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.

Passive solar options for reducing heating demand and maintain indoor climate in a multifamily house in Sweden

This research was carried out by studying possible renovation of a two-storey detached multifamily building by using passive solar design options in a cold climate in Borlänge, Sweden where the heating Degree Days are 4451 (base 20°C). Borlänge`s housing company, Tunabyggen, plans to renovate the project house located inthe multicultural district, Jakobsgårdarna. The goal of the thesis was to suggest a redesign of the current building, decrease the heating energy use, by applying passive solar design and control strategies, in a most reasonable way. In addition ensure a better thermal comfort for the tenants in the dwellings. Literatures have been studied, from which can be inferred that passive design should be abasic design consideration for all housing constructions, because it has advantages to ensure thermal comfort, and reduce the energy use. In addition further savings can be achieved applying different types of control strategies, from which the house will be more personalized, and better adapted to the user’s needs.The proposed method is based on simulations by using TRNSYS software. First a proper building model was set up, which represents the current state of the project building. Then the thermal insulation and the windows were upgraded, based on today's building regulations. The developments of the passive solar options were accomplished in two steps. First of all the relevant basic passive design elements were considered, then those advantages were compared to the advantages of applying new conventional thermostat, and shading control strategies.The results show that there is significant potential with the different types of passive solar design; their usage depends primarily on the location of the site as well as the orientation of the project building. Applying the control strategies, such as thermostat, and shading control, along the thermal insulation upgrade, may lead to significant energy savings (around 40 %), by comparison to the reference building without any upgrade.

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.