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- Hedberg, Berith, et al.
(författare)
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Care-planning meetings with stroke survivors : Nurses as moderators of the communication
- 2007
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 15:2, s. 214-221
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Stroke survivors often have communicative disabilities. They should, however, be involved when decisions are made about their care treatment. Aim: To explore and describe how nurses act as moderators of the communication in cooperative care-planning meetings and what kind of participant status the patients achieve in this type of multi-party talk. Method: Thirteen care-planning meetings were audio-recorded and transcribed. Nurses, social workers and stroke survivors were the main participants for the meetings. A coding scheme was created and three main categories were used for the analysis: pure utterance types, expert comments (EC) and asymmetries. Results: The nurses never invited the patients to tell their own versions without possible influence from them. Mostly the nurses gave ECs. The nurses acted as the patients' advocates by talking for or about them. They rarely supported the patients' utterances. Conclusion: There is an urgent need for nurses to learn how to involve the patients in the communicative process about their treatment. Assessment of the patients' communicative abilities before the care-planning meetings as well as knowledge about how to invite them can improve the patients' participant status. © 2007 The Authors. Journal compilation 2007 Blackwell Publishing Ltd.
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| 3. |
- Hedberg, Berith, 1951-
(författare)
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Communicative approaches in the decision making process
- 2009
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Ingår i: 7th Interdisciplinary Conference on Communication, Medicine Ethics (COMET).
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Communication in health care is sometimes problematic because of the participants' asymmetrical positions when negotiating the patients' future care. When decisions are made about stroke survivors' care treatment they should be involved despite communicative disabilities. Method: In a total of five hours recorded talk, data from care-planning meetings with elderly persons surviving stroke, has been transcribed and analyzed. To identify how the actors agreed upon decisions about care efforts after discharge, an inductive analyzing approach was used through the procedure of coding and categorization. By looking for patterns the two approaches emerged. Findings: Two distinctive approaches appeared in the communicative process, the open-minded and the aimdriven. The open-minded was characterized by questioning, merging information discussing alternative solutions leading to a goal step by step. The other communicative approach appeared to be aim-driven and was characterized by alliances between some of the participants. When the participants were involved in communicative alliances, they seemed to share a predetermined common goal for the patient's further care after discharge. The most significant alliance involved the patient together with relatives. The most noteworthy finding is that of the patient's need for communicative alliances with other participants when negotiating their needs and desires of further care. It was shown the stroke survivors are able to express their life world perspective when they are in alliances with relatives or healthcare professionals.
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| 4. |
- Hedberg, Berith
(författare)
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Decision Making and Communication : Aspects of Nursing Competence
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to understand the conditions and prerequisites of nurses’ decision making on nursing measures and their communication in multiparty talk, activities nurses manage in their work. By analysing both environmental elements in nursing practice and how experienced nurses manage decision-making processes, the intention has been to understand how nurses’ competence occurs and is expressed in nursing practice. A specific problem concerns the attention given to the patients’ right to participate in co-operative care planning meetings when decisions are made about their further care and how the conditions for patient involvement and influence become visible in multiparty talk. In the theoretical framework, it is argued that competence generally speaking concerns the individual’s potential capacity for action in relation to a certain task, situation and context. The expectations as regards nursing competence at work are expressed in work regulations and recommendations; however, the content of nursing education and practice constitutes powerful institutional frames, influencing how nurses are able to perform their tasks. The individual’s cognitive ability, the context-specific and collaborative knowledge, can be seen as additionally elements of nursing competence. The thesis is based on two different datasets which have generated four sub-studies. Studies I and II focus on the nurses’ decision-making process and the influence of the simultaneous presence of environmental elements. The empirical data consist of 30 hours of participant observation and inter-views with 6 experienced nurses at three different wards. Studies III and IV concern nurses involve-ment in a dynamic communicative process with co-workers, patients and, at times, their relatives including data from audio-recordings of 14 co-operative care planning sessions concerning stroke survivors. Throughout the four studies, a gap is visible between nurses’ decision making and communication in practice and the expectations of how nurses should manage these activities related to work regulations and the goals formulated in the nursing educational programs. How nurses make their decisions depends on their competence, the complexity of the task and how much they involve themselves in talk with others. The medical perspective dominates when nurses give priority to what should and can be done in nursing activities. As regards patients’ participation in co-operative care planning meetings, the professionals dominate the discourse space. The nurses never openly invited the patients to elicit their own perspective of their illness or care planning. The nurses mostly suggest-ed opinions or asked the patients to confirm these opinions. There is, however a hidden power agenda when patients and relatives try to reach a desired decision. The same phenomenon may occur when patients are in alliances with health care professionals. The above-mentioned issues are discussed in the light of nursing competence and the need for nurses to discuss what it means to be a nurse in relation to institutional frames of power relationships. If the official regulations and recommendations are to be satisfied, there is an urgent need for increased collaboration between nurses, the health care system and the nursing education programs.
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| 5. |
- Hedberg, Berith, 1951-
(författare)
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Flerpartssamtalet före utskrivning
- 2008
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Ingår i: Stroke i fokus. - Lund : Studentlitteratur. - 9789144019710
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 8. |
- Hedberg, Berith, 1951-, et al.
(författare)
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Utvärdering av Samverkan i Vårdkedjan
- 2008
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet var att utvärdera samverkan i vårdkedjan genom att belysa om Esther får vård i eller nära hemmet, får lika vård på hela Höglandet, upplever vården och omsorgen som en vårdgivare, har en individuell vårdplan och vet vart hon/han ska vända sig. Kvantitativ data avseende åldersfördelning, vårdnivå, vårdtillfällen, medelvårdtid, väntetid på akutmottagningen, medicinklinikens rådgivande koordinatorsfunktion och ”Medicin direkt” samt avvikelserapportering har insamlats från befintlig statistik från Höglandets sjukvårdsvårdsområde. Kvalitativ data har insamlats genom fokusgruppsintervjuer med 29 äldre personer > 65 år och 21 vård- och omsorgspersonal inom Höglandets sjukvårdsområde. Statistiken visar att antalet inskrivna individer i hemsjukvården har ökat, primärvårdsbesöken likaså och antalet läkarbesök i patientens bostad/motsvarande har i det närmaste fördubblats. På motsvarande sätt visar statistiken att antalet inläggningar, medelvårdtid samt återinläggningar har minskat. För åldersgruppen 80 år och äldre har antal besök på kirurgisk mottagning ökat medan besöken på medicinsk mottagning har minskat. I samma åldersgrupp visar statistiken att medelväntetiden på kirurgkliniken respektive medicinkliniken har ökat med 52 respektive 53 minuter. Rådgivningar via medicinklinikens koordinator har ökat samtidigt som överföringen av patienten till akutmottagningen vid Höglandsjukhuset också har ökat. Resultatet från den kvalitativa analysen visar att Esther känner sig trygg när hon/han behöver hjälp och stöd av vårdgivaren. För ”Esther som individ” innebär samverkan i vårdkedjan tillgänglighet, kontinuitet och aktivitet men också delaktighet, integritet och trygghet. Sitt beroende av andra hanterar Esther genom att använda strategier som eget ansvar, anpassning, acceptans och passivisering. För personalen utgör ramar och villkor som omger deras arbete i relation till Esthers behov av vård och omsorg, faktorer som påverkar samverkan i vårdkedjan. Slutsatsen är att grundtanken i Esther nätverk finns förankrad i vårdkedjan. Personalens gemensamma synsätt avspeglas i att Esther i hög grad är nöjd med den vård och omsorg hon får och att hon känner sig trygg med den. Trygghet är grundläggande för Esther och innebär kontinuitet, tillgänglighet och att få en individ- och behovsanpassad vård och omsorg genom hela vårdkedjan. Inom ramen för samverkan är detta områden som skulle kunna förbättras ytterligare.
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| 9. |
- Hedberg, Berith
(författare)
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Vem styr dig i jobbet?
- 2006
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Ingår i: Omvårdnadsmagasinet. - 1652-0858. ; :2, s. 18-19
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Forskningsöversikt (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Kvarnström, Susanne, 1958-, et al.
(författare)
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Multiparty team talk : Constructions of user participation in an interprofessional team context
- 2009
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Ingår i: Communication, Medicine & Ethics.
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Konferensbidrag (refereegranskat)abstract
- Background. Today health and social care delivery are largely team based but the question remains whether the voice of the user is perceived as a team member or merely as the recipient of the care. There have however been few efforts to understand or change the smallest interprofessional frontline units who generate the actual service, i.e. the microsystems.Purpose. This paper presents preliminary findings regarding descriptions of constructions of user participation in a multiparty negotiation context.Materials and methods. The material consisted of ethnographic field notes and audiotapes from observations (n=8) of interprofessional team meetings in one clinical healthcare microsystem. The teams included the user and health professionals, e.g. medical social worker, physician and psychologist. The users who participated in the observed team meetings had all long-term mainly physical conditions.Findings and discussion. Preliminary inductive analyses of observations of interprofessional team situations involving users indicates identity constructions in multiparty talk where the user is beheld primarily as a loyal and active member of the team. Discussions will relate to how user participation is learned and constructed by users and health professionals in collaborative care at the microsystem level.
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