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.

Metoder som stöd vid livsstilsförändringar hos patienter med typ-2 diabetes

Syfte: Syftet med litteraturstudien var att söka evidens för metoder som kan stödja patienter med typ-2 diabetes till livsstilsförändringar. Metod: En litteraturstudie, som innehåller 16 kvantitativa och kvalitativa vetenskapliga artiklar, som var publicerade mellan 2000-2010. Databasen som användes var Cinahl och sökmotorn Elin@Dalarna. Sökorden som använts var: diabetes type 2, type 2 diabetes, lifestyle changes, patient education, empowerment, health behaviour och self-management. Resultat: I resultaten kom uppsatsförfattarna fram till olika kategorier som visar olika åtgärder till livsstilsförändringar. Studierna baserades på olika åtgärder såsom; datorintervention, utbildningar, telefonsamtal, motiverande samtal, transteoretiska modellen och sjuksköterskespecialister. Empowerment var enligt uppsatsförfattarna det övergripande temat som de flesta studier baserade åtgärderna på.

Elevers uppfattningar av vad man bör uppnå efter avslutad kurs i Idrott och Hälsa A : En studie av två gymnasieskolor i årskurs 2 – ett elevperspektiv

The purpose of this work is to see if the students, on two separate high schools, understand what skills you should achieve after completing the course in physical education and health A 100 points. The entire study is based on a student perspective. In order to best answer the purpose, the questionnaire used in the "available groups" in schools. The questions for the work are: To what extent and how students perceive what they should achieve after completing the course in Sport and Health A?, Which is the goal, based on the curriculum in Physical Education, that students feel are important to achieve? and how do a comparison like between these two schools on the basis of what students perceive that they must achieve in Sport and Health A?The result shows that the main goal that finds support in the course objectives is an assertion; Has knowledge of what to eat to maintain or improve health, which over 90% of students had checked in. The least important goal was the claim 14; Know woods and fields and carry out outdoor activities, as 30% of students had checked in. The most important goal that does not find support in the course objectives is claim 10; to be reversed to the lessons, which was 88% in response rate among students. Here was the least important goal, claim 6; to be skilled in various ball games, which received 17% of student responses. The findings revealed that there is a clear health perspective in physical education in the studied groups at the two schools, one can also see that there is an uneven distribution of the elements included in the curriculum of Sport and Health A, and the outdoor life and dance is rare in the teaching of the groups studied at the two schools. Finally, it appeared that the lesson content and teaching are likely to have a significant role in student perceptions of course goals.

Ways of knowing in ways of moving : A study of the meaning of capability to move

The overall aim of this thesis has been to investigate the meaning of the capability to move in order to identify and describe this capability from the perspective of the one who moves in relation to specific movements. It has been my ambition to develop ways to explicate, and thereby open up for discussion, what might form an educational goal in the context of movements and movement activities in the school subject of physical education and health (PEH). In this study I have used a practical epistemological perspective on capability to move, a perspective that challenges the traditional distinction between mental and physical skills as well as between theoretical and practical knowledge. Movement actions, or ways of moving, are seen as expressions of knowing. In order to explore an understanding of the knowing involved in specific ways of moving, observations of  actors’ ways of moving and their own experiences of moving were brought together. Informants from three different arenas took part: from PEH in upper secondary school, from athletics and from free-skiing. The results of the analyses suggest it is possible to describe practitioners’ developed knowing as a number of specific ways of knowing that are in turn related to specific ways of moving. Examples of such specific ways of moving may be discerning and modifying one’s own rotational velocity and navigating one’s (bodily) awareness. Additionally, exploring learners’ pre-knowing of a movement ‘as something’ may be fruitful when planning the teaching and learning of capability to move. I have suggested that these specific ways of knowing might be regarded as educational goals in PEH. In conducting this study, I have also had the ambition to contribute to the ongoing discussion of what ‘ability’ in the PEH context might mean. In considering specific ways of knowing in moving, the implicit and taken-for-granted meaning of ‘standards of excellence’ and ‘sports ability’can be discussed, and challenged.

Role of headmasters, teachers and supervisors in knowledge transfer about occupational health and safety to pupils in vocational education

Background Young people are at an increased risk for illness in working life. The authorities stipulate certain goals for training in occupational health and safety (OHS) in vocational schools. A previous study concluded that pupils in vocational education had limited knowledge in the prevention of health risks at work. The aim of the current study, therefore, was to study how OHS training is organized in school and in workplace-based learning (WPL).   Method The study design featured a qualitative approach, which included interviews with 12 headmasters, 20 teachers, and 20 supervisors at companies in which the pupils had their WPL. The study was conducted at 10 upper secondary schools, located in Central Sweden, that were graduating pupils in four vocational programs.   Result The interviews with headmasters, teachers, and supervisors indicate a staggered picture of how pupils are prepared for safe work. The headmasters generally give teachers the responsibility for how goals should be reached. Teaching is very much based on risk factors that are present in the workshops and on teachers’ own experiences and knowledge. The teaching during WPL also lacks the systematic training in OHS as well as in the traditional classroom environment.   Conclusion Teachers and supervisors did not plan the training in OHS in accordance with the provisions of systematic work environment management. Instead, the teachers based the training on their own experiences. Most of the supervisors did not get information from the schools as to what should be included when introducing OHS issues in WPL.