| 1. |
- Hjelmfors, Lisa, 1984-
(författare)
-
Communication about the Heart Failure Trajectory in Patients, their Families and Health Care Professionals
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: There is an increasing awareness in the field of cardiology regarding the need for improved delivery of palliative care in patients with heart failure (HF). Professional guidelines have drawn attention to the importance of discussing the heart failure trajectory with patients and their families. These discussions can include, for example, talking about the prognosis, expectations for the future, and care at the end-of-life. It seems difficult for health care professionals to choose the right time for initiating these discussions. They often avoid these conversations because they are afraid of taking away hope and make the patients and their families anxious.Aim: The overall aim of this thesis was to improve communication about the heart failure trajectory in patients, their families, and health care professionals.Design and methods: This thesis includes five studies using different designs and data collection methods. Study I has a cross-sectional design using a questionnaire to collect data to describe heart failure nurses’ perceptions of and practice in discussing prognosis and end-of-life care with heart failure patients. Study II has a descriptive and comparative design, where a survey was performed to describe Swedish and Dutch heart failure nurses’ reasons for discussing or not discussing prognosis and end-of-life care with patients. Study III has an inductive and exploratory design, where HF patients participated in focus groups or individual interviews. Data was collected based on their perceptions of communication about the heart failure prognosis. Study IV was a small-scale ethnographic study describing and evaluating the delivery of a simulation when teaching third-year nursing students about end-of-life care at a Swedish university. Study V used co-design in which patients with HF from primary care, their family members and health care professionals (physicians and nurses) from palliative and HF care were invited to be constructive participants in the design process of a communication intervention. Health care professionals participated in a first feasibility testing of the intervention.Results: Most Swedish HF nurses had discussed prognosis (96%) and end-of-life care (84%) with a HF patient at some point in clinical practice. The nurses often reported that a physician was to have the main responsibility for such discussions (69%), but that the nurse was also believed to have a role to play (I). Prognosis and end-of-life care were, together with sexual activity, () the three least frequently discussed topics in HF clinics in both Sweden and the Netherlands (II). In conversations with 1,809 Swedish and Dutch HF patients, prognosis was discussed with 38% of the patients and end-of-life care was discussed with 10%. In study III, patients expressed different experiences of and preferences for communication about their HF prognosis. Many patients described that the health care professionals had not provided them with any prognosis information at all. The patients had different understandings of HF as a chronic illness, which had an impact on their preferences for communication about their prognosis (III). The simulation training described in the ethnographic study (IV) was part of an end-of-life care simulation during the last term of the 3- year bachelor degree level nursing education program, where students learn and practice basic palliative care. The students felt that the simulation training was a good opportunity to practice handling end-of- life situations as it gave them a chance to experience this situation and their own feelings and thoughts on death and dying. In study V, an intervention to improve communication about prognosis and end-of-life care in HF care was developed and some areas were feasibility tested. Heart failure patients, their families and health care professionals working in HF care or palliative care participated in the development process. Health care professionals (nurses and physicians) participated in the following feasibility testing of the intervention.Conclusions: This thesis shows that prognosis and end-of-life care are seldom discussed with HF patients in Swedish and Dutch heart failure care. and that many heart failure nurses have ambiguous attitudes towards discussing these topics with patients and their families (I+II). The patients described that they receive different messages concerning their heart failure, and that they also have different preferences for discussing the heart failure trajectory with health care professionals. The professionals need to understand the impact of heart failure on each patient and adapt the communication to each individual (III). End-of-life care simulation with skilled supervisors shows great promise for health care professionals to learn good communication skills in end-of-life care conversations (IV). A Question Prompt List and a communication course might be useful for improving communication about the heart failure trajectory in patients, their families, and health care professionals
|
|
| 2. |
- Boström, Eva, 1966-
(författare)
-
Proximity and distance : challenges in person-centred care for diabetes specialist nurses in primary health care
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Type 2 diabetes demands self-management over time, to maintain health and reduce the risk for diabetes complications. However, despite efforts, many persons with type 2 diabetes are not reaching the treatment targets. In diabetes, person-centred care and group education are recommended. Diabetes specialist nurses (DSNs) working in primary healthcare have an important role in supporting patients with type 2 diabetes in their self-management to adapt to the demands of the disease in everyday life. Therefore, it is important to explore the DSNs’ professional role and their experiences of practising person-centred care. The overall aim of the thesis was to explore the professional role of DSNs in primary healthcare, and to describe their experiences of person-centred diabetes care.Methods The thesis includes three studies with qualitative, and one with a quantitative, approach. Data collection consisted of focus group interviews, individual interviews, observations, and questionnaires. Qualitative content analysis and statistics were used in the analysis. In studies I and II, 29 and 31 DSNs participated, respectively. In study III, 10 DSNs and 44 persons with type 2 diabetes participated. Lastly, in study IV, 10 DSNs participated.Results The results in the thesis showed that DSNs have a complex and multifaceted professional role that entails striving to be an expert, a fosterer, a leader, an executive, and a role model, which they found challenging. The DSNs perceived high job demands, such as decision-making and learning. The thesis also showed that the interaction between DSNs and persons with type 2 diabetes shifted from empowerment to authority struggles during group support sessions based on person-centred care. The experience of person-centred care was described as enriching, but DSNs also expressed ambivalence, related to an altered professional role.Conclusion There is a desire by DSNs to be close to persons with type 2 diabetes, although they have several challenges to fulfil, which makes it difficult to uphold a relation with proximity; thus, distance is also present. Even though person-centred care is recommended in healthcare, and despite DSNs’ efforts to practise PCC, the result of this thesis shows that it also implies an altered professional role for DSNs that has to be addressed.
|
|
| 3. |
- Sjöström, Anna, 1979-
(författare)
-
eHealth literacy and internet use for health information : a study in Swedish primary healthcare
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Primary healthcare (PHC) is facing significant challenges in Sweden and around the world. One way to address such challenges is through health-related Internet information (HRII) and other eHealth services, which are resources for high-quality, accessible and cost-effective care. Such resources have been found to assist in improving individual health, especially for people with chronic conditions such as type 2 diabetes. More specifically, eHealth services may play an important role in increasing patients’ knowledge, engagement and autonomy in health management, as well as enhancing their self-care practices. However, patients must have adequate capabilities – collectively known as eHealth literacy (eHL) – in order to use eHealth services effectively. Aim: The overall aim of this thesis was to explore eHL and HRII use in the context of Swedish PHC. Methods: Data collection for paper I was conducted through individual interviews with PHNs, which were then analysed using qualitative content analysis. Paper II involved patients with type 2 diabetes who were interviewed individually or responded to open-ended survey questions; the data were analysed using thematic analysis. In paper III, which was a translation and validation study, the data consisted of cognitive interviews and questionnaires predominantly answered by PHC visitors, and employed psychometric analysis methods. The same data from PHC visitors were used in paper IV, in which descriptive and comparative statistics and logistic regression analyses were employed. Results: In paper I, the interviewed PHNs expressed mixed feelings regarding consultations with Internet-informed patients. While they recognised benefits such as increased patient engagement and the support of self-care, their responses focused on the challenges they encountered. These challenges included patient confusion and unwarranted anxiety stemming from HRII, as well as conflicted, time-consuming and unnecessary healthcare consultations. In paper II, patients with type 2 diabetes outlined their challenges associated with online COVID-19 information, which encompassed information overload, conflicting content and notable emotional impact. They described employing diverse coping strategies to address these challenges, including restricting their information consumption, relying on authoritative sources, actively evaluating source credibility, engaging in discussions with others and applying common sense. In paper III, the eHealth Literacy Questionnaire (eHLQ) was translated and culturally adapted to assess eHL in a Swedish context. The Swedish version of the eHLQ was found to demonstrate robust psychometric properties. In paper IV, it was determined that older age groups (>60) were assessed with lower eHL in several eHLQ domains, including those regarding motivation and ability to use HRII and digital technology. In addition, older age groups reported that eHealth services did not suit their individual needs. Variables that were found to be independently associated with lower eHL across several domains were advanced age and the perception that HRII was not useful or important. Conclusion: Both the patients and PHNs in this thesis encountered challenges related to patients’ acquisition of HRII and utilisation of eHealth services. A collective and important objective for healthcare professionals and authorities should be to facilitate patients’ HRII and eHealth service usage. Therefore, PHNs and other healthcare professionals should actively encourage open discussions with patients about the latter’s HRII findings, recommend credible websites, explore potential barriers to patients’ eHealth usage, motivate patients to use eHealth services and suggest ways for patients to enhance their eHL. Healthcare authorities and eHealth developers are suggested to increasingly involve end-users in the development of eHealth services and provide opportunities for customisation based on individual needs.
|
|
| 4. |
- Valan, Lotha, 1970-
(författare)
-
Barnhälsovårdens förändrade roller och behov av digital utveckling
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Den svenska barnhälsovården är frivillig och kostnadsfri, och de flesta svenska familjer följer programmet. Den är dock inte jämlikt fördelad över landet och kan därför behöva utvecklas med fler digitala element och bli mer familjefokuserad. Många, särskilt kvinnor, beskrivs behöva mycket stöd under övergången till föräldraskap och uppskattar professionell hjälp för att hantera känslomässig och psykosocial stress. Familjefokuserad omvårdnad ligger till grund för omvårdnadspraktiker inom barnhälsovården, vilket innebär att specialistsjuksköterskan skapar vård tillsammans med familjen och tar vara på alla kompetenser på bästa sätt. Att involvera föräldrarna i utvecklingen av barnhälsovården är därmed av yttersta vikt.Syfte: Det övergripande syftet var att utröna hur föräldrar och Barnavårdscentralensspecialistsjuksköterskor (BVC-sjuksköterskor) uppfattar och använder Internet som en källa för hälsokompetens, samt att utvärdera effekten av en digital pilotinterventionutvecklad i samarbete med föräldrar med målet att minska föräldrastress, öka hälsolitteracitet och tillfredsställelse med barnavårdscentralen (BVC).Metoder: Kvalitativa (I, III), mixade (II) och kvantitativa (IV) metoder baserade på intervjudata, gruppdiskussioner och frågeformulär användes i de fyra studierna som syftade till att; I) beskriva BVC-sjuksköterskors erfarenheter och åsikter om föräldrars internetanvändning, II) beskriva hälso- och barnutvecklingsrelaterade sökmönster på internet hos föräldrar till friska barn och hur informationen användes i kontakter med barnhälsovården (BHV), III) beskriva föräldrars behov och förväntningar på digitalt stöd i samband med barnhälsovård, och slutligen IV) utvärdera effekten av en digital pilotintervention riktad till föräldrar, avseende föräldrars stress och eHälsolitteracitet. Kvalitativa data analyserades med hjälp av kvalitativ innehållsanalys och kvantitativa data med beskrivande och jämförande statistiska metoder.Resultat: Studie I visade att föräldrars internetanvändning påverkade BVC-sjuksköterskors arbete på olika sätt. Internet ansågs underlätta vård, tillgång och tillhandahållande men kunde också komplicera den professionella rollen och prestationen, vilket innebar att de upplevde ett imperativ för en förändrad roll som BVC-sjuksköterskor. I studie II framkom att föräldrar i mycket hög grad sökte på Internet efter hälsorelaterade ämnen, och resultaten belyser också frågan om svårigheterna att bedöma källornas pålitlighet. Studien visade också att Internet kunde stärka föräldrarna med ny kunskap och stödja deras förmåga till egenvård, men att denna kunskap å andra sidan också oroade dem och gjorde dem osäkra i sin föräldraroll. Studie III, som rapporterade om föräldrars behov av och förväntningar på digitalt stöd, visade att de ville bli mer självständiga i sitt föräldraskap men fortfarande behövde stöd och meningsfulla relationer. Viktiga aspekter, förutom förbättrad tillgänglighet som efterfrågades var ökad tillit långsiktiga relationer och stärkt oberoende. Studie IV visade att den digitalasupport-intervention inte gav de effekter på föräldrastress och e-hälsolitteracitet som förväntades, även om tendenser kunde identifieras. Detta ansågs främst bero på en alltför kort genomförandeperiod med alltför få deltagare, då det visades att endast en femtedel av familjerna i interventionsgruppen använde supporten, resten tycktes intebehöva den eller hade kanske ännu inte upptäckt nyttan av den.Slutsats: Den digitala eran utmanar både föräldrar och BVC-sjuksköterskor. Digitalt stöd som utvecklas tillsammans, dvs där BVC-sjuksköterskor och föräldrar i samarbete kommer överens om hur, när och om vilka ämnen denna typ av stöd och kommunikation ska omfatta, kan dock upplevas som meningsfullt. Ett genomförande i större omfattningskulle öka tillgängligheten, samtidigt stärka föräldrarnas egenmakt och leda till mer långsiktiga relationer med andra föräldrar. Implementerat klokt bland fler deltagare och över längre perioder är det möjligt att den digitala supporten också kan ha mer positiva effekter på tillfredsställelse med BHV samt på minskad föräldrastress och ökad eHälsolitteracitet.
|
|
| 5. |
- Backman Lönn, Beatrice, 1974-
(författare)
-
The registered nurse as a clinical research nurse
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Clinical research studies are important for the developmentof new treatments in healthcare. The quality of clinical research relies on the competence, skills, and knowledge of the research team. Clinical research nurses (CRNs) are important members of clinical research teams as they are responsible for various tasks specified in study procedures. Internationally, nurses have been engaged as CRNs in in many areas of medicine, such as oncological research, for several decades. However, there is a lack of consensus concerning their professional role and a clear work description is lacking. In Sweden, nurses are becoming increasingly involved in research as CRNs, yet the CRN role is undefined as there is no Swedish national competence description that could guide CRNs’ work tasks, requirements for education, and management of ethical issues. Furthermore, the processof becoming a CRN is not understood. Increasing international research into the CRN role has shown that the role differs between countries.There is a lack of Swedish studies, including studies of the process of transitioning from being a registered nurse (RN) to a CRN. Since consensus is lacking concerning the CRN role in Sweden, we need to explore it further and examine how nursing perspectives are influencing it. The overall aim of this thesis was therefore to explore the professional role of CRNs in Sweden and the transition of RNs to being CRNs.Methods: Both quantitative (studies I and II) and qualitative (studies III and IV) methods were used. The analyses are based on data from questionnaires and individual interviews of CRNs in Sweden. In study I, descriptive statistics and test–retest analyses were used to analyze the validity and reliability of the translated CTNQ-SWE. In study II, descriptive statistics and one-way ANOVA were used to analyze reported work tasks, perceptions, and differences between groups of CRNs. In studies III and IV, qualitative content analysis according to Graneheimet al., (2004) was used to analyze the transition, i.e., becoming and being a CRN.Results: CRNs perform new and diverse work tasks and are often involved throughout the study process, with the greatest activity in data management and the actual conducting and evaluation of clinical studies (e.g., scheduling and performing procedures and tests according to the research protocols). There is seldom any work description or competence framework to guide nurses through the transition to the CRN role, placing them in an uncertain position where they must struggle to adaptiv to their new role and work tasks. To perform these new work activities, CRNs need more support as well as education in research procedures, regulations, and ethics. During the transition, CRNs improve their knowledge of research, regulations, and ethics and increase their experience of clinical research practice and collaboration in networks. They also learn and develop from dealing with challenging situations, such as the informed consent process. Furthermore, problem solving, study requirements, and ethical reasoning are emphasized as challenging. When passing through the different phases of transition to the CRN role, the nurses achieve expanded competence, change didentity, and growing confidence as informal leaders. CRNs also advocate for patient rights and mentor others involved in research, but they simultaneously lack acknowledgement and a formal leadership role.Conclusions and clinical implications: This thesis provides important insights into the CRN role in Sweden. It highlights the transition of RNs to becoming CRNs as well as their experiences of working as and becoming CRNs. The thesis reports that CRNs, overall, seem to be satisfied with their work, but some of their experiences highlight that skills, education, and organizational structures require improvement; forexample, appropriate introduction and support are required during the transition to the CRN role. Ethical challenges call for ongoing discussion in research teams. One conclusion is that CRNs’ competences and tasks need to be clarified. Developing clear competence pathways for nurses to become CRNs, including mentorship and support, could be one way of acknowledging CRNs’ important work, thereby creating a better outlook for high-quality clinical research procedures. Making the CRN professional title more homogeneous nationally and internationally would make comparisons easier. This would clarify CRNs’ work tasks and role in Sweden and extend the nursing perspective on ethics. This thesis adds to a slowly growing body of literature on the CRN role and is relevant to both practitioners and policymakers. Additionally, it illustrates a need to develop both educational and mentoring support aswell as career pathways for RNs to become CRNs, which could improve the quality of clinical research in Sweden.
|
|
| 6. |
- Holmlund, Lena, 1967-
(författare)
-
Patients’ experiences of atrial fibrillation and an evaluation of a nurse-led person-centred clinic
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Living with and managing atrial fibrillation (AF) can be complex. Some people have no symptoms, while others have a significant symptom burden. Health-related quality of life (HRQoL) is often low and partly associated with symptom burden. However, the impact of the condition on daily life differs between those affected and is not fully understood. Therefore, more knowledge is needed about patients’ experiences of AF and factors influencing HRQoL. Research indicates that the care of patients with AF needs to change and be more based on personal preferences and values.Aim: The overall aim of this thesis was to explore patients’ experiences of AF and to evaluate the effects of a nurse-led, person-centred clinic.Methods: The thesis contains four studies. Study I was based on interviews with 15 patients about their experiences of living with symptomatic AF. Studies II and III were based on data from questionnaires completed before and 6 months after scheduled electrical cardioversion. Study II was a cross-sectional study with 52 women and 115 men describing illness perceptions and HRQoL and exploring their relationship. Study III was a longitudinal study comparing 53 newly diagnosed (<6 months) and 76 previously diagnosed patients with AF (≥6 months) regarding HRQoL, illness perceptions, symptoms, symptom burden, anxiety and depression. Study IV was a randomised controlled trial evaluating the effects of a nurse-led, person-centred clinic on patient-reported outcomes measures in patients with AF. Patients were randomly assigned to a nurse-led intervention group (n=50) or a control group with a physician visit (n=53) and completed questionnaires on the same subjects as in Study III at baseline before the visit to the clinic and 6 months after. Study I were analysed with qualitative content analysis. The other studies are quantitative and were analysed with descriptive statistics (Studies II–IV), comparative statistics (Studies II–IV), and correlation analysis and multiple linear regression analysis (Study II).Results: In Study I, three themes (striving for illness control, becoming a receiver or an active partner in care, and dealing with a changed self-image) were reflected in the main theme, balancing life. The participants described their struggles in understanding AF, preventing recurrence and managing anxiety. Some were not involved in decision-making, lacked continuity of care, felt that most information focused on medical issues and requested more support and self-care advice. Study II showed that HRQoL was related to and negatively affected by attributing more symptoms, severe consequences, and negative emotions (e.g., anxiety, anger) to AF and perceiving AF as recurrent. Women reported worse HRQoL and lower personal control than men. Study III showed that newly diagnosed (vs. previously diagnosed) patients at baseline reported AF as a more temporary condition to a greater extent and had stronger belief that the illness was controllable. After 6 months, newly diagnosed patients reported better HRQoL, higher personal control, and lower symptom burden than previously diagnosed patients. Over time, HRQoL improved and AF symptom burden and symptoms of anxiety decreased in newly diagnosed patients, who viewed the illness as chronic to a greater extent than at baseline. Study IV showed that, in the nurse-led intervention group, the patients’ negative emotions towards AF decreased more than in the control group. In addition, their concerns regarding AF decreased and their personal control increased. In both groups, HRQoL and patients’ understanding of AF improved.Conclusions: This thesis demonstrates that for many, AF meant a change in life in which they had to manage anxiety and symptoms and oscillate between being strong and weak and a changed self-image. Men (vs. women) and newly diagnosed (vs. previously diagnosed) patients reported more positive outcomes, such as better HRQoL and greater belief in their ability to control AF. Worse HRQoL was associated with negative illness perceptions, such as more perceived recurrences, symptoms, severe consequences, and negative emotions. The findings in Study IV suggest that the support from a nurse-led person-centred clinic may reduce patients’ negative emotions and concerns attributed to AF and improve their personal control.
|
|
| 7. |
- Schimmer, Robyn, Doktorand, 1979-
(författare)
-
Between health and healthcare : a lifeworld perspective on personal informatics
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis explores the role of technology in digitized life focusing on lived experiences of personal informatics technologies in health and healthcare contexts. The work departs from an interest in how digital technologies affects us as individuals in contemporary life. The use personal informatics and self-tracking technologies are explored both in everyday and healthcare contexts. These technologies are used to support self-monitoring and behavioral change, both to improve general health and for patients with chronic illness. In the thesis, personal informatics technologies are studied in the contextual transition between health to healthcare with the purpose of providing a deeper understanding of how these particular kinds of digital devices affect human experience in everyday life.This research is based on four empirical studies addressing different aspects of how personal informatics technologies redefine the understanding of self at the intersection between health and healthcare contexts. Data was analysed in two steps: an inductive analysis followed by a deductive analysis based on a postphenomenological framework. Findings from the inductive analysis give support for the existing critique of personal informatics being too much concerned with metrics, behaviour and a simplified understanding of self. Applying a postphenomenological framework to the empirical material demonstrates how personal informatics technologies mediates experiences of self, health and healthcare. The analysis also reveals the bidirectional nature of technological mediation making particular experiences foregrounded and more accessible, while downplaying other experiences as less visible and accessible. This lifeworld perspective opens up for understanding the lived experiences of personal informatics technologies in everyday life. This is a contribution to understanding the role of technology in digitized life. It is also a contribution to user experience design as the lifeworld perspective opens up several design challenges concerning how design of personal informatics can shift its focus from the user to the everyday life of a person.The design challenges found in this thesis are closely related to fields such as norm-critical design, norm-creative design and speculative design, aspiring beyond normative understandings of technology use and design. The postphenomenological analysis suggest four dimensions for further scrutiny in health and healthcare contexts. The dimensions are ontological, epistemological, practical and ethical. For each of these dimensions there are bidirectional aspects that can be used in order to deliberate on implications for design. It is about what is revealed and concealed, what is magnified and reduced, what is enabled and constrained and finally what involves and alienates when people engage with personal informatics technologies. The thesis concludes that the lifeworld perspective on personal informatics, including the postphenomenological analytical framework, supports further critical examinations of the role of technology in digitized life.
|
|
| 8. |
- Wennberg, Anna Lena, 1952-
(författare)
-
Pregnant women and midwives are not in tune with each other about dietary counseling : studies in Swedish antenatal care
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background During pregnancy, a healthy diet is beneficial for the expecting mother and her fetus. Midwives in antenatal care have an ideal position for promoting a healthy diet and thereby help women to not only lower the risks of pregnancy complications and adverse birth outcomes, but improve maternal health. The overall aim of this thesis was to describe diet and dietary changes during pregnancy from the women’s and the midwives’ perspectives with a focus on dietary counseling. The thesis comprises four studies. The specific aims in the respective studies were to: I) Describe pregnant women’s attitudes to and experiences of dietary information and advice, as well as dietary management during pregnancy. II) Explore midwives’ strategies in challenging dietary counseling situations. III) Describe how midwives’ perceive their role and their significance in dietary counseling of pregnant women. IV) Describe women’s food habits during pregnancy and up to six months postpartum.Methods Studies I-III were qualitative. Study I included focus group interviews with 23 pregnant women. Study II included telephone interviews with 17 experienced midwives working in Swedish antenatal health care. Study III included the same 17 interviews from study II and supplemented them with four face-to-face-interviews. Qualitative content analysis was performed in all three studies. Study IV was a longitudinal study including a quantitative analysis of a questionnaire, which was given to women at five occasions during and after pregnancy. It concerned their food habits and it was answered by 163 women. The quantitative data was analyzed using comparative and descriptive statistics.Results The overall findings of the thesis were summarized as the main theme “Pregnant women and midwives are not in tune with each other about dietary counseling”. The main theme included the two themes ‘Pregnant women are concerned about risks for their child but fail to change to healthier dietary habits over time’, and ‘Midwives view themselves as authorities, though questioned ones’. In subthemes it was highlighted that pregnant women are well informed and interested in risk reduction for their child’s best and that they try to do their best to improve their diet during pregnancy. However, their diet did not reach levels of healthy eating recommendations and became even unhealthier after pregnancy. It was also highlighted that midwives experienced insufficient knowledge in dietary issues and related risks and that they had difficulties to give dietary support to pregnant women. Midwives were found to mainly focus on giving information and they lacked sufficient competence for challenging counseling.Conclusion Pregnant women, on the one hand, experience a lack of support from the midwives when dealing with dietary changes. The midwives, on the other hand, feel exposed and express a need for both further education in dietary issues and training in counseling. Women’s food habits during, but in particular after pregnancy need improvement, and dietary counseling could be more focused on healthy eating in a long-term perspective.
|
|
| 9. |
- Öberg, Ulrika, 1969-
(författare)
-
Finding a common ground : a pilot implementation of digital self-managment support in Swedish primary health care
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Due to an ageing, multi-diseased population, type 2 diabetes (T2D) and other chronic conditions pose a challenge for primary healthcare. To meet such challenges, primary healthcare nurses must adapt to new roles and acquire new skills regarding self-management support. eHealth and digital solutions are suggested to facilitate the increasing need for care in chronic conditions. However, how these solutions are experienced among users has not yet been sufficiently explored. To successful implement new working methods in primary healthcare, it is important to identify prerequisites and barriers that exists.Aim: The overall aim of this thesis was to explore perceptions among primary healthcare nurses and patients about digital self-management support in T2D and also to develop and evaluate a digital screening instrument assessing individual needs for self-management support. This thesis is based on four papers. Papers I and II aimed to describe perceptions among primary healthcare nurses and persons with T2D of using eHealth services for self-management support. Paper III aimed to develop and psychometrically test a screening instrument for person-centred guidance and self-management support. Paper IV aimed to describe diabetes specialist nurses’ experiences of a pilot implementation of the instrument labelled the Self-Management Assessment Scale (SMASc) as a basis for person-centred digital self-management support.Methods: A combined approach was used to collect and analyse data. Data in the qualitative studies were collected by means of focus group interviews (I) and individual interviews (II, IV) as well as participant observations (IV) were analysed using qualitative content analysis (I, II, IV). Quantitative data in study III were psychometrically tested. The participants in the respective studies were in Paper I primary healthcare nurses (n = 24), in Papers II and III persons with T2D (n = 11; n = 104) and in Paper IV diabetes specialist nurses (n = 5) and persons with T2D (n = 14). All data were collected in a county in northern Sweden.Results: The overall results constituted a web of mixed experiences and feelings towards using digital self-management support. Primary healthcare nurses pronounced their ambivalence towards the digital development in healthcare (I). Patients as well had mixed feelings, but they also pronounced benefits and potentials leading to increased involvement and empowerment (II). The psychometric assessment of the screening instrument, SMASc, demonstrated high potential and promising results for clinical assessments on factors affecting self-management behaviours (III). Preliminary results suggest that the SMASc instrument is considered suitable for screening of patients’ needs for self-management support (IV). Conclusion: The results of this thesis suggest that digitalization needs stepwise implementation. Digital tools such as the SMASc instrument can be useful in facilitating identification of patients in need of targeted interventions. However, primary healthcare nurses must be open to discussing patients’ emotional adaptation to the disease as well as the knowledge, sometimes not evidence based, the patients may have obtained from Internet sources. Targeted self-management support including person-centred guidance is suggested to be an effective way to achieve patient.
|
|
| 10. |
- Ekdahl, Ann
(författare)
-
Living with Chronic Obstructive Pulmonary Disease Stage III or IV from the Perspective of the Affected Women and Their Close Relatives : A Qualitative Study
- 2021
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Living with chronic obstructive pulmonary disease stage III or IV has a major impact on a person's everyday life. The aim of this licentiate thesis was to describe the experiences of women living with chronic obstructive pulmonary disease stage III or IV, as well as the experiences as a close relative to women with chronic obstructive pulmonary disease stage III or IV. In both studies, data were collected through individual, semi-structured interviews. The interview texts were then subjected to qualitative content analysis. A purposive sample of 15 women with either stage III or IV chronic obstructive pulmonary disease stage and a total of 9 close relatives participated in the studies. The findings showed that breathlessness restricted women with chronic obstructive pulmonary disease, to live with a breathing and body which they had to wait for. Stabilizing an ever-present breathlessness by restoring strength helped them manage everyday life and adapt to their limited abilities and energy. This restoration required detailed planning and a good knowledge of their breathing and bodies. Women were afraid of contracting life-threatening infections that would cause suffering. Fear led to isolation, and digital media were described as an important means of communication (I). Close relatives were of major importance to women with chronic obstructive pulmonary disease in their everyday life in terms of being flexible to accommodate the women’s needs. They were flexible, available, and on stand-by. The COVID-19 pandemic was experienced by close relatives as a reinforced threat to women with chronic obstructive pulmonary disease. Close relatives raised awareness of their vulnerability to potentially life-threatening infections, leading them to carefully avoid exposure and thus rely more on digital media. A more sedentary life was one effect of living in a gradually, yet controlled everyday life for close relatives. Women with chronic obstructive pulmonary disease stage III or IV and their close relatives expressed that they lacked continuity, participation, and support from healthcare professionals (I, II). In conclusion, the findings of this licentiate thesis show that women with chronic obstructive pulmonary disease stage III or IV and their close relatives experience both health and suffering in their everyday lives. By gaining understanding and insights into the lives of women with chronic obstructive pulmonary disease, as well as the needs and everyday challenges of their close relatives, better health outcomes can be supported.
|
|
