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Swedish primary healthcare nurses' perceptions of using digital eHealth services in support of patient self-management
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0002-2803-8006
Umeå University, Faculty of Social Sciences, Department of Informatics. Department of Computer Science and Media Technology, Malmö University, Malmö, Sweden.
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Social Sciences, Department of Informatics.
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2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 2, p. 961-970Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Nurses have expressed doubts about the ongoing digitalisation of Swedish primary health care. Given the potential role of eHealth in primary health care, including supporting interactive self-management for people with chronic conditions, it is important to highlight nurses' experiences. This study is part of a larger project aimed at implementing person-centred interactive self-management support (iSMS) in primary health care.

AIM: The aim of this study was to describe Swedish primary healthcare nurses' perceptions of using digital eHealth systems and services to support patient self-management.

METHODS: Focus group interviews were conducted with primary healthcare nurses (n = 20). The interview transcriptions were analysed using qualitative content analysis.

RESULTS: Three themes emerged from the content analysis: caregiving in the midst of digital chaos; a lack of overview and control in daily work; and mixed feelings towards digitalisation. Each theme was subdivided into three subthemes.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: The results of this study provide insight into a number of concerns that stand in the way of success when it comes to the implementation and use of digital technology. If nurses are to adapt to the new policies and practices that accompany the current digitalised development in Swedish primary health care, the concept of a nurse's traditional work role needs to be amended in terms of the scope of work tasks and established views of traditional nursing. The study also highlights the need for more research to enable eHealth systems/services to be designed to fulfil multiple requirements. The digitised systems should be a tool for achieving good quality self-management support as well as giving the primary healthcare nurses adequate resources to support patients' self-management while still maintaining the values associated with person-centred care.

Place, publisher, year, edition, pages
2018. Vol. 32, no 2, p. 961-970
Keywords [en]
chronic conditions, eHealth, nurses, primary health care, self-management, technology, type 2 diabetes
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-145996DOI: 10.1111/scs.12534ISI: 000436254800053PubMedID: 28960451OAI: oai:DiVA.org:umu-145996DiVA, id: diva2:1193019
Available from: 2018-03-26 Created: 2018-03-26 Last updated: 2019-05-16Bibliographically approved
In thesis
1. Finding a common ground: a pilot implementation of digital self-managment support in Swedish primary health care
Open this publication in new window or tab >>Finding a common ground: a pilot implementation of digital self-managment support in Swedish primary health care
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Due to an ageing, multi-diseased population, type 2 diabetes (T2D) and other chronic conditions pose a challenge for primary healthcare. To meet such challenges, primary healthcare nurses must adapt to new roles and acquire new skills regarding self-management support. eHealth and digital solutions are suggested to facilitate the increasing need for care in chronic conditions. However, how these solutions are experienced among users has not yet been sufficiently explored. To successful implement new working methods in primary healthcare, it is important to identify prerequisites and barriers that exists.

Aim: The overall aim of this thesis was to explore perceptions among primary healthcare nurses and patients about digital self-management support in T2D and also to develop and evaluate a digital screening instrument assessing individual needs for self-management support. This thesis is based on four papers. Papers I and II aimed to describe perceptions among primary healthcare nurses and persons with T2D of using eHealth services for self-management support. Paper III aimed to develop and psychometrically test a screening instrument for person-centred guidance and self-management support. Paper IV aimed to describe diabetes specialist nurses’ experiences of a pilot implementation of the instrument labelled the Self-Management Assessment Scale (SMASc) as a basis for person-centred digital self-management support.

Methods: A combined approach was used to collect and analyse data. Data in the qualitative studies were collected by means of focus group interviews (I) and individual interviews (II, IV) as well as participant observations (IV) were analysed using qualitative content analysis (I, II, IV). Quantitative data in study III were psychometrically tested. The participants in the respective studies were in Paper I primary healthcare nurses (n = 24), in Papers II and III persons with T2D (n = 11; n = 104) and in Paper IV diabetes specialist nurses (n = 5) and persons with T2D (n = 14). All data were collected in a county in northern Sweden.

Results: The overall results constituted a web of mixed experiences and feelings towards using digital self-management support. Primary healthcare nurses pronounced their ambivalence towards the digital development in healthcare (I). Patients as well had mixed feelings, but they also pronounced benefits and potentials leading to increased involvement and empowerment (II). The psychometric assessment of the screening instrument, SMASc, demonstrated high potential and promising results for clinical assessments on factors affecting self-management behaviours (III). Preliminary results suggest that the SMASc instrument is considered suitable for screening of patients’ needs for self-management support (IV). 

Conclusion: The results of this thesis suggest that digitalization needs stepwise implementation. Digital tools such as the SMASc instrument can be useful in facilitating identification of patients in need of targeted interventions. However, primary healthcare nurses must be open to discussing patients’ emotional adaptation to the disease as well as the knowledge, sometimes not evidence based, the patients may have obtained from Internet sources. Targeted self-management support including person-centred guidance is suggested to be an effective way to achieve patient.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2019. p. 77
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2037
Keywords
Type 2 diabetes, diabetes specialist nurse, district nurse, diabetes care, primary healthcare, eHealth, digitalization, technology, person-centred care, self-management, self-management support, qualitative research, questionnaire, psychometrics, pilot implementation
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-158932 (URN)978-91-7855-081-4 (ISBN)
Public defence
2019-06-07, Aulan, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-05-17 Created: 2019-05-15 Last updated: 2019-05-16Bibliographically approved

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Öberg, UlrikaOrre, Carl-JohanIsaksson, UlfSchimmer, RobynHörnsten, Åsa

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