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.

Personalens förväntningar inför sammanslagning av förlossnings-, BB- och neonatalavdelningen och att samtidigt införa samvård : Kvalitativ studie med fokusgruppsintervjuer

Bakgrund: Anknytningen underlättas mellan barn och föräldrar om de kan vara tillsammans redan från förlossningen. Teamarbete förbättrar kvalitén och bidrar till helhetsperspektiv i vården. En god arbetsmiljö och ett gott samarbete mellan personal är viktigt för effektiviteten av samvård. Att undersöka personalens förväntningar inför ett nytt arbetssätt är betydelsefullt eftersom det kan avspegla sig i den vård som senare ges.Syftet med studien var att belysa personalens förväntningar inför sammanslagning av olika vårdavdelningar och att samtidigt införa samvård.Metoden var en kvalitativ metod med totalt 14 deltagare i tre fokusgruppsintervjuer. Datainsamlingen analyserades med en kvalitativ innehållsanalys.Resultatet sammanfattades med temat ”Tryggt och välkänt eller nytt och osäkert – förändringsarbetets balansgång” som beskrev personalens känslor inför sammanslagningen. Kategorierna ”Att få en bra miljö för föräldrar och personal”, ”Att samarbeta med familjen i fokus”, ”Att förena två kliniker och kulturer” och ”Att genomgå en arbetsplatsförändring” beskrev de förväntningar och farhågor personalen uttryckte.Slutsatser: Resultatet visade på förväntningar av att vård- och arbetsmiljö skulle förbättras samt att samarbetet mellan klinikerna skulle bli mer effektivt. Det framkom att det var av betydelse att ha fungerande informationsflöden, uppleva delaktighet samt ha en tydlig ledning i en genomgripande organisationsförändring.

An analysis of Samoan reaction to The Orator (O Le Tulafale)’s Fāgogo defining Samoan identity

The Orator (O Le Tulafale) was promoted as the first Samoan language film shot in Samoa with a Samoan cast and crew. Written and directed by Samoan filmmaker Tusi Tamasese, the film succeeded at several of the movie industry’s prestigious festivals. The Orator (O Le Tulafale) is about an outcast family of a dwarf (Saili), his wife and her teenage daughter. As the main protagonist, Saili battles to overcome his fears to become a chief to save his family and land. The film’s themes are courage, love, honour , as well as hypocrisy, violence, and discrimination. A backlash by Samoans was predicted ; however, the opposite occurred. This raised the following questions: first, what is it about the film causing this reaction? It is a 106 -minute film shot in Samoa about Samoans and the Samoan culture . D espite promotional claims about the film , there have been Samoan -produced films in Samoa . Secondly, to what are Samoans really responding? Is it 1) just to the film because it is about Samoa, or 2) are they responding to themselves , and how they reacted during the act of watching the film? This implies levels of reactions in the act of watching, and examining the dominant level of response is important. To explore this, t he Samoan story telling technique of Fāgogo was used to analyse the film’s narration and narrative techniques. R. Allen’s (1993, 1997) concept of projected illusion was employed to discuss the relationship between Samoans and the film developed during the act of watching. An examination of the term Samoan and a description of the framework of Fa’a Samoa (Samoan culture) were provided. Also included were discussions of memory and its impact on Samoan cultural identity. The analysis indicated that The Orator (O Le Tulafale) acted as a memory prompt through which Samoans recalled memories confirming and defining cultural bonds. These memories constituted the essence of being Samoan. These memories were awakened, and shared as oral histories as fāgogo. The receivers appeared to interpret the shared memories to create their own memories and stories to suit their contexts, according to Facebook postings. An interpretation is that the organic sharing of memories as fā gogo created a global definition of Samoan that Samoans internationally claimed.

Europeisk familjelycka : Om användandet av familjemetaforen i EU

The re-unification of a family of nations: usages of the family metaphor in the EU This article analyses usages of the family metaphor in the EU. It starts up with a scrutiny of feminist theories of the nation-as-family metaphor. Introducing the concept of domopolitics, the author infers that the family, on the one hand, connotes to feelings of security and homelyness and, on the other hand, fears of the well-known, of immanent threats to in-group cohesion. The significance of the family metaphor in the EU rhetoric connects to a renewed emphasis on distinct values, principles and norms that balance the otherwise technocratic image of the EU. He further applies the nation-as-family metaphor to contemporary EU rhetoric. In the analysis, he infers that all three dimensions of the metaphor (ethnic, civil and hierarchic) are manifest in the EU political language making its use an enterprise that strives at moving beyond, but not completely away from the nation-state paradigm.