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Holmen H, Larsen MH, Sallinen MH, Thoresen L, Ahlsen B, Andersen MH, Borge CR, Eik H, Wahl AK, Mengshoel AM. Working with patients suffering from chronic diseases can be a balancing act for health care professionals - a meta-synthesis of qualitative studies. BMC Health Serv Res 2020; 20:98. [PMID: 32039723 PMCID: PMC7011477 DOI: 10.1186/s12913-019-4826-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/10/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The number of patients with long-term chronic diseases is increasing. These patients place a strain on health care systems and health care professionals (HCPs). Presently, we aimed to systematically review the literature on HCPs' experiences working with patients with long-term chronic diseases such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD). METHOD A systematic search of papers published between 2002 and July 2019 was conducted in the Embase, AMED, PsycINFO, MEDLINE, CINAHL, and COCHRANE databases to identify studies reporting qualitative interviews addressing HCPs' experiences working with adults with COPD, CKD or type 2 diabetes. An interdisciplinary research group were involved in all phases of the study. With the help of NVivo, extracts of each paper were coded, and codes were compared across papers and refined using translational analysis. Further codes were clustered in categories that in turn formed overarching themes. RESULTS Our comprehensive search identified 4170 citations. Of these, 20 papers met our inclusion criteria. Regarding HCPs' experiences working with patients with COPD, CKD, or type 2 diabetes, we developed 10 sub-categories that formed three overarching main themes of work experiences: 1) individualizing one's professional approach within the clinical encounter; 2) managing one's emotions over time; 3) working to maintain professionalism. Overall these three themes suggest that HCPs' work is a complex balancing act depending on the interaction between patient and professional, reality and professional ideals, and contextual support and managing one's own emotions. CONCLUSION Few qualitative studies highlighted HCPs' general working experiences, as they mainly focused on the patients' experiences or HCPs' experiences of using particular clinical procedures. This study brings new insights about the complexity embedded in HCPs' work in terms of weighing different, often contrasting aspects, in order to deliver appropriate practice. Acknowledging, discussing and supporting this complexity can empower HCPs to avoid burning out. Leaders, health organizations, and educational institutions have a particular responsibility to provide HCPs with thorough professional knowledge and systematic support. TRIAL REGISTRATION PROSPERO number: CRD42019119052.
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Affiliation(s)
- Heidi Holmen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Marie Hamilton Larsen
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Box 1089, Blindern, 0317 Oslo, Norway
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Merja Helena Sallinen
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Box 1089, Blindern, 0317 Oslo, Norway
- Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | - Lisbeth Thoresen
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Box 1089, Blindern, 0317 Oslo, Norway
| | - Birgitte Ahlsen
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Marit Helen Andersen
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Box 1089, Blindern, 0317 Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Christine Råheim Borge
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Box 1089, Blindern, 0317 Oslo, Norway
- Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Hedda Eik
- Faculty of Health Sciences, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Klopstad Wahl
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Box 1089, Blindern, 0317 Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Marit Mengshoel
- Faculty of Medicine, Institute of Health and Society, Department of Interdisciplinary Health Sciences, University of Oslo, Box 1089, Blindern, 0317 Oslo, Norway
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Johansson K, Österberg SA, Leksell J, Berglund M. Supporting patients learning to live with diabetes: a phenomenological study. ACTA ACUST UNITED AC 2019; 27:697-704. [PMID: 29953270 DOI: 10.12968/bjon.2018.27.12.697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article describes a study of the phenomenon of supporting patients who are learning to live with diabetes, from a diabetes specialist nurse (DSN) perspective. Guided by principles of reflective lifeworld research, data from six interviews (four in groups and two individual) with 16 DSNs were analysed. The results show that, in order to support learning, DSNs use a self-critical approach with the insight that they should not take over responsibility for their patients' diabetes. The DSNs support, encourage and challenge the patients to self-reflect and take responsibility based on patients' own goals and needs. To provide support, DSNs need to assume a tactful, critically challenging approach, dare to confront patients' fears and other emotions and have the insight to know that the responsibility for learning and integration of the condition lies with the patient. To be able to support patients in this way, it is necessary that the DSN is mentored and supported in this role.
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Affiliation(s)
- Karin Johansson
- Diabetes Specialist Nurse in Primary Health Care, Department of Administration/Primary Care, Region Kronoberg County Council, Växjö, Sweden
| | - Sofia Almerud Österberg
- Associate Professor, Department of Health and Care Sciences, Faculty of Health and Life Science, Linnaeus University, Växjö, Sweden
| | - Janeth Leksell
- Associate Professor, School of Health and Social Sciences, University Dalarna, Falun, and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Mia Berglund
- Associate Professor, School of Health and Education, University of Skövde, Skövde, Sweden
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Haltbakk J, Graue M, Harris J, Kirkevold M, Dunning T, Sigurdardottir AK. Integrative review: Patient safety among older people with diabetes in home care services. J Adv Nurs 2019; 75:2449-2460. [PMID: 30835874 DOI: 10.1111/jan.13993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/29/2018] [Accepted: 12/21/2018] [Indexed: 12/01/2022]
Abstract
AIMS To identify diabetes specific patient safety domains that need to be addressed to improve home care of older people; to assess research from primary studies to review evidence on patient safety in home care services for older people with diabetes. DESIGN An integrative review. DATA SOURCES Domains for patient safety in diabetes home care settings were identified by conducting two searches. We performed searches in: CINAHL, Medline, Embase, and Cochrane Library for the years 2000-2017. REVIEW METHODS The first search identified frameworks or models on patient safety in home care services published up to October 2017. The second search identified primary studies about older people with diabetes in the home care setting published between 2000-2017. RESULTS Data from the 21 articles populated and refined 13 predetermined domains of patient safety in diabetes home care. These were used to explore how the domains interact to either increase or reduce risk. The domains constitute a model of associations between aspects of diabetes home care and adverse events. The results highlight a knowledge gap in safety for older persons with diabetes, influenced by e.g. hypoglycaemia, falls, pain, foot ulcers, cognitive impairment, depression, and polypharmacy. Moreover, providers' inadequate diabetes-specific knowledge and assessment skills contribute to the risk of adverse events. CONCLUSION Older persons with diabetes in home care are at risk of adverse events due to their reduced ability to self-manage their condition, adverse medication effects, the family's ability to take responsibility or home care service's suboptimal approaches to diabetes care.
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Affiliation(s)
- Johannes Haltbakk
- Department of Health- and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marit Graue
- Department of Health- and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Centre for Evidence Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Janet Harris
- MPH in International Health Management & Leadership, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marit Kirkevold
- Centre for Evidence Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trisha Dunning
- Centre for Quality and Patient Safety Research, Deakin University and Barwon Health Partnership, Geelong, Melbourne, Australia
| | - Arun K Sigurdardottir
- School of Health Sciences, University of Akureyri, Akureyri, Iceland.,Akureyri Hospital, Akureyri, Iceland
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Bendixen BE, Kirkevold M, Graue M, Haltbakk J. Experiences of being a family member to an older person with diabetes receiving home care services. Scand J Caring Sci 2017; 32:805-814. [PMID: 28833315 DOI: 10.1111/scs.12511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/28/2017] [Indexed: 11/29/2022]
Abstract
AIM To describe family members' experiences of attending to an old person with diabetes receiving home care services, including their interaction with the formal caregivers. METHODS AND RESULTS The study has a qualitative descriptive design. From May to August 2015, eight family members were interviewed. Interviews were analysed using qualitative content analysis. To describe family members' experiences, the following four themes were identified: Security through patients' self-management skills and diabetes knowledge; Perceived burden due to the old persons' deteriorated health; Security through competent home care services; and Doubt due to personnel's inadequate approach and interaction. CONCLUSION It is important for personnel in home care services to consider patients' self-management skills and the family members' diabetes knowledge as key aspects in order to limit experiences of burden when the older person with diabetes has deteriorating health. The findings underscore that interaction with home care personnel skilled in managing diabetes helps family members feel secure.
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Affiliation(s)
- Bente E Bendixen
- Department of Nursing, Faculty of Health- and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marit Kirkevold
- Centre for Evidence-Based Practice, Faculty of Health- and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Marit Graue
- Department of Nursing, Faculty of Health- and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Centre for Evidence-Based Practice, Faculty of Health- and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Johannes Haltbakk
- Department of Nursing, Faculty of Health- and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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