| 1. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Variations in understanding the drug-prescribing process : a qualitative study among Swedish GPs
- 2009
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 26:2, s. 121-127
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A majority of doctor-patient meetings result in the patient getting a prescription. This underlines the need for a high-quality prescription process. While studies have been made on single therapeutic drug groups, a complete study of the physicians' general thought process that comprises the prescription of all drugs still remains to be made. OBJECTIVE: To identify variations in ways of understanding drug prescribing among GPs. METHODS: A descriptive qualitative study was conducted with 20 Swedish physicians. Informants were recruited purposively and their understandings about prescribing were studied in semi-structured interviews. Data were analysed using a phenomenographic approach. RESULTS: Five categories were identified as follows: (A) GP prescribed safe, reliable and well-documented drugs for obvious complaints; (B) GP sought to convince the patient of the most effective drug treatment; (C) GP chose the best drug treatment taking into consideration the patient's entire life situation; (D) GP used clinical judgement and close follow-up to minimize unnecessary drug prescribing and (E) GP prescribed drugs which are cheap for society and environmentally friendly. The categories are interrelated, but have different foci: the biomedical, the patient and the society. Each GP had more than one view but none included all five. The findings also indicate that complexity increases when a drug is prescribed for primary or secondary prevention. CONCLUSIONS: GPs understand prescribing differently despite similar external circumstances. The most significant factor to influence prescribing behaviour was the physician's patient relation approach. GPs may need to reflect on difficulties they face while prescribing to enhance their understandings.
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| 2. |
- Holmström, Inger, et al.
(författare)
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Improving the diabetes-patient encounter by reflective tutoring for staff
- 2004
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 53:3, s. 325-32
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Tidskriftsartikel (refereegranskat)abstract
- There is relative consensus about the advantages of patient-centred consultations. However, they have not been easy to realise in clinical praxis. The aim of this study was to investigate whether an intervention focused on health care professionals' understanding of the diabetes-patient encounter could facilitate a patient-centred way to encounter these patients. Two GPs and two nurses participated in the year-long intervention. The intervention focused on the staff's understanding of the encounter. Staff video recorded four to five encounters each and reflected together with a supervisor on their understanding of the encounters and how they were conducted. The encounters were analysed with the Verona-MICS/Dr coding system and patients' comments were analysed separately. The content of the consultations and how they were conducted was also assessed. There was a significant change of two patient-centred items by the staff over time. Two staff seemed to change their educational model. Modern theories of competence development seem to be useful in clinical settings.
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| 3. |
- Holmström, Inger, et al.
(författare)
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Interventions to support reflection and learning: a qualitative study
- 2004
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Ingår i: Learning in Health and Social Care. - : Wiley. - 1473-6853 .- 1473-6861. ; 3:4, s. 203-12
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this research was to explore the role of a professional development supervisor in helping health professionals to reflect on their role in patient consultations. This article is written from the viewpoint of patient-centred care and seeks to examine how the mentor/supervisor can facilitate reflection and learning by discussing, with professionals, videotapes of their regular meetings with patients. The specific context of the article is an educational intervention in Sweden, based on modern theories of competence development for professionals in diabetes care. A purposeful sample of 18 patients with type 2 diabetes agreed to have their regular meeting with a general practitioner (GP) or diabetes nurse videotaped. The GPs or diabetes nurses of these patients then participated in an intervention, comprising sessions when they reviewed with a supervisor their consultations with the patients. These supervising sessions were videotaped and are investigated in this article. The supervisor's role was to make observations that could alter the professional's understanding of the diabetes consultation through video-cued narrative reflection. Five overarching themes were identified from the content (the what-aspect) of the intervention: medical problems; patient characteristics and reactions; patient education; the consultation as such; and the healthcare organization. The activities used in carrying out the intervention (the how-aspect) were: confirmation and feedback; interpretation; reflective questioning; suggestions and corrections; and closed-end questions or brief answers. It was hypothesized that this way of conducting reflective educational interventions would be beneficial for healthcare professionals when working with patients with various longstanding medical conditions, recognizing that a patient-centred approach which included the patient's learning and possibilities for self-management are more suitable for the chronic illness encounter.
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| 4. |
- Holmström, Inger, et al.
(författare)
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Swedish health care professionals' diverse understandings of diabetes care
- 2003
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Ingår i: Patient Education and Counseling. - 0738-3991 .- 1873-5134. ; 51:1, s. 53-58
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Tidskriftsartikel (refereegranskat)abstract
- Knowledge of health care professionals’ different understandings of diabetes care is important when preparing such professionals in patient education. For patients to manage illness effectively, the actions of health care professionals are crucial. Patients’ understanding of their condition should be taken as the point of departure when creating a learning situation. The professionals’ understandings of diabetes care were mapped using a survey including 169 primary care doctors, nurses, assistant nurses and chiropodists in Stockholm, Sweden. The responses were analysed using a phenomenographic approach. Five understandings were identified: the professionals treat the patients, the professionals give information, the professionals focus relation and organisation, the professionals seek the patient’s agreement, and the professionals focus the patient’s understanding of the situation. Only 20 (12%) of the 169 professional caregivers focused the patient’s understanding. Professionals need to develop their understandings of health care and the professional–patient interaction in order to support the patients’ learning.
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| 5. |
- Holmström, Inger, et al.
(författare)
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Understanding the job in a new way - a basis for development of competence in diabetes care
- 2000
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Ingår i: Upsala Journal of Medical Sciences, Supplement. - 0300-9726. ; 105:2, s. 161-169
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Tidskriftsartikel (refereegranskat)abstract
- Patients complain that doctors and nurses do not listen, and therefore a need to develop the patient encounter is at hand. Phenomenological theory has opened new ways to develop professional competence. If the idea holds that we express our understanding about our work through our actions, a change in understanding might further develop professional competence. This idea offers a new way to develop competence in diabetes health care service. The aim of this study was to map health care professionals' understanding of the patient encounter before and after an educational intervention that focused the way the health care professional experienced the encounter, and to describe how their understanding changed. Two general practitioners and two diabetes nurses participated. They were interviewed before and after the intervention. The intervention comprised 4-5 sessions during which they together with a tutor reviewed their videotaped consultations with different persons with diabetes. The tutors' role was to make interventions that could alter the persons understanding of the diabetes consultation through questioning. The interviews were analysed using phenomenographic method. The results show that the professionals changed their ways of experiencing the encounter after the intervention. They started to question their way of working, focused the patient's learning process and became interested in how to stimulate it.
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