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.

Part-time employment within the Swedish retail business : – A study of part-time employment from a management perspective

Research question: How has the presence of PT employees affected the role of managers in the Swedish food retail business? Research purpose: The purpose of this paper was to describe the change that accompanies part-time employment from a management perspective, and particularly, describe how the presence of part-time employment has influenced the role of the manager within the Swedish food retail business. Conceptual framework: The main focused in this chapter is directed towards the role of managers. The basis of the conceptual framework consist of the model developed by Mintzberg including the ten managerial roles and Quinn's eight leadership roles and how the presence of PT employments might affect these roles. Methodology: In this paper, the authors adopted a qualitative design and used narrative inquiry as a research strategy in order to gain a deep understanding of the context. Semi- structured interviews have been collected through a self-selection sampling and the total number of participants was ten. Conclusions: Based on the findings of this paper the presence of PT employees have not influenced and changed the role of managers. The changes that have influenced and caused the change of the role of the managers constitutes of the increased workload, the delegations of tasks and responsibilities, changed positions, the change of the organisational structure of the individual store, and the increased workforce.