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.

Difficulties for Vietnamese when pronouncing English : Final Consonants

Vietnamese people have many difficulties when pronouncing English. Among those, this paper will firstly deal with the hypothesis “English word-final consonants are not pronounced in a native-like way by Vietnamese speakers”. Theoretical phonological research about final consonants in the Vietnamese language and English has been carried out to characterize the difficulties. Data from Vietnamese informants were collected and analyzed, then synthesized to the most significant problems. Vietnamese effort to pronounce English word-final consonants will be towards omitting, adding schwa or replacing by sounds closer to those existing in their mother-tongue. Results of native speakers’ evaluation of Vietnamese-accented final consonants are also concluded to clarify how comprehensible informants’ pronunciation is. These findings will hopefully be useful for those who are interested in the topic and for further research.

Los Principales Problemas Fonéticos y Fonológicos en la enseñanza del Español para Extranjeros

The purpose of this study is to investigate the most common phonetic and phonological difficulties in the teaching of Spanish as a foreign language. The study has been based on the following questions: Which difficulties can teachers encounter when teaching phonetics and phonology? Which difficulties can students encounter when learning phonetics and phonology? How is phonetics and phonology taught? In order to be able to investigate the difficulties, a questionnaire has been handed out to five experienced teachers. The results of the questionnaires, together with the theory, has been analysed in the analysis. The outcome of the analysis shows that several difficulties can be detected in both the teaching and in the learning process. The results of the questionnaires also show us that the teachers mostly teach phonetics the same way: through repetition and imitation, the conductive method, and very few think outside of the box to encounter new methods.

Skicklig läs- och skrivundervisning i åk 1-3 : Om lärares möjligheter och hinder

This study focuses on teachers’ opportunities and obstacles to perform skillful reading and writing instruction. It’s about the ability to accurately identify where students are in their reading and writing process and to help them develop good reading skills. It is also about the ability to recognize signs of difficulties that students may have in their written language development and to know what efforts are needed to help them advance their reading and writing skills. The research is based on teachers’ own statements and survey responses on the external conditions for teaching and on their approach, attitudes and knowledge in reading and writing. The empirical material consists of interviews, surveys and test data. The interview study was conducted with eight teachers. The questionnaire was answered by 249 teachers, while the knowledge test was conducted of 269 teachers and 31 special education teachers. Many of the teachers in this study have lack knowledge in the structure of language and common Swedish spelling rules. Furthermore, it appears that a large part of them are unaccustomed to explaining, in detail, students’ reading development and find it difficult to systematically describe the aspects of daily literacy instruction. The overall picture is that many teachers teach without having tools to reflect on how their education really affects students’ reading and writing. These shortcomings make it difficult to conduct effective literacy instruction. Once students have learned to decode or if they have reading difficulties, many teachers seem to one-sidedly focus on getting students to read more. The consequence could be that those who would need to practice more on the technical basic of reading or comprehension strategies are left without support. Lack of variety and individuality in fluency and comprehension training can challenge the students’ reading and writing development. The teachers in the study, who have the old junior school teacher and elementary teacher education, have the highest amount of knowledge of reading and writing (the test). Good education can provide student teachers with professional skills that they may develop further in their careers. Knowledge of the meaning of phonological and phonemic awareness as well as knowledge of how to count phonemes seem to be important for knowledge of reading and writing (the test). Knowledge of basic reading processes can be obtained by systematic and structured work with students’ linguistic development, and through continuous dialogues with experienced colleagues on how and why questions. This is one important way to work also in teacher training. When essential professional skills are established in the teacher education, in practice students will obtain the school’s learning goals.

ICT as a tool in English teaching : A literature review on the use of ICT for Swedish students with learning difficulties and their literacy learning in grades 7-9

Information and communication technology (ICT) is a subject that is being discussed as a tool that is used within education around the world. Furthermore it can be seen as a tool for teachers to individualize students´ education. Students with literacy difficulties, such as dyslexia, are in constant need of new ways to learn, and new ways to be motivated to learn. The aim of this study is to see what research says in regard to how ICT can be used as a tool to help students with literacy difficulties. Literacy difficulties can be due to a number of things, such as the student has not been taught how to read, trouble within the family which can cause distress, or a neurological disorder such as dyslexia. Furthermore, the main research questions will focus on how ICT can be compared to traditional education forms, such as books and a more teacher centered education within the classroom, and whether ICT can be preferred. The results of this literature review indicates that ICT can be seen as a way for teachers to help students with literacy difficulties gain more self-esteem – something the literature tells us students with learning difficulties lack. The results also show how ICT can lead to a more individualized education. This is due to tools that increase reading comprehension and tools that give direct response when working with ICT, which helps students work more independently.

Psychometric properties of the Swedish version of the Fear of Complications Questionnaire

Objectives: To translate and evaluate the psychometric properties of the Swedish version of the Fear of Complications Questionnaire. Design: Cross-sectional study design and scale development. Settings: Totally, 469 adults (response rate 63.5%) with Type 1 diabetes completed the questionnaires. Participants were recruited from two university hospitals in Sweden. Participants: Eligible patients were those who met the following inclusion criteria: diagnosed with Type 1 diabetes, diabetes duration of at least 1 year and aged at least 18 years. Methods: The Fear of Complications Questionnaire was translated using the forward-backward translation method. Factor analyses of the questionnaire were performed in two steps using both exploratory and confirmatory factor analysis. Convergent validity was examined using the Hospital Anxiety and Depression Scale and the Fear of Hypoglycaemia Fear Survey. Internal consistency was estimated using Cronbach’s alpha.Results: Exploratory factor analysis supported a two-factor solution. One factor contained three items having to do with fear of kidney-related complications and one factor included the rest of items concerning fear of other diabetes-related complications, as well as fear of complications in general. Internal consistency was high Cronbach’s alpha 0.96. The findings also gave support for convergent validity, with significant positive correlations between measures (r = 0.51 to 0.54). Conclusion: The clinical relevance of the identified two-factor model with a structure of one dominant subdomain may be considered. We suggest, however a one-factor model covering all the items as a relevant basis to assess fear of complications among people with Type 1 diabetes.

Distance teacher education – some experiences from Dalarna University, SwedenPaper presented at the 33rd Annual ATEE Conference Brussels, Belgium, 23rd – 27th August 2008

Distance teaching is now-a-days used in different shapes. However, it is something different from traditional campus organised education as it systematically uses Information Communication Technology (ICT) as a key element. When the distance teacher education started in Sweden many teacher educators doubted the wisdom of this. They expressed that the educational process to become a teacher would be deteriorated. For instance, they feared for high drop out rates and difficulties to examine in a proper way. The Swedish National Agency for Higher Education has recently edited a report that showed that this form of teacher education was well adapted to the labour market, but the possibilities for the teacher students to shape their education were relatively limited. However, we still know quite little about the effects of this way to educate teacher students. This paper explores the possibility of using distance teacher education.In a case study 20 students, who were the first to finish a complete a distance teacher education at Högskolan Dalarna, were asked in a questionnaire how they had apprehended their education. We also interviewed four of these students, as well as five teacher educators.One of our findings were that the distance teacher education reached new target groups, who not had been able to participate in university studies if it not had been offered in this form. Especially, this was valid for the middle-aged women, living a long distance away from a university, with social responsibilities for children or old parents. Other findings were that these students in general were target oriented and ambitious, wrote more than the campus students and developed that kind of skill better. Marratech, an ICT system for small groups, e-mail and chat were used for the communication. Marratech was considered to permit free and spontaneous communication, both of the teacher educators and the students. Initially the teacher educators were sceptical to distance teacher education, but afterwards they were surprised of how well it had worked. They declared that they had better and nearer contact with their students and more control over the students´ performance, but some parts of the teacher education were better suitable for campus education, for example, power of creating characters. Distance teacher education was considered time consuming and demanded much activity from the teacher educators as the students wanted rapid responses. This study indicates that distance teacher education works well for mature individuals with high motivation. However, it demands more time from the teacher educators, but it gives in general good results. Still, there are pedagogical challenges to overcome. Maybe we should reflect on a mix of distance teacher education and campus based teacher education, instead of separated ways of accomplishing teacher education?

Swedish translation and psychometric testing of the safety attitudes questionnaire (operating room version)

Background: Tens of millions of patients worldwide suffer from avoidable disabling injuries and death every year. Measuring the safety climate in health care is an important step in improving patient safety. The most commonly used instrument to measure safety climate is the Safety Attitudes Questionnaire (SAQ). The aim of the present study was to establish the validity and reliability of the translated version of the SAQ. Methods: The SAQ was translated and adapted to the Swedish context. The survey was then carried out with 374 respondents in the operating room (OR) setting. Data was received from three hospitals, a total of 237 responses. Cronbach's alpha and confirmatory factor analysis (CFA) was used to evaluate the reliability and validity of the instrument. Results: The Cronbach's alpha values for each of the factors of the SAQ ranged between 0.59 and 0.83. The CFA and its goodness-of-fit indices (SRMR 0.055, RMSEA 0.043, CFI 0.98) showed good model fit. Intercorrelations between the factors safety climate, teamwork climate, job satisfaction, perceptions of management, and working conditions showed moderate to high correlation with each other. The factor stress recognition had no significant correlation with teamwork climate, perception of management, or job satisfaction. Conclusions: Therefore, the Swedish translation and psychometric testing of the SAQ (OR version) has good construct validity. However, the reliability analysis suggested that some of the items need further refinement to establish sound internal consistency. As suggested by previous research, the SAQ is potentially a useful tool for evaluating safety climate. However, further psychometric testing is required with larger samples to establish the psychometric properties of the instrument for use in Sweden.