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- Edwall, Lise-Lotte
(författare)
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Rutinbesöket hos diabetessjuksköterskan - Vårdmötet och dess innebörd för personer med typ 2 diabetes
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: Diabetes care with diabetes nurse-led clinics in primary care has been established in Sweden since the 1980s. Patients with Type 2 diabetes are involved in lifelong treatment through annual diabetes check-up performed by the diabetes nurse specialists. The meaning is to promote patient’s health, diabetes control as well as the recommended physical examination. Knowledge about patients’ lived experience of these regular check-ups is important for the further development of diabetes nursing in primary care (study I). However, the communication depends on each party’s agenda or goals and the interaction structure during these check-ups is rarely studied (study II). Another aim was to elucidate the essential meaning of a consultation between diabetes nurse specialists and patients to gain a deeper understanding of the patients’ experiences (study III). Finally the glycaemic control, patients’ perceived foot problems, reported self foot care and outcomes of foot examination performed by DNSs over a four year period were investigated (study IV). Methods: Narrative interviews were conducted with 20 patients and a phenomenologicalhermeneutic method was used in the analysis and interpretation of the text (study I, III). In study II an applied conversation analysis was used in 20 video observations. A descriptive longitudinal study on foot examinations was completed at two diabetes nurse-led clinics in primary care (study IV). Patients (n=243) were examined at the clinics in 1999 and 2004. Results: Patients showed an overall positive influence on their way of living with the disease by being confirmed, being guided within the disease process, becoming confident and independent and being relieved(study I). Annual check-ups consisted of five phases: opening, health history, physical examination, conclusion and closing. The informative value of checkups varied depending on, the patients’ problems and the type of examination used, among other things (study II). The patient’s experience of a consultation was interpreted as manifestation of hold on the disease control. This means a safeguard to continue daily life shown in the four themes being controlled, feeling exposed, feeling comfortable, and feeling prepared (study III). Although the increased risk to patients’ foot complications over the period, a lack of compliance to basic foot care was revealed. This raised question about the informative value of foot care discussions at regular annual check-ups (study IV). Relevance to clinical practice and implications: The development of diabetes-nurse-led clinics from the perspective of the patient must consider the patient’s individual need for support and continuity with the diabetes nurse specialist. Routines of instruction to patients during physical examination procedures have an influence on patients’ understanding of measurement outcomes. Diabetes nurse specialists need to monitor all patients’ foot care as patients need to know the importance of self foot care .
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| 2. |
- Edwall, Lise-Lotte, et al.
(författare)
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The lived experience of the diabetes nurse specialist regular check-ups, as narrated by patients with type 2 diabetes.
- 2008
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 17:6, s. 772-81
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Tidskriftsartikel (refereegranskat)abstract
- The Sahlgrenska Academy, Göteborg University, Institute of Health and Care Sciences, Göteborg, Sweden. Lise-lotte.edwall@epost.tidanet.se AIM: The aim was to elucidate the lived experience of regular diabetes nurse specialist check-ups among patients with type 2 diabetes. BACKGROUND: Diabetes care with diabetes nurse-led clinics in primary care has been established in Sweden since the 1980s. Information about patients' lived experience of these regular check-ups is important in the further development of diabetes nursing in primary care. METHODS: Narrative interviews were conducted with 10 women and 10 men with type 2 diabetes regarding their lived experience in everyday life and the regular check-ups by the diabetes nurse specialist. A phenomenological-hermeneutic method inspired by Ricoeur was used in the analysis. RESULTS: Patients'- with type 2 diabetes - lived experience of regular check-ups showed an overall positive influence on the patients' way of living with the disease by underpinning and developing their understanding and management of daily life. This influence was interpreted as an interlinked chain comprising the following elements; being confirmed, being guided within the disease process, becoming confident and independent and being relieved. Every link contained a positive influence from being dependent-independent, autonomous and a feeling of freedom in patients striving for an everyday life with a disease under control. RELEVANCE TO CLINICAL PRACTICE: The development of diabetes-nurse-led clinics from the perspective of the patient must consider the patient's individual need for support and continuity with the diabetes nurse specialist. Consultations with collaborative partnership and specific expertise that is easy to access implied autonomous disease self-management in terms of patients' own control of the disease over time. In view of the increasing number of patients with diabetes, this could positively impact the availability of diabetes nursing care.
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| 3. |
- Edwall, Lise-Lotte, et al.
(författare)
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The meaning of a consultation with the diabetes nurse specialist.
- 2010
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 1471-6712 .- 0283-9318. ; 24:2, s. 341-8
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to elucidate the essential meaning of a consultation between diabetes nurse specialists and patients to gain a deeper understanding of the patients' experiences.
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