourth strategy, competing, involved both winning and competing, primarily in card, board, and physically active games. Several variations existed in this strategy. These involved just liking to win, just liking to compete, or liking to both win and compete. Another variation involved not caring about either winning or competing as long the participation was pleasurable or provided exercise.
Edifying. The fifth strategy, edifying, involved feeding one's soul and gaining inner satisfaction. These were accomplished through reading the Bible and religious literature, and taking advantage of religious content on radio, television, and audiotape cassettes. Residents stated that feeding their souls helped them to be strengthened spiritually, to know what God would have them be, to be a witness for their Lord, and to affirm their feelings of belonging to God. Further descriptions involved gaining inner spiritual satisfaction, which was identified as a feeling of comfort and peace.
Engaging. The sixth and final strategy of authoring leisure, engaging, described residents actively engaged in, rather than passively disengaged from, activities selected primarily to pass the time. The strategy of engaging was used mainly with sedentary activities that used the mind. Residents were adamant that they were not just wasting time but that they were still busy using their mind. For example, they relished the triumph of determining answers before the contestants on television game shows, solutions to crossword and word search puzzles, and plays the coaches would decide next in television ball games.
Consequence of Authoring Leisure
The consequence of authoring leisure for these residents was satisfaction with their choice of leisure activities for their free time. The following definition of leisure satisfaction was derived from this study: Leisure satisfaction is the sense of contentment that older adults experience as a result of authoring leisure. The process of authoring leisure enables older adults to meet their individual needs by using the strategies of educating, continuing, contributing, competing, edifying, and engaging.
Authoring leisure emerged as an active process in which retirement home residents create their leisure experiences and, subsequently, achieve leisure satisfaction. The majority (n = 38, 95%) initiated all or most of their favorite leisure activities, rather than relying on home-initiated activities. Because these subjects always were involved actively in their leisure choices, these findings lend support for continuity theory that suggests older adults maintain previous habits and preferences (Atchley, 1989).
The model of authoring leisure validates elements of leisure previously described by primarily nonnursing investigators. Chin-Sang and Allen's (1991) exploration of leisure among older Black women was the only nursing study reviewed for this article that focused specifically on the meaning of leisure. Subjects' definition of leisure is consistent with the previously identified central defining elements - leisure as freedom (i.e., relating to the themes of choice and nonwork) and leisure as intrinsic satisfaction (i.e., relating generally to the themes of relaxation and enjoyment) (Kelly, 1982). The strategies used to author leisure, and the consequence of authoring leisure which incorporates the strategies, are similar to those partially addressed in the Literature Review of leisure meanings. Examples are given in Table 3. These similarities between the literature and the findings support the conceptual refinement of leisure derived from this study.
The model highlights differences from the literature in three important ways. First, the active nature of the strategy of engaging as a way of passing time is inconsistent with the more passive nature described by Tinsley et al.'s (1985) "temporary disengagement" (p. 176) from interaction or stimulation.
Second, the importance of the strategy of "edifying" with its spiritual connotation is not consistent with the decision of Beard and Ragheb (1980) to delete the only spiritually oriented statement from their frequently used LSS in the shortened version. In fact, in Kaufman's (1984) study of members of the American Association for Retired Persons using the shortened version, one subject protested, saying, "This questi onair [sic] had no question about religion. My religion and my church are very important to me and, I think, to many others. Much of my leisure time is spent in church work" (p. 123).
Finally, the findings generated from this ethnically Dutch sample differ drastically from findings in the only recent qualitative study found on the meaning of leisure. In a study of Sudanese refugee women of all ages, Russell and Stage (1996) found that for the refugee women leisure was viewed as a burden. Themes that emerged from the data included:
* Time (i.e., too much worthless free time).
* Changing roles (i.e., a loss of previously held roles and stature).
* Dependency on assistance (i.e., lack of power when reliant on the benevolence of others).
The findings of this study indicate a need for further development of the model of authoring leisure. Future studies to expand the model should address the meaning of leisure for older adults from different ethnic groups, care settings, and health and financial situations. Expansion of the model would promote generalizability of the study findings regarding the meaning of leisure to a broad population.
Lawton (1993) notes that meanings of leisure need to be studied because, although there has been much leisure research, "there has been relatively little new research directed explicitly at meaning" (p. 25) since the original work of Donald and Havighurst (1959). Studies should be qualitative because subjects then can define the meaning of leisure in their own words.
Other ethnic groups must be studied because culture-specific research is lacking (Freysinger, 1993). Ethnicity has both social and personal meanings which impact leisure meanings. Thus, for nurses to be culturally competent in their practice, they need to know what meanings are guiding their clients' behavior.
In addition, similar studies should be conducted on the concepts of diversion and recreation to differentiate these clearly from the concept of leisure. This would promote clarity of the presently ambiguous definition of the nursing diagnosis of diversional activity deficit in which these concepts are used interchangeably with leisure. Notably, ambiguities persist in the conceptualization and measurement of the concept of leisure in the leisure literature (Henderson, 1996; Ragheb, 1996), which complicate the knowledgeable use of the concept in nursing practice.
Finally, because a major focus of the practice of nursing is health promotion (Pender, Barkauskas, Hay man, Rice, & Anderson, 1992), nurses must recognize that leisure is an important component of health promotion (Caldwell & Smith, 1988). Nurses must know that leisure is important within one's overall lifestyle and not just as a fragmented activity (e.g., walking to improve cardiovascular health). Nurses must be able to assess older adults' ability to author their leisure experiences. Furthermore, nurses must be able to assist older adults in selecting and initiating activities that will enable them to achieve leisure satisfaction, using strategies such as educating, continuing, contributing, competing, edifying, and engaging.
Integrating leisure into the domain of nursing in this way will enable nurses to implement care that promotes mental, physical, and spiritual health and, thereby, positively contributes to older adults' quality of life (Fine, 1996).
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DEFINITION OF LEISURE THEMES WITH EXAMPLES FROM SUBJECTS
STRATEGIES OF AUTHORING LEISURE WITH EXAMPLES FROM SUBJECTS
SELECTED RESEARCH SUPPORT FOR STRATEGIES