Motiverande samtal mellan sjuksköterskan och personer med diabetes typ 2 – en litteraturöversikt

Bakgrund: Antalet personer med diabetes i världen ökar. Det har blivit en global epidemi. Risken för dödsfall bland människor med diabetes, är ungefär dubbelt så stor, som för människor i samma ålder utan diabetes. Diabetes typ 2 (DT2) är den vanligaste typen av diabetes. Inom hälso- och sjukvården används alltmer motiverande samtal (MI) som behandlingsmetod för livsstilsrelaterade problem som till exempel: kost, motion alkohol och tobak. Syfte: Syftet med studien var att beskriva hur sjuksköterskans användning av MI påverkar livsstilsförändringar hos personer med DT2 och deras upplevelse av behandlingen. Metod: En litteraturöversikt. Resultat: MI som behandlingsmetod gav flera positiva hälsoeffekter. Det framgick bland annat genom en sänkning av HbA1c. Även kunskapsnivån gällande livsstilsförändringar ökade efter MI-behandling. Vid användning av MI stärktes personens inneboende motivation till förändring. Slutsats: MI är en relativt ny metod som ännu inte fått stor genomslag inom diabetesvården. MI ger positiva hälsoeffekter som till exempel sänkt HbA1c. Deltagarna blev mer motiverade och medvetna om sitt eget ansvar för att göra livsstilsförändringar. Mer forskning om MI för personer med DT2 behövs.

Sjuksköterskans stöd till personer med psykiska funktionsnedsättningar i utövandet av fysisk aktivitet och dess hälsoeffekter Litteraturstudie

Det har forskats mycket om fysisk aktivitets positiva effekter på människokroppen rent fysiskt. Tidigare har det inte varit en naturlig del av behandlingen inom psykiatrin vilket gjorde författarna nyfikna på hur det kan lyftas fram i vården av personer med psykiska funktionsnedsättningar. Syfte: Syftet med litteraturstudien var att beskriva hälsoeffekterna av fysisk aktivitet för personer med psykiska funktionsnedsättningar och sjuksköterskans stöd genom handledning. Metod: Litteraturstudie. Resultat: Under sammanställningen av resultatet framkom att sjuksköterskor kan ge stöd genom Motiverande samtal (MI) som var av central betydelse. Då patienten själv hörsammas och bygger upp sina mål som ska vara mätbara tillsammans med utbildad vårdpersonal, men även genom stöd i patienternas egen utbildning och kunskap av den fysiska aktivitetens positiva inverkan på psykisk ohälsa. Slutsats: Sjuksköterskans metod att stödja och motivera personer med psykiska funktionsnedsättningar till att utöva fysisk aktivitet visade sig vara flera. Då det var viktigt med personcentrarad metod, var viktigt att de behärskade och kände till olika vägar att kunna motivera personer med psykiska funktionsnedsättningar. Andra betydelsefulla tillvägagångssätt var god vårdrelation, individualiserade träningsprogram, samt stöd och utbildning i de positiva hälsoeffekterna som fysisk aktivitet gav.

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.

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.

The Role of Motivational Strategies in the Upper Elementary Classroom : A systematic literature review about teacher strategies that promote self-confidence, motivation and a conducive learning environment

The aim of this literature review is to investigate which strategies teachers use to motivate pupils to communicate orally in English. The literature review also investigates how these teacher strategies affect pupils. The methodology used for this investigation is a systematic literature review. Various databases have been used when searching for literature. Scientific articles and theses have been searched for. They have also been read and analyzed before they have become a part of this review. The results indicate that some teachers feel insecure when speaking English. Therefore Swedish is spoken in many language classrooms. Teachers speaking in front of the class is the traditional way of teaching, and it does not seem to be a strategy who influences pupils positively. If teachers speak the target language among pupils they often get more motivated and focused pupils who feel comfortable speaking English. Young pupils are fast learners. By exposing them to the English language in early ages they receive great opportunities to learn a foreign language and strengthen their self-confidence. Drama, songs and rhymes are preferable strategies to use when teaching young learners. What position teachers decide to take in the classroom is also a significant element when teaching foreign languages.

ICT as a tool in English teaching : A literature review on the use of ICT for Swedish students with learning difficulties and their literacy learning in grades 7-9

Information and communication technology (ICT) is a subject that is being discussed as a tool that is used within education around the world. Furthermore it can be seen as a tool for teachers to individualize students´ education. Students with literacy difficulties, such as dyslexia, are in constant need of new ways to learn, and new ways to be motivated to learn. The aim of this study is to see what research says in regard to how ICT can be used as a tool to help students with literacy difficulties. Literacy difficulties can be due to a number of things, such as the student has not been taught how to read, trouble within the family which can cause distress, or a neurological disorder such as dyslexia. Furthermore, the main research questions will focus on how ICT can be compared to traditional education forms, such as books and a more teacher centered education within the classroom, and whether ICT can be preferred. The results of this literature review indicates that ICT can be seen as a way for teachers to help students with literacy difficulties gain more self-esteem – something the literature tells us students with learning difficulties lack. The results also show how ICT can lead to a more individualized education. This is due to tools that increase reading comprehension and tools that give direct response when working with ICT, which helps students work more independently.

L1 Use in the EFL-classroom : A Literature Review on Teachers’ Use of the L1 in the EFL-classroom on Upper Secondary Level

Even though English should mainly be used in the EFL-classroom according to the Swedish national curriculum, some recent scholars have argued that a judicious use of the students’ L1 by the teachers in some particular situations may benefit the learning environment there. From this context, this thesis examines what research says about in what particular situations the L1 is used by teachers in upper secondary EFL-classrooms as well as the teachers’ and the students’ attitudes towards this practice. The method used was a systematic literature review, where seven articles from all across the globe were analyzed, compared and synthesized. The results show that the L1 was mainly used by the teachers when managing discipline, when explaining grammar and when teaching vocabulary. However, the articles did not conclude how the L1 could be used strategically by the teachers. Concerning the teachers’ and students’ attitudes, the majority of these were positive towards L1 use by the teacher in the above mentioned situations. However, the teachers were not aware of how the L1 could be used by them in a judicious and a strategic way. Lastly, it can be concluded that more research is needed on how the L1 can be used more strategically by the teachers as well as on the students’ perspective on this.