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.

Language and interaction in online asynchronous communication in university level English courses

Interaction involves people communicating and reacting to each other. This process is key to the study of discourse, but it is not easy to study systematically how interaction takes place in a specific communicative event, or how it is typically performed over a series of repeated communicative events. However, with a written record of the interaction, it becomes possible to study the process in some detail. This thesis investigates interaction through asynchronous written discussion forums in a computer-mediated learning environment. In particular, this study investigates pragmatic aspects of the communicative event which the asynchronous online discussions comprise. The first case study examines response patterns to messages by looking at the content of initial messages and responses, in order to determine the extent to which characteristics of the messages themselves or other situational factors affect the interaction. The second study examines in what ways participants use a range of discourse devices, including formulaic politeness, humour and supportive feedback as community building strategies in the interaction. The third study investigates the role of the subject line of messages in the interaction, for example by examining how participants choose different types of subject lines for different types of messages. The fourth study examines to what extent features serving a deictic function are drawn on in the interaction and then compares the findings to both oral conversation and formal academic discourse. The overall findings show a complex communicative situation shaped by the medium itself, type of activity, the academic discipline and topic of discussion and by the social and cultural aspects of tertiary education in an online learning environment. In addition, the findings may also provide evidence of learning.  

Re-thinking bilingualism : challenges of multilingualism and communication in classroom settings

Editors’ preface to the special issue of the journal.

Teaching Intercultural Communication in Foreign Language Education through Video Conferencing

Since 1980s, Western linguists and specialists on second language acquisition have emphasized the importance of enhancing students’ intercultural communication competence in foreign language education. At the same time, the demand for intercultural communicative competence increased along with the advances of communication technology with its increasingly global reach and the process of globalization itself.In the field of distance language education, these changes have resulted in a shift of focus from the production and distribution of learning materials towards communication and learning as a social process, facilitated by various internet-based platforms. The current focus on learners interacting and communicating synchronously trough videoconferencing is known as the fourth generation of distance language education. Despite the fact that teaching of Chinese as a foreign language (CFL) faces the same or even greater challenges as teaching other languages, the intercultural communication perspective is still quite a new trend in CFL and its implementation and evaluation are still under development. Moreover, the advocates of the new trends in CFL have so far focused almost exclusively on classroom-based courses, neglecting the distance mode of CFL and leaving it as an open field for others to explore. In this under-researched context, Dalarna University (Sweden), where I currently work, started to provide web-based courses of the Chinese language in 2007. Since 2010, the Chinese language courses have been available only in the distance form, using the same teaching materials as the previous campus-based courses. The textbooks used in both settings basically followed the functional nationalism approach. However, in order to catch up with the main trend of foreign-language education, we felt a need to implement the cross-cultural dimension into the distance courses as well. Therefore in 2010, a pilot study has been carried out to explore opportunities and challenges for implementing a cross-cultural perspective into existing courses and evaluating the effectiveness of this implementation based on the feedback of the students and on the experience of the teacher/researcher.

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.

Enhancing Intercultural Communication in Teaching Chinese as a Foreign Language : An Action Research Study

Enhancing Intercultural Communication in Teaching Chinese as a Foreign Language – An Action Research Study Over the past few decades, the rapid development of information communication technology, internationalization and globalization worldwide have required a shift in the focus of Chinese as a foreign language (CFL) towards competence in intercultural communication in which the role of culture in the acquisition of CFL and in the pragmatic use of the language is emphasized and promoted. However, most of the current research in this academic area remains only on a theoretical level. Practical examples, particularly with regard to distance learning/teaching of the Chinese language, are very limited. This motivated the implementation of an action research study which aimed at exploring the possibilities and limitations of integrating Chinese culture and applying intercultural communication theory into a contemporary distance CFL course for beginners. By observing and comparing the performance of subjects in the control and experimental groups, this action research study focuses on exploring three basic areas. Firstly, it discloses the cultural elements which underlie effective daily communication. Secondly, it investigates how students acquire cultural knowledge and develop their ability to competently communicate in the target course. And thirdly, it evaluates how the modified course syllabus could enhance students’ intercultural communicative competence. The findings of the research aim to serve as both a resource and reference for educators and researchers who are interested in carrying out reforms and research in this academic domain.

Citizens and Contemporary Science Ways to dialogue in science centre contexts.

The current paper presents a study conducted at At-Bristol Science Centre, UK. It is a front-end evaluation for the “Live Science Zone” at At-Bristol, which will be built during the autumn of 2004. It will provide a facility for programmed events and shows, non-programmed investigative activities and the choice of passive or active exploration of current scientific topics. The main aim of the study is to determine characteristics of what kind of techniques to use in the Live Science Zone. The objectives are to explore what has already been done at At-Bristol, and what has been done at other science centres, and to identify successful devices. The secondary aim is mapping what sorts of topics that visitors are actually interested in debating. The methods used in the study are deep qualitative interviews with professionals working within the field of science communication in Europe and North America, and questionnaires answered by visitors to At-Bristol. The results show that there are some gaps between the intentions of the professionals and the opinions of the visitors, in terms of opportunities and willingness for dialogue in science centre activities. The most popular issue was Future and the most popular device was Film.

The Impact of Transnational Conflicts on Christian-Muslim Relations in Nigeria (2001-2006)

This Master’s Thesis examines transnational conflicts and Christian-Muslim relations in Nigeria between the years 2001 and 2006. It focuses on two major transnational conflicts: The September 11, 2001 attacks in the United States and the Danish cartoon controversy of 2005/2006. It discusses the impact of these transnational conflicts on Christian-Muslim relations in Nigeria in the light of the implementation of the Sharia Law in some northern Nigerian states and the improved access to the broadcast media and mobile telephone communication in Nigeria. By underscoring the relationship between transnational conflicts and the local context, this study provides a new perspective for understanding Christian-Muslim relations in Nigeria

Discourse strategies and power roles in student-led distance learning

The assertion of identity and power via computer-mediated communication in the context of distance or web-based learning presents challenges to both teachers and students. When regular, face-to-face classroom interaction is replaced by online chat or group discussion forums, participants must avail themselves of new techniques and tactics for contributing to and furthering interaction, discussion, and learning. During student-only chat sessions, the absence of teacher-led, face-to-face classroom activities requires the students to assume leadership roles and responsibilities normally associated with the teacher. This situation raises the questions of who teaches and who learns; how students discursively negotiate power roles; and whether power emerges as a function of displayed expertise and knowledge or rather the use of authoritative language. This descriptive study represents an examination of a corpus of task-based discussion logs among Vietnamese students of distance learning courses in English linguistics. The data reveal recurring discourse strategies for 1) negotiating the progression of the discussion sessions, 2) asserting and questioning knowledge, and 3) assuming or delegating responsibility. Power is defined ad hoc as the ability to successfully perform these strategies. The data analysis contributes to a better understanding of how working methods and materials can be tailored to students in distance learning courses, and how such students can be empowered by being afforded opportunities and effectively encouraged to assert their knowledge and authority.

A home environment test battery for status assessment in patients with motor fluctuations

Background and aims Evaluating status in patients with motor fluctuations is complex and occasional observations/measurements do not give an adequate picture as to the time spent in different states. We developed a test battery to assess advanced Parkinson patients' status consisting of diary assessments and motor tests. This battery was constructed and implemented on a handheld computer with built-in mobile communication. In fluctuating patients, it should typically be used several times daily in the home environment, over periods of about one week. The aim of this battery is to provide status information in order to evaluate treatment effects in clinical practice and research, follow up treatments and disease progression and predict outcome to optimize treatment strategy. Methods Selection of diary questions was based on a previous study with Duodopa® (DIREQT). Tapping tests (with and without visual cueing) and a spiral drawing test were added. Rapid prototyping was used in development of the user interface. An evaluation with two pilot patients was performed before and after receiving new treatments for advanced disease (one received Duodopa® and one received DBS). Speed and proportion missed taps were calculated for the tapping tests and entropy of the radial drawing velocity was calculated for the spiral tests. Test variables were evaluated using non-parametric statistics. Results Post-treatment improvement was detected in both patients in many of the test variables. Conclusions Although validation work remains, preliminary results are promising and the test battery is currently being evaluated in a long-term health economics study with Duodopa® (DAPHNE).

Factors associated with evidence-based practice among registered nurses in Sweden : a national cross-sectional study

Background: Evidence-based practice (EBP) is emphasized to increase the quality of care and patient safety. EBP is often described as a process consisting of distinct activities including, formulating questions, searching for information, compiling the appraised information, implementing evidence, and evaluating the resulting practice. To increase registered nurses' (RNs') practice of EBP, variables associated with such activities need to be explored. The aim of the study was to examine individual and organizational factors associated with EBP activities among RNs 2 years post graduation. Methods: A cross-sectional design based on a national sample of RNs was used. Data were collected in 2007 from a cohort of RNs, included in the Swedish Longitudinal Analyses of Nursing Education/Employment study. The sample consisted of 1256 RNs (response rate 76%). Of these 987 RNs worked in healthcare at the time of the data collection. Data was self-reported and collected through annual postal surveys. EBP activities were measured using six single items along with instruments measuring individual and work-related variables. Data were analyzed using logistic regression models. Results: Associated factors were identified for all six EBP activities. Capability beliefs regarding EBP was a significant factor for all six activities (OR = 2.6 - 7.3). Working in the care of older people was associated with a high extent of practicing four activities (OR = 1.7 - 2.2). Supportive leadership and high collective efficacy were associated with practicing three activities (OR = 1.4 - 2.0). Conclusions: To be successful in enhancing EBP among newly graduated RNs, strategies need to incorporate both individually and organizationally directed factors.

Sjuksköterskans upplevelse och beskrivning av kommunikation med vuxna patienter med ADHD inom öppenvårdspsykiatrin : En kvalitativ intervjustudie

Bakgrund: Studier visar på patienters upplevelse av kommunikation med sjuksköterskor, att sjuksköterskor behöver ha kunskap om kommunikation och kunskap om de funktionsnedsättningar patienter med ADHD kan ha. Tidigare studier belyser också olika kommunikationsteorier som är användbara i vårdrelationer, men inte så mycket om sjuksköterskors upplevelser. Syfte: Att beskriva hur sjuksköterskor vid öppenvårdsmottagningar inom psykiatrin upplever och beskriver kommunikation med vuxna patienter med ADHD. Metod: Studien hade en kvalitativ design där data samlades in genom semistrukturerade intervjuer. Analysmetoden utgjordes av en kvalitativ innehållsanalys. Resultat: Analysen resulterade i ett tema, fyra kategorier och elva subkategorier. Sjuksköterskor vid öppenvårdsmottagningar upplevde kommunikation med patienter med ADHD som tärande och närande på samma gång. Olika kommunikationstekniker användes i kombination med kunskap om funktionsnedsättningar för att skapa de bästa förutsättningarna för kommunikationen med patienter. Bra bemötande och ett bra förhållningssätt rapporterades vara viktiga i kommunikationen med patienter. Slutsats: Sjuksköterskor inom öppenvårdspsykiatrin upplevde kommunikationen med patienter med ADHD som både närande och tärande. Sjuksköterskorna anpassar kommunikationen efter patientens behov och förmåga, och bemöter alla patienters olika behov med respekt. Sjuksköterskor ansåg att ett bra förhållningssätt och en gott bemötande var viktigt för att kommunikationen med patienter med ADHD skulle fungera optimalt.