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 f��rv��ntningar inf��r sammanslagning av f��rlossnings-, BB- och neonatalavdelningen och att samtidigt inf��ra samv��rd : Kvalitativ studie med fokusgruppsintervjuer

Bakgrund: Anknytningen underl��ttas mellan barn och f��r��ldrar om de kan vara tillsammans redan fr��n f��rlossningen. Teamarbete f��rb��ttrar kvalit��n och bidrar till helhetsperspektiv i v��rden. En god arbetsmilj�� och ett gott samarbete mellan personal ��r viktigt f��r effektiviteten av samv��rd. Att unders��ka personalens f��rv��ntningar inf��r ett nytt arbetss��tt ��r betydelsefullt eftersom det kan avspegla sig i den v��rd som senare ges.Syftet med studien var att belysa personalens f��rv��ntningar inf��r sammanslagning av olika v��rdavdelningar och att samtidigt inf��ra samv��rd.Metoden var en kvalitativ metod med totalt 14 deltagare i tre fokusgruppsintervjuer. Datainsamlingen analyserades med en kvalitativ inneh��llsanalys.Resultatet sammanfattades med temat ���Tryggt och v��lk��nt eller nytt och os��kert ��� f��r��ndringsarbetets balansg��ng��� som beskrev personalens k��nslor inf��r sammanslagningen. Kategorierna ���Att f�� en bra milj�� f��r f��r��ldrar och personal���, ���Att samarbeta med familjen i fokus���, ���Att f��rena tv�� kliniker och kulturer��� och ���Att genomg�� en arbetsplatsf��r��ndring��� beskrev de f��rv��ntningar och farh��gor personalen uttryckte.Slutsatser: Resultatet visade p�� f��rv��ntningar av att v��rd- och arbetsmilj�� skulle f��rb��ttras samt att samarbetet mellan klinikerna skulle bli mer effektivt. Det framkom att det var av betydelse att ha fungerande informationsfl��den, uppleva delaktighet samt ha en tydlig ledning i en genomgripande organisationsf��r��ndring.

Friskfaktorer p�� en enhet : Identifiera & fortsatt bevara

Detta ��r en kvalitativ studie med syftet att inom en enhet p�� Stockholms Stad identifiera friskfaktorer och unders��ka vad som kr��vs f��r att fortsatt bevara dessa. Vidare ��r syftet att unders��ka vilket st��d som ��r n��dv��ndigt f��r bevarandet samt HR-funktionens roll i detta avseende. Enheten ��r, sett till sjukfr��nvaro, en v��lm��ende grupp som st��r inf��r f��r��ndringar inom marknaden och m��ls��ttning d�� de p��verkas av det nyligen genomf��rda regeringsskiftet. Ett fr��geverktyg anv��ndes f��r att framst��lla de ��tta viktigaste dimensionerna av det attraktiva arbetet och en f��rdjupad diskussion kring dessa f��rdes sedan under en fokusgruppsintervju tillsammans med enhetens medarbetare. Resultatet visade att de viktigaste dimensionerna var bland annat arbetstid och relationer. Vidare p��visades att en balans mellan arbetsliv och privatliv ��r av stor vikt f��r medarbetarnas h��lsa och v��lm��ende. F��r att fortsatt bevara det attraktiva i arbetet visade empirin att gruppens relationer och ledaren var nyckelfaktorer och att HR-funktionen, den personalstrategiska avdelningen, enbart bidrar med en administrativ och v��gledande roll i fr��gan om st��d. Arbetets slutsatser innefattar att bevarandet av friskfaktorer kr��ver att tillvaron m��ste vara begriplig, hanterlig och meningsfull men ��ven att medarbetarna beh��ver rimliga krav i relation till deras handlingsutrymme. En vidare slutsats ��r behovet av en f��r��ndring i ledarskapsbeteendet i kommande stadier d�� gruppen eventuellt kommer att hamna i en ny mognadsfas p�� grund f��r��ndrade omst��ndigheter. F��rfattarna drar ��ven slutsatsen att friskfaktorer ��r till viss del individuellt beroende p�� livssituation men att balansen mellan arbetsliv och privatliv ��r betydande f��r de flesta. HR-funktionen, den personalstrategiska avdelningen, har en informativ och administrativ roll i fr��gan om st��d och f��rfattarna anser att det ligger en logik i denna roll. Sett till organisationens storlek ��r det l��ttare att v��nda psykosociala fr��gor till f��retagsh��lsov��rd eller en psykologgrupp och f�� det arbetsr��ttsliga st��det eller information fr��n HR-funktionen.

Strategisk utveckling och ekonomistyrning : Ett livscykelperspektiv

This dissertation synthesizes previous research and develops a model for the study of strategic development, strategic congruence and management control. The model is used to analyze a longitudinal case study of the Swedish engineering company Atlas Copco. Employing contingency theory, the study confirms that long-term survival of a company requires adaption to contingencies. Three levels of strategy are examined: corporate, business and functional. Previous research suggests that consistency between these levels (strategic congruence) is necessary for a company to be competitive. The dissertation challenges this proposition by using a life-cycle perspective and analyzes strategic congruence in the different phases of a life cycle. It also studies management control from a life-cycle perspective. In this context, two types of management control are examined: formal and informal. From a longitudinal perspective, the study further discusses how these types interact during organizational life cycles. The dissertation shows that strategic development is more complex than previous studies have indicated. It is a long, complex and non-linear process, the results of which cannot always be predicted. Previous models for strategy and management control are based on simple relationships and rarely take into account the fact that companies often go through different phases of strategic development. The case study shows that strategic incongruence may occur at times during organizational life cycles. Furthermore, the use of management control varies over time. In the maturity phase, formal control is in focus, while the use of informal control has a bigger role in both the introduction and decline phases. Research on strategy and management control has intensified in recent years. Still there is a gap regarding the coordination of complex corporate structures. The present study contributes with further knowledge on how companies manage long-term strategic development. Few studies deal with more than two levels of strategy. Moreover, the present study addresses the need to understand strategic congruence from a life-cycle perspective. This is particularly relevant in practice, when management in large companies face difficult issues for which they expect business research to assist them in the decision-making process.

An analysis of Samoan reaction to The Orator (O Le Tulafale)���s F��gogo 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 F��gogo 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 f��gogo. 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 f�� gogo created a global definition of Samoan that Samoans internationally claimed.

Europeisk familjelycka : Om anv��ndandet 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.