| 1. |
- Andersen-Hollekim, Tone, et al.
(författare)
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Narratives of patient participation in haemodialysis
- 2020
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 29:13/14, s. 2293-2305
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Tidskriftsartikel (refereegranskat)abstract
- Aim and objective: To explore how working-age adults experience patient participation in hospital haemodialysis. Background: End-stage kidney disease is a progressive, chronic condition imposing patients with high treatment burdens and low health-related quality of life. Patients face multiple medical decisions related to living with kidney failure. Given their frequent interaction with health services, patient participation may be of special value. Design: Qualitative design with a narrative approach. Methods: In 2018, eleven patients aged 35–64 years undergoing hospital haemodialysis participated in individual interviews. All interviews were analysed using a narrative approach. Reporting followed the Consolidated criteria for Reporting Qualitative Research guidelines. Findings: The patients’ narratives of participation comprised three themes following their healthcare trajectory: Informed, but not involved in treatment choices; Duality of care and control; and Frail trust reflecting collaborative deficiencies. The patients received good information about dialysis, but were not involved in choice of treatment modality. Professional work, as well as the nature of treatment, contributed to restricted patient autonomy. Patients’ trust suffered from collaborative deficiency generating delays in their treatment trajectories, and patients extended their responsibility into the coordination of transitions as a way of coping with these issues. Conclusions: The study identified challenges related to patient involvement and interdisciplinary collaboration. Involving patients through dialogue and acknowledging their experiences, preferences and lifestyles may strengthen the mutual patient–professional understanding of treatment. Despite increased focus on seamless trajectories, patients face obstacles regarding interdisciplinary collaboration and coordination of health services. Relevance to clinical practice: The findings indicate a want of individually customised care for people requiring dialysis. Patients need to be involved in the choice of treatment modality as well as decisions related to the current treatment. Information must include potential consequences of the different treatment modalities. Health services need to strengthen collaboration in order to secure treatment continuity and patient involvement.
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| 2. |
- Andersen-Hollekim, Tone, et al.
(författare)
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Nephrologists’ experiences with patient participation when long-term dialysis is required
- 2021
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Ingår i: BMC Nephrology. - : Springer Science and Business Media LLC. - 1471-2369. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: For individuals in need of dialysis, patient participation is important when determining care goals and in decision making regarding dialysis modality. Nephrologists hold a key role in delivering evidence-based healthcare that integrates patient preferences and values throughout the trajectory, and their experiences with patient participation are important for improving health care. The aim of this study was to explore nephrologists’ experiences with patient participation in different phases of the end-stage renal disease trajectory for working-age individuals who require dialysis. Methods: This explorative study comprised interviews with ten nephrologists from four different dialysis units in Central Norway. We analysed the interviews by applying an interpretive phenomenological approach. Results: Nephrologists had varied experiences with patient participation throughout the different phases of the treatment trajectory. During decision making on the dialysis modality, nephrologists emphasised patients’ choices in two approaches. In the first approach, they expected patients to choose the modality based on the provided information, which could be actively steered. In the second approach, they recognised the patients’ values and lifestyle preferences through shared decision-making. Within hospital haemodialysis, nephrologists considered patients’ self-care activities equivalent to patient participation, seeing self-care as a source of patient empowerment. They identified divergent patient–professional values and organisational structures as barriers to patient participation. Conclusion: Our study shows that nephrologists have different approaches to patient participation in different phases of the end-stage renal disease trajectory. Individual understanding as well as organisational structures are important factors to address to increase patient participation in end-stage renal disease care. Shared decision making, in which patient values are balanced against biomedical treatment targets, allows for mutual agreement between patients and healthcare professionals concerning medical plans and minimises the potential for patient–professional tensions.
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| 3. |
- Andersen-Hollekim, Tone E., et al.
(författare)
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Patient participation in the clinical pathway : Nurses' perceptions of adults' involvement in haemodialysis
- 2019
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Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 6:2, s. 574-582
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To develop knowledge of nurses' perceptions of participation for patients treated with haemodialysis and their next of kin.Design: A qualitative study with a hermeneutic approach.Methods: The data were collected in 2015 through focus groups with 13 nurses in Central Norway.Results: The nurses reported that patient participation ranging from non-involvement to shared decision-making was related to whether dialysis was initiated as acute or scheduled. The restrictions required in chronic haemodialysis limited participation. The next of kin were not involved. The nurses highlighted interventions on both the individual and system levels to strengthen participation.Conclusion: Dialysis units should develop strategies for participation related to individual needs and design treatment in cooperation with patients and their families, ensuring involvement early in the clinical pathway. Further research is needed on issues related to next of kin, including their desired level of involvement.
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| 4. |
- Bårdsgjerde, Elise Kvalsund, et al.
(författare)
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Patients' narratives of their patient participation in the myocardial infarction pathway
- 2019
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 75:5, s. 1063-1073
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore how patients in areas without local percutaneous coronary intervention (PCI) facilities experience patient participation in different phases of the myocardial infarction pathway. Background: Acute treatment of myocardial infarction often involves PCI. In Norway, this treatment is centralized at certain hospitals; thus, patients often require long-distance transportation and experience frequent hospital transfers. Short hospital stays, transfers between hospitals and the patient's emotional state pose challenges to promoting patient participation. Design: A qualitative design with a narrative approach. Methods: Participants were recruited through purposive sampling. Eight men and two women were interviewed in 2016. Findings: Four themes related to the patients' experiences at the beginning, middle and end of the pathway were identified: (a) Lack of verbal communication in the acute phase; (b) trust in healthcare professionals and treatment; (c) lack of participation and coordination at discharge; and (d) shared decision-making in rehabilitation. The findings showed how the patients moved from a low level of patient participation in the acute phase to a high level of patient participation in the rehabilitation phase. Conclusion: This is the first study to explore patient participation in different phases of the myocardial infarction pathway. We argue that individual plans for information and patient participation are important to improve patient involvement in an earlier stage of the pathway. Further research from a healthcare professional perspective can be valuable to understand this topic. Impact: This study gives new insight that can be valuable for healthcare professionals in implementing patient participation throughout the pathway.
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| 5. |
- Bårdsgjerde, Elise Kvalsund, et al.
(författare)
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Physicians’ perceptions of patient participation in the myocardial infarction pathway
- 2021
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Ingår i: Communication & Medicine. - : Equinox Publishing. - 1612-1783 .- 1613-3625. ; 18:2, s. 111-125
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Tidskriftsartikel (refereegranskat)abstract
- Myocardial infarction is an acute, frightening and life-threatening condition for patients who are affected. They need plain and simple information about the disease and the treatment, yet patient participation might be challenging in acute situations. Previous studies have shown that patient participation leads to improved patient satisfaction, cooperation with healthcare professionals and better management of the disease. Physicians have a key role in facilitating patient participation in the healthcare services. This study explores physicians’ perceptions of patient participation in the myocardial infarction pathway. In 2018 we interviewed nine experienced physicians in Norway working in different phases of the pathway. Hermeneutics was chosen as the underpinning analytical framework. Four themes illustrated patient participation in the myocardial infarction pathway. Paternalism characterised the acute phase. During hospitalisation the physicians perceived a lack of continuity in physician–patient communication. In the discharge phase, the physicians focused on strengthening health literacy. In the rehabilitation phase, dialogue and shared decision making was central to achieving treatment adherence. We found variations in the level of patient participation along the different phases of the myocardial infarction pathway. Strengthening continuity to ensure patient participation and collaboration between healthcare professionals is essential. The physicians proposed introducing checklists for patient information to enhance interprofessional collaboration and strengthen patient participation.
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| 6. |
- Giske, Solveig, et al.
(författare)
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Medical students' learning experience and participation in communities of practice at municipal emergency care units in the primary health care system : a qualitative study
- 2022
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Ingår i: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Medical education has been criticised for not adapting to changes in society, health care and technology. Internationally, it is necessary to strengthen primary health care services to accommodate the growing number of patients. In Norway, emergency care patients are increasingly treated in municipal emergency care units in the primary health care system. This study explores medical students' learning experience and how they participated in communities of practice at two municipal emergency care units in the primary health care system. Methods In this qualitative study, we collected data from March to May 2019 using semi-structured individual interviews and systematic observations of six ninth-semester medical students undergoing two-week clerkships at municipal emergency care units. The interview transcripts were thematically analysed with a social constructivist approach. A total of 102 systematic observations were used to triangulate the findings from the thematic analysis. Results Three themes illuminated what the medical students learned and how they participated in communities of practice: (i) They took responsibility for emergency care patients while participating in the physicians' community of practice and thus received intensive training in the role of a physician. (ii) They learned the physician's role in interprofessional collaboration. Collaborating with nursing students and nurses led to training in clinical procedures and insight into the nurses' role, work tasks, and community of practice. (iii) They gained in-depth knowledge through shared reflections when time was allocated for that purpose. Ethical and medical topics were elucidated from an interprofessional perspective when nursing students, nurses, and physicians participated. Conclusions Our findings suggest that this was a form of clerkship in which medical students learned the physician's role by taking responsibility for emergency care patients and participating in multiple work tasks and clinical procedures associated with physicians' and nurses' communities of practice. Participating in an interprofessional community of practice for professional reflections contributed to in-depth knowledge of ethical and medical topics from the medical and nursing perspectives.
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| 7. |
- Kvalslund Bårdsgjerde, Elise, et al.
(författare)
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Nurses' perceptions of patient participation in the myocardial infarction pathway
- 2020
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Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 7:5, s. 1606-1615
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore nurses' perceptions of patient participation in different phases of the myocardial infarction pathway. Design: Qualitative design with a hermeneutical approach. Methods: Five focus groups were conducted at two hospitals, one with and one without percutaneous coronary intervention facilities, between February–November 2018. Participants were recruited through purposive sampling. Twenty-two nurses experienced in cardiac care participated. The analysis had a hermeneutical approach. Results: The findings revealed nurses' perceptions of patient participation in different phases of the myocardial infarction pathway. Four themes were identified: (a) variation between paternalism and autonomy in the acute phase; (b) individualization of dialogue and patient participation during treatment; (c) lack of coherence in the pathway hinders patient participation at discharge; and (d) cardiac rehabilitation promotes patients' autonomous decisions in lifestyle changes.
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| 8. |
- Kvangarsnes, Marit, et al.
(författare)
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Narratives of breathlessness in chronic obstructive pulmonary disease
- 2013
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 22:21-22, s. 3062-3070
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To explore patient perceptions of chronic obstructive pulmonary disease exacerbation and the patients' experiences of their relations with health personnel during care and treatment.BACKGROUND: Patients suffering from acute exacerbation of chronic obstructive pulmonary disease often experience life-threatening situations and undergo noninvasive positive-pressure ventilation via bi-level positive airway pressure in a hospital setting. Theory on trust, which often overlaps with the issue of power, can shed light on patient's experiences during an acute exacerbation.DESIGN: Narrative research design was chosen.METHODS: Ten in-depth qualitative interviews (n = 10) were conducted with patients who had been admitted to two intensive care units in Western Norway during the autumn of 2009 and the spring of 2010. Narrative analysis and theories on trust and power were used to analyse the interviews.RESULTS: Because of their breathlessness, the patients perceived that they were completely dependent on others during the acute phase. Some stated that they had experienced an altered perception of reality and had not understood how serious their situation was. Although the patients trusted the health personnel in helping them breathe, they also told stories about care deficiencies and situations in which they felt neglected.CONCLUSIONS: This study shows that patients with an acute exacerbation of chronic obstructive pulmonary disease often feel wholly dependent on health personnel during the exacerbation and, as a result, experience extreme vulnerability.RELEVANCE TO CLINICAL PRACTICE: The findings give nurses insight into building trust and a good relationship between patient and caregiver during an acute exacerbation of chronic obstructive lung disease.
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| 9. |
- Kvangarsnes, Marit, et al.
(författare)
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Pasientmedverknad ved akutt sjukdom : ein metasyntese av pasient og helsepersonellerfaringar
- 2020
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Ingår i: Michael. - Oslo : Michael - The Norwegian Medical Society. - 1504-0658. ; 17:24, s. 77-94
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Tidskriftsartikel (refereegranskat)abstract
- Ein metasyntese syner at pasientmedverknad under akutt sjukdom kan variere frå at pasienten tek autonome val til at pasientane blir møtt med paternalistiske haldningar. Når livreddande behandling må gjennomførast, er det risiko for at helsepersonell må gjennomføre behandling utan samtykke frå pasienten. Då er det fare for at pasienten kan oppleve situasjonen som krenkande. Akutt sjukdom fører ofte til krevjande samhandling mellom pasient og helsepersonell samt at helsepersonell opplever etiske dilemma. Pasientar opplever mangel på informasjon og har behov for samtaler om eksistensielle problem. Behandling ved akutt sjukdom krev særleg aktsemd for at pasienten ikkje skal misse tillit til helsepersonellet.
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| 10. |
- Landstad, Bodil, 1965-, et al.
(författare)
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Brukermedvirkning i helsetjenesten : realitet og retorikk
- 2020
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Ingår i: Michael. - Oslo : Det norske medicinske Selskab. - 1504-0658. ; 17:24, s. 7-13
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- KattenKatten siti tunet når du kjem.Snakk litt med katten.Det er han som er varast i garden. Olav H. Hauge (1988) Dette diktet formidler en grunnleggende sannhet. Å lytte til dem som er til stede og nærværende, ligger til grunn også for brukermedvirkning i helsetjenesten. Helsehjelp angår først og fremst pasienter og pårørende, og helsepersonell skal ivareta deres interesser. Det er pasientene som erfarer sykdom på kropp og sinn, og det er pasienter og pårørende som må leve med konsekvensene av ulike behandlingsvalg. Det er derfor viktig at helsepersonell lytter til deres innsikt og erfaringer. Det er pasientene som er «varast i garden».
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