| 1. |
- Aasen, Elin Margrethe, et al.
(author)
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Scandinavian Online Cancer Information as Expressions of Governmentality
- 2023
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In: Advances in Nursing Science. - : Wolters Kluwer. - 0161-9268 .- 1550-5014. ; 46, s. 293-305
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Journal article (peer-reviewed)abstract
- We compared online distributed information provided to patients with cancer in Scandinavian countries through the lens of governmentality. A secondary comparative qualitative analysis was conducted. Discourses in online patient information showed differences in governmentality techniques across the countries: Norway used a paternalist approach, Denmark an educative approach, and Sweden an individualistic approach and expected the patients to make the “right” decisions. Online information for patients with cancer in Denmark and Norway showed high professional and health care system involvement, whereas in Sweden, there was high patient involvement. There was almost no use of the person-centered approach among the online discourses
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| 2. |
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| 3. |
- Boman, Åse, 1957-, et al.
(author)
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Conceptions of Diabetes and Diabetes Care in Young People With Minority Backgrounds.
- 2015
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In: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 25:1, s. 5-15
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Journal article (peer-reviewed)abstract
- Adolescents with type 1 diabetes (T1DM) need stable self-care routines for good metabolic control to minimize future cardiovascular health complications. These routines are demanding, and might be particularly challenging in underprivileged groups. The aim of this study was to gain in-depth knowledge on the experience of adolescents with T1DM and a non-Swedish background regarding factors that might influence their ability to take care of themselves; in particular, factors that might influence diabetes management routines, their social situation, and the support they receive from caregivers. We interviewed 12 adolescents with T1DM and minority backgrounds. The results indicated resources and constraints in the adolescents' social context and in the health care organization. The adolescents developed conceptions that helped to explain and excuse their self-care failures, and their successes. These findings highlight the importance of integrating T1DM as part of the individual's personal prerequisites. We discuss implications for the organization of diabetes care for adolescents.
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| 4. |
- Boman, Åse, 1957-, et al.
(author)
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Fathers' encounter of support from paediatric diabetes teams : the tension between general recommendations and personal experience
- 2013
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In: Health & Social Care in the Community. - : Hindawi Limited. - 0966-0410 .- 1365-2524. ; 21:3, s. 263-270
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Journal article (peer-reviewed)abstract
- The purpose of this grounded theory study was to explore and discuss how fathers involved in caring for a child with type 1 diabetes experienced support from Swedish paediatric diabetes teams (PDTs) in everyday life with their child. Eleven fathers of children with type 1 diabetes, living in Sweden and scoring high on involvement on the Parental Responsibility Questionnaire, participated. Data were collected from January 2011 to August 2011, initially through online focus group discussions in which 6 of 19 invited fathers participated. Due to high attrition, the data collection continued in eight individual interviews. A semi-structured interview guide was used, and the fathers were asked to share experiences of their PDT's support in everyday life with their child. A simultaneous and constant comparison approach to data collection and analysis allowed the core category to emerge: the tension between general recommendations and personal experience. This core category illuminates how the fathers experienced tension between managing their unique everyday life with their child and balancing this to meet their PDT's expectations with regard to blood glucose levels. The core category was supported by two categories: the tension between the fathers'and their PDT's knowledge, whereby fathers reported discrepancies between their PDT's medical knowledge and their own unique knowledge of their child; and the tension between the fathers'and their PDT's goals, whereby the fathers identified differences between the familys' and their PDT's goals. As a dimension of the core category, fathers felt trust or distrust in their PDT. We conclude that to achieve high-quality support for children with diabetes and to enhance their health and well-being, involved fathers' knowledge of their unique family situation needs to be integrated into the diabetes treatment.
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| 5. |
- Boman, Åse
(author)
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Fathers involved in children with type 1 diabetes : finding the balance between disease control and health promotion
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Background:Type I diabetes is a chronic disease that places great demands on the child and family. Parental involvement has been found to be essential for disease outcome. However, fathers’ involvement has been less studied, even though high paternal involvement has been correlated with less disease impact on the family and higher quality of life among adolescents.Aim: The overall aim of the study was to explore and analyze constructions of fathers’ involvement in their child’s everyday life with type 1 diabetes from an ecological and health promotion perspective. Four specific aims were applied: 1) explore and describe discourses in health care guidelines for children with type 1 diabetes in Nordic countries, focusing on parents' positioning (I), 2) analyze how Swedish pediatric diabetes teams perceived and discussed fathers’ involvement in the care of their child with type 1 diabetes, and to discuss how the teams’ attitudes toward the fathers’ involvement developed during a focus group process (II), 3) explore and discuss how fathers involved in caring for their child with type 1 diabetes experience support from their pediatric diabetes team in everyday life with their child (III), and 4) analyze how involved fathers to children with type 1 diabetes understand their involvement in their child’s daily life and to discuss their perceptions from a health promotion perspective (IV).Material and methods: A qualitative and inductive approach was applied. Data were collected and analyzed during 2010-2012. The sample consisted of three pediatric guidelines originating from Norway, Denmark and Sweden (I), three Swedish pediatric diabetes teams (PDTs) (II), and 11 (III) and 16 (IV) fathers of children with type 1 diabetes who scored high involvement on the Parental Responsibility Questionnaire. Data were collected through repeated focus group discussions with the PDTs (II), online focus group discussions (III) and individual interviews (III, IV) with the fathers. Three analysis methods were applied: analysis of discourses (I), Constructivist Grounded Theory (II, III) and content analysis (IV).Findings: The findings illuminated the complex interaction between the pediatric guidelines, the PDTs and the fathers. Fathers highly involved in their child’s daily life experienced different levels of tension between the general recommendations and their personal experiences of living with a child with type 1 diabetes (III). The fathers regarded their involvement in their child’s diabetes care as additional to their general parenting, and a fine balance was identified between a health promotion perspective and a controlling involvement. The common denominator between the highly involved fathers was their use of parental leave (IV). The PDTs initially perceived fathers’ involvement as gendered and balanced on the mother’s agement, but as focus was set on fathers’ engagement the PDTs increased their awareness of this and started to identify and encourage their engagement II). At the macro-level, parents’ voices were diminished in Nordic pediatric diabetes guidelines in favor of an expert discourse (I).Conclusions: Fathers’ involvement concerning a child with type 1diabetes is constructed in a complex way, based on an interaction between the fathers’ perceptions of their additional involvement and the support provided by the PDTs; the PDTs’ perceptions of the fathers’ involvement; and how parents/fathers are constructed in pediatric diabetes guidelines. In order to promote the health and well-being of children with type 1 diabetes, fathers’ involvement needs to be taken into account in the pediatric guidelines as well as in clinical practice.
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| 6. |
- Boman, Åse, et al.
(author)
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Fathers of Children With Type 1 Diabetes : Perceptions of a Father's Involvement From a Health Promotion Perspective
- 2014
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In: Journal of Family Nursing. - : SAGE Publications. - 1074-8407 .- 1552-549X. ; 20:3, s. 337-354
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Journal article (peer-reviewed)abstract
- This study describes how fathers of children diagnosed with type 1 diabetes understand their involvement in their child's daily life from a health promotion perspective. Sixteen Swedish fathers of children living with type 1 diabetes were interviewed. Manifest and latent content analysis was used to identify two themes: the inner core of the father's general parental involvement and the additional involvement based on the child's diabetes. The former was underpinned by the fathers' prioritization of family life and the fathers being consciously involved in raising the child, and the latter by the fathers promoting and controlling the child's health and promoting and enabling the child's autonomy. The results highlight that the quality of the fathers' involvement is essential in the management of a child's chronic illness. It is important for pediatric diabetes health care professionals to assess the quality of fathers' involvement to promote the child's health.
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| 7. |
- Boman, Åse, 1957-, et al.
(author)
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Health care to empower self-care in adolescents with type 1 diabetes mellitus and an immigrant minority background
- 2017
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In: Sage Open medicine. - : SAGE Publications. - 2050-3121 .- 2050-3121. ; 5
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Journal article (peer-reviewed)abstract
- Background: The pediatric diabetes team aims to support health, quality of life, and normal growth and development among adolescents with type 1 diabetes mellitus. Adolescents with an immigrant background have been found less successful in self-care. Previous research indicated that adolescents who had integrated the disease as a part of their self-image reasoned differently about their self-care to those who had not. Objective: The aim of this study was to identify elements in the patient–pediatrician consultations that might influence such integration of the disease among adolescents with type 1 diabetes mellitus. Methods: A total of 12 pediatrician–adolescent consultations were video-recorded and analyzed. The adolescents all had an immigrant background. Results: Integration of the disease appeared enabled when responsibility was shared; when hope, autonomy, and emotions were confirmed; and when the pediatrician asked probing questions. Letting objective data dominate the adolescent’s experiences, using risk as a motivator, neutralizing emotions in relation to having diabetes, and confirming forgetfulness, may instead inhibit disease integration. Conclusion: An extended person-centered approach with focus on the adolescent’s experiences of everyday life with a chronic disease and less attention on physical parameters in the pediatrician–adolescent consultations may increase integration of the disease.
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| 8. |
- Boman, Åse, 1957-, et al.
(author)
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If dad comes, we are happy - if mom fails to appear, we become desperate : A Grounded Theory study of Swedish diabetes teams perecption of fathers’ involvement in their child's everyday life
- 2011
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In: 4th International Research Seminar on SALUTOGENESIS and meeting of the IUP-GWG-SAL. ; , s. 1-12
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Conference paper (peer-reviewed)abstract
- Background: Since parental involvement is essential to the outcome of diabetes type 1 treatment in childhood and high paternal engagement in everyday life promote the child's health, it is of value to explore how professionals, the diabetes teams (DT), perceive fathers' involvement in their child with diabetes type 1.Method: The study design was Constructivist Grounded Theory and data was collected by Repeated Focus Groups discussions with three Swedish pediatric diabetes teams, between May 2010 and January 2011.Results: The core category for the diabetes teams' perception of fathers' involvement was If dad comes, we are happy – if mom fails to appear, we become desperate. The core category relied on three subcategories. Societal and cultural context where DTs perceived fathers involvement as having specific properties and specific areas of responsibility, Balancing where the DTs balanced the father's involvement against the mother's engagement and Becoming aware where the DTs raised awareness of the fathers from being a indistinct parents-unit till to identify and appreciate the father's engagement.Conclusions: Perceiving fathers as equal caregivers, and becoming aware of fathers as a health resource, could support an active health promotion perspective in pediatric diabetes care.
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| 9. |
- Boman, Åse, 1957-
(author)
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Learning by supporting others : experienced parents' development process when supporting other parents with a child with Type 1 diabetes
- 2018
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:5-6, s. E1171-E1178
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Journal article (peer-reviewed)abstract
- AIMS AND OBJECTIVES: This study's purpose was to describe and analyze coach-parents' development process when supporting parents of children recently diagnosed with Type 1 Diabetes Mellitus (T1DM).BACKGROUND: It has been found repeatedly that providing social support for families with a child diagnosed with T1DM promotes health and wellbeing for both the child and the parents. Less explored are the processes experienced by those who provide this support. However, research has found that acting as a provider of social support promotes personal development, strengthens communication skills, and increases self-confidence.METHODS: The study design was based on Constructivist Grounded Theory and data were collected, through Repeated Focus Group Discussions, from eight coach-parents at a Swedish hospital from 2012-2015.RESULTS: The core category in the data was identified as a learning process where coach-parents emphasized their own learning in the dyad supporter - supported, and in the interaction with other parents in the Repeated Focus Group Discussions. The coach-parents' motivation for participation was a wish to learn more and to help other parents in a life-changing situation. They also pointed out hindrances and their frustration when unable to provide support.CONCLUSIONS: This study leads to the conclusion that people who provide support benefit from doing so. Encountering people with similar experiences in a supportive situation promotes a reciprocal learning process, based on the supporter's wish to help people in a situation they recognize. A further conclusion is that social support is not only essential initially, but is also important over a longer period and that it follows various life stages.RELEVANCE TO CLINICAL PRACTICE: Setting up repeated focus group discussions might be a relevant and effective tool for pediatric diabetes nurses to use in promoting health and wellbeing for both families with a newly diagnosed child and experienced families. This article is protected by copyright. All rights reserved.
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| 10. |
- Boman, Åse, 1957-, et al.
(author)
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Parents' discursive resources : Analysis of discourses in Swedish, Danish and Norwegian health care guidelines for children with diabetes type 1
- 2012
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 26:2, s. 363-371
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Journal article (peer-reviewed)abstract
- The incidence of diabetes type 1 in children, the most common metabolic disorder in childhood, increases worldwide, with highest incidence in Scandinavia. Having diabetes means demands in everyday life, and the outcome of the child's treatment highly depends on parents' engagement and involvement. The aim of this study was to explore and describe discourses in health care guidelines for children with diabetes type 1, in Sweden, Norway and Denmark during 2007-2010, with a focus on how parents were positioned. As method a Foucauldian approach to discourse analysis was applied, and a six-stage model was used to perform the analysis. The findings shows a Medical, a Pedagogic and a Public Health discourse embedded in the hegemonic Expert discourse. The Expert discourse positioned parents as dependent on expert knowledge, as recipients of education, as valuable and responsible for their child's health through practicing medical skills. This positioning may place parents on a continuum from being deprived of their own initiatives to being invited to take an active part and could result in feelings of guilt and uncertainty, but also of security and significance. From this study we conclude that guidelines rooted in the Expert discourse may reduce opportunities for parents' voices to be heard and may overlook their knowledge. By broadening the selection of authors of the guidelines to include patients and all professionals in the team, new discourses could emerge and the parents' voice might be more prominent. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.
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| 11. |
- Boman, Åse, 1957-, et al.
(author)
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Salutogen omvårdnad
- 2015. - 1. uppl.
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In: Salutogenes. - Stockholm : Liber. - 9789147111336 ; , s. 191-208
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Book chapter (other academic/artistic)
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| 12. |
- Boman, Åse, 1957-, et al.
(author)
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Swedish pediatric diabetes teams' perception of fathers' involvement : A Grounded Theory study
- 2013
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In: Nursing and Health Sciences. - : Wiley. - 1441-0745 .- 1442-2018. ; 15:2, s. 179-185
-
Journal article (peer-reviewed)abstract
- The purpose of this study was to analyze how Swedish pediatric diabetes teams perceived and discussed fathers' involvement in the care of their child with type 1 diabetes. It also aimed to discuss how the teams' attitudes towards the fathers' involvement developed during the data collection process. The Constructivist Grounded Theory design was used and data were collected during three repeated focus group discussions with three Swedish pediatric diabetes teams. The core category of the teams' perception of fathers' involvement emerged as: If dad attends, we are happy – if mom doesn't, we become concerned. Initially the teams balanced their perception of fathers' involvement on the mother's role as the primary caregiver. In connection with the teams' directed attention on fathers, in the focus group discussions, the teams' awareness of the importance of fathers increased. As a consequence, the team members began to encourage fathers' engagement in their child's care. We conclude that by increasing the teams' awareness of fathers as a health resource, an active health promotion perspective could be implemented in pediatric diabetes care.
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| 13. |
- Boman, Åse, 1957-, et al.
(author)
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The reasonable patient : A Swedish discursive construction
- 2021
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In: Nursing Inquiry. - : Wiley. - 1320-7881 .- 1440-1800. ; 28:3
-
Journal article (peer-reviewed)abstract
- The aim of this study was to analyse how the patient is constructed and socially positioned in Swedish patient information. Corpus-assisted critical discourse analysis methodology was utilised on a sample of 56 online patient information texts about cancer containing a total of 126,711 words. The findings show an overarching discourse of informed consent guided by specific features to produce a patient norm that we name “the reasonable patient”, who is receptive to arguments, emotionally restrained and makes decisions based on information. Through the discourse of informed consent, the norm of the reasonable patient emerges, apparently to even out the imbalance of power between patient and professional, but in reality, more likely to construct a patient who is easily controlled and managed. When the self-responsibility towards health is incorporated into the everyday domestic spaces via digital health technologies, the ideas and concepts of the patient role need to be reconsidered based on these new conditions. We conclude that it is important for nursing researchers to broaden the research on patients to include the relationship of power created through language. This study demonstrates both methodological and empirical possibilities to do so
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| 14. |
- Dahlborg, Elisabeth, 1974-, et al.
(author)
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Encircling discourses : A guide to critical discourse analysis in caring science
- 2023
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In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 38, s. 177-184
-
Journal article (peer-reviewed)abstract
- AimThe aim of this article was to introduce Fairclough's critical discourse analysis (CDA) in caring and nursing science, to provide a guide on how to perform such an analysis, and to describe the wider context of discourse epistemology.DesignThe article is designed as a methodological paper, including (a) epistemological roots of discourse analysis, (b) an overview of discourse analytical research within caring and nursing science which points out an increased trend, and (c) a guide to conducting a CDA.AnalysisIt is important that discourse analysis is available and accessible to nursing and caring researchers. Through the process of encircling discourses, valuable insight is given into fields that otherwise would be lost or would not be available.ConclusionOur summary stance is that discourse analysis as it is presented in this article is strongly advisable for use in nursing and caring sciences.
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| 15. |
- Dahlborg, Elisabeth, 1974-, et al.
(author)
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The struggle between welfare state models and prevailing healthcare policy in Scandinavian healthcare legislative documents
- 2021
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In: International Journal of Health Governance. - 2059-4631. ; :1, s. 51-64
-
Journal article (peer-reviewed)abstract
- Purpose The paper aims to compare and discuss the findings of discursive constructions of patients in legal texts from the three Scandinavian countries. Since traditional welfare state systems in Scandinavia are being challenged by new governance systems, new questions are being raised about patient positions and agency, carrying with them potential ethical dilemmas for healthcare professionals.Design/methodology/approachThe methodology of the paper is inspired by critical discourse analysis. Comprehensively analysing the findings of previous discourse studies on how "the patient" is constructed in central policy texts, this study compares the position of the patient in Norway, Sweden and Denmark.FindingsThe paper reveals ideological struggles across the Scandinavian countries, operating at a political level, a legislative level and a healthcare level. It is shown that national governance systems still exert hegemonic power by strongly influencing patients' degree of choice and autonomy. The discursive struggle between welfare state governance and other governance systems in Scandinavia indicates a shift towards a commercial healthcare market although a traditional welfare model is advocated by professionals and researchersResearch limitations/implicationsBecause of the specific conditions of Scandinavian healthcare policy, the findings lack generalisability. The research approach should therefore be explored further in additional contexts.Practical implicationsThe findings of this study can inform policymakers, professionals and patients of the ideological values underlying seemingly objective shifts in national policy.Originality/valueA comparative critical discourse analysis can expose patterns in the Scandinavian approaches to patient rights.
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| 16. |
- Dahlborg Lyckhage, Elisabeth, 1956-, et al.
(author)
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Analysis of discourses in a health care context
- 2010
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In: Challenging the Boundaries, Vancouver, Canada, 3-5 October 2010.
-
Conference paper (peer-reviewed)abstract
- Abstract To develop nursing as a critical normative science (Kirkevold, 2009), a description of the various care areas and different health phenomena is needed. This is being done on the basis of various qualitative methods´; hence within nursing discourse analysis is used to a limited extent. The aim of this paper is to exemplify phenomenon and topics within nursing that have been studied by using discourse analysis. The examples are from studies conducted during the previous years by the authors. Discourses within palliative care based on documents and observations (2009), nursing as a subordinated profession, based on media analysis (2009), and an ongoing study about discourses within care of children with diabetes based on policy documents in the Nordic countries. Discourse analysis provides data, such as interviews, actions and documents to be analyzed in a broader system of knowledge (Wilkinson & Kitzinger, 2000., Lupton, 1993). A discourse is a “systems of thought and systematic ways of carving out reality and is composed by structures of knowledge that influences systems of practice” (Chambon, 1999). All discourses are textual and an inter-textual drawing upon other texts, contextually embedded in historical political and cultural settings. A given text also transforms in a manner that is socially constrained and conditional upon relations of power (Foucault 1979). As Bacchi (2005) urges it is possible to adopt a more comprehensive dual-focus agenda in discourse analysis, taking into account the dual movement of discourse: the way discourse speaks us and the way we speak the discourse.
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| 17. |
- Dahlborg Lyckhage, Elisabeth, 1974-, et al.
(author)
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Health care systems in transition: Equality, access and health literacy in three Scandinavian welfare states. : “The Emperor’s new clothes”: discourse analysis on how the patient is constructed in the new Swedish Patient Act
- 2017
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Conference paper (peer-reviewed)abstract
- The Swedish welfare debate increasingly focuses on market liberal notions and its healthcare perspective aims for more patient-centered care. This article examines the new Swedish Patient Act describing and analyzing how the patient is constructed in government documents. This study takes a Foucauldian discourse analysis approach following Willig’s analysis guide. The act contains an entitlement discourse for patients and a requirement discourse for healthcare personnel. These two discourses are governed by a values-based healthcare discourse. Neo-liberal ideology, in the form of New Public Management discourse, focusing on the value of efficiency and competition, is given a hegemonic position as laws and regulations are used to strengthen it. The new Swedish Patient Act seems to further strengthen this development. The Act underlines the increased entitlement for patients, but it is not legally binding as it offers patients only indirect entitlement to influence and control their care. To safeguard the patient’s entitlement under the Patient Act, healthcare personnel should be made aware of the contents of the Act, so that they can contribute to the creation of systems and working methods that facilitate respect of the Act’s provisions in daily healthcare work.
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| 18. |
- Dahlborg Lyckhage, Elisabeth, 1974-, et al.
(author)
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"The Emperor's new clothes" : discourse analysis on how the patient is constructed in the new Swedish Patient Act.
- 2017
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In: Nursing Inquiry. - : Wiley. - 1320-7881 .- 1440-1800. ; 24:2
-
Journal article (peer-reviewed)abstract
- The Swedish welfare debate increasingly focuses on market liberal notions and its healthcare perspective aims for more patient-centered care. This article examines the new Swedish Patient Act describing and analyzing how the patient is constructed in government documents. This study takes a Foucauldian discourse analysis approach following Willig's analysis guide. The act contains an entitlement discourse for patients and a requirement discourse for healthcare personnel. These two discourses are governed by a values-based healthcare discourse. Neo-liberal ideology, in the form of New Public Management discourse, focusing on the value of efficiency and competition, is given a hegemonic position as laws and regulations are used to strengthen it. The new Swedish Patient Act seems to further strengthen this development. The Act underlines the increased entitlement for patients, but it is not legally binding as it offers patients only indirect entitlement to influence and control their care. To safeguard the patient's entitlement under the Patient Act, healthcare personnel should be made aware of the contents of the Act, so that they can contribute to the creation of systems and working methods that facilitate respect of the Act's provisions in daily healthcare work.
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| 19. |
- Hellström Muhli, Ulla, et al.
(author)
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Meeting the Challenges for the health and elderly care: Problematizing Vulnerability in Care Encounters.
- 2014
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In: <em>Symphosium: Meeting the Challenges for the health and elderly care: Problematizing Vulnerability in Care Encounters.</em>. - : Equinox Publishing Ltd..
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Conference paper (peer-reviewed)abstract
- Research statement/question: The main concern in this panel (colloquium) presentation was to show how a discourse and communication based approach in the context of the health and elderly care, provides a basis for reflecting on vulnerability. How can the patient`s and/or elderly client´s vulnerability be reflected and reduced within the context of health and elderly care? How can professional vulnerability be understood in the light of patient involvement? In general, the panel (colloquium) analyzed the challenges of different kind of vulnerability in client encounters e.g. to be or not to treated as accountable.Theoretical framework: From a four-dimensional, interdisciplinary perspective. Discourse Analysis, Micro-sociology, Phenomenology and Nursing, the panel (colloquium) featured five different presentations.Methods: Different kind (video, audio and interview) of transcribed and translated data from talk encounters between care professionals and clients, have been analyzed. Used analytical methods were qualitative method of Conversation Analysis; Meta-synthesis; activity analysis and phenomenographic analysis.Findings: When looking for possible convergence between principles characterizing the approaches used by the authors and their findings, in this panel (colloquium) there are key-ideas which also have to do with what we would call communicative vulnerability. E.g., considering the vulnerability of older persons with dementia, the authors argue that a flexibility of practices may be a step towards implementing a client-centred approach in care plan meetings; it is also suggested that the caring aspect of professional skills in client encounter is to support hope; and that awareness of and understanding of the own professional vulnerability may gain understanding of implicit motives for decision-making.Conclusions:Humanization of health and eldercare professionals´ work by identifying the aspect of patients´ vulnerability is dealt with in this panel (colloquium) through carefully applied research methods from areas as discourse analysis, phenomenology, phenomenographic, and micro-sociology. This panel (colloquium) attests to relevant productivity of the researcher network: Talk, Text and Tools (3T), Scandinavian Interdisciplinary Health Communication Research.
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| 20. |
- Johnsson, Anette
(author)
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Creating and establishing a positive care relationship between nurses, patients and relatives : An ethnographic study of encounters at a department of medicine for older people
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Background and aim: Numerous encounters take place in the healthcare sector every day. Although the encounters should be conducted in a safe and respectful manner, an increased number of complaints about communication and interaction have been reported to the Health and Social Care Inspectorate. When a nurse, patient and relative meet in a so-called triad encounter, the focus is on creating and establishing a care relationship with the facilitated by communication and interaction. Thus, if communication and interaction fail in these encounters there is a risk that the care relationship will be bad and the patient's needs not fulfilled, which can lead to poorly prepared patients with difficulties participating in their own care. The overall aim of this thesis was to explore and describe the care relationship, communication, content and social interaction in the triad encounter between nurses, patients and relatives at a department of medicine for older people.Methods: The four studies were designed using a qualitative, ethnographic approach guided by Vygotsky’s sociocultural and Goffman’s interactional perspective. Participatory observations (n=40) and informal field conversations (n=120) with patients, relatives and nurses were carried out (October 2015-September 2016) at the same time as field notes were written. Studies I, II and III were underpinned by an ethnographic analysis, while in study in IV, a thematic analysis with an abductive approach was conducted.Results: The result of study I, identified a process where patients, relatives and nurses used different strategies for navigating before, during and after a triad encounter. The process was based on the following categories: orienting in time and space, contributing to a care relationship and forming a new point of view. Study II, showed how nurses communicated, using four different voices which reinforced by body language, which formed patterns that constituted approaches that changed depending on the situation and orientation: a medical voice, a nursing voice, a pedagogical voice and a power voice. Study III, emphasized three categories of content of the communication exchanges: medical content focusing on the patient’s medical condition; personal content focusing on the patient’s life story; and explanatory content characterized by nurses attempting to increase the patient’s and relative’s knowledge about the patient’s health and nursing needs. Study IV showed that, to create social interaction, the nurses employed greetings, small talk and bodily expressions. Patients accepted the invitation with body language, while relatives employed various strategies to receive an invitation. Nurses led the conversation, patients followed and described their health problem through gestures, while relatives captured the moment to receive and give information. Nurses summarized using ritual language, patients expressed gratitude’s through verbal and non-verbal expressions and relatives verbally clarified the agreements. The synthesis of the four results showed a model with the four activities as puzzle pieces: navigating through different perspectives, being involved in the communication, being attentive to social interaction and explaining the relevant content. When the institutional environment is such that the asymmetry between the nurse, patient and relative is limited, and the norms and routines promote communication between them, it is more likely that the puzzle pieces fit together and an opportunity arises to create and establish a positive care relationship in the triad encounters.Conclusion: The nurses' role as a professional is crucial, as they start, lead and end the encounter. If nurses minimize the asymmetry and combine the medical, personal and pedagogical questions, an opportunity arises for creating and establishing a positive care relationship that enables the patients to become more active and relatives more visible. This can contribute to strengthening the patient’s position in the healthcare system and increasing patient safety.
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| 21. |
- Johnsson, Anette, 1963-, et al.
(author)
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Manoeuvring between interplay and context : an ethnographic study of social interaction in encounters between registered nurses, older patients and their relatives
- 2021
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In: BMC Nursing. - : Springer Nature. - 1472-6955. ; 20:1
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Journal article (peer-reviewed)abstract
- Background: Social interactions between registered nurses, older patients and their relatives are essential and play a central role in developing a successful care relationship in healthcare encounters. How nurses interact with patients affects the patient’s well-being. Limited time and demands for efficiency influence the encounter and complaints from patients and relatives often concern social interactions. Therefore, the aim of this study was to explore the social interaction in encounters between registered nurses, older patients and their relatives at a department of medicine for older people.Methods: The study has an ethnographic approach including participatory observations (n = 21) and informal field conversations (n = 63), followed by a thematic analysis with an abductive approach reflecting Goffman’s interactional perspective.Result: The result revealed a pattern where the participants manoeuvred between interplay and context. By manoeuvring, they defined roles but also created a common social situation. Nurses led the conversation; patients followed and described their health problems, while relatives captured the moment to receive and provide information. Finally, nurses summarised the encounter using ritual language, patients expressed gratitude through verbal and non-verbal expressions, while relatives verbally confirmed the agreements.Conclusion: The social interaction between registered nurses, older patients and relatives was shaped by a pattern where the participants manoeuvred between interplay and context. When all participants assume responsibility for the social interaction, they become active and listen to each other. The approach adopted by nurses is crucial, thus training in communication and social interaction skills are important. When the asymmetry due to imbalance, is reduced, less misunderstanding and a satisfactory care relationship can be achieved.
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| 22. |
- Johnsson, Anette, 1963-, et al.
(author)
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Striving to establish a care relationship -Mission possible or impossible? : Triad encounters between patients, relatives and nurses
- 2019
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In: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 22:6, s. 1304-1313
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Journal article (peer-reviewed)abstract
- BACKGROUND: When patients, relatives and nurses meet, they form a triad that can ensure a good care relationship. However, hospital environments are often stressful and limited time can negatively affect the care relationship, thus decreasing patient satisfaction.OBJECTIVE: To explain the care relationship in triad encounters between patients, relatives and nurses at a department of medicine for older people.DESIGN: A qualitative explorative study with an ethnographic approach guided by a sociocultural perspective.METHOD: Participatory observations and informal field conversations with patients, relatives and nurses were carried out from October 2015-September 2016 and analysed together with field notes using ethnographic analysis.RESULT: The result identifies a process where patients, relatives and nurses use different strategies for navigating before, during and after a triad encounter. The process is based on the following categories: orienting in time and space, contributing to a care relationship and forming a new point of view.CONCLUSION: The result indicates that nurses, who are aware of the process and understand how to navigate between the different perspectives in triad encounters, can acknowledge both the patient's and relatives' stories, thus facilitating their ability to understand the information provided, ensure a quality care relationship and strengthen the patient's position in the health-care setting, therefore making the mission to establish a care relationship possible.
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| 23. |
- Johnsson, Anette, 1963-, et al.
(author)
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Voices used by nurses when communicating with patients and relatives in a department of medicine for older people : An ethnographic study
- 2018
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:7-8, s. E1640-E1650
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Journal article (peer-reviewed)abstract
- AIM: To describe how nurses communicate with older patients and their relatives in a department of medicine for older people in western Sweden.BACKGROUND: Communication is an essential tool for nurses when working with older patients and their relatives but often patients and relatives experience shortcomings in the communication exchanges. They may not receive information or are not treated in a professional way. Good communication can facilitate the development of a positive meeting and improve the patient's health outcome.DESIGN: An ethnographic design informed by the sociocultural perspective was applied.METHOD: Forty participatory observations were conducted and analyzed during the period October 2015 to September 2016. The observations covered 135 hours of nurse-patient-relative interaction. Field notes were taken and 40 informal field conversations with nurses and 40 with patients and relatives were carried out. Semi-structured follow-up interviews were conducted with five nurses.RESULTS: In the result, it was found that nurses communicate with four different voices: a medical voice described as being incomplete, task-oriented and with a disease perspective; a nursing voice described as being confirmatory, process-oriented and with a holistic perspective; a pedagogical voice described as being contextualized, comprehension-oriented and with a learning perspective; and a power voice described as being distancing and excluding. The voices can be seen as context-dependent communication approaches. When nurses switch between the voices this indicates a shift in the orientation or situation.CONCLUSION: The results indicate that if nurses successfully combine the voices, while limiting the use of the power voice, the communication exchanges can become a more positive experience for all parties involved and a good nurse-patient-relative communication exchange can be achieved.RELEVANCE TO CLINICAL PRACTICE: Working for improved communication between nurses, patients and relatives is crucial for establishing a positive nurse-patient-relative relationship, which is a basis for improving patient care and healthcare outcomes. This article is protected by copyright. All rights reserved.
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| 24. |
- Johnsson, Anette, 1963-, et al.
(author)
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What are they talking about? Content of the communication exchanges between nurses, patients and relatives in a department of medicine for older people : An ethnographic study
- 2018
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:7-8, s. E1651-E1659
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Journal article (peer-reviewed)abstract
- AIMS AND OBJECTIVES: To explore and describe the content of the communication exchanges between nurses, patients and their relatives in a department of medicine for older people in western Sweden.BACKGROUND: Information, messages and knowledge are constantly being communicated between nurses, older patients and relatives in the healthcare sector. The quality of communication between them has a major influence on patient outcomes. A prerequisite for good care to be given and received is that there is mutual understanding between the parties involved.DESIGN: An ethnographic study was informed by a sociocultural perspective.METHOD: Data were collected through 40 participatory observations of meetings between nurses and older patients and/or relatives which covered 135 hours of nurse-patient-relative interaction, field notes, 40 field conversations with 24 nurses and 40 field conversations with patients (n=40) and relatives (n=26). Five semi-structured interviews were conducted with nurses. An ethnographic analysis was performed.RESULTS: The analysis identified three categories of content of the communication exchanges: medical content focusing on the patient's medical condition, personal content focusing on the patient's life story, and explanatory content focusing on the patient's health and nursing needs. The content is influenced by the situation and context.CONCLUSIONS: Nurses would benefit from more awareness and understanding of the importance of the communication content and of the value of asking the didactic questions (how, when, what and why) in order to improve the patients' and relatives' understanding of the information exchanges and to increase patient safety.RELEVANCE TO CLINICAL PRACTICE: Nurses can use the communication content to create conditions enabling them to obtain a holistic view of the patient's life history and to develop an appropriate person-centered care plan. This article is protected by copyright. All rights reserved.
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| 26. |
- Tengelin, Ellinor, 1982-, et al.
(author)
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The struggle between ancient welfare thinking and prevailing health care policy in Scandinavian health care legislative documents
- 2019
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In: 25th Annual Qualitative Health Research (QHR) Conference. ; , s. 67-
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Conference paper (other academic/artistic)abstract
- Traditional welfare state systems in Scandinavia are challenged by new governance systems. Demands for efficiency and productivity in healthcare increase, raising questions about patients' positions and agency. This also implies ethical dilemmas for healthcare professionals. Comprehensively analysing the findings of previous discourse studies on how the patient is constructed in central policy texts, this study compares the position of the patient and the accompanying ideological struggles in Norway, Sweden, and Denmark. The purpose was to compare and discuss the findings of discursive constructions of patients in law and policy text from the three countries. We found an ideological struggle across the Scandinavian countries, operating at a political level, a legislative level and a healthcare level, with variation in how the new value-based patient care is constructed. We conclude that national governance systems still exert hegemonic power by strongly influencing patients' degree of choice and autonomy. The Scandinavian countries may all be heading towards a commercial healthcare market, despite their tradition of a welfare model of healthcare. Today, healthcare strategies move in the opposite direction, controlled by politicians' financial goals. The ideological struggle between welfare state governance and other governance systems, may exist also in other western countries in our globalized world.
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| 27. |
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