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- Österlund Efraimsson, Eva, et al.
(författare)
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Communication and self-management education at nurse-led COPD clinics in primary health care
- 2010
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Ingår i: European Association for Communication in Health Care. - Verona.
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Konferensbidrag (refereegranskat)abstract
- The general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD. Designs: Observational, prospective observational and experimental designs were used. Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker. Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.
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| 2. |
- Österlund Efraimsson, Eva, et al.
(författare)
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Communication and self-management education at nurse-led COPD clinics in primary health care
- 2009
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Ingår i: Patient Education and Counseling. - : Elsevier. - 0738-3991 .- 1873-5134. ; 77:2, s. 209-217
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the study was to explore the structure, content in communication and self-management education in patients' first consultations at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary healthcare. Method: Thirty consultations performed by seven registered nurses were videotaped; structure and content in the consultation was analyzed using Pendleton's Consultation Map. Nurses' self-management education was assessed from the content of the conversation: whether important and relevant information and self-management education was given, and how investigations were performed. Results: Each consultation lasted for a mean time of 37.53 min. Communication about reasons for consultations concerned mainly medical and physical problems and to a certain extent patients' perceptions. Teaching about self-management and smoking cessation was of an informative nature. Two consultations ended with shared understanding, and none of the patients received an individual treatment-plan. Conclusion: Nurses rarely planned the consultations on an individual basis and rarely used motivational dialogue in self-management education and in smoking cessation. Practice implications: The findings could be used to help nurses to reflect on how to improve the structure of the visit, self-management education, smoking cessation and patient communication.
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| 4. |
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| 5. |
- Österlund Efraimsson, Eva, et al.
(författare)
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Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care
- 2015
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Ingår i: European Clinical Respiratory Journal. - : Informa UK Limited. - 1399-3003 .- 2001-8525. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes.Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care.Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations.Results: Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communicationwasmainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation.Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking.Practice implications: To make patients more active, the nurses need more education and continuous training in motivational communication.
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| 6. |
- Österlund Efraimsson, Eva, et al.
(författare)
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Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care
- 2011
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Ingår i: International Primary Care respiratory Group (IPCRG). - Amsterdam.
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Konferensbidrag (refereegranskat)abstract
- Aim: To examine smoking cessation communication between patients and registered nurses, with a few days of Motivational Interviewing (MI) based education, in consultations over time at nurse-led Chronic Obstructive Pulmonary Disease (COPD) clinics in primary health care (PHC). Method: The first and third of three consultations were videotaped, involving 13 smokers and six nurses. In these consultations smoking cessation communication was analyzed using the Motivational Interviewing Treatment Integrity (MITI) Scale and Client Language Assessment in Motivational Interviewing (CLAMI). Results: The nurses did, but only to a small extent, evoke patients’ reasons forchange, foster collaboration and support patients’ autonomy. In the registration of specific utterances; they provided a lot of information (42%), asked closed (21%) rather than open questions (3%) and made more simple (14%) than complex (2%) reflections. Most of the registration of the patients’ utterances in the communication were either toward or away from smoking cessation coded in the category Follow/Neutral (59%), followed by utterances in the categories of Reason for change 40%, Taking steps 1% and Commitment 0%. No significant differences could be observed in the results of MITI and CLAMI between the first and third consultations. Conclusion: Smoking cessation communication at nurse-led COPD clinics neither focused on the patients’ reasons for or against smoking nor motivated patients to express commitment to, or take steps towards, smoking cessation
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| 7. |
- Österlund Efraimsson, Eva, et al.
(författare)
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Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care
- 2011
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Ingår i: European Respiratory Society (ERS). - Amsterdam.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To explore smoking cessation communication between patients and registered nurses in consultations over time at nurse-led Chronic Obstructive Pulmonary Disease (COPD) clinics in primary health care. Method: The first and third of three consultations were videotaped, involving 13 smokers and six nurses with a few days of Motivational Interviewing (MI) based education. In these consultations smoking cessation communication was analyzed using the Motivational Interviewing Treatment Integrity Scale (MITI) and Client Language Assessment in Motivational Interviewing (CLAMI). Results: The nurses did only to a small extent evoke patients’ reasons for change, foster collaboration and support patients’ autonomy. Nurses provided a lot of information (42%), asked closed (21%) rather than open (3%) questions and made more simple (14%) than complex (2%) reflections. Patients communication were mainly Follow/Neutral (59%), Reasons for and against smoking 40%, least common were Taking steps (1%) and Commitment (0%) toward smoking cessation. Conclusion: The nurses did not use professional smoking cessation communication and the patients did not talk about how to quit smoking. Practice Implications: To make the patients more active in their smoking cessation process at nurse-led COPD clinics in primary health care the nurses need continuous education and training in smoking cessation communication.
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| 10. |
- Österlund Efraimsson, Eva, et al.
(författare)
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Support in smoking cessation at nurse-led Chronic Obstructive Pulmonary disease clinics
- 2010
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Ingår i: European Respiratory Society. - Barcelona.
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Konferensbidrag (refereegranskat)abstract
- Aim: To describe to what extent registered nurses use Motivational Interviewing (MI) in smoking cessation communication over time at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care. Background: For smokers with COPD the most crucial and evidence-based intervention is smoking cessation. Method and Results: The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. The nurses’ smoking cessation communication was analyzed using the Motivational Interviewing Treatment Integrity scale, a behavioral coding system that assesses the practitioners’ use of motivational interviewing. Nurses and patients talked for equal amounts of time in one third of the 26 consultations, whilst nurses talked for longer in the remaining two thirds. To capture an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five as the top score. Evocation, collaboration, autonomy-support and empathy averaged between 1.31 and 2.23 whereas direction scored five in all consultations. Of communication behaviors, giving information was the most frequently used, followed by closed questions, MI non–adherent and simple reflections. MI Adherent, open questions and complex reflections occurred rarely. There were no significant individual or group-level differences in any of the ratings between the first and the third consultations. Conclusion: In smoking cessation communication the nurses had low scores on evocation, collaboration, autonomy-support, empathy and high scores on direction. They also supplied large amounts of information, posed closed questions and made simple reflections. Open questions and complex reflections occurred rarely.
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