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Patient-centred care in type 2 diabetes: an altered professional role for diabetes specialist nurses
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing. (Arcum)
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing.
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2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, 675-682 p.Article in journal (Refereed) Published
Abstract [en]

Little research has been done to try to understand how patient-centred care is understood and practised by healthcare professionals specialising in patients with diabetes. Experiences from patient-centred practices need to be highlighted as a way of motivating diabetes specialist nurses to take a patient-centred approach. The aim of this study was to describe diabetes specialist nurses' experiences of practising patient-centred care in the context of a type 2 diabetes intervention. The study design was descriptive and used qualitative methods. Focus group interviews complemented by individual semi-structured interviews were analysed by qualitative content analysis. The main theme of the diabetes specialist nurses' experiences of practising patient-centred care was an altered professional role. The main theme was based on two themes: ambivalence towards practising patient-centred care and enriched relationships with the patients. The ambivalence towards practising patient-centred care was based on the three subthemes: a position of withdrawn expertise, inconvenience of changing routines and insights that patient-centred care is difficult but possible. Their experiences of enriched relationships with patients were based on the two subthemes: courage to discuss the severity of diabetes and increased engagement in patients' daily lives. The diabetes specialist nurses' experiences with practising patient-centred care included doubts about their ability to practise in such a way and about the feasibility of such care. At the same time, their enriched relationships with patients were seen as an opportunity to engage in patients' lives. Training and support for practising patient-centred care may improve diabetes specialist nurses skills in patient-centred care and self-management support in type 2 diabetes.

Place, publisher, year, edition, pages
2014. Vol. 28, no 4, 675-682 p.
Keyword [en]
Diabetes specialist nurse, intervention, pateint-centred care, pateint education, qualitative content analysis, type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:umu:diva-80905DOI: 10.1111/scs.12092ISI: 000345314000006PubMedID: 24164307OAI: oai:DiVA.org:umu-80905DiVA: diva2:651912
Projects
Diabetes intervention in Västerbotten DIVA 2
Available from: 2013-09-27 Created: 2013-09-27 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Proximity and distance: challenges in person-centred care for diabetes specialist nurses in primary health care
Open this publication in new window or tab >>Proximity and distance: challenges in person-centred care for diabetes specialist nurses in primary health care
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Närhet och distans : utmaningar i personcentrerad vård för diabetessjuksköterskor inom primärvården
Abstract [en]

Background Type 2 diabetes demands self-management over time, to maintain health and reduce the risk for diabetes complications. However, despite efforts, many persons with type 2 diabetes are not reaching the treatment targets. In diabetes, person-centred care and group education are recommended. Diabetes specialist nurses (DSNs) working in primary healthcare have an important role in supporting patients with type 2 diabetes in their self-management to adapt to the demands of the disease in everyday life. Therefore, it is important to explore the DSNs’ professional role and their experiences of practising person-centred care. The overall aim of the thesis was to explore the professional role of DSNs in primary healthcare, and to describe their experiences of person-centred diabetes care.

Methods The thesis includes three studies with qualitative, and one with a quantitative, approach. Data collection consisted of focus group interviews, individual interviews, observations, and questionnaires. Qualitative content analysis and statistics were used in the analysis. In studies I and II, 29 and 31 DSNs participated, respectively. In study III, 10 DSNs and 44 persons with type 2 diabetes participated. Lastly, in study IV, 10 DSNs participated.

Results The results in the thesis showed that DSNs have a complex and multifaceted professional role that entails striving to be an expert, a fosterer, a leader, an executive, and a role model, which they found challenging. The DSNs perceived high job demands, such as decision-making and learning. The thesis also showed that the interaction between DSNs and persons with type 2 diabetes shifted from empowerment to authority struggles during group support sessions based on person-centred care. The experience of person-centred care was described as enriching, but DSNs also expressed ambivalence, related to an altered professional role.

Conclusion There is a desire by DSNs to be close to persons with type 2 diabetes, although they have several challenges to fulfil, which makes it difficult to uphold a relation with proximity; thus, distance is also present. Even though person-centred care is recommended in healthcare, and despite DSNs’ efforts to practise PCC, the result of this thesis shows that it also implies an altered professional role for DSNs that has to be addressed.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2013. 63 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1593
Keyword
Diabetes specialist nurse, professional role, self-management support, type 2 diabetes, caring relation, power relation, person-centred care
National Category
Nursing
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-80908 (URN)978-91-7459-735-6 (ISBN)
Public defence
2013-10-25, Vårdvetarhusets Aula, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Projects
Diabetes intervention in Västerbotten, DIVA 2
Available from: 2013-10-03 Created: 2013-09-27 Last updated: 2013-10-03Bibliographically approved

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Boström, EvaIsaksson, UlfLundman, BeritHörnsten, Åsa

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