| 1. |
- Broström, Anders, et al.
(författare)
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Communication between patients with obstructive sleep apnoea syndrome and healthcare personnel during the initial visit to a continuous positive airway pressure clinic
- 2017
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 26:3-4, s. 568-577
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: To describe facilitators and barriers from a patient perspective in communications between patients with obstructive sleep apnoea syndrome and healthcare personnel during the first meeting when continuous positive airway pressure is initiated.Background: Adherence to continuous positive airway pressure treatment tends to be poor, especially at the initial phase of treatment. Communication between the patient and healthcare personnel has not been studied from the patient perspective, as either a barrier or facilitator for adherence.Methods: A descriptive design using qualitative content analysis was used. Interviews with 25 patients with obstructive sleep apnoea syndrome took place after their initial visit at four continuous positive airway pressure clinics. A deductive analysis based on The 4 Habits Model (i.e. emphasise the importance of investing in the beginning of the consultation, elicit the patient's perspective, demonstrate empathy and invest in the end of the consultation) was conducted.Results: Building confidence (i.e. structure building, information transfer, commitment) or hindering confidence (i.e. organisational insufficiency, stress behaviour, interaction deficit) was associated with investing in the beginning. Motivating (i.e. situational insight, knowledge transfer, practical training) or demotivating (i.e. expectations, dominance and power asymmetry, barriers) was associated with eliciting the patient's perspective. Building hope (i.e. awareness, sensitivity, demonstration of understanding) or hindering hope (i.e. unprepared, uncommitted, incomprehension) was associated with showing empathy. Agreement (i.e. confirmation, responsibilities, comprehensive information) or disagreement (i.e. structural obscurity, irresponsibility, absent-mindedness) was associated with investing in the end.Conclusions: Understanding of facilitators and barriers, as described by patients, can be used to improve contextual conditions and communication skills among healthcare personnel.Relevance to clinical practice: A patient-centred communication technique should be used in relation to all stages of The 4 Habits Model to facilitate shared decision-making and improve adherence to continuous positive airway pressure treatment.
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| 2. |
- Broström, Anders, et al.
(författare)
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Validation of CollaboRATE and SURE - two short questionnaires to measure shared decision making during CPAP initiation
- 2019
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Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869. ; 28:5
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Tidskriftsartikel (refereegranskat)abstract
- Adherence to continuous positive airway pressure (CPAP) treatment tends to be low. Brief validated instruments focusing on shared decision making have not been used in a CPAP context. The aim was to investigate factorial structure, categorical functioning of the response scale and differential item functioning across sub-populations of the CollaboRATE and Sure questionnaires among patients with obstructive sleep apnea (OSA) before CPAP treatment is initiated. A prospective design, including 193 objectively diagnosed (polygraphy) OSA patients (68% men, 59.7 years, SD 11.5) from two CPAP clinics was used. Data were collected with the following questionnaires; Sure, CollaboRATE, Attitudes to CPAP Inventory, Epworth sleepiness scale, minimal insomnia symptoms scale, and hospital anxiety and depression scale. Objective CPAP use was collected after 6 months; 49% demonstrated decisional conflict on SURE and 51% scored low levels of shared decision making on CollaboRATE. Unidimensionality was found for both CollaboRATE (one factor explaining 57.4%) and SURE (one factor explaining 53.7%), as well as local independence. Differential item functioning showed both to be invariant across both male and female patients. Internal consistency (Cronbach's alpha 0.83) and composite reliability (0.89) were good. Latent class analyses showed that patients with low decisional conflict and high shared decision making were more adherent to CPAP treatment. CollaboRATE and SURE provided good validity and reliability scores to measure shared decision making and decisional conflict in relation to CPAP treatment. The questionnaires can be used by healthcare personnel as a tool to simplify the assessment of shared decision making.
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| 3. |
- Fritzell, K., et al.
(författare)
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Making the BEST decision : The BESTa project development, implementation and evaluation of a digital Decision Aid in Swedish cancer screening programmes-a description of a research project
- 2023
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:12 December
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Tidskriftsartikel (refereegranskat)abstract
- Sweden has a long tradition of organized national population-based screening programmes. Participation rates differ between programmes and regions, being relatively high in some groups, but lower in others. To ensure an equity perspective on screening, it is desirable that individuals make an informed decision based on knowledge rather than ignorance, misconceptions, or fear. Decision Aids (DAs) are set to deliver information about different healthcare options and help individuals to visualize the values associated with each available option. DAs are not intended to guide individuals to choose one option over another. The advantage of an individual Decision Aid (iDA) is that individuals gain knowledge about cancer and screening by accessing one webpage with the possibility to communicate with health professionals and thereafter make their decision regarding participation. The objective is therefore to develop, implement and evaluate a digital iDA for individuals invited to cancer screening in Sweden. Methods This study encompasses a process-, implementation-, and outcome evaluation. Multiple methods will be applied including focus group discussions, individual interviews and the usage of the think aloud technique and self-reported questionnaire data. The project is based on The International Patient Decision Aid Standards (IPDAS) framework and the proposed model development process for DAs. Individuals aged 23 74, including women (the cervical-, breast-and CRC screening module) and men (the CRC screening module), will be included in the developmental process. Efforts will be made to recruit participants with selfreported physical and mental limitations, individuals without a permanent residence and ethnic minorities. Discussion To the best of our knowledge, the present study is the first attempt aimed at developing an iDA for use in the Swedish context. The iDA is intended to facilitate shared decision making about participation in screening. Furthermore, the iDA is expected to increase knowledge and raise awareness about cancer and cancer screening.
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| 4. |
- Hedberg, Berith
(författare)
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Beslutsfattande i klinisk verksamhet : En studie om sjuksköterskans beslutsfattande i praktiken
- 2003
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the project was to investigate how decision-making is expressed by experienced nurses in practice. A research questions were to describe how nurses make decisions of measures in practice and another research question were to explore contextual elements related to decision-making in nursing practice. A problem-solving-model could be used by the nurse to systematize tasks in which she is responsible. Specific competence is required when nurses act from such a model, when it comes to ability to manage information and to make clinical assessments, necessary claims for decision-making on measures. The theoretical starting point draws on naturalistic decision theory, which is based within a phenomenological perspective. One of the assumptions herein is that actions from experienced nurses are based in intuition and not in rationalistic and analytical mental models. Participant observations and interviews with six nurses from three differ-ent domains constituted the data. To call on the experience of the nurses, limited decision-making activities, identified from the field notes, served as a spring-board during the interviews. The data were analysed by an inductive content analysis. The results reveal that nurses uses observation of cues, confirmation of information and acting from strategies, developed from experience, as tools in their decision-making process. Observation of cues emerged as a powerful tool, used by the nurses to as soon as possible get to know the patient. When the nurses used confirmation as a tool, they used it to vali-date their interpretation of noticed cues and to choose appropriate meas-ures. From their experience the nurses had developed strategies which they used to be able to act independently when to choose measures. An-other finding highlighted important environmental elements, such as dis-ruption and procedures the nurse has to do as a part of her professional function, affecting the decision-making process.
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| 5. |
- Hedberg, Berith, et al.
(författare)
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Care-planning meetings with stroke survivors : Nurses as moderators of the communication
- 2007
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 15:2, s. 214-221
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Stroke survivors often have communicative disabilities. They should, however, be involved when decisions are made about their care treatment. Aim: To explore and describe how nurses act as moderators of the communication in cooperative care-planning meetings and what kind of participant status the patients achieve in this type of multi-party talk. Method: Thirteen care-planning meetings were audio-recorded and transcribed. Nurses, social workers and stroke survivors were the main participants for the meetings. A coding scheme was created and three main categories were used for the analysis: pure utterance types, expert comments (EC) and asymmetries. Results: The nurses never invited the patients to tell their own versions without possible influence from them. Mostly the nurses gave ECs. The nurses acted as the patients' advocates by talking for or about them. They rarely supported the patients' utterances. Conclusion: There is an urgent need for nurses to learn how to involve the patients in the communicative process about their treatment. Assessment of the patients' communicative abilities before the care-planning meetings as well as knowledge about how to invite them can improve the patients' participant status. © 2007 The Authors. Journal compilation 2007 Blackwell Publishing Ltd.
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| 6. |
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| 7. |
- Hedberg, Berith, 1951-
(författare)
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Communicative approaches in the decision making process
- 2009
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Ingår i: 7th Interdisciplinary Conference on Communication, Medicine Ethics (COMET).
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Communication in health care is sometimes problematic because of the participants' asymmetrical positions when negotiating the patients' future care. When decisions are made about stroke survivors' care treatment they should be involved despite communicative disabilities. Method: In a total of five hours recorded talk, data from care-planning meetings with elderly persons surviving stroke, has been transcribed and analyzed. To identify how the actors agreed upon decisions about care efforts after discharge, an inductive analyzing approach was used through the procedure of coding and categorization. By looking for patterns the two approaches emerged. Findings: Two distinctive approaches appeared in the communicative process, the open-minded and the aimdriven. The open-minded was characterized by questioning, merging information discussing alternative solutions leading to a goal step by step. The other communicative approach appeared to be aim-driven and was characterized by alliances between some of the participants. When the participants were involved in communicative alliances, they seemed to share a predetermined common goal for the patient's further care after discharge. The most significant alliance involved the patient together with relatives. The most noteworthy finding is that of the patient's need for communicative alliances with other participants when negotiating their needs and desires of further care. It was shown the stroke survivors are able to express their life world perspective when they are in alliances with relatives or healthcare professionals.
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| 8. |
- Hedberg, Berith
(författare)
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Decision Making and Communication : Aspects of Nursing Competence
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to understand the conditions and prerequisites of nurses’ decision making on nursing measures and their communication in multiparty talk, activities nurses manage in their work. By analysing both environmental elements in nursing practice and how experienced nurses manage decision-making processes, the intention has been to understand how nurses’ competence occurs and is expressed in nursing practice. A specific problem concerns the attention given to the patients’ right to participate in co-operative care planning meetings when decisions are made about their further care and how the conditions for patient involvement and influence become visible in multiparty talk. In the theoretical framework, it is argued that competence generally speaking concerns the individual’s potential capacity for action in relation to a certain task, situation and context. The expectations as regards nursing competence at work are expressed in work regulations and recommendations; however, the content of nursing education and practice constitutes powerful institutional frames, influencing how nurses are able to perform their tasks. The individual’s cognitive ability, the context-specific and collaborative knowledge, can be seen as additionally elements of nursing competence. The thesis is based on two different datasets which have generated four sub-studies. Studies I and II focus on the nurses’ decision-making process and the influence of the simultaneous presence of environmental elements. The empirical data consist of 30 hours of participant observation and inter-views with 6 experienced nurses at three different wards. Studies III and IV concern nurses involve-ment in a dynamic communicative process with co-workers, patients and, at times, their relatives including data from audio-recordings of 14 co-operative care planning sessions concerning stroke survivors. Throughout the four studies, a gap is visible between nurses’ decision making and communication in practice and the expectations of how nurses should manage these activities related to work regulations and the goals formulated in the nursing educational programs. How nurses make their decisions depends on their competence, the complexity of the task and how much they involve themselves in talk with others. The medical perspective dominates when nurses give priority to what should and can be done in nursing activities. As regards patients’ participation in co-operative care planning meetings, the professionals dominate the discourse space. The nurses never openly invited the patients to elicit their own perspective of their illness or care planning. The nurses mostly suggest-ed opinions or asked the patients to confirm these opinions. There is, however a hidden power agenda when patients and relatives try to reach a desired decision. The same phenomenon may occur when patients are in alliances with health care professionals. The above-mentioned issues are discussed in the light of nursing competence and the need for nurses to discuss what it means to be a nurse in relation to institutional frames of power relationships. If the official regulations and recommendations are to be satisfied, there is an urgent need for increased collaboration between nurses, the health care system and the nursing education programs.
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| 9. |
- Hedberg, Berith, et al.
(författare)
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Environmental elements affecting the decision-making process in nursing practice.
- 2004
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Ingår i: Journal of Clinical Nursing. - 0962-1067 .- 1365-2702. ; 13:3, s. 316-324
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In their practice nurses constantly make decisions in a dynamic context including complex situations. Besides affecting elements related to the decision-maker and the task itself, the setting where the decision-making process takes place are of decisive importance to the quality of the decision-making outcome. AIM: The aim of this study was to explore environmental elements related to the decision-making process in nursing practice. METHODS: Six expert nurses, from three Swedish nursing settings, participated voluntarily in the study, which were designed of participated observations in everyday nursing practice. Permission to carry out the study was given by the clinics and an ethical committee. A content analysis was used to analyse the field notes where themes emerged which were found to be environmental elements affecting decision-making process of nurses. CONCLUSIONS: The most striking theme, environmental elements, included the sub-themes interruptions and the work procedures are presented in this report. The implications of environmental elements, are discussed from a perspective of nurses' competence, where the elements could be seen as a facilitator or as a hindrance to developing nursing competence. It were concluded that environmental elements have to be well considered before knowledge can be reached about decision-making in practice. RELEVANCE TO CLINICAL PRACTICE: Interpersonal and technological interruptions were features highlighted in the study, features which could jeopardize the decision-making outcome. Therefore, it is of greatest importance that nurses learn to use decision-making strategies to guarantee patient care security and patient care quality.
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| 10. |
- Hedberg, Berith, 1951-, et al.
(författare)
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Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation
- 2018
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 17:5, s. 446-455
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making.AIM: The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms.METHODS: A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale-Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data.RESULTS: Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication.CONCLUSION: Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.
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