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.

Baking Dalarna's biking cake : Collaboration as a means for destination competitiveness, a case study of “Biking Dalarna"

In the contemporary tourism industry, the competitive game is between destinations. Tourism operations struggle to remain competitive on the international market and their success depends to a large extent on other complementary and competing tourism organizations at the destination. It is the sum of the total tourism offerings at the destination which determines its attractiveness. This research explores tourism collaboration process as a means of generating destination competitiveness. The focus of the research is on the enhancing factors which contribute to the success of the collaboration and to the development of quality tourism products. The research studies the case of Biking Dalarna, a collaboration of different organizations at five biking destinations in Dalarna, Sweden. Its purpose is to develop biking tourism in the region and to make Dalarna into Sweden’s leading biking destination. It is a qualitative research; the empirical data was collected through in depth interviews with representatives of six Biking Dalarna member organizations. The qualitative data collected from the participants provides inside look into the members reflections and experience of collaborating. The findings of this research demonstrate how collaboration has improved the biking product in Dalarna and promoted solutions to development problems. The research finds the good relationship between the collaborating actors and the involvement and leadership of the regional tourism management organization as the most contributing factors to the success of Biking Dalarna. The research also suggests that a third desired outcome of collaboration, improved marketing attributes was yet to be achieved in the case of Biking Dalarna.

Nurses’ and patients’ communication in smoking cessation at nurse-led COPD clinics in primary health care

Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes. Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care. Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations. Results: Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communicationwasmainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation. Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking. Practice implications: To make patients more active, the nurses need more education and continuous training in motivational communication.

Omvårdnad av patienter som vårdas enligt lagen om psykiatrisk tvångsvård (LPT) inom psykiatrisk slutenvård: Sjuksköterskors upplevelser och erfarenheter : En kvalitativ intervjustudie

Bakgrund: All sjukvård i Sverige styrs av Hälso-och sjukvårdslagen [HSL]. Under vissa omständigheter kan denna lag behövas kompletteras med Lagen om psykiatrisk tvångsvård [LPT]. Dessa personer vårdas inom psykiatrisk slutenvård. Omvårdnadens syfte är att patienten samtycker till vården och tvångsvården kan över gå till frivillig vård. Dessa personers problematik är dock ofta komplex och omvårdnaden upplevs innebära många svårigheter för sjuksköterskorna. Syfte: Att beskriva sjuksköterskors erfarenheter och upplevelse av omvårdnad i samband med LPT-vård inom sluten psykiatrisk vård. Metod: Empirisk kvalitativ studie med deskriptiv design. Studien baseras på sju semistrukturerade intervjuer med sjuksköterskor. Dessa analyserades med manifest innehållsanalys. Resultat: Resultatet visade att en förutsättning för att uppnå målet med tvångsvården genom omvårdnad var att skapa en allians med patienten. Kommunikation som innefattade individuellt anpassad information var en nyckelfaktor till alliansskapande. Omvårdnadsarbetet innefattade samverkan och sjuksköterskorna upplevde ett behov av kompetensutveckling. Slutsats: Sjuksköterskor upplever att omvårdnad enligt LPT är en utmaning och sammankopplat med flertalet svårigheter. Erhålls kompetens, tid för reflektion och trygghet i arbetsgruppen ses dock inte omvårdnaden som en omöjlighet utan kan upplevas som positivt för både den som vårdar och för den som vårdas.

About Collaboration, Interaction, and the Negotiation of Meaning in Synchronous Written Chats in L2-German

Open Access