Communication in Smoking Cessation and Self-management : a study at Nurse-led COPD-clinics in Primary Health Care

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

Användbarhetstest i samband med utveckling av webbplats

Varje år lägger företag ner hundratusentals kronor för egna webbplatser. När programmerare och ledning är nöjda med utseende och funktionalitet sätts webbplatsen i bruk. Det är ofta först nu som företaget får in respons på om webbplatsen från användarna. I vissa fall blir detta en katastrof eftersom fel produkt erbjuds till användaren eller att användaren inte förstår hur han ska använda produkten.För att förhindra detta problem på bästa möjliga sätt används användbarhetstest för att utreda vad användaren av det blivande systemet vill ha innan systemet distribueras.Målet med examensarbetet är att konstruera en webbplats avsedd för den kommande utbildningen Creative business management. Syftet är därefter att visa hur användbarhetstest på bästa möjliga sätt bör användas i samband med utvecklingsarbetet av webbplatser. Utvecklingsarbetet sker med hjälp av en anpassad version av Siegels utvecklingsmodell. För att utföra användbarhetstest används sedan Molich modell för användbarhetstest.Arbetet visar vidare att användbarhetstest bör användas kontinuerligt under hela utvecklingsarbetet för att inte riskera att arbetet glider iväg åt fel riktning. Det krävs endast fem testdeltagare för att finna 80 % av de möjliga användbarhetsproblemen på en webbplats. Det optimala är att använda fem testdeltagare i flera etapper i samband med olika versioner och uppgraderingar av webbplatsen för att kvalitetssäkra arbetet.

Intern kontroll: En fallstudie på Trafikverket

Internal control is something that’s grown more important for enterprises to keep in mind. The community is increasingly affected by the IT-development which demands a bigger degree of security. Enterprises needs to make sure that their systems are up to date and secure enough to keep it safe from unauthorized to take part of sensitive information. Internal control can exist in a major part of the work. If an enterprise have a goal for no harm or serious injury at work, internal control is necessary to reach that goal. The purpose for this essay is to examine how five different departments of Trafikverket practices internal control. How internal control is described. How the guidance from the managements is described and how it reaches the rest of the enterprise. This will lead to a proposal of improvement of the internal control at Trafikverket. We focus our frame of reference on the COSO-model and its five components. The components included in the COSO-model are control environment, risk valuation, control activities, information and communication and monitoring. The essay is a case-study of Trafikverket. We have chosen a qualitative method and interviewed five respondents from the different departments on Trafikverket. The respondents we interviewed works with internal control in their everyday work or have a god insight in the subject. We used a semi structured interview guide with questions based on the COSO framework. The results from our study shows that it exist big variations between how the departments work with internal control. It emerged that there are new guidelines for how the work should be done. This makes it necessary with education to implement the new ways to work. How the departments use the COSO-model varies. Some of them have incorporated the model in their new ways to work others have never heard of it. The conclusion of our study shows that the COSO-model and it´s components contribute to a functioning internal control. Implementing the components is important and the most important feature to good internal control is the corporate management. Education within the enterprise is the most effective way to inform the staff about the model and to implement it.

Implementation and role of device management Solutions to the end users

This research is based on consumer complaints with respect to recently purchased consumer electronics. This research document will investigate the instances of development and device management as a tool used to aid consumer and manage consumer’s mobile products in order to resolve issues in or before the consumers is aware one exists. The problem at the present time is that mobile devices are becoming very advanced pieces of technology, and not all manufacturers and network providers have kept up the support element of End users. As such, the subject of the research is to investigate how device management could possibly be used as a method to promote research and development of mobile devices, and provide a better experience for the consumer. The wireless world is becoming increasingly complex as revenue opportunities are driven by new and innovative data services. We can no longer expect the customer to have the knowledge or ability to configure their own device. Device Management platforms can address the challenges of device configuration and support through new enabling technologies. Leveraging these technologies will allow a network operator to reduce the cost of subscriber ownership, drive increased ARPU (Average Revenue per User) by removing barriers to adoption, reduce churn by improving the customer experience and increase customer loyalty. DM technologies provide a flexible and powerful management method but are managing the same device features that have historically been configured manually through call centers or by the end user making changes directly on the device. For this reason DM technologies must be treated as part of a wider support solution. The traditional requirement for discovery, fault finding, troubleshooting and diagnosis are still as relevant with DM as they are in the current human support environment yet the current generation of solutions do little to address this problem. In the deployment of an effective Device Management solution the network operator must consider the integration of the DM platform, interfacing with many areas of the business, supported by knowledge of the relationship between devices, applications, solutions and services maintained on an ongoing basis. Complementing the DM solution with published device information, setup guides, training material and web based tools will ensure the quality of the customer experience, ensuring that problems are completely resolved, driving data usage by focusing customer education on the use of the wireless service In this way device management becomes a tool used both internally within the network or device vendor and by the customer themselves, with each user empowered to effectively manage the device without any prior knowledge or experience, confident that changes they apply will be relevant, accurate, stable and compatible. The value offered by an effective DM solution with an expert knowledge service will become a significant differentiator for the network operator in an ever competitive wireless market. This research document is intended to highlight some of the issues the industry faces as device management technologies become more prevalent, and offers some potential solutions to simplify the increasingly complex task of managing devices on the network, where device management can be used as a tool to aid customer relations and manage customer’s mobile products in order to resolve issues before the user is aware one exists. The research is broken down into the following, Customer Relationship Management, Device management, the role of knowledge with the DM, Companies that have successfully implemented device management, and the future of device management and CRM. And it also consists of questionnaires aimed at technical support agents and mobile device users. Interview was carried out with CRM managers within support centre to further the evidence gathered. To conclude, the document is to consider the advantages and disadvantages of device management and attempt to determine the influence it will have over customer support centre, and what methods could be used to implement it.

Part-time employment within the Swedish retail business : – A study of part-time employment from a management perspective

Research question: How has the presence of PT employees affected the role of managers in the Swedish food retail business? Research purpose: The purpose of this paper was to describe the change that accompanies part-time employment from a management perspective, and particularly, describe how the presence of part-time employment has influenced the role of the manager within the Swedish food retail business. Conceptual framework: The main focused in this chapter is directed towards the role of managers. The basis of the conceptual framework consist of the model developed by Mintzberg including the ten managerial roles and Quinn's eight leadership roles and how the presence of PT employments might affect these roles. Methodology: In this paper, the authors adopted a qualitative design and used narrative inquiry as a research strategy in order to gain a deep understanding of the context. Semi- structured interviews have been collected through a self-selection sampling and the total number of participants was ten. Conclusions: Based on the findings of this paper the presence of PT employees have not influenced and changed the role of managers. The changes that have influenced and caused the change of the role of the managers constitutes of the increased workload, the delegations of tasks and responsibilities, changed positions, the change of the organisational structure of the individual store, and the increased workforce.