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Barrett RV, Hebron C. Working as a physiotherapist in a rapid response team: 'An emotional rollercoaster'. Physiother Theory Pract 2024; 40:1551-1567. [PMID: 36919458 DOI: 10.1080/09593985.2023.2183100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/17/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND AND INTRODUCTION Rapid Response Teams (RRTs) are multidisciplinary, 'hospital at home' services which have developed over the last 10 years, aiming to improve recovery from illness more efficiently, prevent unnecessary hospital admission, and prevent early admission to residential care. However, little is known about the experience of professionals working in these roles. PURPOSE The aim of this study was to explore how working in an RRT is experienced and perceived by physiotherapists. METHODS This study used phenomenographically inspired methodology. Six participants who were working in RRTs were recruited to this study and all were working in the South of England. Data were collected via semi-structured interviews, and phenomenographic analysis was undertaken. RESULTS Participants working in RRTs described a range of varied, concrete lived-through experiences in addition to a more rhetorical discussion of how they conceptualized their work. Six main categories of description were generated from the analysis; each was assigned a metaphor. These included 'the detective,' 'the guru,' 'the lone ranger,' 'the team player,' 'the bricoleur,' and 'an emotional rollercoaster'; all categories were present with varied meanings. 'An emotional rollercoaster' was present within and throughout participants' descriptions of all other categories. CONCLUSION This study provides valuable insights into physiotherapists' experience and conceptualization of working within this discipline, which may have implications for physiotherapy practice, workforce development, new and current RR physiotherapy services, RRT health professionals, and physiotherapy education.
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Affiliation(s)
- Rosalie V Barrett
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
- Faculty of Sport, Allied Health and Performance Science, St Mary's University, London, UK
| | - Clair Hebron
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
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Yu SV, Åkerlind GS. Being a Doctor: From Treating Individual Patients to Maximising Community Health and Social Justice. HEALTH CARE ANALYSIS 2024:10.1007/s10728-024-00484-0. [PMID: 38780875 DOI: 10.1007/s10728-024-00484-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/25/2024]
Abstract
This study examined variation in medical practitioners' practice-based conceptions of what it means to be a doctor, based on interviews with 30 clinicians who were also medical educators. Participants included general practitioners, surgeons and physicians (non-surgical specialists). Participants were asked to draw a concept map of 'being a doctor', followed by semi-structured interviews using a phenomenographic research design. Three conceptions were identified, varyingly focused on (1) treating patients' medical problems; (2) maximising patients' well-being; and (3) maximising community health. Each conception was distinguished by variation in awareness of six underlying dimensions of being a doctor: (1) doctors' actions; (2) treatment success; (3) patients' actions; (4) patients' well-being; (5) community needs; and (6) social justice. Whilst all participants included dimensions 1 and 2 in their described practice, numerous participants did not include dimensions 3 and 4, i.e. did not take the patients' role and the impact of patients' psychosocial context into account in their practice. This is concerning, especially amongst medical educators, given the widely acknowledged importance of patient-centred care in medical practice. Similarly, only some of the participants considered community health needs and felt a broader social responsibility beyond their responsibility to individual patients. These findings highlight aspects of the medical profession that need to be further emphasised in medical training and continuing professional development.
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Affiliation(s)
- Suet Voon Yu
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Gerlese S Åkerlind
- Emeritus Faculty, Centre for Educational Development and Academic Methods, Australian National University, Building 1c, 24 Balmain Crescent, Acton, 2601, Australia.
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Alruwaili MAF. Lived experience of having type 2 diabetes: A phenomenological research in three villages in rural Northern Saudi Arabia. J Family Med Prim Care 2021; 10:149-153. [PMID: 34017718 PMCID: PMC8132778 DOI: 10.4103/jfmpc.jfmpc_1421_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/17/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background: The study was aimed to explore the lived experience among patients with type-2 diabetes living in rural settings. Methods: A qualitative phenomenological study design was used in this study. Results: First, the patients' reactions were a mixture of denial and shock regarding their diagnosis of diabetes. Second, they faced challenges of having debilitating disease. Third, all were Muslims, and their faith led them to accept their disease as their destiny from Allah. Fourth, they psychologically accepted the disease to gain the physical acceptance of their condition. Finally, the participants demonstrated a degree of adaptation. Conclusion: The study findings suggested that type-2 diabetes is viewed as a matter of destiny. Although participants in the current study revealed natural feelings of shock and denial towards their illnesses in the early stages; however, they soon became more familiar with their disease and expressed a feeling of acceptance and adaptation, especially during Ramadan.
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Affiliation(s)
- Mofreh A F Alruwaili
- Eradah Hospital for Mental Health, No. 5108 Qara King Khaled Street, Al-Jouf 72347, Saudi Arabia
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Larsson K, Bremer A, Årestedt K, Gunnarsson LL, Strömberg A, Hjelm C. Ways of understanding cognitive impairment in cardiac arrest survivors: A phenomenographic study. Intensive Crit Care Nurs 2020; 63:102994. [PMID: 33342651 DOI: 10.1016/j.iccn.2020.102994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 12/01/2022]
Abstract
AIM To describe the variation in ways that registered nurses perceive and understand cognitive impairment in cardiac arrest survivors. DESIGN A qualitative, inductive design with individual semi-structured interviews was applied. Data was analysed using a phenomenographic approach. SETTING The participants were nineteen Swedish registered nurses, experienced in cardiovascular care and providing follow-up care. FINDINGS The nurses perceived the cognitive impairment of the survivors in qualitatively different ways, as illustrated in two categories: 'The perceptible and obvious' and 'The elusive and challenging'. The nurses perceived a variety of signs of cognitive impairment, emotional expressions related to these, and recovery from cognitive impairment. They perceived confidence in capturing cognitive function when they understood the signs of cognitive impairment as severe and obvious. However, it was perceived as difficult to assess cognitive function when impairments were subtle, resulting in uncertainty in terms of how to make assessments. Nurses made use of their own strategies for assessments, which were sometimes found to be inadequate when they understood that they had misinterpreted the survivors' cognitive impairment. CONCLUSION Nurses feel uncertainty regarding detecting mild impairment in cardiac arrest survivors. By involving next of kin, nurses will gain a broader understanding of survivors' cognitive function.
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Affiliation(s)
- Karin Larsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Växjö, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Växjö, Sweden; The Research Section, Region Kalmar County, Kalmar, Sweden
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Cardiology, Linköping University, Linköping, Sweden
| | - Carina Hjelm
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Röing M, Holmström IK, Larsson J. A Metasynthesis of Phenomenographic Articles on Understandings of Work Among Healthcare Professionals. QUALITATIVE HEALTH RESEARCH 2018; 28:273-291. [PMID: 28715988 DOI: 10.1177/1049732317719433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Phenomenography is a qualitative research method based on the assumption that almost any phenomenon will be understood by a group of people in a limited number of ways. Our aim in this article was to identify the different ways work can be understood by healthcare professionals. In a world where the delivery of healthcare is continually changing, a metasynthesis of phenomenographic articles on healthcare professionals' understandings can provide knowledge about the focus and meaning of work for these individuals today. Our metaethnographic synthesis of 14 selected phenomenographic articles identified five different ways of understanding work, ranging from a limited to an all the more comprehensive view on patients and their needs. This range of understandings reveals problem areas and challenges facing healthcare professionals today. The possibility exists as well that limited understandings of work may be negative consequences of current demands for efficiency and all the more limited healthcare resources.
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Affiliation(s)
| | - Inger K Holmström
- 1 University of Uppsala, Uppsala, Sweden
- 2 Mälardalen University, Västerås, Sweden
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Boström E, Isaksson U, Lundman B, Sjölander AE, Hörnsten Å. Diabetes specialist nurses’ perceptions of their multifaceted role. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.204] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Boström E, Isaksson U, Lundman B, Graneheim UH, Hörnsten Å. Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes. PATIENT EDUCATION AND COUNSELING 2014; 94:187-92. [PMID: 24268676 DOI: 10.1016/j.pec.2013.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 09/20/2013] [Accepted: 10/26/2013] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The aim of this study was to explore the interaction between diabetes specialist nurses (DSNs) and patients with type 2 diabetes (T2D) during group sessions about self-management. METHODS Ten DSNs and 44 patients were observed during group sessions about self-management, and thereafter the observations were analyzed using qualitative content analysis. RESULTS The interaction was characterized by three themes: becoming empowered, approaching each other from different perspectives, and struggling for authority. The interaction was not a linear process, but rather a dynamic process with distinct episodes that characterized the content of the sessions. CONCLUSION It is important to achieve an interaction that is patient-centered, where the DSN is aware of each patient's individual needs and avoids responding to patients in a normative way. A satisfying interaction may strengthen patients' self-management, and also may strengthen the DSNs in their professional performance. PRACTICE IMPLICATIONS Authority struggles between patients and DSNs could be a prerequisite for patients to become autonomous and decisive in self-management. DSNs might benefit from an increased awareness about this issue, because they can better support patients if they do not perceive authority struggles as threats to their professional role.
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Affiliation(s)
- Eva Boström
- Department of Nursing, Umeå University, Umeå, Sweden.
| | - Ulf Isaksson
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Berit Lundman
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Åsa Hörnsten
- Department of Nursing, Umeå University, Umeå, Sweden
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Boogerd EA, Noordam C, Verhaak CM. The Sugarsquare study: protocol of a multicenter randomized controlled trial concerning a web-based patient portal for parents of a child with type 1 diabetes. BMC Pediatr 2014; 14:24. [PMID: 24472527 PMCID: PMC3909406 DOI: 10.1186/1471-2431-14-24] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Type 1 diabetes demands a complicated disease self-management by child and parents. The overwhelming task of combining every day parenting tasks with demands of taking care of a child with diabetes can have a profound impact on parents, often resulting in increased parenting stress. Tailored disease information, easy accessible communication with healthcare professionals and peer support are found to support parents to adequately cope with the disease and the disease self-management in everyday life. Internet can help facilitate these important factors in usual pediatric diabetes care. Therefore, we will develop a web-based patient portal in addition to usual pediatric diabetes care and subsequently evaluate its efficacy and feasibility. The web-based patient portal, called Sugarsquare, provides online disease information, and facilitates online parent-professional communication and online peer support. We hypothesize that parenting stress in parents of a child with type 1 diabetes will decrease by using Sugarsquare and that Sugarsquare will be feasible in this population. Methods/Design We will test the hypotheses using a multicenter randomized controlled trial. Eligible participants are parents of a child with type 1 diabetes under the age of 13. Parents are excluded when they have no access to the internet at home or limited comprehension of the Dutch language. Participants are recruited offline from seven clinics in the Netherlands. Participants are randomly allocated to an intervention and a control group. The intervention group will receive access to the intervention during the twelve-month study-period; the control group will receive access in the last six months of the study-period. Self-reported parenting stress is the primary outcome in the present study. Data will be gathered at baseline (T0) and at six (T1) and twelve (T2) months following baseline, using online questionnaires. User statistics will be gathered throughout the twelve-month study-period for feasibility. Discussion Dependent on its feasibility and efficacy, the intervention will be implemented into usual pediatric diabetes care. Strengths and limitations of the study are discussed. Trial registration NTR3643 (Dutch Trial Register)
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Affiliation(s)
- Emiel A Boogerd
- Department of Medical Psychology, Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
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Boström E, Isaksson U, Lundman B, Lehuluante A, Hörnsten Å. Patient-centred care in type 2 diabetes - an altered professional role for diabetes specialist nurses. Scand J Caring Sci 2013; 28:675-82. [DOI: 10.1111/scs.12092] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/24/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Eva Boström
- Department of Nursing; Umeå University; Umeå Sweden
| | - Ulf Isaksson
- Department of Nursing; Umeå University; Umeå Sweden
| | | | | | - Åsa Hörnsten
- Department of Nursing; Umeå University; Umeå Sweden
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Stenfors-Hayes T, Hult H, Dahlgren MA. A phenomenographic approach to research in medical education. MEDICAL EDUCATION 2013; 47:261-70. [PMID: 23398012 DOI: 10.1111/medu.12101] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
CONTEXT Phenomenography is a qualitative approach to research which has revolutionised the way that researchers and teachers think about the processes and outcomes of learning in higher education. Phenomenography has also been used successfully in medical and health care research for the last 20 years. Phenomenography provides a lens through which to view certain types of research question. It also provides direction for how to empirically carry out the research. METHODS This paper introduces phenomenography as a viable qualitative approach for use in medical education research. RESULTS A phenomenographic study maps the qualitatively different ways in which people experience a phenomenon. This type of study can have an important impact on, for example, patient communication, clinical practice and health care education. CONCLUSION We suggest that a phenomenographic approach can be used to explore many medical education research issues, and can facilitate more solid links between research and educational development and change.
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Affiliation(s)
- Terese Stenfors-Hayes
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
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Svenningsson I, Gedda B, Marklund B. Experiences of the encounter with the diabetes team-a comparison between obese and normal-weight type 2 diabetic patients. PATIENT EDUCATION AND COUNSELING 2011; 82:58-62. [PMID: 20434292 DOI: 10.1016/j.pec.2010.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 03/12/2010] [Accepted: 04/02/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE the aim of this study was to highlight and compare obese and normal-weight type 2 diabetic patients' perceptions and reported behaviors in terms of their care encounter with the diabetes team. METHODS interviews were conducted with 28 diabetic patients. Qualitative content analysis was used as analysis method. RESULTS the experiences revealed that when the care encounters took place from a health care perspective, there were no opportunities for individual support. For the obese diabetic patients, especially women, this gave rise to feelings of being stuck, defiance and shame, for those of normal weight, it created a sense of being left, despair and confusion. When encounters took place from the perspective of the individual, the diabetic patients need for support was fulfilled. For the obese diabetic patients this meant that the health care professionals recognised their needs and for those of normal weight, a feeling of security was created. CONCLUSIONS the results demonstrate differences in the experiences of obese and normal-weight diabetic patients' men and women in terms of their encounters with the diabetes team. PRACTICE IMPLICATION diabetic patients, especially the obese diabetic women, require tailor-made support provided by the health professionals in the diabetes team.
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Affiliation(s)
- Irene Svenningsson
- Sahlgrenska School of Public Health and Community Medicine, University of Gothenburg, Sweden.
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Boll M, Rosenqvist U. Variations in How Physiotherapists Understand Their Work on Organizational and Societal Levels. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2010; 16:101-8. [DOI: 10.1002/pri.484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 05/17/2010] [Indexed: 11/06/2022]
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Edwall LL, Danielson E, Ohrn I. The meaning of a consultation with the diabetes nurse specialist. Scand J Caring Sci 2009; 24:341-8. [PMID: 20030773 DOI: 10.1111/j.1471-6712.2009.00726.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to elucidate the essential meaning of a consultation between diabetes nurse specialists and patients to gain a deeper understanding of the patients' experiences. METHODS Twenty patients with type 2 diabetes were interviewed about their experience of a consultation at an annual check-up with the diabetes nurse specialist. A phenomenological hermeneutic method was used in the analysis and interpretation of the text. RESULTS The patient's experience of a consultation was interpreted as manifestation of hold on the disease control. This means a safeguard to continue daily life shown in the four themes being controlled, feeling exposed, feeling comfortable, and feeling prepared. CONCLUSION The patients' experiences of a consultation with the diabetes nurse specialist became the basis for a health maintenance process in dealing with critical health-disease aspects. IMPLICATIONS TO PRACTICE: In a consultation, professionals have to take into account the potential emotional turbulence that disease progression can mean to a patient. Diabetes care implies patient dependence on support to avoid a potential self-management insufficiency and call attention to professionals' time for listening to patients' perceptions.
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Affiliation(s)
- Lise-Lotte Edwall
- The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Göteborg, Sweden.
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Larsson J, Holmström I. Phenomenographic or phenomenological analysis: does it matter? Examples from a study on anaesthesiologists’ work. Int J Qual Stud Health Well-being 2009. [DOI: 10.1080/17482620601068105] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kaminsky E, Rosenqvist U, Holmström I. Telenurses’ understanding of work: detective or educator? J Adv Nurs 2009; 65:382-90. [DOI: 10.1111/j.1365-2648.2008.04877.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Edwall LL, Hellström AL, Öhrn I, Danielson E. The lived experience of the diabetes nurse specialist regular check-ups, as narrated by patients with type 2 diabetes. J Clin Nurs 2008; 17:772-81. [DOI: 10.1111/j.1365-2702.2007.02015.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Björkman IK, Schmidt IK, Holmström I, Bernsten CB. Developing the role of the drug and therapeutics committees: perceptions of chairs. Int J Health Care Qual Assur 2008; 20:161-78. [PMID: 17585614 DOI: 10.1108/09526860710731843] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE According to Swedish law, every county is required to have a local drug and therapeutics committee (DTC) to contribute to safe and cost-effective drug use. The law presents merely a framework and gives no detailed instructions addressing, for example, organisation and methods. The aim of this study is to explore the variation of conceptions of the role of the DTCs among committee Chairs and to compare the results with an earlier study. DESIGN/METHODOLOGY/APPROACH Data were collected by questionnaires and telephone interviews with committee chairs, which were analysed using a phenomenographic approach. FINDINGS Four conceptions were identified, namely: traditional, patient-aware, influential, holistic and cooperative, which all involved prescribers. In one conception the DTC acted as an expert to decision-makers. One conception included the notion that cooperation across the bureaucratic borders was important. Patients were involved in two conceptions. Comparison with the earlier study showed a trend toward higher patient awareness and a higher agreement on DTC goals with an increased focus on quality issues. ORIGINALITY/VALUE This study demonstrates an alternative research method bringing in new perspectives when exploring activities within healthcare. Patient involvement in the work of the DTCs is increasing, but should be further explored and developed.
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Affiliation(s)
- Ingeborg K Björkman
- Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden.
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Bastholm Rahmner P, Tomson G, Rosenqvist U, Gustafsson LL, Holmström I. “Limit work to here and now”—A focus group study on how emergency physicians view their work in relation to patients’ drug treatment. Int J Qual Stud Health Well-being 2008. [DOI: 10.1080/17482620701788644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abdulhadi N, Al Shafaee M, Freudenthal S, Ostenson CG, Wahlström R. Patient-provider interaction from the perspectives of type 2 diabetes patients in Muscat, Oman: a qualitative study. BMC Health Serv Res 2007; 7:162. [PMID: 17925030 PMCID: PMC2174468 DOI: 10.1186/1472-6963-7-162] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 10/09/2007] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients' expectations and perceptions of the medical encounter and interactions are important tools in diabetes management. Some problems regarding the interaction during encounters may be related to a lack of communication skills on the part of either the physician or the patient. This study aimed at exploring the perceptions of type 2 diabetes patients regarding the medical encounters and quality of interactions with their primary health-care providers. METHODS Four focus group discussions (two women and two men groups) were conducted among 27 purposively selected patients (13 men and 14 women) from six primary health-care centres in Muscat, Oman. Qualitative content analysis was applied. RESULTS The patients identified some weaknesses regarding the patient-provider communication like: unfriendly welcoming; interrupted consultation privacy; poor attention and eye contact; lack of encouraging the patients to ask questions on the providers' side; and inability to participate in medical dialogue or express concerns on the patients' side. Other barriers and difficulties related to issues of patient-centeredness, organization of diabetes clinics, health education and professional competency regarding diabetes care were also identified. CONCLUSION The diabetes patients' experiences with the primary health-care providers showed dissatisfaction with the services. We suggest appropriate training for health-care providers with regard to diabetes care and developing of communication skills with emphasis on a patient-centred approach. An efficient use of available resources in diabetes clinics and distributing responsibilities between team members in close collaboration with patients and their families seems necessary. Further exploration of the providers' work situation and barriers to good interaction is needed. Our findings can help the policy makers in Oman, and countries with similar health systems, to improve the quality and organizational efficiency of diabetes care services.
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Affiliation(s)
- Nadia Abdulhadi
- Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institutet, SE-171 77, Sweden.
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Adolfsson ET, Starrin B, Smide B, Wikblad K. Type 2 diabetic patients' experiences of two different educational approaches--a qualitative study. Int J Nurs Stud 2007; 45:986-94. [PMID: 17822705 DOI: 10.1016/j.ijnurstu.2007.07.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 06/14/2007] [Accepted: 07/11/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the current study was to explore patients' experiences of participating in an empowerment group education programme or receiving individual counselling. METHOD In total, 28 patients from seven primary care centres were interviewed. Of these, 14 had received individual counselling and the remaining 14 had also participated in 4-5 empowerment group sessions. The semi-structured interviews were tape-recorded, transcribed verbatim and analysed using qualitative content analysis. FINDINGS Three main categories crystallized from the interviews: (I) relationships, (II) learning and (III) controlling the disease. The relationships in the individual counselling seemed vertical, characterized by one-way communication with care providers acting as superiors and patients as subordinates. The relationships in the empowerment group appeared to be horizontal, characterized by trust and mutual communication. Those who had received individual counselling talked about learning by compliance--care providers acted as superiors, giving advice they expected the patients to follow. In the empowerment groups the patients talked more about participatory learning, whereby the facilitators and patients shared their knowledge and experiences. Controlling the disease could be labelled external in individual counselling, which made it difficult for patients to take responsibility for and control of their diabetes self-care. On the contrary, the patients in the empowerment group achieved the insight that diabetes is a serious disease but can be influenced, which contributed to their experience of self-control. CONCLUSIONS The current study indicates that vertical relationships, learning by compliance and external control seem to limit patients' ability to take responsibility for their disease, while horizontal relationships, participatory learning and self-control may contribute to strengthening patients' ability to influence and be actively involved in their own care.
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Affiliation(s)
- Eva Thors Adolfsson
- Department of Medical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden.
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Abdulhadi N, Al-Shafaee MA, Östenson CG, Vernby Å, Wahlström R. Quality of interaction between primary health-care providers and patients with type 2 diabetes in Muscat, Oman: an observational study. BMC FAMILY PRACTICE 2006; 7:72. [PMID: 17156424 PMCID: PMC1764013 DOI: 10.1186/1471-2296-7-72] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2006] [Accepted: 12/07/2006] [Indexed: 11/10/2022]
Abstract
Background A good patient-physician interaction is particularly important in chronic diseases like diabetes. There are so far no published data regarding the interaction between the primary health-care providers and patients with type 2 diabetes in Oman, where diabetes is a major and growing health problem. This study aimed at exploring how health-care providers interact with patients with type 2 diabetes at primary health-care level in Muscat, Oman, focusing on the consultation environment, and some aspects of care and information. Methods Direct observations of 90 consultations between 23 doctors and 13 diabetes nurses concerned with diabetes management during their consultations with type 2 diabetes patients in six primary health-care centres in the Muscat region, using checklists developed from the National Diabetes Guidelines. Consultations were assessed as optimal if more than 75% of observed aspects were fulfilled and sub-optimal if less than 50% were fulfilled. Results Overall 52% of the doctors' consultations were not optimal. Some important aspects for a positive consultation environment were fulfilled in only about half of the doctors' consultations: ensuring privacy of consultation (49%), eye contact (49%), good attention (52%), encouraging asking questions (47%), and emphasizing on the patients' understanding of the provided information (52%). The doctors enquired about adverse effects of anti-diabetes drugs in less than 10% of consultations. The quality of the nurses' consultations was sub-optimal in about 75% of 85 consultations regarding aspects of consultation environment, care and information. Conclusion The performance of the primary health-care doctors and diabetes nurses needs to be improved. The role of the diabetes nurses and the teamwork should be enhanced. We suggest a multidisciplinary team approach, training and education to the providers to upgrade their skills regarding communication and care. Barriers to compliance with the guidelines need to be further explored. Improving the work situation mainly for the diabetes nurses and further improvement in the organizational efficiency of diabetes services such as lowering the number of patients in diabetes clinic, are suggested.
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Affiliation(s)
- Nadia Abdulhadi
- Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
- Department of Health Affairs, Ministry of Health, Muscat, Oman
| | - Mohammed Ali Al-Shafaee
- Department of Family Medicine and Public Health, Sultan Qaboos University, College of Medicine and Health Sciences, Muscat, Oman
| | - Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Endocrine and Diabetes Unit, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Vernby
- Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
| | - Rolf Wahlström
- Department of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
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Kjeldmand D, Holmström I, Rosenqvist U. How patient-centred am I? A new method to measure physicians' patient-centredness. PATIENT EDUCATION AND COUNSELING 2006; 62:31-7. [PMID: 16024208 DOI: 10.1016/j.pec.2005.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 05/25/2005] [Accepted: 05/31/2005] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To describe a new method to determine physicians' self-perceived degree of patient-centredness. A pilot study combining qualitative and quantitative methods. METHODS Forty-one general practitioners (GPs) answered a questionnaire consisting of three open-ended questions about their view of the consultation and by choosing among 28 roles of the physician in the physician-patient relationship. Twenty of the GPs had participated in Balint groups while 21 had had no access to Balint group. Patient-centredness is central to Balint groups and consequently Balint group participants would be expected to be patient-centred. RESULTS The answers to the two parts were divided into three groups each, patient-centred, non-patient-centred and intermediary, and analysed statistically. Significantly more Balint participants were patient-centred than the reference group. CONCLUSION The instrument describes physicians' self-perceptions of their patient-centredness and can distinguish a group of patient-centred physicians from a group of non-patient-centred physicians. PRACTICE IMPLICATIONS The instrument can be useful to evaluate educational programmes and detect decline in patient-centredness as early sign of burnout.
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Affiliation(s)
- Dorte Kjeldmand
- Department of Public Health and Caring Sciences, Section for Health Services Research, University of Uppsala, Sweden.
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Abstract
AIM The aim of this paper is to report the findings of a study that elucidated the experiences and reflections of people with type 2 diabetes about clinical encounters. BACKGROUND Several patient satisfaction surveys have focused on privacy, cheerfulness and amenities rather than on how the care was delivered. A great deal of research has also focused on communication and various consultation styles, particularly within health promotion and diabetes care, but how these factors tie up with patient satisfaction has rarely been discussed. This study was performed in order to elucidate patients' perspectives about clinical encounters in diabetes care. METHOD Interviews were carried out during 2001 with 44 patients with diabetes. The transcribed interviews were analysed using qualitative content analysis. RESULTS Five themes were connected to patient satisfaction and dissatisfaction, namely 'being in agreement vs. in disagreement about the goals'; 'autonomy and equality vs. feeling forced into adaptation and submission'; 'feeling worthy as a person vs. feeling worthless'; 'being attended to and feeling welcome vs. ignored'; and, lastly, 'feeling safe and confident vs. feeling unsafe and lacking confidence'. CONCLUSION Despite efforts to individualize diabetes care and find ways to communicate with patients, many people have experiences of clinical encounters that they find dissatisfying. Experiences of dissatisfying encounters have elements that may threaten their perception of self and identity, while elements included in satisfying encounters are those characterizing patient-centred care.
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Affiliation(s)
- Asa Hornsten
- Department of Nursing, Umeå University, Umeå, Sweden.
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25
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Björkman IK, Bernsten CB, Schmidt IK, Holmström I. The role of drug and therapeutics committees. Int J Health Care Qual Assur 2005; 18:235-48. [PMID: 16167640 DOI: 10.1108/09526860510602523] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Improved quality and safety in drug use is a public health goal of major importance. In Sweden, local drug and therapeutics committees (DTCs) have adopted the task of working for safe and rational drug use. This study aimed to explore how chairs conceived the role of the DTCs, to explore how information officers conceived their own role, and to determine whether the respondents included patients in their answers. DESIGN/METHODOLOGY/APPROACH Data were collected using questionnaires and the answers were analysed according to phenomenographic method to identify conceptions. "Patient awareness" was studied by content analysis. FINDINGS In both groups the prescribers were the focus of attention, and only a few respondents mentioned patients. A variation of four conceptions was found among chairs and three among information officers. It would be beneficial if DTCs used this knowledge in their development. ORIGINALITY/VALUE The importance of "patient awareness" within DTCs must be further explored.
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Affiliation(s)
- Ingeborg K Björkman
- Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
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26
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Stewart J, Kendrick D. Setting and negotiating targets in people with Type 2 diabetes in primary care: a cross sectional survey. Diabet Med 2005; 22:683-7. [PMID: 15910616 DOI: 10.1111/j.1464-5491.2005.01496.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To investigate the provision of diabetes care, the frequency of practices setting targets for their diabetic population, the targets set and the frequency of targets being negotiated with people with diabetes. METHODS Cross-sectional study using a survey of 123 general practices within four Primary Care Trusts in Nottingham UK. RESULTS Eighty per-cent (99) of practices responded. Of these, 88 and 89%, respectively, had set glycosolated haemoglobin (HbA1c) and blood pressure targets for people with Type 2 diabetes. Twenty-five per-cent (24) of practices reported negotiating targets with almost all people with Type 2 diabetes for HbA1c and 31% (30) for blood pressure. In 46% (45) of practices, the annual diabetic review for some or all of the people with Type 2 diabetes was carried out by the practice nurse alone. In these practices, targets were negotiated with a smaller proportion of people than those where the doctor was involved in the annual review for both blood pressure [43 vs. 64% negotiated blood pressure targets with almost all or many people odds ratio (OR) 0.42 (95% CI 0.19, 0.96), P = 0.04] and HbA1c [39 vs. 60% negotiated HbA1c targets with almost all or many people, OR 0.41 (95% CI 0.18, 0.94), P = 0.03]. CONCLUSIONS Negotiating targets with people with Type 2 diabetes does not routinely occur in primary care. Targets are negotiated less often in practices where nurses undertake reviews alone and further work is needed to explore the reasons for this.
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Affiliation(s)
- J Stewart
- Nottingham Primary Care Research Partnership, Hucknall Health Centre, Nottingham, UK.
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Holmstrom I, Rosenqvist U. Interventions to support reflection and learning: a qualitative study. ACTA ACUST UNITED AC 2004. [DOI: 10.1111/j.1473-6861.2004.00075.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Holmström I, Larsson J, Lindberg E, Rosenqvist U. Improving the diabetes-patient encounter by reflective tutoring for staff. PATIENT EDUCATION AND COUNSELING 2004; 53:325-332. [PMID: 15186871 DOI: 10.1016/j.pec.2003.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2003] [Revised: 11/28/2003] [Accepted: 12/01/2003] [Indexed: 05/24/2023]
Abstract
There is relative consensus about the advantages of patient-centred consultations. However, they have not been easy to realise in clinical praxis. The aim of this study was to investigate whether an intervention focused on health care professionals' understanding of the diabetes-patient encounter could facilitate a patient-centred way to encounter these patients. Two GPs and two nurses participated in the year-long intervention. The intervention focused on the staff's understanding of the encounter. Staff video recorded four to five encounters each and reflected together with a supervisor on their understanding of the encounters and how they were conducted. The encounters were analysed with the Verona-MICS/Dr coding system and patients' comments were analysed separately. The content of the consultations and how they were conducted was also assessed. There was a significant change of two patient-centred items by the staff over time. Two staff seemed to change their educational model. Modern theories of competence development seem to be useful in clinical settings.
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Affiliation(s)
- Inger Holmström
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala Science Park, SE-751 85 Uppsala, Sweden.
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Snoek FJ, Visser A. Improving quality of life in diabetes: how effective is education? PATIENT EDUCATION AND COUNSELING 2003; 51:1-3. [PMID: 12915274 DOI: 10.1016/s0738-3991(03)00204-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Frank j Snoek
- Department of Medical Psychology, Free University, Amsterdam, The Netherlands.
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