Understanding the job in a new way--a basis for development of competence in diabetes care

Healthcare professionals' experiences of eHealth in palliative care for older people: challenges, compromises and the price of dignity

PURPOSE

To explore whether and how eHealth solutions support the dignity of healthcare professionals and patients in palliative care contexts.

METHOD

This qualitative study used phenomenographic analysis involving four focus group interviews, with healthcare professionals who provide palliative care to older people.

RESULTS

Analysis revealed four categories of views on working with eHealth in hierarchical order: Safeguarding the patient by documenting-eHealth is a grain of support, Treated as less worthy by authorities-double standards, Distrust in the eHealth solution-when the "solution" presents a danger; and Patient first-personal contact with patients endows more dignity than eHealth. The ability to have up-to-date patient information was considered crucial when caring for vulnerable, dying patients. eHealth solutions were perceived as essential technological support, but also as unreliable, even dangerous, lacking patient information, with critical information potentially missing or overlooked. This caused distrust in eHealth, introduced unease at work, and challenged healthcare professionals' identities, leading to embodied discomfort and feeling of a lack of dignity.

CONCLUSION

The healthcare professionals perceived work with eHealth solutions as challenging their sense of dignity, and therefore affecting their ability to provide dignified care for the patients. However, healthcare professionals managed to provide dignified palliative care by focusing on patient first.

Being a Doctor: From Treating Individual Patients to Maximising Community Health and Social Justice

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.

Nurses' models of spiritual care: A cross-sectional survey of American nurses

OBJECTIVES

Despite there being many models for how spiritual care should be provided, the way nurses actually provide spiritual care often differs from these models. Based on the premise that the way a person enacts their work role is related to how they understand that role, this study aims to describe the qualitatively different ways that nurses understand their spiritual care role.

METHODS

A convenience sample of 66 American nurses completed an anonymous, online questionnaire about what spiritual care means for them and what they generally do to provide spiritual care. Their responses were analyzed phenomenographically.

RESULTS

Four qualitatively different ways of understanding emerged: active management of the patient's experience, responsive facilitation of patient's wishes, accompaniment on the patient's dying journey, and empowering co-action with the patient. Each understanding was found to demonstrate a specific combination of 5 attributes that described the spiritual care role: nurse directivity, the cues used for spiritual assessment, and the nurse's perception of intimacy, the patient, and the task.

SIGNIFICANCE OF RESULTS

The findings of this study may explain why nurses vary in their spiritual care role and can be used to assess and develop competence in spiritual care.

Infectious disease management in primary care: perceptions of GPs

Background

It is important to keep the level of antibiotic prescribing low to contain the development of resistant bacteria. This study was conducted to reveal new knowledge about how GPs think in relation to the prescribing of antibiotics - knowledge that could be used in efforts toward rational treatment of infectious diseases in primary care. The aim was to explore and describe the variations in GPs' perceptions of infectious disease management, with special reference to antibiotic prescribing.

Methods

Twenty GPs working at primary care centres in a county in south-west Sweden were purposively selected based on the strategy of including GPs with different kinds of experience. The GPs were interviewed and perceptions among GPs were analysed by a phenomenographic approach.

Results

Five qualitatively different perceptions of infectious disease management were identified. They were: (A) the GP must help the patient to achieve health and well-being; (B) the management must meet the GP's perceived personal, professional and organisational demands; (C) restrictive antibiotic prescribing is time-consuming; (D) restrictive antibiotic prescribing can protect the effectiveness of antibiotics; and (E) patients benefit personally from restrictive antibiotic prescribing.

Conclusions

Restrictive antibiotic prescribing was considered important in two perceptions, was not an issue as such in two others, and was considered in one perception although the actual prescribing was greatly influenced by the interaction between patient and GP. Accordingly, to encourage restrictive antibiotic prescribing several aspects must be addressed. Furthermore, different GPs need various kinds of support. Infectious disease management in primary care is complex and time-consuming, which must be acknowledged in healthcare organisation and planning.

Ways of understanding the encounter with head and neck cancer patients in the hospital dental team—a phenomenographic study

INTRODUCTION

Head and neck cancer is the sixth most common malignancy in the world. Fifty percent of the patients can be cured by surgery, radiotherapy or a combination approach. Head and neck cancer is life-threatening, and treatment may leave the patient with visible facial disfigurements and impairment of functions such as speech and eating. This affects not only the patient, but may arouse difficult feelings in the treatment staff. Dental personnel are involved in all facets of treatment, yet they have no specific training in cancer care.

BACKGROUND

The aim of this study was to describe the variation in ways dental personnel understand and experience the encounter with head and neck cancer patients, as the way of understanding a certain phenomenon is judged to be fundamental to the way we act and form our beliefs.

METHODS

Twenty members of hospital dental teams were interviewed. The interviews focused on experiences of the encounter with head and neck cancer patients. A qualitative research approach, phenomenography, was used in analysing the interviews. The encounter was perceived in three qualitatively different ways: as an act of caring, as a serious and responsible task and as an overwhelming emotional situation. The results indicate that hospital dental personnel are not able to lean on education and professional training in finding ways of dealing with situations with strong emotional impact. This has implications for the treatment of patients with head and neck cancer, as well as education of dental personnel.

The role of drug and therapeutics committees

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.

Improving the diabetes-patient encounter by reflective tutoring for staff

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.

Swedish health care professionals' diverse understandings of diabetes care

Knowledge of health care professionals' different understandings of diabetes care is important when preparing such professionals in patient education. For patients to manage illness effectively, the actions of health care professionals are crucial. Patients' understanding of their condition should be taken as the point of departure when creating a learning situation. The professionals' understandings of diabetes care were mapped using a survey including 169 primary care doctors, nurses, assistant nurses and chiropodists in Stockholm, Sweden. The responses were analysed using a phenomenographic approach. Five understandings were identified: the professionals treat the patients, the professionals give information, the professionals focus relation and organisation, the professionals seek the patient's agreement, and the professionals focus the patient's understanding of the situation. Only 20 (12%) of the 169 professional caregivers focused the patient's understanding. Professionals need to develop their understandings of health care and the professional-patient interaction in order to support the patients' learning.

Professional artist, good Samaritan, servant and co-ordinator: four ways of understanding the anaesthetist's work

BACKGROUND

Evaluating clinical competence among anaesthetists has so far focused mostly on theoretical knowledge and practical skills. According to theory, however, the way anaesthetists understand their own work has also greatly influenced the development of professional competence. The aim of this study was to investigate how anaesthetists understand their work.

METHODS

Nineteen Swedish anaesthetists were interviewed. The interviews were open and sought answers to three questions 1) When do you feel you have been successful in your work?; 2) What is difficult or what hinders you in your work?; and 3) What is the core of your professional anaesthesia work? Phenomenographic analysis was performed.

RESULTS

Four ways of understanding the anesthesiologists' professional work were found: 1) Give anaesthesia and control the patient's vital functions; 2) Help the patient, alleviate his/her pain and anxiety; 3) Give service to the whole hospital to facilitate the work of other doctors and nurses, caring for severely ill patients; and 4) Organize and direct the operation ward to make the operations list run smoothly.

CONCLUSIONS

This study shows that anaesthetists understand their work in qualitatively different ways, which can be assumed to affect their work actions and also the way their competence develops. This has implications for the education of anaesthetists; it is important to find ways of making anaesthetists in training consciously aware of the different ways their work can be understood, as this will give them better prerequisites for future competence development.